Best Ways to Use NBME Practice Exams to Prepare for the Real Thing

My students often ask me, “why am I doing well on UWorld but scoring poorly on practice exams?” There isn’t a single answer to this question that’s true for everyone, but often the most common solution to this problem is to take more practice exams. The NBME, or National Board of Medical Examiners, writes practice exams for Step 1, Step 2 CK, and Step 3. These exams contain questions similar to those found on your USMLE exams and are a great way to practice your test-taking. But what is the best way to use the NBME practice tests? I prepared for exams the same way as I prepared for high school theatre productions.

I was a theater kid in high school (cue laughter, go ahead and get it out of your system). Despite how uncool theater was at my school, I loved preparing for shows and getting into the heads of my characters during performances. My theater club had a systematic way of performing for shows. First, we would break up each part of the show into scenes and practice them over and over again. Then we would put on dress rehearsals in full costume and character. During dress rehearsals, we would identify issues with the show so that we wouldn’t mess up on the big opening night. 

Practice exams are dress rehearsals for the USMLE. Your test day is your opening night.

Let’s talk about the best way to use your NBME practice tests and how you can use your CBSSA/NBME strategically to prepare for your USMLE exams.

Scoring Your NBME/CBSSA

Your NBME/CBSSA score can be located in the top right-hand corner of your score report. This three-digit score is meant to represent your performance based on your peers who also took the test. It can be converted into an approximate USMLE Step score using the USMLE conversion charts (often found at the bottom of the score report).

When to Take Your NBMEs for Step 1

There is no right or wrong time to take your practice exams. There are a few to choose from, however. The UWorld Self-Assessments 1 and 2, or UWSA1 and UWSA2, are probably the most reliable practice exams out there. In particular, UWorld 2 is strongly correlated with your Step 1 score/pass rate.

The NBME practice exams are a great way to fill the space between the UWSAs for Step 1. I normally recommend my students take an NBME before they start their dedicated study to get a baseline for where they could expect to score if they took the test that day. The next practice test I recommend they take is UWSA1. After that, take various NBMEs leading up to the week before your test. About a week before your Step 1, take UWSA2 to try to predict how you might do on the exam.

I once had a student who agonized over which order to take their NBME practice exams so much that they hadn’t taken any of them by the first time we met for Step 1 tutoring. They felt paralyzed by the decision about which test to take first. Deciding which test to take can feel like a monumental decision, but the order you take the tests truly isn’t that important. After our first session, we created a Step 1 study schedule and talked about which tests to take and when. Ultimately, the most important practice exam is UWSA2, which should be taken approximately 2 weeks before your exam. This student went on to earn her goal score on Step 1 and matched into pediatrics in the 2023/2024 ERAS Residency Match!

The Best Way to Use Your NBME Practice Exams to Review Step 1, 2, or, 3 Content

The NBME performance profile is probably the most useful part of your score report. By looking at the graphs on your score report, you can not only find out how you performed on each physician task, system, and discipline on your NBME when compared to your peers, but it can also tell you how you performed compared to your prior NBMEs. 

What were your weakest areas? Set aside a time to focus on these areas. This can consist of a 10-20 question UWorld test plus review of that subject using whatever resource you’re using for content acquisition (e.g., Board and Beyond, First Aid, Pathoma, etc.).

What were your strongest areas? Studying for your USMLE exams is all about efficiency. You should still review these subjects, but dedicating the same amount of time studying subjects you excel at with subjects you struggle with is a mistake. You do not need to dedicate as much time/UWorld questions to strong subjects as you should to weaker subjects.

Using Your NBME to Get in the Testing Mindset and Build Your Confidence

Fifty percent of doing well on USMLEs is your knowledge. The other 50% is your mentality. Mindset is everything. Have you ever taken a practice test only to review it later and kick yourself for questions you feel like you shouldn’t have missed? I know I have. 

Use your NBMEs to build up your confidence. NBME practice exams are a great way to put yourself in the right testing mindset. Prove to yourself that you know the information in a high-pressure environment. Practice being more confident in what you know and being honest with yourself about what you don’t. Use your NBMEs (and UWSAs) to learn how to trust your intuition and trust that you’ve prepared well for your exam.

If you are looking for help in your USMLE exams, Elite Medical Prep is here to help! Our professional Step 1, 2, and 3 tutors can help provide you with 1-on-1 online tutoring, customized study plans, test-taking strategies, and much more! Schedule a free consultation call to learn more about how we can help you cruise through your next USMLE exam here.