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Using the Old NBME Exam Forms Before They Are ‘Retired’

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Medical school student taking an old NBME practice exam in a computer room.


This blog was originally published 0n February 24, 2019, and may contain some out-of-date information. You may be interested in some of our more recent posts on this subject:

NBME 25- NBME 30: Which is the Best Predictor for Passing Step 1

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



Original Blog on Using the Old NBME Exam Forms Before They Are ‘Retired’:


If you haven’t heard, the NBME will be retiring CBSSA Step 1 practice exam forms 13, 15, 16, 17, and 19 on March 25th, 2019 and releasing 5 new forms in two release dates.  NBME Form 18 will remain available. Depending on your planned Step 1 test date, the way that these new and old forms should be used will vary. Some students will be able to take all the old exams officially and take at least 3 of the new ones as well. Other students may not have time to take all of them officially and may try to simply make sure they have the old tests available as back up. In a previous post, we discussed this issue.


Regardless of how far your test date is after the March 25th switchover, it is important to see the NBME CBSSA forms as practice exams that provide:


  • score prediction (if taken officially),
  • an opportunity to evaluate your strengths and weaknesses
  • a chance to learn new material, and
  • a look inside the minds of the Step 1 test writers.  


If you are going to make the best use of each of these NBME forms, then it’s best to obtain at least 2 or more of these things (listed above) from each NBME practice exam you take.  


Score prediction is easy and is the thing that most students focus on. They often do this at the expense of seeing the NBME exam as a learning opportunity. Score prediction is important, but unless you are truly assessing whether you are ready to just pass the USMLE Step 1, then there is no point predicting your score unless you provide yourself time after the test to work on the weaknesses that are revealed.  Also, keep in mind that the predicted score is actually just the mid-point of a score range. It is often best to average your last two NBME practice exam scores in order to get a very accurate assessment of your performance.


One of the best uses of any NBME practice exam, or any good USMLE style question, is to evaluate your strengths and weaknesses.  The NBME forms come with enhanced feedback that shows from which categories your wrong questions are derived. Obviously, any topic where the bar is touching (with a *) the ‘Lower Performance’ part of the graph is a definite area to work on. Don’t shy away from your weaknesses–we know it’s tough to face them but if you don’t you will likely get exposed on the actual Step 1 test. Because you can review the NBME questions and your prior answer, you can start looking for more specific patterns within these wrong questions.  For example, you might see that questions with very short vignettes tripped you up. Or you might see that a certain number of questions were essentially errors due to misreading or reading too fast. Within the topic of General Principles (a ‘Discipline’), you can look for more specific sub-topics such as cell signaling (e.g. Tyrosine kinase receptors, G-coupled receptors) or normal cellular function.


Every test should be seen as a chance to learn new material. Especially if you are trying to get a higher than average (>230) Step 1 score, it is important to evaluate the wrong answers as well as the right ones.  Often one or more of the wrong answers deal with esoteric topics, topics that are lower yield to the average student but which may show up on future exams. Remember, the USMLE Step 1 never includes answers that represent fake diseases. If you see a really rare disease–for example xanthogranulomatous pyelonephritis–you should recognize that this is a real entity, even if unlikely to be the correct answer on any Step 1 questions.  Sometimes nothing more than a cursory look online is enough to get you the information you need to know for Step 1.  Other times, you may see an answer choice you don’t recognize and then you look it up in First Aid (as our tutors often recommend) and see that you may have totally missed this particular point.  There are lots of diseases and terms that are mentioned only once in First Aid and may be hidden in images or at the end of the longer descriptions. The information is all there! It can just be hard to find. This content is all fair game on Step 1 test day.  


As you review the NBME CBSSA practice forms and address your weaknesses, it’s also a chance to start thinking about how the test writers have constructed the questions.  As many students know, buzz-words and eponyms for many diseases have been progressively replaced on Step 1. However, at Elite Medical Prep, we find that certain terms or sets of words are still commonly used to describe a specific process or entity.  Hormones that ‘cross cell membranes without a membrane-bound receptor’ or hormones that ‘bind a cytoplasmic receptor and translocate to the nucleus’ are just steroid hormones. Essentially buzz words have become replaced with buzz phrases. Another concept to look at is how a particular disease is being presented.  Most students are familiar with Wilson’s disease presenting with elevated ceruloplasmin levels and Kayser-Fleischer rings (copper deposition in the Descemet’s membrane in the cornea). However, this disease may also be tested largely on the basis of the neuropsychiatric symptoms, with only secondary mention of the liver disease and maybe no explicit discussion of copper. In fact, a large number of patients with Wilson’s disease initially present to their doctor with neuropsychiatric complaints.


As you can see there is more than just score prediction that comes with each NBME practice exam. Some students will figure this out on their own, and others won’t.  However, if you are looking for this kind of higher-level analysis and want to profit from it on your Step 1 test, then tutoring from one of our experienced and highly trained tutors may be a good option for you. If you are looking for the best nbme for step 1, then we suggest checking out the ones that are just coming out.  Feel free to contact us.

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Elite Medical Prep

The Elite Medical Prep team consists of MD and MD candidate tutors from the top medical schools and residency programs, our founders, Dr. Brus-Ramer and…

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