Home » New NBMEs- Our Professional Opinion

New NBMEs- Our Professional Opinion

8 min


A group of doctors reviewing the new NBME practice exams.


On March 25th of 2019, NBME retired forms 16,17, and 18, and replaced them with new NBME forms 20, 21, and 22. Many of our students taking NBMEs have reported in the past using many excellent resources available including video walkthroughs and question explanations. As always with new NBME releases, the YouTubers, Redditers, and bloggers need some time to create new resources for the new forms.

Over the last couple weeks, certainly we have felt through our students the many anxieties surrounding the new forms. What is their accuracy? What is the question dispersion? The list goes on. Well, we have sent some of our most veteran tutors who have dealt with many NBME retirements and introductions to take a look at these new forms.

By popular demand, here are our initial thoughts:


Difficulty and Accuracy

The new NBMEs seem to have similarity to NBME 19 in terms of difficulty. Now, we know that NBME 19 is far from a student favorite and definitely seems to have questions that are extremely difficult to answer as well as many problems in terms of score prediction. At this time we are still working on checking the score prediction accuracy of new forms 20, 21, and 22, (we won’t know that until the end of the test season) but we can say the difficulty level is similar. It is worth noting that almost all of the new information we’ve seen on the new forms is listed in First Aid. Some of these points are buried in various diagrams or tables. But bottom line, 99% of the material is in First Aid.



The NBME seems to be reaching further into its bag of tricks in order to test the same diseases. From what we’ve seen, the new forms 20, 21, and 22 seem to have more clinically oriented questions than previous forms. Although more clinical, the length of the vignettes are not longer than on the earlier (now retired) NBMEs. There seems to be more incorporation of advanced imaging. For example, MR Angiography is the basis of an anatomy question. Other clinical topics come up in new ways. For example, anemia of chronic disease appears a couple of times and is presented in the context of an auto-immune disease (we won’t specify which disease so as not to spoil the question for you). Another example includes testing differences between acute pancreatitis and chronic pancreatitis sequela. Although pancreatitis is being tested, the underlying cause is not one of the two most common causes (gallstones or alcohol), so students will need to expand their differential diagnoses for the underlying causes of common disorders. Pancreatitis and its various causes should not be a huge surprise for those actively preparing for Step 1, this disease is commonly tested on the USMLE and, as many of our MD tutors can tell you, this is very important in the real world of clinical practice. Similar to pancreatitis Z the new NBMEs test dilated cardiomyopathy in a new clinical context, peripartum cardiomyopathy, that hasn’t been shown before on any prior NBME dating back to NBME 1. Yes have analyzed ever NBME ever released! That’s because our founders have been tutoring and mastering this exam for more than a decade.


Our Final Initial Thoughts and Advice

The new questions on forms 20, 21, and 22 are overall not highlighting new diseases or concepts than on past forms. Rather, we believe the NBME is using the new clinical contexts for the tried and true concepts and using this to expand their pool of questions on the new forms. We can safely say after looking over these 3 newly released NBMEs that UWorld remains an excellent resource for practice questions, and that UWorld explanations remain a strong learning resource. If you’re conflicted with this new NBME form release and are trying to decide whether or not to take a particular NBME, we recommend (as we always have) considering how taking the practice test will affect your study plan. Similar to the way a good physician considers the decision to order a CT scan or any exam, think: ‘How does it affect management.’

As of now, our bottom line is that if you decide to take an NBME, form 18 remains the best score predictor. Therefore reserve that test for your last or second to last practice test. All students should take multiple practice tests during their dedicated study period. For the time being, we strongly recommend taking one of the older NBMEs such as 13, 15, or 16 if you have them available. We also believe taking one of more of the new exams, Forms 20, 21, or 22, provide a valuable challenge and exposure to the evolution of the test.


*Three additional tests we haven’t discussed here are the UWSA 1, UWSA 2 and the NBME free 120. Look for upcoming posts on these very useful practice exams as they can be used as a replacement for some of the NBMEs we’ve recommended, or better yet as an adjunct to help you better calibrate your performance and knowledge.

Remember! You can always reach out to us with questions at [email protected]. Our team of USMLE professional are ready to help!

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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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