Using the UWSA Practice Tests After New NBME Releases

Should I still use the UWSA practice tests to help measure predicted test score now that there are more NBMEs?

The question this blog post aims to answer is: Now that there will be so many available NBME practice exams (as of March 25th, 2019), should students still be using the UWorld self-assessment practice exams to help measure their level of expected performance on the actual USMLE Step 1 exam?

First of all, many students–and our tutors–know that the UWSA is notorious for producing a predicted score performance that can overstate students score performance by 10-25 points (more pronounced for UWSA 1).  We regularly see students score 15 or more points higher on the UWSA than on a comparable NBME such as form 18. Clearly, the UWSA is not ideal from a score prediction standpoint. With the availability of the additional exam forms, students who will have access to both the old forms and the new forms should be able to obtain more than enough score prediction to suit their needs.  At Elite Medical Prep, we regularly advise students to take the average of their last 2 scores on their NBME practice exams in order to get a good assessment of their predicted performance on the USMLE Step 1. For most students, this currently means taking NBME forms 17 and 18 about a week apart and about 1-2 weeks before exam day.

Taking these exams too close to your actual USMLE Step 1 exam date can create unforeseen problems.  Most importantly, if you take the practice exam too close to the actual exam, you may leave no time to work on the weaknesses that the exam report can reveal for you. Additionally, students can get into a mode that we call ‘NBME practice exam overload’. This is where the student becomes almost entirely focused on taking exams and measuring exam performance and loses sight of the bigger picture, which is to improve and solidify knowledge for the actual exam.  Remember, the USMLE is like a marathon, and if you have ever trained for a marathon you will know that marathon training rarely involves a full 26-mile practice run. Rather, the marathon runner prepares with a variety of shorter runs varying between ¾ and 1/2 length runs, and even sprints.

Just because the UWSA may not be necessary for score prediction, it does not mean that this test is not valuable.  Unlike the NBMEs, the UWSA provides excellent feedback and explanations that improve a student’s knowledge base. The UWSAs are great resources for questions that are distributed fairly evenly across all the tested topics.  At Elite Medical Prep, we recommend that students aim to review all the questions in the UWorld Q-bank twice before test day. Therefore, it’s nice, especially near the tail end of one’s dedicated study period, to have a fresh set of well-designed, mixed topical questions with which to challenge oneself. Doing these questions one block at a time and reviewing each block afterward is a perfectly acceptable method to get some assessment and lots of educational benefit. Furthermore, breaking up UWSA into separate blocks, and comprehensively reviewing each block before moving on to the next, deemphasizes the role of UWSA as a self-assessment. This is helpful given the availability of NBMEs for more accurate score prediction.

Especially in the last two weeks of one’s study period, reading and videos start to become stale, and questions and flashcard review should dominate one’s time. We recommend that many of our students spend 75% or more of their time on questions during those last two weeks, and then pull back on the intensity slightly in the last few days before the test. Specifically, the ‘taper method’ we use in our standard Step 1 study schedule dictates 3, 2, 1, and then 0 question blocks in the days leading up to the real exam.

So the bottom line is the following: UWorld Self Assessment Step 1 exams may not be necessary for getting another score prediction because of the new NBME Step 1 practice forms.  However, the UWSA Step 1 exams are still extremely valuable and a great source for mixed question review and learning.  We recommend that Step 1 students continue to work through UWSA 1 and UWSA 2 before exam day.