A few people have been asking for the experience and preparation-details of Step 3
So in a nutshell, I would say do UWorld properly; three times at least…
Still, the exam will be new to you; many prognosis kinds of questions which you can’t prepare from anywhere, will be in the exam, like percentages or may be most common finding, treatment, and investigations etc!
Secondly, along with uworld quickly read both MTBs and Step 2 CK UWorld tables. You will find many things from Step 1 FA and NBMEs. So be prepared to meet your old fellows like cornstarch toxicity. Keep your common sense alive. Know the time management. Take NBME and try to score in 500 plus.
Solve Kaplan qbank; it is said to be low yield but I feel it is extremely high yield… they won’t even bother to change the lines of the question in a few cases. So please do it thoroughly.
Do Step 3 UW managements and tables again and again or stick them in your room.Do biostats from all steps including Step 1 to extra UW biostatistics. If you are aiming very high, solve CMS questions too. Know high-yield behavioral sciences for example adopted child, raped women and other legal rights. Know vaccination and toxicity well.
Lastly, If you want to pass the exam with flying colors in a month do Crush CCS and practice CCS daily from day one for 2 hours. Make it interesting! Do CCS by Fischer and learn it well. All the orders and counsel and consent stuff. Know the timing and clock well. It needs practice!!
Any question will be welcome! Please don’t contact if the question is other than USMLE. Please!
Wish you best of luck in your future endeavors!
If this experience was helpful, check out the following:
USMLE Step 3 is a two day exam which consists of:
Following are experiences of high scorers in USMLE Step 1 which are very helpful for everyone preparing this test:
As we all know the USMLE Exams are very lengthy and hence time management is crucial both during the exam blocks as well as during the breaks. USMLE Step 1 Exam is 8 hours long and is divided into 7 blocks of 40 questions per block and a total of 280 questions overall. The USMLE Step 2 CK Exam is also similarly lengthy, being 9 hours in length with every block having 40 questions and a total of 318 questions spread across 8 blocks of 60 minutes each.
Each USMLE Step has a break time of 45 minutes. Most students find the USMLE Blocks significantly lengthy and finish the blocks in just the nick of time. So utilizing the time during the blocks optimally is very important. The break time is also limited and we have to use the rest room, eat and refresh ourselves so as to tackle the next block. Optimally utilizing that time is also very crucial.
According to my observation, Test Day performance is the most important variable in deciding the actual USMLE score.
Giving the test well by preparing before hand could mean the difference between a 230 or a 260. So i advise you to plan well in advance to get the highest possible score.
I used the following methods to make sure that not only do i finish the blocks on time but also have sufficient break time to relax and recoup before the next block. I recommend you read this in it’s entirety as i believe it helped me improve my score by atleast a few points. The suggestions are easy to follow but many of them are creative and not practiced widely. So it is worth having a look.
The USMLE steps have a tutorial at the beginning which explains how the test is structured. It gives information about the interface, the buttons in it, the layout, how the timer works, etc. All of this information is already given in the free practice materials that are provided in the FRED simulation on the official USMLE site. Skipping the tutorial would mean that the 15 minutes allocated to it would automatically be allocated to the break time. That increases the break time from 45 minutes to 60 minutes. I recommend you skim over the simulation a day before the exam so that you are aware about how the interface and the exam is structured. This would mean that you dont waste time in going over it before the exam. This is a commonly used method for time saving in the USMLE break time.
Usually the most important part of the question is the last sentence. The USMLE questions have a habit of misdirecting us in the wrong way and then revealing the most important part in the end. For example: there could be an entire question describing cystic fibrosis, like: Child had meconium ileus, mother says that the child tastes salty on kissing it, it has positive chloride sweat test, etc.. they would explain the entire disease in detail giving lab findings and everything. While you are reading all this your mind may be going through a 100 different things related to Cystic Fibrosis. However, the question could be something like: If this couple has another child then what is the possibility that it too shall have the disease ? So while you are reading a lengthy question stem you are actually wasting time thinking about the signs and symptoms, diagnostic findings, treatment guidelines, etc of cystic fibrosis and wasting time.
Now imagine how easy the question would have been had you read the last line of the question i.e. the actual question stem before reading the earlier part “If this couple has another child then what is the possibility that it too shall have the disease ?” . If you would have read this first then you would already have known that the question was related to genetics. Then the only thing left to do would be to diagnose the disease and then think about ONLY the genetic component. This would save an incredible amount of your time (which is already scarce in the USMLE test). Hence, I would recommend that the FIRST thing to read in a question is the LAST thing written in a question. This will be a big time saver while doing the USMLE blocks.
As is already known the USMLE Exam is pretty lengthy. While the USMLE provides lab values in the interface, it is a good idea to memorize the list provided in the USMLE website. Following is the list of lab values you should remember. While it is always possible to lookup a value in case you dont remember it, it is much better to not waste time doing so in the exam. Memorizing lab values will save an incredible amount of time. In many questions there will be almost a page full of lab values and it would become practically impossible to go into the lab values part of the interface to check out each of them.
This point alone is the greatest time saver while doing the USMLE blocks
The “mark” function in the USMLE interface is the most inappropriately used function in the world. The purpose of the function is to MARK a question so that you can come back to it later. However, when faced by a tough exam with many WTF questions, many people mark tons of questions and eventually dont have time to come back to them or see them again. This is an incorrect way of using the MARK function. It should not be used indiscriminately. For example if there is a question which you have never heard about and they are asking you the chromosome number of the disease, then there is no way you can make a better calculated decision than the one you would make the first time. So I think the right way to use the USMLE “MARK” function should only be to mark questions where there is a reasonable chance that if you are given more time then you would be able to make a better decision. Marking 15 questions in a block and then not having time to review any of them is not a smart idea. Mark wisely !
For example if they ask you the function of the gene causing Aarskog syndrome and you have never heard of it before then a smart decision would be to just make a calculated guess and move forward instead of marking it.
If however, on the other hand if there is a question about something common like ACE inhibitors then it would be smarter to MARK the question if you cannot figure it out for sure on the first try and think that reading it again would be helpful.
This tip will help save time during the USMLE blocks solving process.
A common issue faced during the exam are the repeated security checks, pat downs, signatures and finger prints that you must take each and every time you go out and come back in. The process of checking in and checking out in between blocks during the break time, in and of itself is very time wasting and anxiety provoking. A smarter way to take a break if you dont need to go to the washroom, dont need to eat or drink and just want to take a couple minutes off between the blocks is to take the block at the computer table itself. After a block ends you could just take a break and sit at the table itself instead of going out to the lounge area and back. This is because merely going out and coming back in would likely take 4-5 minutes every time. It is a much better use of time to just click on take a break after a block ends and even closing your eyes for a couple of seconds or just resting while sitting at the table might help freshen you up in the exam break time. This is a simple way to save a couple of minutes during the break time.
As mentioned previously the check in and check out process is quite tedious and time consuming. An easy way to save a few minutes during the break time is to get a pair of pocketless Tshirt and Pants. The reason is that they make you invert your pockets everytime you check in and check out. This time can be saved by merely not having any pockets ! 😀
Make sure you follow these suggestions. These have been created after reading hundreds of experiences and represent the collective wisdom of many doctors who have aced the USMLE in the past. While everywhere else Time = Money, in the USMLE, Time = Marks !!
The NBME (National Board Of Medical Examiners) Test forms are a series of 4 block tests conducted at a cost of $60 to test USMLE exam readiness for potential examinees. The score received on the NBME forms is highly predictive of the real exam and is a good metric to gauge how well is your preparation. While the NBME is a good proxy to the USMLE score and is a must-do for USMLE preparation, there are certain differences that one should be aware of. I have in the past written an article on How to Best Use the NBME ? In this article I highlight those differences which are frequently overlooked by many. Being aware of these differences will better prepare you for what’s in store for exam day. Additionally every potential issue is followed by a solution to help you test yourself in an environment that best emulates a real exam:
The NBME tests are given at your home, in a familiar surrounding. You have a fridge full of your favorite food, can get up and grab a snack while giving the test and are in a comfortable surrounding. You can keep your feet up on the table and give the exam as you please all while checking your favourite cat photo pages on Facebook.
This changes completely in the USMLE Prometric exam center. Instead of being at ease, you are constantly forced to do a security check, patted down, fingerprint scanned and signed entry and exit. All of this adds to the high pressure situation and is uncomfortable.
We perform best when the situation is under our control. When we give the exam in the Prometric center, the same brain which performed well at home is under an immense amount of stress. Stress that may be caused by having to travel out of town, given an exam under unfamiliar surroundings, carrying documentations, and taking the test under strict security. In addition to this, if i may share my own experience, i was giving the test along with examinees who needed to type for their exam (like the GMAT, IELTS, etc). Their noise disturbed me a lot. In addition to this i had to tolerate the constant sniffing and coughing of a girl giving the test next to me. All of this lead to unnecessary irritation and distraction.
Because the real test was not a very comfortable experience, i made sure i emulate this. I took 2 NBME tests back to back every time i gave a mock test. I considered my score as a mean of the 2 tests. I have a little sister who plays with toys, i asked her to be in the room while i gave the NBME tests. In addition to emulating the noise distractions, i also prepared a small snacks packet including a sandwich and chips and 2 Red Bulls. I gave the exam with the snack pack on a table next to me. After every block i would get up and take a break if i wanted to. I would time my breaks and make sure that i don’t take more than the alloted time. This method of testing in uncomfortable situations helped me simulate the real exam environment
The real exam is 7 blocks whereas the NBME is only 4 hours in length. While the vast majority of people take only 1 NBME a day, this overestimates our performance. The reason is : In the early hours of a test we are fresh and perform better. However after 7 hours in an 8 hour exam, our brain starts to fatigue out and hence a 4 hour test is not rigorous enough to emulate a 8 hour test.
As alluded to previously, i took 2 NBME tests back to back in order to emulate a real testing environment. This was actually very helpful as i usually scored lesser in my second NBME as compared to my first one. I would take the average of the 2 tests as my mock test score.
The NBME questions are notoriously short. This is not the case with the real exam. While in most NBME tests, the questions are direct and to the point, in the real exam questions are filled with tons of labs which do not necessarily have anything to do with question but are kept in there to confuse you and use up your time.
The Uworld questions are of a similar length as the actual exam and since most people are going to do UWorld not once but multiple times, we already have decent practice with longer question formats. One extra tip i used to decrease time spent to solve a question and make longer questions easier is to not use the labs value button and instead memorize ALL the normal lab values. Following is a list of the lab values which you need to memorize for Step 1 , Step 2 as well as the for the clinics in the future when you are in a residency. Make sure you memorize these.
The real exam has a lot of media items which are not on the question sets of the NBME. For example, there are no 12 Lead ECGs on the NBME tests. There are only Single (1 lead) ECGs in the NBME tests. In a 12 lead ECG we have to pick out an aberrant finding from all the leads. The NBME forms have ECG questions with just 1 lead in the question. This makes the questions incredibly easy and hence are not a good proxy to the actual USMLE because the real USMLE has multiple questions with 12 lead ECGs. For example, you may encounter a practice question in an NBME of a single lead ECGs like an ECG segment with a clear cut T wave elevation (for hyperkalemia) [SEE IMAGE BELOW].
Now this is incredibly easy to diagnose as your options are narrowed down to just one lead. Had the question been a 12 lead ECG the difficulty level would have been very high. I recommend you practice 12 lead ECGs [Like the Below Image] to emulate the real exam scenario.
Also, the heart sounds in the real exam are not like those in UWorld or NBME and don’t have a simple, single play button. Instead they have different auscultation sites [AS SHOWN IN IMAGE] and then it is on you to find out where the abnormal sound is located.
The reason this is important to note is that the heart sounds you practice will have a simple play button with the abnormal area already given to you. This narrows down the choices sometimes to just 2-3 diseases and doing such questions will create a false feeling of being good at these diagnoses. However, the reality is that the questions on heart sounds in the practice tests like UWorld and NBME are MUCH MUCH easier than the real exam and hence
For example, having a single button which says, Apex area sound is as follows decreases the difficulty level a lot in the NBME questions. But many people find it very tough and frustrating while trying to diagnose a multiple site heart auscultation in the real exam. Following is how the heart sounds are to be diagnosed in the real test (excerpt from Official USMLE Practice Materials):
Note that there are multiple auscultation zones and diagnosing the above scenario should be practiced many times before the real exam.
While the NBME forms are the closest you can get to the actual USMLE exam style and scenario, it is worth keeping in mind the differences between the 2. These differences may prove to be much bigger problems than anticipated, if not mitigated in advance. A lot of your USMLE score will depend not on your preparation but on your test day performance. I would suggest you keep this page bookmarked to refer to later. It will definitely payoff to have these in mind.
The NBME self assessment exams (also known commonly as the NBME Tests) are a set of tests for USMLE Step 1, Step 2 CK and Step 3. These tests are widely known to closely approximate the actual exam and have a very high PREDICTIVE value. This article will show you how to use these tests not just as a predictive tool but also as a learning tool. There is a lot of mystery around how to use the NBME forms ? When to give the NBME Practice Tests ? etc. This article will solve all your queries about NBMEs. This article has been written by a student who has scored over 260 on his USMLE. I recommend you READ THIS POST COMPLETELY… It may help you score maybe 15-20 points more at the least. You can skip the basic parts if you know and go down to the last few headings.
➣ What are the NBME Forms ?
The NBME is the organization which makes the USMLE Step exams. While the USMLE Step 1 has more than 300 questions each NBME form has just 200 questions. The forms are meant to be roughly gauge your potential on the actual exam. They can be bought on the NBME website for $50 (basic) & $60 (extended feedback). In basic you get just the final score. In extended feedback you get the questions you got incorrect. In neither do you get the questions you got correct with the correct answer.
➣ How many NBME forms are there & how many questions ?
There are 15 NBME test forms, however, they are not sequentially numbered. There is NBME 1, NBME 2, NBME 3, NBME 4, NBME 5, NBME 6, NBME 7, NBME 11, NBME 12, NBME 13, NBME 15, NBME 16, NBME 17, NBME 18, NBME 19 There there is no NBME 8, 9, 10, 14.. so there are 15 NBMEs in total with 200 questions in each. Hence, there are 3000 questions. The NBME forms in themselves thus represent the largest and most important question bank. 3000 questions of NBME are larger than UWorld or Kaplan or Becker. The importance of this should not be underestimated. Forms 1, 2, 3, 4, 5, 6, 7, 11,12 are not available online anymore and the only way to do these are to see the screenshots pdf which are circulating. Forms 13 and later are available online and it is a good idea to give atleast a couple online.
➣ NBME Lingo – What is Online vs Offline NBME ?
On forums you will see people say I did 6 NBME tests online and 7 offline or something like that. What it means is: Online = You pay and you buy the test via NBME website Offline= You don’t pay and you do it via screenshots pdf (i.e. screenshot version).
PROs and CONs of each : Online you can give the test in a controlled environment and the test will be timed. Offline you can give it in a similar way too but you have to setup your timer and be precise with timing. Online you pay, offline you don’t. Online you get only test forms 13, 15, 16 , 17, 18,19. Rest 9 forms.. i.e. 1,2,3,4,5,6,7,11,12 have to be done offline only as the NBME sells only 6 at a time. So you decide whichever you want..online or offline. I was just explaining the lingo as sometimes people don’t understand it. Online : Paid, Offline : Free.. this is basic meaning.
When you give it offline use following formula:
Total correct questions out of 200 multiplied by 1.39 and that will give you the score as online roughly.. plus or minus 2 points..
So 180 correct out of 200 makes it 250 approx. score.. This is quite accurate actually..
➣ What is the difficulty level and question pattern of the NBME forms with respect to actual USMLE ?
While no one can give a precise answer to this as the USMLE does not divulge their questions and neither are people allowed to talk about it but following is a rough non-specific general idea. The real USMLE questions are a bit longer than the NBME questions. The core concept is the same but sometimes they may put extra information in there. Like instead of saying that a person has hyperuricemia perhaps an entire panel of lab values may be given and then finally Uric acid is given somewhere in the list. It is same concept but they make it lengthy by putting irrelevant info to make you feel like it is tougher.
➣ What is the usage of the NBME Forms ?
The NBME forms may be used for 2 purposes: Assessment & Learning.
➣ How best to use the NBME questions as an ASSESSMENT TOOL to IMPROVE YOUR SCORE ?
NBME tests are highly predictive of not just the actual USMLE score but also of subjects and sections within subjects you may be weak at.
For example : After taking your first NBME, you see the subject areas you are weak in are Behavioural Sciences and Neuro Anatomy. You look at the exact questions you got incorrect and see that the Behavioural Sciences questions are all Patient – Physician Relations (PPR). If the Neuro Anatomy questions which are incorrect are related to brainstem cross sections & brainstem syndromes.. then from the above two you can deduce that you need to focus on those 2 parts specifically. If before the next test you prepare these 2 areas well (and anything else you were getting wrong questions on) then your score will likely improve. I know this because i did this and my score improved from mid 230s to mid 260s over the course of 4 online NBMEs i gave (and many offline). When you assess yourself and look at the incorrect questions it is essential that you look at them in an objective way.
You could be facing one of the following mistakes:
WAYS TO MITIGATE THE ABOVE PROBLEMS :
➣ How best to use the NBME questions as a LEARNING TOOL to IMPROVE YOUR SCORE ?
Now I will let you in on a big secret: While the NBME is not providing any answers or explanations to their questions. A group of top scorers who have got more than 270 on their test have created an answer & explanations list which has everything explained in depth. I did this after every NBME. I would do an NBME and then i would do answers and explanations. The answers and explanations were unbelievably good. As good or even better than UWorld answers and explanations. I recommend you do this for sure. The value of this great resource is underestimated. Guys 3000 questions & answers of amazing content ! Questions are made by USMLE themselves and many people including myself who did the NBMEs in depth before their exam felt that the NBMEs an amazing resource for exam prep. If someone tells you NBMEs aren’t that helpful after their exam you ask them whether they had really done it well.. whether they really understand slipped strand DNA mismatch abnormality & they really know the differences between Pelger Huet and Pseudo Pelger Heut anomaly..these both are in NBME as options.. you must dissect NBME inside out..not just read superficially. Many people will give you an opinion that it’s not so helpful..but make sure you ask them well and understand if they had actually done this resource well or had just glanced over randomly. I believe that doing the 3000 questions is the SOLE reason for me going from 230s to 260s.
➣ Where can I get Answers and Explanation to the NBMEs ?
Previously there were no concrete 100% correct answers and explanations.. I have seen the circulating pdfs.. every one of them has atleast 5% or more incorrect answers. Many have more. Some even give incorrect explanation and incorrect logic to incorrect answer choice. There is one team of 270s and 260s scorers working on the explanations.. they have posted it for free online on their own websites..so make sure you join the following group and page it has the links to answers and explanations. 10 or so people are involved…it is a group initiative. Go to following FB Group & FB Page. Answers are available there:
➣ When should we use the NBME tests / Timing of when to do the NBME questions ?
People do not do the NBME questions till the very end. It is so prevalent among the USMLE community that it feels almost like an epidemic. Guys, NBME is same organization which makes USMLE. When we all have heard how people get many repeats from the NBME directly onto their actual exam then why would we ignore this amazing resource ? This is my recommendation. It is what I have done and it is what I believe everyone should do. It s what helped me get a 264. Give NBME s early on and don’t wait till then end. I have seen people try to do all 3000 questions & answers with explanations in 1 week and sometimes I laugh (i know i shouldn’t laugh but it is hilarious).. Guys change your thinking..as USMLE and the match process gets tougher and tougher every year we need to understand that taking such a valuable resource lightly and not adapting to change is a mistake. Darwin once said: “it is not the strongest nor the most intelligent of a species that survives but the most adaptable to change”. Adapt and win or ignore and lose.. your choice.. If people really follow a proper system then they can score so high that 260s will become a regular phenomenon.. It is not that tough if you plan. Just every week for the last 4 months… on a weekend do one NBME.. But make sure you do all the answers along with explanations which i talked about above. The explanations have some hidden gems from which many questions are repeated on the real test. So this should be a ideal plan: start form number 1 and go to 19.. this way you have 15 total and you can do for like 3.5 months. Ever week you must assess yourself & then do the explanations with it.. you must try and understand your mistakes. What areas you are weak in.. being blindfolded and having AK – 47 gun in your hand if you go to war you may lose against someone with a small pocket knife in their hand. You don’t want to be shooting in wrong direction. Doing easy stuff repeatedly but not recognizing one’s mistakes can be fatal. Also, don’t keep NBME till last, if you don’t have time at the end you will feel that you will not be able to do anything new and then you will not do NBME at all. I have seen so many people who make such mistakes. Do it from a while ago. Many people do NBME in last month. I kept last month without NBME.. You may think how is this possible..well let me tell you..i finished all NBME in 3 months..then in that time i assessed my weakness and gradually improved my score from 230s to 260s.. in last month I knew myself and my prep inside out.. I knew what I had to do..what is frequently asked questions and how to prepare. I see people fumble at last moment. I was at peak on my test day. Doing NBME 3 days before exam will cause only one thing: Anxiety… think about it.. you wanna score 260..havent given single NBME till last month.. you give and get 240s.. you work hard and think you will improve..now 3 days before exam you give another test and get 230s.. then what will happen to your confidence ? It will be finished.. do it early ! At last moment don’t assess.. Assess in advance..and prepare in advance.. Have you seen Troy ? Did you see Achilles (Brad Pitt’s role) do bench press 15 minutes before going to fight ? Have you heard any great athlete like Mohammed Ali try to do revision 2 minutes before a world championship ? They may warm up.. but will not be actually trying to like grow muscle 1 week before a fight.. Prepare in advance folks.. at last moment everything you think can go wrong..might all go wrong at once..and it would be tough to give test in such high stress environment.. Sleep is essential too.. so last few days..my rule was..no exam..no test.. only revise the stuff already done..can’t be doing all that and causing anxiety to yourself.. Well this is my advise.. If you think you know a better method..then by all means..do your style.. but just remember.. Achilles never bench pressed a day before going to war.. you cant grow muscle at last moment..its all long term kinda thing.. Do all NBME along with answers and explanations in advance ! 🙂
➣ Ending Notes:
Do the the NBME forms from the beginning and use them for self improvement as stated in the list of mistakes one may do. Analyse yourself objectively. Analyse where you stand and how you can improve. Understand that a lower score is a product of lower level of planning usually and hard work can mitigate all problems. Just work hard and you will make it. I will be posting more. I hope this helps you.