How to use NBME ?

➣ Introduction:

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 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.

Further differences between the NBME and the USMLE can be looked into by checking out this article which enlists the differences between the NBME and the USMLE as well as means to solve this discrepancy.

➣ What is the usage of the NBME Forms ?

The NBME forms may be used for 2 purposes: Assessment & Learning.

  1. Assessment tool: These tests are the most predictive assessment tools out there. Use NBME 16, 17, 18, 19 for predictive value as they are the latest and hence the most accurate. UWorld Self Assessment forms are the worst kind. It will over predict by 20 points..use at your own peril. It is worthless to me.
  2. Learning tool: The NBME questions..all 3000 are extremely high yield. Whether it is NBME 1 or 19..there is a likelihood to encounter similar test items. While the USMLE has never and will never say so but it is a logical conclusion as the USMLE test is created by the NBME themself. Also many examinees report getting test items directly from NBME on actual test.

➣ 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:

  1. You did not know a fact which was covered in the books you read.
  2. You knew all the facts but your thought process was incorrect.
  3. You knew it all but your brain was not alert and you were half asleep. It feels terrible to get these type of questions incorrect.
  4. Stuck between 2/3 options.
  5. You had no f*cking idea what the question is asking and have no clue about anything.. Try to assess questions properly as in NO NBME test are there more than maybe 2 questions like this out of 200. Very rare and you can’t get these correct no matter what you study.
  6. You read question incorrectly..perhaps one or two words you overlooked or read incorrectly.
  7. You knew it all but you saw one option and went with your first hunch.. first option you saw lured you in. You need to pick best possible answer. Not the first you see because the first you see may not be the best. It may be correct but not right 100%.. there may be better option. Ceftriaxone can be given for Lyme’s and cures lyme’s well but doxy is DOC as cephalosporins are parenteral and tetra is oral. So while ceftriaxone may be correct and may is a good option and not BEST option.
  8. You saw a question via a cursory glance and made a pre-formed opinion and went ahead with the biased thought process and got the answer incorrect.


  1. If you did not know something which was given directly in books then go back to your books and start memorizing it. No other way out. Work hard and you will score higher.
  2. If you knew facts but thought process was incorrect then you need to do more questions as practice. Best practice is doing the 8 earlier forms of NBME. NBME 1, 2, 3, 4, 5, 6, 7, 11.. they combined make up 1600 questions. It is the best possible practice.
  3. If alertness is an issue then you need to buck up. You worked hard for a year and now you are letting your hard work go down the drain. Sleep well before the test day and be on top of your game. This is the most important test ever.
  4. Again answer is same as point 1. You need to do your course material well. Problem 4 is not as bad as problem 1. Atleast you could come down to 2/3 options. In problem 1 you did not even know the concept. Atleast in 4 you knew concept but didn’t know it well enough. Go to your books and read them well.
  5.  WTF questions are just that.. wtf !! However, even when you think it is a wtf question think hard. Sometimes, you may get a clue hidden in question stem..sometimes options elimination may work…sometimes you can do good guesswork. If nothing works..just say wtf..and move no point wasting excessive time on questions which ask you crazy stuff.
  6. Again as point 3.. read well !! be alert !! You absolutely cannot afford to be wrong on this test. Your career depends on it. Take it seriously.
  7. and 8. Always think well and be in sync with the examiner’s psyche.. UWorld will train you to overthink as if every question is trying to fool you. It is not so in actual exam or on NBME. The questions which look like they have an obvious answer do indeed have an obvious answer. Do not over think and make pre-formed opinions. Ofcourse you must think well and deduce a correct answer but UWorld is terrible simulation for actual exam. It makes you overthink a lot. I had to train myself not to do so as it was costing me valuable points. Be careful to be in-sync with the examiner…try to question yourself and the question..what realistically is the examiner asking me here ? That usually turns out to be correct and the examiner is usually asking you the simpler topic..not the weird logic you created in your head.

➣ 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 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 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 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 rule 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 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.

While the NBMEs are a great assessment tool and a great learning tool for USMLE prep es[pecially if done with all answers and explanations, there are also some differences between the NBME and the USMLE. It is worth checking out this article which enlists the differences between the NBME and the USMLE as well as means to solve this discrepancy.


September 21, 2017