Four Key Differences Between Your NBME & USMLE Step 1

  • /Reviewed by: Amy Rontal, MD
  • At MST, we love NBME tests because of the striking similarities they have to your real Step exams. NBME questions come from the governing body that make all 3 steps of the USMLEs, so the 3-digit score you receive at the end provides a fairly accurate prediction of your performance on a real Step exam, and lets you know where you stand in your preparation. There is no better barometer for your USMLE performance than your NBME tests.

    But, as philosopher Alfred Korzybski reminds us, “The map is not the territory.”

    There are certain and marked differences between NBME practice tests and your Step 1 exam. Here, we will elaborate on the finer points.

    (For the purposes of this article, we will be focusing exclusively on Step 1).

    1. Step 1 Exam Length

    While the USMLE Step 1 exam is a bear of a test, holding you a captive for a full work day, the NBME exam is more of a cub, albeit a large one. The standard test has four 75-minute sections, each with 50 questions. Your real Step 1 test has ~280 questions (7 blocks of 40), which is nearly 50% more than any NBME practice test. For this reason, we recommend completing a full length self-assessment (or, short of that, back-to-back NBMEs) to build the stamina and get the feel for 8 straight hours of testing. Some students cut corners with the delusion that “If I can hold it together for 4-5 hours, I know I’ll be good for 8.” Don’t be lazy. Make sure you get a full length 8 hour session before the real test.

    2. Setting and Flow of Test Day

    NBMEs can be taken in your computer room with your feet up on the desk, texts and Snapchats getting delivered in the background, with a fridge full of food at your disposal, while in your pajamas. While the same brain is answering questions on test day, the stringent rules of the testing center (e.g., incessant Passport and fingerprint scans) definitely add an element of discomfort to the scenario. We perform best when we are in control, and the stress of traveling to a location, carrying necessary documentation, and taking the test under the governing body’s rules (instead of your own) can throw a wrench into your performance.

    Something that really got to me was the other 15 students in my testing room. Students working on writing-based exams endlessly pounding away at the keyboard. The girl in the next cubicle who was clearing her throat and sniffing every 12 seconds. The constant transit of test takers into and out of my room. What test were they taking? Are they going faster than me? For many people, it can all be a little unsettling. Do your best to assimilate, staying focused to only what’s on the screen in front of you. I highly recommend bringing earplugs on top of the leaf-blower style earmuffs that the test center provides. Most importantly, do what works for you.

    3. Exam Scores and Feedback

    The day ends. You answer your final question, sign out of the testing center, and breathe fresh outside air for the first time in a long time. But, it’s… anticlimactic. It’s done! Maybe it felt great, maybe it beat you down, but how did you really fare? You won’t know for weeks. WEEKS! This is quite the opposite of UWorld tutor mode, getting little surges of dopamine (or fury) after each question. Even the mighty NBME throws you a bone, giving you a final score, a breakdown of where you did well and poorly, and even feeds back to you the questions that you missed. Step 1 gives you nothing except an electronic screen with something along the lines of “Thank you for choosing Prometric Test Centers” (as if you had a choice).

    Go into the test with this in mind: It might feel weird giving 280 answers and getting nothing in return. Don’t worry about how you feel at the end of the day. No matter how it went, your mind will be burned out, and likely unable to properly assess how the test actually went. Let the score report next month tell you how it went and leave the conjecture aside.

    4. The Stakes Are Higher on Your Step 1 Exam

    You can slack off through a UWorld block. You shouldn’t, but you’ll have 100 chances to redeem yourself. You might tell yourself, “I really knew this one was B, but I chose C just to see what would happen / I didn’t really try my hardest on this one.” It’s possible to coast through an NBME giving 75% effort. Not a great idea when you dropped $60 on it and want to see how your studying is progressing, but it’s possible. The one thing you can’t do is give subpar effort to your real Step 1 test. It is the only one that actually counts.

    Therefore, here’s what we suggest in order to straddle the disconnect between NBME practice tests and Step 1 exam day:

    • Do whatever it takes to treat your NBME practice test test the same as you would Step 1.
    • Psych yourself up and respect the NBME.
    • Wear the same type of outfit for both NBME and Step 1.
    • Take the test in a quiet, controlled setting.
    • Logout of Facebook, put your phone on airplane mode, and pop in your ear plugs.

    The more that your NBME practice test mimics Step 1, the more routine that the real test will feel, and the more brainpower you will have to focus on delivering correct answers. And that, my friends, will put you on the path to success.