USMLE Winter is Coming: Prepare with NBMEs

  • /Reviewed by: Amy Rontal, MD
  • You’re prepping for the USMLE. You have your UWorld subscription, a shiny new copy of First Aid, a subscription to Boards&Beyond, and a tattered, well-loved copy of BRS Physiology. But have you taken an NBME?

    The National Board of Medical Examiners compiles what are colloquially known as “NBME self-assessments,” tests comprised of 200 multiple-choice USMLE questions.

    Taking NBME self-assessments is essential as you prepare for Step 1 and Step 2 CK. Period. But when should you take them? How many to take? Are they all equivalent? In this post, we will demystify these tests, and turn them into crucial allies as you prepare for the real deal.

    The most important aspect of the NBME self-assessments is that they are assembled and edited by the very same governing body who selects the questions that appear on Step 1 and 2. While we absolutely love UWorld for being our daily teacher (and shoulder to cry on) during our study periods, no one group can emulate the USMLE questions like the test writers and editors themselves. I’ve had a number of students say that they “don’t like” NBME-style questions, or that they find UWorld questions to be “clearer and better written.”

    Sadly, this is inconsequential; on test day, you will be answering NBME/USMLE questions. The bottom line is that NBMEs are crucial to our USMLE preparation.

    So, how do I implement NBME self-assessments during my study period?

    You should absolutely start your study period by taking an NBME test. This will accomplish more than you think. It gives you a baseline three-digit score, which can ultimately be used to decide the duration and intensity of your dedicated study period. It will impartially indicate, “This is where you are now.”

    Your initial NBME comes with the gravity of taking a “real” test. While UWorld blocks are helpful, they are numerous, and no singular one means very much in the long run. When your NBME is over, there will be no “I actually knew that one,” no “I wasn’t really concentrating.” (How many times have you told yourself that after a UWorld question? If you are anything like I was, too many to count.) There will only be a score and an experience to learn from.

    Taking an NBME early will also give you a breakdown of the areas where you are excelling, as well as the areas that definitely need extra work. Whether preparing on your own or with a tutor, this information is important when deciding how many days will be spent on certain topics. While you may already know “I’m great at cardiology and terrible at biochemistry,” having an objective metric to show you how far ahead or behind you are is a valuable tool.

    This NBME will also teach you what it feels like to take a serious four-hour test, a skill that you will build upon so that you’ve got the necessary stamina on test day.

    You should be taking multiple NBMEs during your USMLE study period.

    Depending on how long your study period is, your NBME exams can occur as often as weekly (for a truncated Step 2 study block), or as spread out as every six weeks (for a multi-month Step 1 prep period).

    On average, for a six- to eight-week study block, somewhere around every two or three weeks is the recommended cadence for practice NBMEs.

    Everyone’s individual case is different. If nothing else, it is important to feel and live the testing situation at least a couple of times without letting burnout creep in. That means your classic Step 1 study block would have two or three NBME self-assessments.

    When is the best time to take my NBME tests?

    The best time to take the NBME self-assessment is on a Saturday morning.

    This allows time to review incorrect answer choices over the weekend, as well as de-stress after an intense and difficult test.

    The NBME Self-Assessment Services (NSAS) website currently offers Forms 25-30 for Step 1 and Form 9-11 for Step 2.

    Step 1 tests are called Comprehensive BASIC Science Self-Assessment (CBSSA).

    For Step 2 CK, you should take the Comprehensive CLINICAL Science Self-Assessment (CCSSA).

    If you get confused, there is a small blurb about which exam your self-assessment corresponds to. For $60, you get access to the questions and answer explanations. It’s worth every penny.

    See our NBME Self-Assessment FAQs blog post for more NBME basics!


    How to schedule your NBME exams:

    As you plot out your USMLE study schedule (you absolutely should have a study schedule!), place the NBMEs on your calendar, scheduling the test with the highest number (i.e., the most recently released) closest to test day.

    Place the second-newest test about two weeks earlier, and continue until you are satisfied with the number of tests you are taking.

    Newer tests contain the questions that will be most similar to the actual exam, so these “better,” newer tests should fall closer to test day. Make sure you leave about two weeks in between your final NBME and the actual test so that you can adequately decompress.


    One last caveat: Give the review of the test its due time and attention.

    You might feel a little toasted after sitting, thinking, and clicking for four straight hours. That is natural. Take a breather when you are done, but don’t be satisfied with a quick and brief review of the tests. There is so much great material to learn from in these tests, and you should aim to pull all of the value from them that you possibly can. If this bleeds into Sunday, that’s A-OK.

    To close, realize that NBME tests and UWorld serve two different, yet overlapping, purposes. NBME tests will tell you how far you are, how far you need to go, and can teach you a bit about the material. UWorld will be your main teacher but does not offer a great predictive measure as to how you will perform on the test. When used synergistically, NBME self-assessments will allow you to achieve your best possible score.

    Best of luck to you, and let us know what questions you still have about using NBMEs to excel on test day!