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When It Comes to Your First USMLE Step 1 NBME, Timing is the Thing

We’re a little depraved here at MST. Things that normally strike fear and loathing into most people’s hearts tend to tickle us pink. That four-letter word  NBME might fill you with dread as you imagine your Saturday dissolving into a chair, a computer screen, and a day of coffees and boredom. But we hear NBME and reflect lovingly on the exam, remembering all the good times we’ve had together. It’s sad but true, and it’s just the mentality that you should want a tutor to have!

Questions I hear a lot in my work with students regard scheduling NBMEs. How many should I take? When? With feedback or not? All of these answers will come in time. In this post, we will begin at the beginning, with a simple answer to a simple question.

How long should I wait before taking my first Step 1 NBME?

Not very long at all. In fact, you should take your first Step 1 NBME at the very beginning of your dedicated study period.

Why take an NBME so soon, when I haven’t started studying yet and will do poorly? Why would I start now?


We’ve spoken previously about the importance of NBMEs and how they best fit into your study schedule. They provide you with a different, yet necessary approach to USMLE-style questions. Even more than a learning tool, NBMEs let you know where you stand today, how far you are from your goal, and how hard you will have to work to connect the inbetweens.

But why so soon? Why do you need an NBME benchmark of how much or little you know right now?

Four big reasons come to mind:

1. It will home in on how long your dedicated USMLE study period should be.

Everyone needs to put in the necessary time for Step 1 studying, usually in the ballpark of at least 6 weeks. However, some students need less time to prepare and some students need much more. Let’s assume that you’re dead set on becoming an [insert competitive speciality]-ologist, and need to score a 250+ to have a competitive application at desired Program X. If your first NBME was a 174, there’s a good chance you’ll need more than six weeks to internalize the depth and breadth of information necessary to add ~80 points. If you’re already at 220, then maybe four or five weeks will suffice. If your curriculum was weak or you truly struggled through basic science coursework, this first NBME might be an indication that you need multiple months to reconstitute the information in your head.  

2. Early NBMEs will provide you with objective information about where you’re doing well (and poorly) subject-wise.


Med students are proud, as they should be. But sometimes we get overzealous and think we know more than we actually do. “I love cardiology and my parents are cardiologists and I’m just great at it.” Well, imaginary student, your NBME might tell you otherwise. The test doesn’t care which subjects you have an affinity for or which classes had better professors than others. It gives you cold, hard facts about what content you’ve mastered and what needs more time and dedication. No one is as honest as a number.

3. Your second NBME self-assessment will tell you if you’re studying effectively.


By taking your second NBME after two weeks of preparation – about a third of the way into your dedicated study period – you’ll get a better idea of how well you’re actually studying. If everything is going according to plan, you should see improvement in the subjects that you’ve already covered. If you wait two weeks before you take your first NBME, it’ll be much harder to appreciate any progress you may (or may not) be making. Plain and simple, questions should feel easier and you should be getting more right. Your second NBME should feel way more natural and way less daunting. You should ride this trend out so that when test day rolls around, it’s just another day of questions.

4. NBMEs will open your eyes to what a difficult, important, 4-hour test feels like.

NBMEs are so different that UWorld! Although we can delude ourselves into thinking that “questions are questions,” NBME questions actually carry gravity! You have to pay money for each one individually, which makes you bring your A-game to the table. Since you’ll go through literally thousands of UWorld questions, none of them will individually feel very valuable. But on a 200-question NBME test, each one counts, contributing to a devilishly accurate score of how you’d perform if you took Step 1 today.


One last thought: is there such a thing as taking an NBME too early? Of course. Your first NBME should occupy the exact moment when your coursework ends and your dedicated Step 1 studying begins. Deciding when to take your second NBME can be a little trickier. The easiest thing to do is to pepper your study schedule with NBME exams at regular intervals, making sure to leave a mind-clearing gap of about 10 days in between your final NBME and test day. Decide how many of the exams you need to take (most students need 3-4 for optimum performance, but everyone is different), and put them at even intervals in between your first NBME and the big test.

Don’t wait till it’s too late. Kick off your dedicated study period with a delightful foray into the world of NBMEs. (And if you need to get your NBME, here’s the link: