Lauryn Falcone and Dr. Eli Freiman also contributed to this post.
For most students, the anticipation leading up to their first NBME practice test for USMLE Step 1 or 2 is the same. Many wonder: Am I truly prepared? What will happen if my score prediction is much lower than my goal score?
Often, the answers to these questions may initially be discouraging, as it’s common for students to receive an early NBME practice exam score that’s well below their ideal score. Many students see this as an opportunity for improvement, but what happens if your practice exam scores continue to disappoint after multiple NBMEs? What happens if you truly aren’t scoring where you want on the NBMEs before your exam day?
The good news: Low scores aren’t necessarily a cause for concern.
Well, don’t worry just yet. Everyone experiences scoring plateaus on practice tests, and there are numerous reasons for this. It’s very difficult to adequately test you on your growing body of knowledge, so there will be variability from exam to exam.
You could be at a 260 level but get a 235 on a test—that’s the amount of fluctuation you might see due to the nature of the exam. Variation in practice test scores occurs because each exam only assesses a subset of your overall knowledge, making it difficult to capture your true proficiency level consistently.
For instance, some tests may focus more on topics you’ve already mastered, leading to higher scores, while others may emphasize areas where you’re weaker, resulting in lower scores. Additionally, the finite number of questions means that random variation in topic distribution will impact your performance.
Other factors contributing to variability include test-day conditions, such as fatigue, distractions, anxiety, or differences in focus levels. The wording and structure of questions can also play a role. Some exams may present familiar concepts in ways that align with your reasoning style, while others may phrase questions in ways that are more challenging for you to interpret. All that is to say, variance is to be expected.
Ultimately, this fluctuation is normal and doesn’t necessarily reflect a lack of progress. Instead of focusing on isolated practice scores, it’s more important to analyze trends over multiple practice exams and ensure continuous improvement in tested medical knowledge and test-taking strategies.
Should you be worried if your scores hit a plateau?
Often, we underperform on practice exams because they aren’t as high-stakes as the real test. Many students interpret stagnation on NBMEs as a sign that they haven’t been studying the right information or that they’re inefficiently studying. This usually isn’t the case. You’re still learning and improving. (Check out this post for help preparing for Step 2.)
That said, we have some more tips below to help you break through score plateaus on your NBME practice exams.
What to Do When Your NBME Practice Test Scores Aren’t Improving
1. Use more efficient study methods.
A frequent concern among students is: “I’m studying all the time, so why aren’t my scores improving?” I have tutored for over a decade, from SAT and ACT to MCAT to USMLE and board exams. Without fail, I get that question multiple times a year.
Whether you’re taking USMLE Step 1 or 2, the reality is that the amount of time spent studying doesn’t guarantee a good score. The highest-scoring students typically focus on quality over quantity rather than just clocking in hours.
If you’re struggling with your study schedule (i.e., not meeting the number of questions completed daily/weekly) or not seeing improvement, focus on efficiency in these ways:
Get a decent night’s sleep.
If you’re constantly exhausted, your brain isn’t effectively retaining information. When I work with students to create study schedules, I rarely have them work beyond 10 p.m. or before 8 a.m. If you’re nodding off continuously throughout the day, you aren’t truly absorbing those high-yield topics from your lecture or comprehending the explanations in your Qbank.
Turn passive studying into active studying.
First Aid is a great foundational resource, but passive reading isn’t enough. After every few pages, take a moment to actively retain key concepts by doing questions after a tough topic or making some Anki cards to help reinforce learning and ensure that you’re processing the material rather than just skimming through it.
To engage in more active studying, you can:
Write concise notes.
Instead of copying verbatim, distill the main points into simplified explanations as notes or a flashcard. Even highlighting is better than just reading.
Use a “teach-back” method.
Pretend you’re explaining the concept to a classmate. This forces you to organize your thoughts and review key ideas.
Take advantage of awesome flowcharts and diagrams.
Visual representations of disease processes, treatment algorithms, and decision-making pathways can improve recall.
Mix up your resources.
If you feel yourself drifting off while reading, switch to flashcards or practice questions for a while.
Pick up the pace.
Finally, use a timer when reviewing your Qbank questions. Focus on each question in a short time period and move on. Also, use a computer timer or stopwatch rather than your phone for timing! When studying, your phone should be silenced and you should be disconnected from social media.
Looking for a Qbank to help out with USMLE studying this year? Blueprint has got you covered with practice questions, detailed explanations, performance analytics, and more! 💙
🌟 Step 1 Practice Bundle – Includes 2 full-length USMLE practice exams with a total of 560 NBME®-formatted practice questions, plus 500 additional questions in a Qbank.
🌟 Step 2 & Shelf Exams Qbank – Includes 5,500+ practice questions (1,500 Step 2 questions and 4,000 shelf questions across 8 specialties), plus 8 mock shelf exams!
2. Be realistic about your timeline.
A big question students ask is whether or not they should push back the exam. Many students are tempted to push back their exam when their practice exam scores are continuously below their goal score.
In the case of a student who has flexibility in their study schedule and perhaps didn’t prepare well (see above), this may be warranted. Though for Step 1 (now a pass/fail exam) this is less of a concern so long as you’re well within passing range.
For Step 2, however, if you still have stagnant scores after you’ve completed and reviewed your Qbank multiple times and made full passes on your Step 2 resources, it may be time to re-evaluate your goal score rather than postpone indefinitely. Some students may need additional time, but others may benefit more from focusing on refining test-taking strategies rather than extending study time.
If you’d like a (FREE!) resource to help schedule your study tasks, check out Blueprint’s Med School Study Planner! Take the stress out of exam prep with a “smart” study planner that automatically assigns your tasks for each day with just a few clicks. Plus, your schedule automatically rebalances if you fall behind!
3. Change up your study resources.
For both Step 1 and 2, even if you’re studying effectively, sometimes a change of pace can help keep things fresh. Reviewing the same content over and over can cause you to miss critical gaps in your knowledge.
Try mixing up the following resources:
- Use First Aid to supplement your Qbank explanations.
- Watch OnlineMedEd videos for a detailed explanation of tough topics.
- Create Anki flashcards to review later.
- Then put it all together with more Qbank questions (like from Blueprint Prep!) to strengthen your knowledge in high-yield areas.
4. Space out your NBME practice tests.
A common mistake is taking practice exams too frequently and expecting significant improvement in short periods. If you’re testing too often, you might not be allowing enough time to genuinely apply what you’ve learned from previous exams.
A week is a reasonable amount of time to expect a small improvement, but not a large one. With the variability of each practice test (and other factors discussed above), you can expect your scores to stay exactly the same (or even go down) if you take two practice tests within a week or so.
A good rule of thumb is to space your Step 2 practice NBMEs 10-14 days apart to allow for more meaningful growth between tests. Just don’t expect to go from a 220 to a 260!
5. Review your NBME practice exams thoroughly.
This is one of the best pieces of advice, and one that can significantly boost your score.
Your practice exams are more than just a score—they’re learning tools, so please use them as such. Instead of just checking the score and feeling good or defeated, use your practice exam as a gauge to your progress and a guide to target your weaknesses and focus your study efforts.
When reviewing your Step1 and Step 2 practice exams, be sure to:
Identify recurring themes in incorrect answers.
Are you struggling with clinical reasoning, misreading questions, missing small details in the question stem, or second-guessing yourself? There are fixes for all of these problems and the first step is to identify the pattern causing your low score.
Write down key learning points from each question and incorporate them into flashcards or notes.
For example, if you’re constantly missing each and every cardiac pathophysiology question or perhaps you really struggle with biostatistics, review those questions and turn them into study materials.
Be mindful of your time.
Take the Step 1 and Step 2 practice exam in a timed fashion and see how you perform under similar time pressure that you’ll face on exam day.
Make sure you’re not repeating the same mistakes.
Even if you aren’t happy with your practice exam score, you can still make progress by making sure you review the exam thoroughly and knowing why you missed some answers.
This way, even if your NBME score isn’t where you wanted it to be, at least you got a whopping load of knowledge out of it!
6. If you’re taking Step 2, evaluate whether your goal score is realistic.
Not everyone will score 270 on Step 2, and that’s okay. The goal is to achieve a competitive score for your specialty while demonstrating clinical reasoning and decision-making skills.
If you’ve hit a plateau despite extensive preparation, consider adjusting your expectations without undermining your confidence.
Instead of fixating on a single number, focus on being test-ready, so you can consistently apply your knowledge to clinical scenarios by correctly answering hundreds of MCQs under timed conditions.
Final Thoughts
Stagnating NBME scores can be frustrating, but they’re a normal part of the study process. Keep in mind that progress isn’t always linear—sometimes a plateau precedes a major breakthrough.
If your scores plateau, please remember to:
- Stay consistent with questions and adjust your study process as you progress.
- Use practice exams as learning opportunities.
- Maintain a growth mindset and focus on mastery, not just scores.
With the right approach, you’ll pass Step 1 without issue and break through score plateaus with your best possible performance on Step 2. If you need personalized guidance, don’t hesitate to reach out for one-on-one support. Good luck!
