THE RIGHT WAY TO USE NBME FORMS - by Leo (Step 1 264):

Introduction: My name is Leo Garces and I am a recent IMG graduate from Brazil. I
come from humble roots and at an early age I was taught to work very hard. I prepared
for USMLE Step 1 for 1.5 years and I gave exam recently and scored 264. I will post my
experience soon along with many guides like this to help others better prepare. I had to
struggle a lot in my preps and hence I want to help others so they do not have to
struggle. 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 14 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 There there is no NBME 8, 9, 10,
14.. so there are 14 NBMEs in total with 200 questions in each. Hence, there are 2800
questions. The NBME forms in themselves thus represent the largest and most important
question bank. 2800 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 are not
available online anymore and the only way to do these are to see the screenshots pdf
which are circulating. Forms 12 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 dont pay and you do it via screenshots pdf (i.e. pirated 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 dont. Online you get
only test forms 12, 13, 15, 16 , 17, 18. Rest 8 forms.. i.e. 1,2,3,4,5,6,7,11 have to be done
offline only as the NBME sells only 6 at a time. So you decide whichever you want..online
or offline. I was just explaining the lingo as sometimes people dont 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.
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 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 2800 are extremely high yield. Whether it is
NBME 1 or 18..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 cant 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 cure..it 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. WAYS TO
MITIGATE THE ABOVE PROBLEMS :
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 didnt 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 on..lol.. no point
wasting excessive time on questions which ask you crazy stuff.
6. Again as point 6.. 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 examiners 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 ?
The value of this great resource is underestimated. Guys 2800 questions of amazing
content ! It is 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 arent 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 its
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 2800
questions is the SOLE reason for me going from 230s to 260s.
Where can I get Answers and Explanation to the NBMEs ?
As of now there are no concrete 100% correct answers and explanations.. I have seen
the circulating pdfs.. every one 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 working on the explanations.. they are going to post it for free
online soon..so make sure you join the following group and page. I am helping a bit as

much is being done by others.. 10 or so people are involved...it is a group initiative. They
ask me for help so i do some basic work for them.
https://www.facebook.com/NBMEExplanations https://www.facebook.com/groups/NBMEG
roup
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
dont wait till then end. I have seen people try to do all 2800 questions in 1 week and
sometimes I laugh (i know i shouldnt laugh but it is hilarious).. Guys change your
thinking..as 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.. start form number 1 and go to
18.. this way you have 14 total and you an do for like 3.5 months. Ever week you must
assess yourself.. 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 dont want to be shooting in
wrong direction. Doing easy stuff repeatedly but not recognizing ones 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 is
assesses 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 improve..now 3 days before exam you
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 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 highstress environment.. Sleep is essential too.. so last few days..my rule was..no
exam..no 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 bettr method..then by
all means..do 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 it 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