Answering Your Questions about Using the NBME Self-Assessments for Your Preparation for Step 1

Answering your QuestionsAnswering Your Questions about Using the NBME Self-Assessments for Your Preparation for Step 1

A very common question from students preparing for Step 1 is how to use the NBME self-assessment forms that are also known as the CBSSA (Comprehensive Basic Science Self Assessment) exams on the NBME website.  In addition, students want to know when to take the practice exams, and which of the self-assessments are more representative of the actual USMLE exam. We will try to answer some of these questions for you in this column and follow up next week with additional information.

General information:

  • There are 7 forms with 200 multiple-choice items each.
  • The assessments are $50 each at this time.
  • Item formats are similar to those used on Step 1.
  • Some forms have an expanded feedback; these forms are more expensive. ($60).
  • Each form is divided into four sections with 50 questions each.
  • You are allowed up to 1 hour to complete each section if you take the exam under “Standard Conditions” rather than “Self-Paced”.

Students are much better off taking the self-assessments under timed, standard conditions and receiving feedback. If a student wants to take questions in self-paced mode, it might be better to use a question bank or book of questions that is less expensive.

Which exams are the most like the actual USMLE exam??

According to the majority of students in 2009-2010 the:

  • NBME self-assessment 7, 11,12  are more difficult
  • NBME self-assessment 3, 5, 6 are easier

Which NBME self-assessments will be a closer representation to the USMLE Step 1? This is a very common question and a good question. However, the truth may be that the self-assessment that is closest will depend on the exam you end up with on the day you sit for Step 1. Because different exam content is generated for the different USMLE testing sessions, students have historically reported several experiences ranging from:

  • “My Step 1 exam look just like Kaplan Q Bank” (or USMLE World)
  • “The average of my NBME self-assessments exactly predicted my actual score”
  • I saw several questions that were similar to what showed up on my question banks and self-assessments. Studying the explanations was the essential piece
  • “I had several questions that came straight from my question bank”
  • “I didn’t recognize any of the questions from my exam. It could have been from Mars. None of the questions banks helped.” (Bear in mind that these students were very nervous coming out of the exam. However, in scoring they were compared with everyone else taking this same version of the exam and they always did quite well when their scores were returned. They had become good, knowledgeable test takers by completing question banks and thoroughly preparing, even though they did not feel familiar with the question format on their exam.)

Research indicates that there are moderate correlations between performance on the NBME self-assessments and Step 1 scores. It is suggested that a student take 2-3 assessments in a short period of time before their actual Step 1 exam and average those scores together to determine readiness for sitting for the USMLE. Taking this, along with the student’s average on their question bank (USMLE World or Kaplan) over that last 15-20, 45 to 50-question timed practice tests will tell a student if she is ready to take the leap to take the exam.

When to take the Self-Assessments?

We suggest that students take an easier NBME self-assessment at the very beginning of their study period to

  1.  establish a baseline for comparison later progress 
  2.  make decisions about how long it will take to reach your  Step 1 goals 
  3.  make decisions about board preparation plans and programs to useThe NBME Self-Assessment: You will receive a score on a scale of 800, with a mean of 500, but you will receive a profile and a score interpretation sheet which will translate your score into a 3-digit score. If your baseline 3- digit score is 155 or below, a student may want to consider taking additional time to prepare, as this is an indication that foundational work is required for passing the Step 1 exam.

To view a sample NBME self-assessment profile:

You can take self-assessments midway through your study plan period, especially if you are doing this to train yourself to take longer timed tests, attempting to simulate the stresses of the actual examination to practice anxiety management, or tracking your progress with actual NBME type questions. All of these are excellent reasons if you have the $50.00 to purchase the 4-hour exams every 4-5 weeks.

On a 12 to 20 week plan, a student should sit for two NBME self-assessments 4 and 6 weeks, respectively, prior to the end of their plan to make sure they are progressing as planned and will not need to add additional time to their study plan.

It would also be beneficial for a student to take 2-3 NBME self-assessments 2 weeks prior (14-15 days) to sitting for Step 1 for the same reasons. You should be taking the harder exams at this time and attempting to score 195 and above to assure you are not falling too far to the left of the standard deviation resulting in a failing score.  If at all possible, a student should delay taking the exam rather than have a failure on their record.

Additional notes:

If you purchase an NBME form with expanded feedback (the $60 version) you will receive additional information providing a breakdown of incorrect answers by content category. This includes the number of items you answered incorrectly, the average amount of time spent on each item, and the percentage of incorrect items you marked during your self-assessment. You can use this information to figure out your areas of weakness and the number of errors you made on a particular subject (the expanded versions used to come with explanations to the questions. Self-assessment #6 does not, and we are checking with the NBME to see if any of the other 2011 self-assessments are providing explanations). You can also formulate a study plan based on how long you spent on each question category.

You will see many suggestions on the Internet discouraging students from purchasing the NBME self-assessments. These assessments use PDF versions where you take the test and come up with a percentage correct, but conversions to predictive Step 1 scores may not reliable. Even if you are not converting the score, a percentage may not give you the information you need to make informed decisions.

However, it is understandable when funds are limited to do what you can to stretch your dollars as far as they will go. If this is the case, then limit your NBME self-assessments to those closer to the examination date. Make sure they start at least 2 weeks ahead of the examination date and that you take the more difficult self-assessments.

In addition, be sure to take more than one self-assessment. You cannot rely on just one to know if you are ready to take the exam. Be sure to take at least 2, if not 3, close together and average them to get a good idea of how you do under different conditions, with different exam questions, on different days.

Please leave comments on your experiences. It helps all of us to hear what is happening in this current, 2011 season.


NBME self-assessment website

For additional information about the NBME self-assessments (CBSSA)

To see a sample profile


·         “I saw several questions that were similar to what showed up on my question banks and self-assessments. Studying the explanations was the essential piece”

It's important to have a strategy for what and when you will study. Many students find the structure of the Doctors In Training USMLE Step 1 Review Course beneficial to their exam preparations. Our course presents the high yield information you need to know and is updated annually to reflect student feedback.

7 Responses to “Answering Your Questions about Using the NBME Self-Assessments for Your Preparation for Step 1”

  1. Carlos says:

    Can I repeat an nbme that I took over a year ago? I've taken them all, and although there have been some improvement, I am not satisfied with the score. I have no clue on what to do next, If I should just take it, or not.

  2. DIT Team says:

    Yes, you can repeat NBME self-assessments that you have already taken in the past. If you have taken them a year past, then I doubt that you will be remembering answers and your score difference will be knowledge acquisition. Your profile may look different, as scoring has changed on some of the CBSSA forms since last year.

  3. sunrise88 says:

    I just took nbme 6 and scored a 340/184. I feel so discouraged. I start DIT in a few days, i cant wait. i hope the next nbmes i take show improvement. What is a comfortable score for passing?

  4. DIT Team says:

    Hello Sunrise. I am not exactly sure how many weeks you are into your preparations, but if you are like most students using the DIT course as part of their Step 1 preparation, you are 3-4 weeks away from your exam date. If so, then you are doing fine for this stage in your study prep. You should make a lot of gains with the course, as you will as you progress through your question bank and studying the explanations. It is all a part of the process, but it will come together. Everyone gets frustrated with it, but it does work.

    Check in with by email and we can talk about specifics. I need to know how much progress you have made in your question bank and what you have done thus far in your Step 1 prep.

    Hang in there, it is going to get better. One score on an NBME does not define the outcome but we can use the profile to tell you where your strong and weaker subject areas are right now and use that information to better focus your study efforts. You might want to review those subject areas twice when doing the DIT course or go through those questions in your QBank in random mode the first pass and then review the explanations by subject again before your exam. There are several possibilities.

    You are in a much safer area if you score a 210 or above on an NBME practice exam. Any lower than this and you are getting too close to the cutoff for possible failure. The standard deviation on the NBME examinations are fairly large because there are so many variables impacting performance. Students take these exams at different times during their study periods. It is too soon to get an adequate read on how you will do after taking the DIT course and completing your question bank. Give yourself some additional time and take another practice exam closer to your test date.

    If you have the option of changing your test date, then take an NBME as close as 3 days. If not, take it 5-7 days prior to your exam. That way you can tailor your last few days of preparation to strengthen any obvious weak areas that are bringing down your average.

    It's hard to take it one day at a time, but it will come together. It will happen.

  5. Real says:

    After going through the study material including FA once, I took NBME 11 and got 200. I am half way thru USMLE WORLD, with my average score of 55%, but my score keeps fluctuating, initially between 60-36% and now, from 55% to 78%. I have not been going through the explanations of the QBank consistently as I was focusing more on finishing FA. I cant figure out how much time I need to be fully prepared to appear for Step 1. And how should I approach the QBank? I dont want to waste the questions.

  6. DIT Team says:

    Thank you for your Question, Real. Your are progressing through USMLE World very well, especially if you have not dedicated 3-4 hours per block of studying the explanations of practice questions. Studying the explanations provides insight into other possible questions that may show up on the Step 1 exam so it is extremely valuable for MOST students to study in this fashion. However, you are performing on target on UWorld without using this study technique. The vast majority of test takers do not have steady scores until they are well beyond half way through the question bank. In addition, student scores do not usually reach the 70% mark and above on a regular basis until they have completed at least 75% of the questions.

    For very high scores, students have reported having had the best success with their question banks by:

    1) studying the explanations on the first pass

    2) repeating a question bank and studying explanations to questions they do not answer correctly on the second pass

    or - completing a second question bank

    3) doing the question bank in timed, mixed mode in blocks of 46 and several sets of 4 on carefully chosen days closer to the exam to build stamina.

    How much time to take to prepare for Step 1 is dependent on the student, their foundation, their ability to focus, and if they reach a critical period beyond which their performance begins to decline. AFTER completing your question bank, take the diagnostic exam, along with a couple of the NBME CBSSA exams to to determine your readiness to take the exam. If you average 15-20 points above the passing range, you can most likely take the Step 1 exam with a passing score. If your goal is a top score in the 250s, then you must determine if you are experiences signs of burnout to the point that your performance is degrading.

    Many students begin studying while still in classes, taking 10-12 hours per week to prepare beginning in January or February and then 4-6 of concentrated study in April where 10-12 hours per day is dedicated to preparation. My aim here providing this information is to help you determine how much time you need to be fully prepared to take the Step 1 exam.

    Please feel free to ask any additional questions. Keep going at that steady pace and you will reach your goals. The question banks are purposefully challenging so you can be the best test taker possible.

    Best of luck, Dr M

  7. zaina says:

    Hi Dr,

    I scheduled my test 4 weeks from now. I already did UW once (scored 72%, random,timed blocks), did FA twice and currently on my 3rd read. I did an NBME form 7 1 week ago and scored 238. I am aiming for 240+. Any ideas on how to push up that score? I also am wondering how to space out the nbmes through out these remaining 4 weeks.
    Thanks in advance and look forward to hear from you!


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