➣ 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
➣ 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 don’t 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 don’t. 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
or offline. I was just explaining the lingo as sometimes people don’t 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-

You knew all the facts but your thought process was incorrect. Also many examinees report getting test items directly from NBME on actual test. 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). You could be facing one of the following mistakes: 1. .. You did not know a fact which was covered in the books you read. 1. Use NBME 16. ➣ 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. 5. UWorld Self Assessment forms are the worst kind. The real USMLE questions are a bit longer than the NBME questions.all 2800 are extremely high yield. there may be better option.specific general idea.. first option you saw lured you in. Try to assess questions properly as in NO NBME test are there more than maybe 2 questions like this out of 200. 2.. Not the first you see because the first you see may not be the best. 4. you see the subject areas you are weak in are Behavioural Sciences and Neuro Anatomy. So while ceftriaxone may be correct and may cure. The core concept is the same but sometimes they may put extra information in there. It will over predict by 20 points. You had no f*cking idea what the question is asking and have no clue about anything. 2. 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. Ceftriaxone can be given for Lyme's and cures lyme's well but doxy is DOC as cephalosporins are parenteral and tetra is oral. 18 for predictive value as they are the latest and hence the most accurate. When you assess yourself and look at the incorrect questions it is essential that you look at them in an objective way. then from the above two you can deduce that you need to focus on those 2 parts specifically. It is worthless to me. 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. 7. Stuck between 2/3 options. 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. 6.there is a likelihood to encounter similar test items. ➣ What is the usage of the NBME Forms ? The NBME forms may be used for 2 purposes: Assessment & Learning. 3.. Whether it is NBME 1 or 18... Very rare and you can’t get these correct no matter what you study. Assessment tool: These tests are the most predictive assessment tools out there. 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. 17. If the Neuro Anatomy questions which are incorrect are related to brainstem cross sections & brainstem syndromes.Physician Relations (PPR). You knew it all but you saw one option and went with your first hunch. You read question incorrectly. Learning tool: The NBME questions.perhaps one or two words you overlooked or read incorrectly... It is same concept but they make it lengthy by putting irrelevant info to make you feel like it is tougher. You need to pick best possible answer.use at your own is a good option and not BEST option. You look at the exact questions you got incorrect and see that the Behavioural Sciences questions are all Patient . For example : After taking your first NBME. It may be correct but not right 100%..

4. 3. WAYS TO MITIGATE THE ABOVE PROBLEMS : 1. 5. Do not over think and make pre-formed opinions. If you knew facts but thought process was incorrect then you need to do more questions as practice. 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.but make sure you ask them well and understand if they had actually done this resource well or had just glanced over randomly.these both are in NBME as options. 6. No other way out. It is the best possible practice. Atleast you could come down to 2/3 options.. Ofcourse you must think well and deduce a correct answer but UWorld is terrible simulation for actual exam. 3. Again answer is same as point 1.. Be careful to be in-sync with the examiner.just say wtf.. NBME 1.. ➣ How best to use the NBME questions as a LEARNING TOOL to IMPROVE YOUR SCORE ? The value of this great resource is underestimated. 6. Work hard and you will score higher. read well !! be alert !! You absolutely cannot afford to be wrong on this test. 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. Many people will give you an opinion that it’s not so helpful.not the weird logic you created in your head. you must dissect NBME inside out.try to question yourself and the question.sometimes options elimination may work. and 8... they combined make up 1600 questions. you may get a clue hidden in question stem.8... every one them has atleast 5% or more incorrect answers.and move on. You need to do your course material well. they are going to post it for free online soon. Problem 4 is not as bad as problem 1. Take it seriously. Many have more. Always think well and be in sync with the examiner’s psyche.. WTF questions are just that. If someone tells you NBMEs aren’t that helpful after their exam you ask them whether they had really done it well. If alertness is an issue then you need to buck up.. In problem 1 you did not even know the concept. UWorld will train you to overthink as if every question is trying to fool you. Some even give incorrect explanation and incorrect logic to incorrect answer choice. Your career depends on it. It makes you overthink a lot. ➣ Where can I get Answers and Explanation to the NBMEs ? As of now there are no concrete 100% correct answers and explanations.. You worked hard for a year and now you are letting your hard work go down the drain. 5.sometimes you can do good guesswork... This is the most important test ever. I believe that doing the 2800 questions is the SOLE reason for me going from 230s to make sure you join the following group and page. 2. It is not so in actual exam or on NBME.. whether they really understand slipped strand DNA mismatch abnormality & they really know the differences between Pelger Huet and Pseudo Pelger Heut anomaly. even when you think it is a wtf question think hard. There is one team working on the explanations. I had to train myself not to do so as it was costing me valuable points. wtf !! However. Go to your books and read them well..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... If you did not know something which was given directly in books then go back to your books and start memorizing it. 7. I am helping a bit as . Sleep well before the test day and be on top of your game.. Sometimes. 4. 2. Again as point 6... Atleast in 4 you knew concept but didn’t know it well no point wasting excessive time on questions which ask you crazy stuff..not just read superficially. I have seen the circulating pdfs. If nothing works. Best practice is doing the 8 earlier forms of NBME. The questions which look like they have an obvious answer do indeed have an obvious answer. 7... 11.

..... It is not that tough if you plan.facebook.. Achilles never bench pressed a day before going to war.. don't keep NBME till 3 days before exam you get 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.... this way you have 14 total and you an do for like 3.. It is so prevalent among the USMLE community that it feels almost like an exam.. you wanna score 260. Prepare in advance folks..can't be doing all that and causing anxiety to yourself... I see people fumble at last moment. at last moment everything you think can go wrong.and it would be tough to give test in such highstress environment. Ever week you must assess yourself. 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.. Also..facebook.47 gun in your hand if you go to war you may lose against someone with a small pocket knife in their hand. Do it from a while ago. NBME is same organization which makes USMLE... Doing NBME 3 days before exam will cause only one thing: Anxiety. They ask me for help so i do some basic work for them. I knew what I had to do.and prepare in advance. I kept last month without NBME.. but will not be actually trying to like grow muscle 1 week before a fight. Do it in advance ! :) . Guys. You may think how is this possible. It is what I have done and it is what I believe everyone should do... If you think you know a bettr method. You don’t want to be shooting in wrong direction. Adapt and win or ignore and lose..then in that time is assesses my weakness and gradually improved my score from 230s to 260s..... Give NBME s early on and don’t wait till then end. 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.much is being done by others.5 months... Doing easy stuff repeatedly but not recognizing one’s mistakes can be fatal. your choice.then by all 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.. What areas you are weak in. then what will happen to your confidence ? It will be rule was. you cant grow muscle at last moment. Guys change your thinking. so last few days..i finished all NBME in 3 months. It s what helped me get a 264. you give and get 240s. on a weekend do one NBME.. think about it. in last month I knew myself and my prep inside out. start form number 1 and go to 18.. I have seen so many people who make such mistakes... Well this is my advise... you work hard and think you will improve.. Darwin once said: "it is not the strongest nor the most intelligent of a species that survives but the most adaptable to change".it is a group initiative.might all go wrong at once. 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.. 10 or so people are involved.what is frequently asked questions and how to prepare. Just every week for the last 4 months. being blindfolded and having AK .... but just remember... only revise the stuff already done.. Assess in test... Sleep is essential too.its all long term kinda thing.well let me tell your style. Many people do NBME in last month.. I was at peak on my test day. I have seen people try to do all 2800 questions in 1 week and sometimes I laugh (i know i shouldn’t laugh but it is hilarious). you must try and understand your mistakes..havent given single NBME till last month. do it early ! At last moment don't assess. If people really follow a proper system then they can score so high that 260s will become a regular phenomenon.. https://www.

Just work hard and you will make it. Analyse yourself objectively. I hope this helps you . I will be posting more.➣ 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. Understand that a lower score is a product of lower level of planning usually and hard work can mitigate all problems. Analyse where you stand and how you can improve.