In this post, we cover how to interpret your first NBME Practice score and how to figure out what your potential score trajectory is. We also highlight and introduce the science behind the Practice Test Score Tracker section of the website.

If you’re reading this post, then you’ve neared the end of your 2nd year; congratulations. If you haven’t done so yet, you will be taking an NBME practice test (also known as the Comprehensive Basic Sciences Exam) and will likely wonder what this first score means.

For the students in the Step 1 Method program, we see a significant improvement between the first NBME practice exam and the final Step 1 score. The average improvement tends to range between 25-50 pts. There are two key factors that will determine how much your score will rise:

1) Where you are in your prep process

First off, when we refer to the “First NBME” exam, we are referring to the first NBME exam that you take at the end of your 2nd year which is usually at the beginning of your ISP (Intensive Study Period). Some schools will administer an NBME halfway through the 2nd year, or at some other point when students have not had an opportunity to start doing questions in the Step 1 Method format. Often times, students haven’t even finished the 2nd year. Understandably, taking an exam at a premature point is going to yield a result that is not significantly diagnostic or indicative of future potential.

Assuming that you are now referring to the NBME taken at the beginning of your ISP, your score may still not be where you want it to be. Why?

Many of you may not have completed a significant portion of your Q Bank or attacked many of your weak areas. Some of you may have already gone through a significant portion of the qbank, but have not incorporated the S1M style of doing questions which includes high yield annotation and incorporating the S1M framework (more on these in the website or other blog posts). If you still have a considerable amount of work to do, you can expect to see a point increase in the higher spectrum of the range.

Because of the above, it is not uncommon for many students to not have passing scores on the NBME the first time around. Another reason for this initial low performance is that most students take this first NBME cold without any preparatory review. You have not seen many first year topics in over a year, so it is not surprising that you will score low in these areas.

If you have already gone through a large majority of your qbank in the S1M method, your score might already be above the national average, in the 220s. Thus, your score increase will be capped and thus the amount of improvement will be lower. More analysis on this situation below.

We’ve studied students’ score trajectories and we are starting to create predictive models. See below for a chart, and a best guess of your score trajectory based on your first, appropriately taken, NBME practice exam. Note, this is data from students in our program, and therefore only applies to students who utilize the tools in the Step 1 Method program.

2) What your score on this first NBME is

It is much easier to go from a 180 to a 220, than it is to go from a 220 to a 260. Although, it is the same 40 point increase, the trajectory of the increase is very different. In the lower range of scores, knowledge acquisition skills are tested. For example, can you learn the framework for COPD, and answer a 2-3 step question about it? If you are able to do that for a majority of topics, you will score above average, likely in the 230s. In the higher range of scores, knowledge abstraction skills are tested. As we have discussed, these are more experiment based questions and hypothetical scenarios that require you to abstract the knowledge you have learned. To score in the > 240s, you will have to master the knowledge acquisition skills, and then have a significant grasp of the concepts to abstract the knowledge you have learned.

Some students understandably feel pressure when thinking about high scores. All we expect you to do is reach your potential on this exam. The path to higher scores is the same. If you go through the method as we have discussed, and attack your weaknesses, you will reach your potential, whatever that is. With proper, steady preparation, there is nothing that can stop you on this exam.

The goal here is to acquire as much knowledge as you can to prepare for the wards to take care of patients. Your future patients will appreciate all the hard work you invested to learn about their many disease processes. Try and focus on this clinical element of your hard work and less about the test itself. The great thing about the S1M framework, is that this is how clinicians think and apply their knowledge. Fortunately, that is also how the Board examiners test.

Finally, please make sure that you use the Practice Test Strategy (watch the module on the online course if you haven’t) and the other modules within the Step 1 Method to reach your potential on the exam.

3) Score Trajectory Predictions

As difficult as it is to do, we think that it is very valuable to give students realistic score expectations. In order to achieve this, we’ve begun to track the longitudinal performance of students in our program. As you’ll see below, we stratify students into 4 major groups based on their first, appropriately taken, NBME practice exam. We have automated this process on our website. When you use our practice test score tracker, as soon as you enter your first practice test score, the program will automatically place you on a score trajectory based on the below data. Again, anything can happen, and the score ranges are general averages, so students will perform above and below the average. But we believe that it is helpful to see what students in your situation have done historically if they follow the program.

Some highlights. You’ll notice that in the first group, a majority of the students’ first NBME was not passing. On average, these students improved 38 points to scores near the national average. Another thing that you’ll notice is that there is a general standard deviation of around +/- 5–10 points for the final score range.

Another thing you’ll notice is in the last group with students whose first practice test was well above the national average. Predictably, they saw the least total point increase due to the fact that we mentioned above. As you approach higher scores, it is difficult to improve your score because the harder questions tend to test abstract concepts that a majority of students do not answer correctly.

As you can tell, this is a new science that we believe is very promising. We definitely need to add more data points to refine the trajectories, and give students better data to make decisions. That said, the results that we find below are consistent with our anecdotal experience and therefore we are willing to share them with you. We hope this information gives you confidence and security to continue to implement your plan to reach your potential on this exam.