If your NBME scores are stuck in the same range, around the 50s or 60s every time, then it is not always about adding another resource or reviewing most of them again. You should step back and ask yourself why you are actually losing points.

All you should do at this point is start analyzing your NBME exams very carefully to identify the main problem, which will most likely fall into one of these 6 categories:

1. Knowledge Gap

You did not know the concept being tested, or you had not encountered it before during your studies.

Example:
You missed a question about nephritic syndrome because you did not know the association between Goodpasture syndrome and anti-GBM antibodies.

This is an actual content knowledge-gap problem.

What to do: Look for this concept again by watching videos, reading some text, and doing questions related to it.

2. Recall Failure

You know the concept or studied it before, but you could not recall it during the question.

This usually means that the information and concepts are not being actively recalled enough.

What to do: Start your active recall journey by either making your own flashcards or using premade Anki decks.

3. Pattern Recognition Failure

You know the disease and understand the pathogenesis very well. You may even know the diagnosis, but you don’t recognize it from the question stem.

For example, you know everything about Goodpasture syndrome, but you don’t immediately connect:

young patient + hemoptysis + hematuria

You are not able to connect these symptoms together and recognize the diagnosis.

What helps: Start doing more clinical vignettes and focus on learning disease presentations, not just memorizing individual facts.

4. Reasoning / 50-50 Error

You eliminate three answer choices correctly and get stuck between the final two.

Then, you choose the wrong one again. At this point, learning another 50+ facts won't solve this problem and here you need to stop and ask yourself these questions:

What clue in the vignette actually separates these two answers?

What clue made the other answer better?

And start write them down and reviewing them with your incorrects.

This is how you start improving your NBME reasoning.

5. Test-Taking Error

Sometimes you actually knew the answer but lost the point because you:

1. misread the question
2. ignored the patient's age or timing
3. changed a correct answer without new evidence

These are extremely frustrating because they are preventable points. So, the solution is changing how you approach in reading these questions.

6. Performance Error

This includes:

• poor time management
• rushing at the end of a block
• fatigue
• loss of concentration
• anxiety under timed conditions

A student may perform very differently doing 20 relaxed UWorld questions versus completing a full NBME under realistic conditions.

What to do:

Add the same challenge that your are going to encounter in the same exam to your Questions routine.

1. Do Questions in blocks as real exam ( New format is 20 Qs / 30 mins)
2. Do it timed Mode
3. Do 2 blocks or more back to back to increase stamina
4. Use a systematic approach for each question to recognize pattern of the diagnosis faster

The main takeaway

A plateau doesn't always mean: “I need to study more or check for more resources.” Sometimes it means:“I need to figure out exactly what are My weaknesses.”

So, study sequence should be

Analyze mistakes → identify the pattern → target the problem → retest.

So, before start a new NBME just follow this chart. and retest again.

Yet i cant sleep and my exam after 4 hours iam afraid to lost my concentration in exam does someone had the same experience

Can someone explain what I keep reading ab permits disappearing before score release? When does it disappear? The day before?

I took Step 1 yesterday and had a couple of incidents with the proctors during active testing time. I’m trying to decide whether I should report them to USMLE/NBME, and I’d really appreciate hearing from anyone who has had something similar happen.

1. Footwear issue- During the exam I felt hot, so I removed my socks. I was wearing flip-flops/open-back sandals.

At one point, one of the sandals had slipped lower on my foot, and the proctor told me to put it back on properly. I did.

Later, the sandal slipped partially off my foot again. The proctor then asked me to leave the testing room so they could inspect me. This happened while I was in an active block, so it interrupted my testing and concentration.

1. Hand position- At another point, I had one hand between my legs out of habit while reading/answering questions. The proctor told me that I needed to keep my hand visible/on top of the desk. I immediately complied.

I hadn't previously been told that both hands had to remain on top of the desk at all times, so I wasn't intentionally violating a rule. After she told me, I kept my hands visible.

1. The survey at the end didn`t appear!

Would you report this to USMLE/NBME? Did reporting a testing-center incident affect your score release or lead to any other consequences? I just have 10 days after the exam to do the report.

I Finally Passed Step 1 on My Third Attempt

Today, I found out that I passed Step 1 on my third attempt.

I honestly don’t know if I’ve ever felt this much relief in my life.

My first attempt was, looking back, not a good time for me to be taking Step 1. I had a lot going on outside of school—multiple weddings, traveling back and forth to hometown, personal/family hardships, financial stress, and just life being chaotic. I also genuinely underestimated the exam. I didn’t really know how to study for it. I did some Boards&Beyond, a little Sketchy, barely used Anki, and mostly tried to figure it out on my own.

Needless to say, I failed. And I failed badly.

That failure completely destroyed my confidence.

The next year was honestly one of the hardest years of medical school for me. I struggled academically, failed a couple of exams/clinical requirements, and carried the weight of that first Step failure everywhere I went. When I took Step for the second time, I was much more prepared academically, but mentally I was a mess. My anxiety was through the roof. All I could think about was, I have to pass this time. I have to stay on track. I have to graduate with my friends.

I didn’t pass.

I was devastated because I genuinely thought I had done better. My score improved from the first attempt, but nowhere near where it needed to be.

At that point, I realized I needed to step away.

I took a leave of absence from school and spent about a month and a half at home. I slept. I relaxed. I did things I had missed out on during medical school. I got to just be a person again.

And honestly, I needed it.

I felt like I had completely lost myself. Step 1, school, failures, and the fear of not becoming a doctor had taken over my entire life.

When I came back, I started studying again in May, and this time I locked in.

I changed everything. I used High Yield Guru. I used Anki. I worked on actually understanding the material instead of just memorizing it. I completely changed my approach to studying. I also made my mental health a priority and removed a lot of distractions from my life.

For several months, I basically went into hermit mode.

8 AM–8 PM. Study. Eat. Sleep. Repeat.

There wasn’t much of a social life. My “days off” were usually spent sleeping because I was exhausted.

It was the hardest I have ever pushed myself.

But this time, I wasn’t just studying to gain knowledge. I was studying to rebuild the confidence I had lost over the previous year.

There were so many moments where I thought, What if I don’t get to be a doctor? What am I going to do? Where am I going to live? How will I pay off all this debt? How am I going to deal with all of this?

I was terrified.

But I never stopped believing that medicine was where I was supposed to be.

And today, I passed.

I finally fucking did it.

The biggest thing I gained from these three attempts wasn’t just knowledge. It was resilience. I learned that failing something doesn’t mean you’re a failure, and sometimes you have to completely step back, reset, and figure out who you are again before you can move forward.

To anyone who has failed Step 1—or any major exam—please don’t let that failure convince you that you don’t belong here.

I know how embarrassing it feels. I know how isolating it feels. I know what it’s like to watch everyone around you move forward while you’re wondering if you’re ever going to catch up.

But you can.

Today I feel like I finally have my confidence back.

And now I’m ready for third year. I’m ready to work my ass off, learn as much as I can, and finally move forward toward becoming the physician I’ve been fighting so hard to become.

Third attempt. Still here. Still standing. And officially passing Step 1. ❤️

Never give up on yourself.

hey guys,

kept missing 2-step drug interaction questions on uworld blocks (especially the ones where they don't explicitly name the drug), so i put together a clean 5-page pdf with the 50 most tested interactions.

it covers the big ones like sildenafil + nitrates, digoxin + loops, lithium + thiazides, statins + cyp3a4 inhibitors, etc. with the mechanisms, vignette clues, and mnemonics.

i uploaded the pdf to google drive and pinned the link on my reddit profile bio since automod removes links here.

hope it saves you guys some study time!

My NBME scores
NBME 26: 57% took it a 18 months ago as a baseline
NBME 27: 66% 5 months later
Then I took a break from step 1, had to study for medical school finals and graduate.
3 months ago I started prepping, I took my next NBME on
16th/ July
NBME 28: 64%
Two weeks later NBME 29: 67%
Then I reviewed my mistakes, realized that I had specific knowledge gaps in certain topics, I studied them carefully and did NBME 30 on 8th of August
NBME 30: 77%
NBME 31: 79% on 21st of August
NBME 32: 78% on 29th of August

My exam is next weeks, I’m planning to do last NBME in a couple of days and also free 120, 3 days before the exam.

What’s concerning me is when I did my last 3 NBMEs I flagged almost half the questions because I wasn’t sure my answers were right. Is that normal?
And do you have any last minute advices?

Hi everyone i know this might be out of community main context but I recently pass step 1 and i want to do 2-3 months electives in neurology and I don’t know how to find it if anyone can help i will appreciate it also i need to find it before January because I won’t be eligible for electives in march

Hey y'all I am a first year DO student who just finished the second block at my program. We have a reset week where we do sims and other research stuff in between the next block. I was looking into the Anking Deck to do some step 1 prep but, had some questions..

For people who started in year 1 were you guys unsuspending to go along with in house material or were you following some other guidelines. Furthermore, is first aid a resource that should be used now or during dedicated ?

Looking to get some advice and any tips at all. Thank you !

Hi everyone! I’m a non-US IMG preparing for Step 1 and would really appreciate some advice on how to structure the final part of my preparation.
I’m **not starting completely from zero**. I’ve been practicing medicine for around 5 years and have previously taken **PLAB 1 & 2 and MRCP Part 1**, so I have a decent medical foundation and am used to postgraduate-style exams.
My current plan is to finish my **first pass of First Aid + UWorld in about 1 month**. I’m mainly using First Aid as my core resource, with UWorld for questions in tutor mode, and using Sketchy/B&B selectively where needed.
I’m hoping to sit Step 1 **around mid-November**, so I’ll have roughly 6 weeks after finishing my first pass.
Currently I’m not working, on maternity leave so can easily give 12-14hrs/day
This is where I’m unsure about the best strategy:
• After finishing the first pass, should I immediately start a **second pass of UWorld/First Aid**, or should I do an **NBME first** to establish a baseline?
• How should I incorporate the **NMBEs** into the remaining 6 weeks?
• How much time should I realistically reserve for NBMEs and reviewing them?
• Would you recommend doing a second pass of UWorld systematically timed?? I’m afraid not much time will be left for random blocks then ?
• At what point should I start relying more heavily on NBMEs rather than UWorld?
• How many weeks/days before the exam would you ideally want to have the final NBME/Free 120 done?
I **won’t have time for a third pass**, so I’m trying to make the second pass + NBME period as efficient as possible rather than trying to cram in too many resources.
For those who have recently passed Step 1, especially **non-US IMGs who already had a medical background**, what strategy worked best for you?
Thanks!

Does it matter what Qbank you use either UWorld, Amboss, Mehlman or Rx? Also is it the through completion of the questions vs the % correct or is that the wrong thinking? Any advise would be appreciated just spiraling a bit

Hi everyone!
I’m a 3rd-year MBBS student from India and a Non-US IMG, planning to take USMLE Step 1 in 2027.
I’m looking for a serious and consistent study/accountability partner who is also preparing for Step 1 around 2027. The main goal would be to keep each other accountable, study together regularly, discuss difficult topics/questions, and stay motivated throughout the preparation.
I’m starting my preparation and would prefer someone who is also in the early stages rather than someone already near their exam.

Timezone: IST (UTC+5:30)
Exam: Step 1 — 2027
Year: 3rd-year MBBS

If you’re interested, we can discuss our schedules/resources and see if we’re a good fit.
Looking for someone genuinely committed rather than a casual study group. 🙌

My exam is tomorrow, but I realized that I also registered for a practice session.

I didnt book an appointment for the practice session, so is just ignoring it okay or do I have to cancel it somehow? I looked through their website and cancellation only applies for those who booked. Thanks

I have done NBME 29, 30 and 31 and watched jason ryan video explanation of FREE 120 2024. I just gave Free 120 2026 and realised so many questions are literally the same. like exact copy. I got 73%. How am I supposed to evaluate my preparation now. help.

I Anatomy has been a weak spot been reviewing and whenever it feels like I have it down it just idk any tips when reviewing or studying to improve? Whats the best way to approach anatomy question?

As the title said I took the beast on Sunday August 30th. My overall feeling is mixed. There a lot of easy straightforward qs and there were wtf qs. Quick background about my resources

Main resources:
FA ( there is why vouch for it. Literally every information on the exam is found in FA)
Uworld ( wonderful resource unfortunately I only did 20 %. Should’ve have done more)
Physeo ( Underrated resource. Excellent if you have poor foundation in physiology like I was)
Pathoma ( can’t thank Dr Satter enough. I recommend going through all the videos not just chapter 1-5)
Sketchy pharm and micro( excellent resource)

NBME Scores:
Form 26 75 %
Form 27 71%
Form 30-33 were 74 % all 4
F120% 67% ( was little shocked but went on with the exam)

Couple of point for those who will sit for the exam in the coming days:

1- don’t be overwhelmed with long paragraphs. Just the last sentence and skim the answer choices and you’ll get the idea quickly

2- if you don’t know the answer don’t stay on it for 2-3 minutes. Flag it and then come back to it later once you’re done with the block.

3- don’t intimidated by SOAP. They may look long but the majority of it are simple straightforward answers. Actually shorter qs are the are ones that I personally struggled with.
Just look at the last sentence and skim answers and you’re golden.

4- regarding the break I divided mine on 5 minutes every 2 blocks with the last 4 blocks 10 minutes

That’s about it. I don’t know if I will pass, hope I do, but good luck everyone. You’ve made this far don’t panic breath and you’ll do fine. Don’t listen to those who fear monger about not having enough time and finishing the block without answer 4-5 qs . Even with SOAP you can finish with 7-8 to spare. You just have to strategic about your approach. Good to luck to everyone.

Btw I’m on a flight right now so I apologies in advance if I can’t answer your questions but hopefully I will once I land and settle.

Hi my scores are good in nbmes with avg from nbme 27-33 75% with highest 77% in nbme 32 and lowest 63% in nbme 25
Should i review FA modules in the remaining days or go for rapid review and incorrects of NBME 32 and 33 with free 120 incorrects .
My score in free 120 was 75%?
I’ll be very thankful for ur advice.

I think i failed

I've done nbme 26 n 27 and the vignettes are so short. Like some are literally 2 sentences. Especially compared to bootcamps qbank. So my question is are the newer nbmes longer and more like the real deal? I feel like with these short stems its either you know this fact or you don't - there's no reasoning your way through some questions. How are the newer ones?

can someone help me out pls

so basically i am creating my myintealth account and as my email is verified i see these 2 options on application portal for my intealth account establishment - epic and ecfmg

i am an IMG undergrad so which option r we suppose to choose epic or ecfmg for putting all the info of passport and medical school

Step 1 while doing a very demanding Internat ?? Looking for advice from people who have passed Step 1 while working

Hi everyone... I would really appreciate the perspective of people who have passed Step 1, especially those who prepared while working full-time or during residency/internship. ........I am trying to determine whether it would be realistic to prepare for and pass Step 1 during the first year of medical Internship in my country.

For context, the local "Internat" system is a full-time clinical training period. During the year, an intern is assigned to 4 different rotations:

- 6 months in a medical specialty

- 6 months in a surgical specialty

- 6 months in Obstetrics & Gynecology

- 6 months in Pediatrics.....+ In addition to all above where the intern is not simply observing but taking on responsibilities similar to a junior resident, including patient management, clinical documentation/paperwork, following patients.... , the intern has approximately 2 emergency-department calls/shifts per week , with all the fatigue and reduced study capacity afterwards

... would have approximately 6 months to prepare for Step 1 after starting Internship, with a good medical/basic-science foundation but no previous experience with UWorld nor USMLE-style questions. Do you think it is realistically possible to pass Step 1 under these circumstances? and if so what do u suggest rythme and time managment wise

And for those who prepared while working/residency: how did you handle night shifts, fatigue, and weeks where you simply couldn't study as much?

I'd really appreciate practical experiences and suggestions. Thank you in advance and all the best for everyone

Hey everyone,

I took NBME 25 about 3 months ago and got 45%, I reviewed the exam and noticed the huge knowledge gap so I changed my studying strategy accordingly and tried to do the best I could

I decided to take NBME 26 last week and got 66%. I reviewed the exam identified my weaknesses
The thing is I was expecting to get a higher score which made me feel like sht.

Now I’m really lost and don’t know what should I do or what to study. So I would appreciate it if anyone can help

Vague question I know but I posted something about usce visa on the img subreddit and the usmle sub for indians and a few Americans (don't know if they were md/do or just other Americans) commented some shit like 'We don't want you here stay where you are, we have enough us grads etc', want to know if US mds and dos feel similar about the international students, or if that was a rare racist encounter. Bc all my seniors ik who have gotten in the residency has never complained about racism at their workplace.