I've been constantly reading about this, people say the real exam was nothing like the NBMEs. But then why do we continue to use that as a metric for the real exam?
I've seen a lot of posts where people say NBME's are not a good enough predictor of the real thing. I'd like to hear from people who have taken their step-1 this year.
When I went through 108 pass write-ups looking for patterns, I expected the big resources to dominate. UWorld at 88%. First Aid at 66%. Sketchy at 56%.
And they did.
But when I looked at what students specifically said moved their NBME score - Randy Neil kept appearing again and again. ( I applied the 80-20 rule)
17 students mentioned it explicitly by name. All praise.
That's a better praise-to-mention ratio than almost anything else in the dataset.
For those who are new to the prep, what is this ?
It’s just a guy explaining exactly how NBME writes biostats questions; what the traps are, how to recognize them, how to work through them.
Total Watch time is just 4 hours.
Here's why 4 hours is worth it. Biostats feels like only like 10 questions on the exam. Now it might feel like why spend time on 10 questions when cardiology has 25 or 30? But think about it this way: On a 280-question exam, 10 questions is 3.5 percentage. The difference between a 62% NBME and a 65% NBME, that is a lot considering you just spent 4-6 hours to get this 3.5%. In some cases it might mean you no longer have to push your exam dates.
After a lot of pattern recognition I’ve come to this conclusion that students who passed often are the ones who were just smart enough to apply the 80-20 rule constantly. Doing the right thing is the most important and if you don’t know whats important it’s your job to figure that out. Asking yourself - ”Is this the highest ROI resource, strategy, method?” throughout the prep is crucial.
When I went through 108 pass write-ups looking for patterns, I expected the big resources to dominate. UWorld at 88%. First Aid at 66%. Sketchy at 56%.
And they did.
But when I looked at what students specifically said moved their NBME score - Randy Neil kept appearing again and again. ( I applied the 80-20 rule)
17 students mentioned it explicitly by name. All praise.
That's a better praise-to-mention ratio than almost anything else in the dataset.
For those who are new to the prep, what is this ?
It’s just a guy explaining exactly how NBME writes biostats questions; what the traps are, how to recognize them, how to work through them.
Total Watch time is just 4 hours.
Here's why 4 hours is worth it. Biostats feels like only like 10 questions on the exam. Now it might feel like why spend time on 10 questions when cardiology has 25 or 30? But think about it this way: On a 280-question exam, 10 questions is 3.5 percentage. The difference between a 62% NBME and a 65% NBME, that is a lot considering you just spent 4-6 hours to get this 3.5%. In some cases it might mean you no longer have to push your exam dates.
After a lot of pattern recognition I’ve come to this conclusion that students who passed often are the ones who were just smart enough to apply the 80-20 rule constantly. Doing the right thing is the most important and if you don’t know whats important it’s your job to figure that out. Asking yourself - ”Is this the highest ROI resource, strategy, method?” throughout the prep is crucial.
When I went through 108 pass write-ups looking for patterns, I expected the big resources to dominate. UWorld at 88%. First Aid at 66%. Sketchy at 56%.
And they did.
But when I looked at what students specifically said moved their NBME score - Randy Neil kept appearing again and again. ( I applied the 80-20 rule)
17 students mentioned it explicitly by name. All praise.
That's a better praise-to-mention ratio than almost anything else in the dataset.
For those who are new to the prep, what is this ?
It’s just a guy explaining exactly how NBME writes biostats questions; what the traps are, how to recognize them, how to work through them.
Total Watch time is just 4 hours.
Here's why 4 hours is worth it. Biostats feels like only like 10 questions on the exam. Now it might feel like why spend time on 10 questions when cardiology has 25 or 30? But think about it this way: On a 280-question exam, 10 questions is 3.5 percentage. The difference between a 62% NBME and a 65% NBME, that is a lot considering you just spent 4-6 hours to get this 3.5%. In some cases it might mean you no longer have to push your exam dates.
After a lot of pattern recognition I’ve come to this conclusion that students who passed often are the ones who were just smart enough to apply the 80-20 rule constantly. Doing the right thing is the most important and if you don’t know what's important it’s your job to figure that out. Asking yourself - ”Is this the highest ROI resource, strategy, method?” throughout the prep is crucial.
After the study that I did based on 108 passer write ups. Some of the things that were found seemed obvious but then I remembered that common knowledge is very often not common practice. Actually doing them is very different from knowing that you should do them. These are the common habits or strategies that separated passers from others:
I have mentioned this in my previous posts as well but this cannot be emphasised enough. In depth review of NBME questions helped students break score plateaus time and time again. Asking why and spending sometime understanding why is your answer incorrect and why the correct one is so should almost be a rule to be followed.
This was a bit surprising but almost 25% of students emphasized on this. This helped them avoid burnouts a few weeks before exam.
About 19% students from the data set made this their #1 exam day advice. Especially for people scoring above 65%+ in their NBMEs.
This probably correlated to the review advice again as you have to focus on fixing your weak areas after knowing what your weak areas are. About 15% specifically mentioned this being the reason for their breakthrough.
This seems common knowledge but isn’t common practice because to be honest who gives a shit about exercising durning those last few weeks. But 12% correlated this with lower anxiety reports.
Disclaimer: These are based on a limited dataset so many be others too. I've only listed the most common ones.
After the study that I did based on 108 passer write ups. Some of the things that were found seemed obvious but then I remembered that common knowledge is very often not common practice. Actually doing them is very different from knowing that you should do them. These are the common habits or strategies that separated passers from others:
I have mentioned this in my previous posts as well but this cannot be emphasised enough. In depth review of NBME questions helped students break score plateaus time and time again. Asking why and spending sometime understanding why is your answer incorrect and why the correct one is so should almost be a rule to be followed.
This was a bit surprising but almost 25% of students emphasized on this. This helped them avoid burnouts a few weeks before exam.
About 19% students from the data set made this their #1 exam day advice. Especially for people scoring above 65%+ in their NBMEs.
This probably correlated to the review advice again as you have to focus on fixing your weak areas after knowing what your weak areas are. About 15% specifically mentioned this being the reason for their breakthrough.
This seems common knowledge but isn’t common practice because to be honest who gives a shit about exercising durning those last few weeks. But 12% correlated this with lower anxiety reports.
Disclaimer: These are based on a limited dataset so many be others too. I've only listed the most common ones.
A big repeated advice students gave that caught me off guard was - "Don't change your answer".
About 13 out of 108 students said some version of the same thing.
Here is what some of them said:
One person said that he realized he was consistently changing answers to something more "familiar-sounding" so he wrote himself a rule: "Uncertainty and anxiety are not allowed as reasons to change an answer."
Btw, these are not random students, they passed step-1 meaning these are students mostly scoring 65-70% in NBME forms.
The lesson I am taking - Trust your gut and don’t look back. Until and unless I have misread the facts in the questions itself.
I don’t know the reason why this happens but this is what AI had to say:
“After months of UWorld and NBMEs, your brain has built something real — a pattern recognition system trained on thousands of clinical vignettes. When you read a question stem, System 1 (the fast, automatic part of your brain) fires first. It draws on everything you've practiced without you consciously pulling it up. That first answer instinct isn't a guess. It's compressed expertise.
Then you have time left in the block. Anxiety activates. System 2 kicks in — the slow, deliberate, verbal part of your brain that likes to reason things out. It says: "But wait, could it be the other one? What if I misread something?"
Here's the problem: under exam stress, your cortisol is elevated. That interferes with prefrontal cortex function. What feels like careful second analysis is often your anxiety generating alternative explanations for something your gut already answered correctly.”
Curious to know if others have had the same experience?
A big repeated advice students gave that caught me off guard was - "Don't change your answer".
About 13 out of 108 students said some version of the same thing.
Here is what some of them said:
One person said that he realized he was consistently changing answers to something more "familiar-sounding" so he wrote himself a rule: "Uncertainty and anxiety are not allowed as reasons to change an answer."
Btw, these are not random students, they passed step-1 meaning these are students mostly scoring 65-70% in NBME forms.
The lesson I am taking - Trust your gut and don’t look back. Until and unless I have misread the facts in the questions itself.
I don’t know the reason why this happens but this is what AI had to say:
“After months of UWorld and NBMEs, your brain has built something real — a pattern recognition system trained on thousands of clinical vignettes. When you read a question stem, System 1 (the fast, automatic part of your brain) fires first. It draws on everything you've practiced without you consciously pulling it up. That first answer instinct isn't a guess. It's compressed expertise.
Then you have time left in the block. Anxiety activates. System 2 kicks in — the slow, deliberate, verbal part of your brain that likes to reason things out. It says: "But wait, could it be the other one? What if I misread something?"
Here's the problem: under exam stress, your cortisol is elevated. That interferes with prefrontal cortex function. What feels like careful second analysis is often your anxiety generating alternative explanations for something your gut already answered correctly.”
Curious to know if others have had the same experience?
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To understand what the student who were succeeding did differently, I read 108 pass write-ups. I’ve found a lot of the pattern, myths and habits.
“Do I need to complete UWorld ?”, this is a question that is often asked on reddit.
Well here is what I found: Average completion among passers: 65%.
Average accuracy: 59%.
Multiple students passed with under 40% completion lowest being 23% completion.
So, the key differentiator wasn't just volume - it was review depth.
Students who spent 2-3 hours reviewing a 40-question block outperformed those who rushed through 120 questions with light review.
Another pattern that was found - Students who succeeded got into the habit of doing deep analyses of even the correct answers
Here are few other strategies I found in common: