Practice Tests for the USMLE Step 1

In my opinion, The most important resource for Step 1, after UWorld and First Aid, is the practice tests. It absolutely breaks my heart when I hear people say that they haven’t taken a practice test when they are more than 2-3 months into their dedicated study period. TAKE A TEST. Nobody is going to frame you for the result. If the result is good – awesome. If it’s bad, pick yourself up, dust yourself off and use it as fuel to motivate your future studying + use it to help you analyse which subjects/systems you need to work on. At the least, the practice tests will help you start programming your brain to work in exam mode and think the way you need to in the actual exam. On the flip side, please don’t take all the exams back to back and waste them. Start early, space them out, and make sure you work on your pressure points before you take your next test.

There are four main practice test sources that I am aware of for Step 1:

  1. NBMEs
  2. UWorld Self Assessments (UWSA)
  3. Kaplan Simulated Exams
  4. Free 120Q


Ah, the good old NBMEs. Love them or hate them, you can’t live without them. Currently, there are six NBME exams available online – 13, 15, 16-19. They follow a format of 4 blocks, with 50 questions each, with a time allowance of 1 hour and 15 minutes per block (Standard Paced) and 5 hours per block (Self Paced). I always picked the Standard Paced option for my NBMEs. Each form costs $60 to complete online and you need to pick the Comprehensive Basic Science Self Assesment (CBSSA) from the drop-down list that’s available on the site. After you finish the assessment, you are given a feedback report which contains – (1) Approximate total score on the USMLE that you might get (2) Subject and System wise performance review (3) Incorrectly answered questions – the correct answer will be marked, however, there are no explanations for any of the answers.

FAQs on NBMEs:-

1. When should I take my first NBME?

Ideally, your first NBME should be right when you start your studying – to act as a baseline of sorts. It can help you set a target for your studying and for what you hope to achieve in the actual exam. However, I was apprehensive about giving an NBME so early in my prep, and I felt like I didn’t know enough to attempt one at that point in time. I took my first NBME about 2 months into my dedicated study period – try to take one when you are 1-2 months in.

2. What is the order to take the NBMEs in and how do I space them out?

There is no right or wrong order to follow. However, I’ve noticed most people do the older ones first and the newer ones later. I did them in the order: 13, 15, 16, 19 and 18. I took 18 the week before my exam date. In my experience 18 was the most predictive for me, and 19 the least. This would make sense because 19 is the newest NBME and still has data coming in from test takers. Try to take NBME 18 closest to your exam date.

Regarding spacing of the NBMEs, I took: 13 – 4 months before and 15- 2 months before my exam day. 1.5 months before my exam, I took 1 NBME/UWSA a week (so that’s four exams in April and two exams in May). By taking a week between each exam, I got plenty of time to work on the subjects/systems I had performed poorly on the previous exam.

3. Which is most similar to exam?

I felt like the NBME style of questions differed from exam significantly – especially with the older NBMEs. I felt like UWorld and UWSA did a better job of mimicking exam style questions. Having said that, amongst the NBMEs, 18 and 19 were the most similar to the exam in terms of question length and style.

4. Which is the most predicitve?

Knock yourself out with THIS link. For me, it was NBME 18 and UWSA2 that were the closest to my actual score. I’ve said it before and I’ll say it again – the most predictive NBME is the one you take CLOSEST to your exam date.

5. Do the NBMEs overpredict/underpredict your score?

Recently, it was pointed out to me that on the NBME score report it says that 25% of the individuals get a score that grossly differs from the NBME prediction. Those aren’t bad odds guys. Coupled with the fact that you might take more than one NBME, it’s not too shabby at all. My advice? Make sure you are doing consistently well on the NBMEs and hitting your target score before you take the plunge. Overall, it’s highly unlikely that you will get a score that is +/-10 from your NBME scores.

6. Should I take the NBMEs offline or online?

Personally, I was very apprehensive about Step 1, and I wanted as much practice as I could with exam like situations – I ended up taking all of them online. It’s entirely up to you and how much money you have to blow to decide how you want to take them – I’d say make sure you do at least NBME 18 online.

7. What about the older, retired NBME forms?

I went ahead and did the retired forms as well, I tried to fit in at least 1 block at the end of each day. I felt like it helped me learn concepts through repetition. Not to mention, the NBME forms make a question bank in themselves of nearly 2000 questions. They are also great for practising CT/MRI/pathology images. I would look up the answers through Google – by typing in a catch word from the question and the form number. Most of the time, lots of forums had discussions and explanations and I found it to be a great way to actively learn new principles as well as revise older ones.

8. My first NBME was a disaster – Wtf do I do now?

This question was literally me not so long ago. First of all, DO NOT PANIC. Almost everyone messes up their first NBME. Sit down and calmly analyse the situation. How much have you really studied? If you haven’t finished UWorld or First Aid, now is the time to master those resources before you take your next NBME. If you are consistently getting a score that is lower than your target score, take a step back and start considering putting off your exam date and returning to more basic resources to strengthen your fundamentals.

UWorld Self Assessment 

There are two UWSAs, which are usually purchased with the Uworld Qbank. They contain 4 blocks of questions (40 questions per block) with an hour of time per block. The unique feature about the UWSAs is the fact that there are explanations to every question – making this a question bank of its own. I personally loved the style of questions as well as the images. I found them to be most similar to the actual exam. However, there are mixed reviews with regard to their predictive value – some say they grossly overpredict while for me UWSA 2 was quite close to my actual score. I took both UWSAs, in the month of April, 2 weeks apart from each other. Just a word of advice – it does take time to review the answers and explanations – so make sure you reserve your time accordingly.

Kaplan Simulated Exam

Kaplan has two simulated exams which are unique in that they are full-length 8-hour tests. They definitely help you get used to sitting in one place for that long and building stamina for the actual exam. However, the question style was nothing like the actual exam. Bottom line – if you have time, go for it, but if you don’t, give it a miss.

Free 120Q

These are a set of 3 blocks of 40 questions each, with an hour per block – available on the USMLE practice materials site. These questions are a great resource to go through right before your exam – I did them 3 days before mine. The question style and window format are very very close to the actual exam. More importantly – make sure you check out the auscultation simulator! While the test does come with an answer key, there are are some great explanations available online for the answers to these questions here.


That’s all I have about the practice tests for the USMLE Step 1, for now. If you have any questions/comments – you know the drill – leave them in the box below!


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