r/step1

I just wanted to share this for anyone out there feeling discouraged by their NBME scores…

My scores were:

NBME 29: 47

NBME 30: 52

NBME 31: 50

NBME 32: 54

NBME 33: 52

Free 120 (new): 68

I know these aren’t the “ideal” numbers you see posted here all the time. There were moments I genuinely thought I wasn’t ready and considered postponing.

For context, I’m a mom of 2 and was working during this whole process. It wasn’t perfect, and my study schedule wasn’t always ideal, but I stayed consistent where I could.

But here’s what I did consistently:

- I reviewed every NBME thoroughly, not just the questions I got wrong, but also the ones I got correct .

- I made sure I understood why each answer was correct.

- I used ChatGPT to go deeper into topics I felt weak on until I actually understood them.

- I stuck with UWorld, Kaplan, and First Aid and focused on learning, not just scoring.

Test day (03/19): I walked out feeling like I totally failed. I was extremely nervous, and it honestly didn’t feel great. My husband picked me up with flowers and he told me whatever the result is, I am proud of you, so the next two weeks I tried to remain calm, enjoy my babies, but tbh I kept doing Uworld tests because I thought I was going to have to retake it…

and then the result came out… I PASSED 🥹

If you’re in that place right now where your scores feel “borderline” please don’t lose hope. Your NBME score is just one piece of the picture. What matters most is how deeply you review and how much you learn from your mistakes.

Trust your preparation. Trust your process. Keep showing up, even on the days you feel unsure.

You can pass. 💛

Studying for Step 1 the past few weeks. I was bombarded with advice both online in person that you should "just start UWorld right away" and "it should be your #1 priority". I understand the sentiment and agree that it is very very helpful, but this seems kinda backwards to me. Also starting with random blocks right away??? How is the brain supposed to compartmentalize all of that at the same time lol

I tried that and was getting so many things wrong, because *shocker* I just didn't know them yet. I've since transitioned to actually studying systematically via Pathoma, Dirty Medicine, etc. and am finding this much better for my understanding and more importantly, my sanity. In fact I'm thinking I'd rather do more content review and less questions overall.

But then I realized, why is this a discussion at all lol. Practice questions were always meant to come after actual studying... why did this sentiment change for board exams?

Anyway I don't think there's one right way, but IMO the UWorld-ification of dedicated has gotten slightly out of hand.

tl;dr - you need approx. 60% to pass. Trust your prep. Getting past the mental block is just as important as studying. Ethics, micro and pharm are easy points.

Hello! I figured I’d give back to this community after getting a pass on Step 1 :) As the title says, my scores were not great but I still passed on the first try. For the students that are trying their best and are plateauing, this one’s for you.

For context, I took 11 weeks to prepare for the exam. I’m a US MD student who is a below average student (not by choice! Everyone is just so smart so I fall under the curve often). Moved my exam twice due to scores not being where I wanted it to be.

Study Resources (tl;dr - use UWorld, sketchy micro/pharm, FA, dirty med, pathoma, randy neil, and mehlman arrows + risk factors)

1. UWorld - Gotta use it. I got through 95% of the questions with a 51% correct rate. I would also repeat incorrects on topics I struggled in, such as Cardio and Anatomy. The ethics section was enough ethics prep for me personally
2. Sketchy micro/pharm - Finish it, yall. They’re free points! And hammering it into your memory will help with Step 2 and your overall clinical reasoning for clerkships (at least sketchy pharm will)
3. First Aid - My Bible. I didn’t read it cover-to-cover. Instead, I used it as a reference for NBME incorrects. If I missed a question on membranous glomerulonephritis, I’d review all nephritic/nephrotic conditions in FA and make cards for them.
4. Dirty medicine - Watch his Biochem playlist at 2x speed, do the associated cards. At minimum, watch: Galactose Metabolism, Lysosomal Storage Diseases, and Familial Dyslipidemias.
5. Pathoma - Chapters 1–6 are non-negotiable. I annotated the book while watching and reviewed any other chapters I felt shaky on.
6. Anki - I used a self-made deck for UWorld screenshots (especially tables) and high-yield FA diagrams (lymph drainage, embryology).
7. Mehlman - I do not like that man (if you know, you know), but his arrows are a great way to consolidate high yield physiology and pathophysiology. Thanks to him, I will never miss a Cushings-endocrine question ever again. Risk factors pdf good
8. Randy Neil - biostats, you know the deal

Exam Scores:

NBME 29 - 48%

NBME 32 - 50%
Two percent increase after two weeks of studying stung. Spent the next week focusing primarily on sketchy micro and pharm

NBME 28 - 59% (one week after NBME 32)

NBME 31 - 60%

NBME 33 - 56% (Taken under poor conditions—construction noise all day at the library.)

Scoring the 56% shattered me. At that point, I had done all of sketchy micro/pharm, and 75%+ of UWorld. I felt completely worthless. And then I reviewed the exam. It was littered with silly mistakes. I then realized that I absolutely knew this content, I was just second guessing myself. The next two days, I went deep into NBME incorrect review. I got a journal and made it my “incorrect,” journal. I would write out my incorrect questions and expand on the topic. I would reread it every night until the real exam 

NBME 30 - 64% (90% chance of passing; taken two days after NBME 33)

For this exam, I took my time with every question. For each question, I tasked myself with mentally explaining why I chose that answer. Which part of the stem points to the answer? If I couldn’t confidently pick, I’d flag and move on.

NBME 26 - 59% (ten days before real-deal)

Free 120 - 66% (three days before real-deal)

Exam Day:
First thing I wrote on my whiteboard?
“You know the content. You know the answer. You’ll pass”
The self-motivation wasn’t enough because girl, that exam was so HARD. Felt most similar to free120 and NBME 31. I flagged about 15 questions per block, sometimes more. Very heavy in ethics, microbio, niche embryology and VERY TRICKY BIOSTATS. RANDY NEIL HIMSELF COULDN’T HAVE PREPARED ME FOR IT. I had one MSK question, no NBME repeats…no sensitivity, no specificity, it was ridiculous. There were a lot of gimme questions too which was nice. Plus, zero biochem which was great for me (hate biochem)! Otherwise, even though the exam felt brutal and felt like I was guessing for half of the questions, I was quite calm. I only lost my cool around the end of the last block when I realized I might’ve failed. When I left the exam, I proceeded to cry in my car.

The next two weeks were so anxiety inducing, which is commonplace for nearly all students. I was severely depressed because of it all. I was convinced I failed and proceeded to continue my Step 1 Anki, preparing for a retake. When I opened my results that morning, I couldn’t believe it.

Couple of tips!

1. Trust yourself. I knew that I understood the material to pass; I just had to get past the mental block.
2. If your scores start to drop even with thorough review, take a break. Signs of burnout can be insidious 
3. If you see a very hard question on the real deal, flag and move on. Likely experimental 
4. Thoroughly review your incorrects from your NBME exams 
5. Eat well, move your body, call your friends and family
6. Take the practice NBMEs in ascending order.
7. I should’ve started Sketchy micro/pharm before dedicated

Final thoughts:
For the folks frantically searching through this subreddit after taking Step 1 with low scores, you are seen, and your anxiety is so so valid. I did the same thing while waiting for my score. Here’s a reality check. To pass Step 1, you need approx. 60% to pass. This isn’t a hard cut-off! This means a person with an easier exam (ex: an exam with many many repeated questions from old forms) might need a 62% to pass. Compare that to a guy with a much harder form; they might need a 58% to pass. This all could be me coping, since no one really knows how the sausage is made. But personally, if there was a hard-cut off for this exam, I feel like USMLE would explicitly say you need at least a 60% to pass.

Yes, the exam is hard. But I do think that despite the hard questions, you will pass if you’re earnest with your prep.

Message me if you need any help :)

I’ve been writing some Step 1-style questions focused on common reasoning traps.

Noticed something interesting — even strong students fall into the same patterns.

Try these:

A 34-year-old male presents to the clinic complaining of persistent epigastric discomfort and a 5-kg weight loss over the past two months. He reports that his father died of stomach cancer at the age of 38. Upper endoscopy reveals no discrete mass but shows diffuse thickening of the gastric wall, which appears rigid during insufflation. A biopsy is performed, and microscopic examination shows infiltrating cells with large cytoplasmic mucin vacuoles that displace the nuclei to the periphery (signet-ring cells). Which of the following genetic alterations is most likely associated with this patient's condition?

A) Mutation in the APC gene

B) Loss-of-function mutation in the CDH1 gene

C) Microsatellite instability due to MSH2 mutation

D) Overexpression of the HER2/neu receptor

E) Translocation of the c-myc oncogene

A 62-year-old female presents with sudden onset of hematuria, oliguria, and skin rashes. Physical examination reveals sinonasal ulcerations and palpable purpura on her lower extremities. Laboratory studies show a rapidly increasing serum creatinine level. A urinalysis reveals proteinuria and red blood cell casts. A renal biopsy demonstrates crescentic glomerulonephritis with a pauci-immune pattern on immunofluorescence. Which of the following serological markers is most specific for this patient’s underlying condition?

A) MPO-ANCA (p-ANCA)

B) PR3- ANCA (c-ANCA)

C) Anti-double-stranded DNA (dsDNA)

D) Anti-glomerular basement membrane (GBM) antibodies

E) Anti-Scl-70 antibodies bu sorular nasil

Curious how you approached them.

Here were my latest nbmes. the other nbmes i took were also in the 30s. Ive been in dedicated since january. Although my studying strategies werent as consistent.

nbme 25: 34% (took on march 20)

nbme 27: 41% (took on april 11)

I need to take this exam by may 15 or else I would have to postpone my clerkships till next year. My reasonings for the possible score jump were 80 qs a day (from 40 only), consistent anki for 1 hr a day, and i thoroughly took pathoma 1-2 notes so far. I got a 19% on cardio despite working on it for 3 days straight last week so that was weird.

Strongest areas:

• Musculoskeletal/Skin: 61
• Multisystem: 56
• Genetics: 56
• GI: 50
• Behavioral Sciences: 69

Biggest gaps:

• Cardiovascular: 19 — catastrophic to say the least
• Reproductive/Endocrine: 32
• Gross Anatomy/Embryology: 25
• Histology: 28
• Pharmacology: 35
• Behavioral/Neuro: 35

I really would like some sort of hope in knowing i can possibly still increase my score from here. A TON of questions were familiar its just i forgot a particular fact or buzzword that matched up with it. im aware it doesnt look great for me. but i dont know what to do. and i dont want to come to terms with postponing my clerkships.

I have my exam in 3 days, and I am so scared. I delayed my exam from my original date because I had a sudden drop in my 120.

NBME 28 - 65

NBME 32 - 69

NBME 33 - 69

NBME 31 - 70

Free 120 - 60

NBME 30 (This Monday) - 72

After really thinking about my Free 120, I realize my issue was “locking in answers” before taking in the entire vignette. I was also thrown off by how the vignettes were longer and more similar to UWorld than the NBMEs

I tried to change my mindset with this on my last practice exam and UWorld this week by being intentional with the pieces I highlight from the question, but I’m so paranoid…

I’ve started review blocks/topics via First Aid I haven’t seen in a few weeks on UWorld or my NBME, and it doesn’t help that I keep seeing new content that I haven’t seen at all.

I wanted to finish my studying with the 100 concepts anatomy, high yield arrows, a look at Pathoma 1-3, a quick review of micro/ADRs/Drug MOAs, some ethics/charting questions on AMBOSS, and a final review of my NBMEs

But I think I’m gonna leave it at micro/drugs and a review of my NBMEs and rest up half of tomorrow and Monday because I’m so tired and I know I’m gonna get even more burned out if I push this back any more.

Does that sound okay?

Can anyone share what source they used for step 1, I wanted to compare both considering the expense for uworld and the tax for Non-US IMGs. people who have passed via coursology, can you please list down any downsides

P.s alot of our seniors who passed via coursology were saying it's basically the same

​

i finished the nbmes exams with score nbmes 26,27,28,29 = 65%

Nbme25=76%

Nbme30 = 58%

Nbme 31=53%

Nbme 32=56%

Nbme33= 60%

what should i do, how can i know im ready or not ?

I had these pop ups that I appeared 3/4 times in the exam flickered for a second nothing delayed and my device was working fine. I still reported to the prometric and they said it’s normal trust us and also emailed the nbme because someone said report just in case.

Now the pop ups didn’t affect my performance or anything but I’m scared my results will be delayed I’m worried I got a mail from the nbme that they will review my case and it takes them minimum 15 days now i wish o didn’t report it

Question is does reporting if nothing is wrong will cause a score delay ????

I'm currently in a neurology residency in my home country.

Don’t love it, don’t hate it. chose it because it's a more secure path if I ever decide to stay here, but my main goal has been IM in the US.

I'm yet to start my step 2 preparation. starting to wonder if staying in Neuro here and finishing the steps then applying IM will severely hurt my chances of matching. it feels like it's gonna look very messy on any CV especially if I get rejected initially.

I keep getting thrown off by other opinions:

some say switch to IM locally first (IM is a terrible speciality where I'm from)

some say cardio/ICU makes more sense

some say match is getting harder with visa issues anyway and it doesn't matter much.

Now I’m stuck overthinking everything instead of actually committing or progressing.

How bad does it look applying IM after 2–3 years of local Neuro? am I just shooting myself in the foot by doing it this way?

Is switching now smarter or just a waste of time?

am I overestimating how hard matching has become?

I feel like every option has a low success rate and I’m overcomplicating it.

Just want some honest, realistic takes. thank you.

Hi everyone,

I'm 19 days out from Step 1 and just scored 64% on NBME 31 under real exam conditions. Previous NBMEs were 62% and 65%.

My situation:

Dedicated since January

Have a baby at home

Pathoma complete

UWorld 60% complete (I have pharm, gi, infectious disease left), 66% average

Sketchy Micro/Pharm partial

Weak areas: Neuro, Pharm, GI, Biochem

What I've used:

UWorld, Amboss

Pathoma

Sketchy

Dirty Medicine

Anki Duke Pathoma

My goal:

Two NBMEs above 70 for school requirement. Need to get from 64 → 70 in 19 days.

My questions:

What's the highest yield thing to focus on in the final 19 days?

Is completing remaining UWorld systems worth it or should I do mixed blocks?

Any advice for someone who struggles with test anxiety?

Any advice appreciated. Thanks 🙏

Nbme 26 59% Nbme 25 65% Nbme 27 66% but with 3 weeks interval so a lil bit sad cuz i thought i’d jump for reviewing a lot between 25 and 27 Opinions??

I have read 2 different times on here, 7am EST and 11 am EST. which one is it for IMGs? Last Wednesday I started seeing IMG posts about passing at 7am EST.

which one is it?

seriously though, I love stats and she is so boring and monotonous

biochem tutor should do the biostats.

NBME 26: 66% (04/04) (seemed extremely foreign to me ngl)

NBME 25: 78% (11/04) (a lot of guesses were right)

UWORLD 75% done with 65% accuracy.

Planning to give 2 NBMEs each week.

Exam in 6 weeks.

Am i in a safe spot?

Weak sections include anat, micro and neuro. Been doing sketchy for micro, hy neuroanat pdf and 100 concepts.

What is the best way to maximise my scores? Will I be able to hit upper 80s in NBMEs till the end?

what are the highest yield things I can do in last 2 weeks

My exams is 3 weeks out.

I have done uworld plus incorrects. currently revising first aid .

NBMEs are stable in 70s

31-33 scheduled throughout these 3 weeks.

my question is , what are the highest yield essential resources I can use that can pump up your scores in short time.

I know of mehlmans arrows and risk factors, 200 concepts of amboss, 100 essential anatomy topics, rapid reveiw.

Graduate Doctors who are residing in Delhi who are going to give step1 soon. Let us meet up and strategize.

I got my scheduling permit 1 month ago . I had uploaded my passport but it got expired 1 week ago. Now i have my updated passport in my hand. How to update it on fsmb account? Should i go with my old passport for the exam or i have to update it on fsmb? If yes then how? I didnt find any option there

Hey everyone, I'm planning to take Step in the first week of May so I'm the final stretch! I've taken a few NBMEs and my scores are as follows:

26: 80

27: 76

30: 74

31: 75

32: 77

I know that these scores are okay, but there is SO much I haven't reviewed. I want to spend some time reviewing micro, pharm, heme/onc, derm, neuro, and ethics. But I'm not sure if I'll burnout spending another few weeks looking over this material/hit a point of diminishing returns? Should I just bite the bullet and reschedule or spend the next few weeks reviewing content? For reference I'm about 70% done with UWorld with a 71% average.

Anybody who tested today have any thoughts on the exam?