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The NBME practice tests are more representative of the question style of Step 1. The content may appear on your exam, but not the question. For any question you get wrong in a QBank, there is a good chance it was written in a manner unacceptable to the NBME. You will see these mistakes made routinely in many of the available QBanks. Practice questions are different from exam questions.Р’В The NBME publishes guidelines for medical schools to use in writing USMLE board-style questions for classes.Р’В You can read them here.Р’В The guidelines list common errors in question writing. I have also seen underperformance by students who did well on practice tests. I have seen stellar Step 1 scores by students who performed poorly on QBanks and NBME practice exams. I have advised many students over my career. Obviously, students who correctly answer practice questions are more likely to correctly answer Step 1 questions, but practice questions are not destiny.

However, donРІР‚в„ўt be misled into thinking that РІР‚СљsimilarРІР‚Сњ questions on Step 1 mean your performance on practice questions is necessarily predictive. This is undoubtedly true since QBanks, NBME exams, and Step 1 cover the same concepts. Some students will say their actual Step 1 test contained questions similar to a particular QBank or NBME practice test. When so many students keep their scores private, no correlation will be accurate. How many in the class ahead of you revealed their scores? How many showed you an authentic score report sheet? Probably not a lot. This is unreliable and only includes the tiny sliver of students who choose to report their scores. Some websites offer to translate your practice test scores into Step 1 scores, but these correlations are based on self-reporting by students. Practice questions are not necessarily predictive of Step 1 scores.Р’В No valid relationship has ever been established between any practice test and USMLE scores.

The wrong answers donРІР‚в„ўt bother them because they know itРІР‚в„ўs all just practice. They know difficult questions will stick in their mind. They are looking for a tough QBank to really challenge them. In my experience, students who perform best on Step 1 are often the ones who donРІР‚в„ўt panic over РІР‚вЂњ and sometimes even enjoy РІР‚вЂњ questions they get wrong in QBanks. When you are acing 95% of practice questions, you wonРІР‚в„ўtР’В retain as much information. This means wrong answers in the weeks before Step 1 more easily become knowledge at your fingertips during the exam. All of this makes questions РІР‚вЂњ and the topics they cover РІР‚вЂњ stick in our minds.

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Plus we have to work to understand why we were wrong. In general, we think more about questions we get wrong than those we get right.Р’В When we answer incorrectly, it bugs us. There are three important reasons not to worry too much about wrong answers to practice questions which I will explain in this post. And although the panic reaction is understandable, poor performance on practice questions before Step 1 is actually a very good thing in many cases. This scenario happens to everyone to some degree as Step 1 nears. What should the student do? Bump their test date out a few weeks? Find a new resource? Maybe just quit medicine all together? Step 1 is getting closer and panic sets in. Or sometimes a student tells me they just took a NBME practice test and dropped from their previous score. HereРІР‚в„ўs a scenario I am asked about a lot: ItРІР‚в„ўs a month before Step 1 and a student is doing lousy on UWorld questions.

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