Does Step 1 select its questions according to how well you are doing during the test?

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Feb 1, 2002
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I was just wondering what other people's opinions are on whether step 1 selects questions according to how well you do during the test. Now that they have this computer exam, I've heard from some people that step 1 tries to test your mastery of the various topics; therefore, for the topics you don't do well in, they throw more questions just to test your mastery.

I noticed on my test that I had a large, frustrating amount of micro on it (my weak point). Didn't end up hurting my score too badly though. And I know several people who said there was too much of one topic or the other (eg: biochem, behavioral, etc.) You think this is true, or that we just pay attention more to the questions in subjects that we do poorly in?


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Feb 3, 2002
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hi , i think that you r right, as everyone after teh test claims that he was tested on a particular subject or so...and that si the usually the subject in which they are weak....
i agree with you.


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Feb 26, 1999
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The paradigm you are referring to is called, among other names, Computer Adaptive Testing. I know that the Registry Boards for both nurses and respiratory therapists have adopted this style of question selection matrix. However, I don't think that USMLE has done so.

The RN exam (NCLEX) gives you b/t 75 & 275 questions. The level of difficulty of each question is determine by whether or not you answered the previous question correctly. Once you have obtain a specified level of performance and maintained that level for x-number of questions, the test concludes.

For the NCLEX, the minimum number of questions you can demonstrate this in is 75, or at least that's what the number was when my wife boarded in 1994. The max number you can take is 275. She had two classmates who hit 275 -- one passed and the other one did not. My wife succeeded in 75 questions.

I don't know the specifics os the RRT (Reg Rest Terrorist) exam. It was not computerized when I took it in '92.