Official 2013 Step 1 Experiences and Scores Thread

[Phloston]

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I figure now is a good time to jump-start this thread.

Even though some of us who had taken the exam in late-2012 are still awaiting our scores (amid the holiday delays) and could technically still post within last year's thread, it is after all mid-January now, so it's probably apposite that we move forward and hope for a great year.

Cheers to 2013

 

[IkeBoy18]

I definitely don't think it's realistic to expect the real exam to be as simple as the NBMEs. I did forms 6-15 and they are 75% really simple and 15% thinking and 10% really difficult. Real exam is more 50% simple 40% thinking and 10% crazy. As long as the scoring works out similarly in the end it'll be fine. Just don't get freaked out and expect to breeze through the actual exam like the NBMEs.

I wouldve loved 50% simple.. I had more or less 10% simple 60% thinking and 30% crazy

 

[NoLlama]

I didnt have such a great time yesterday. My exam was definitely neuroanatomy heavy. I probably had 20+ questions with sections asking about different correlations. It was nothing, I mean absolutely nothing like the practice exams. I always finish the NBME practice exams with lots of confidence and lots of time. But this exam was ridiculous. I ran out of time on every single block and had to rush through lots of questions. I would say 85 -90% of my question stems were super super long. Basically the longest ones you would see on NBMEs except instead of maybe 10.. it was like 38 of the 46 questions would have long backgrounds coupled with long list of labs.

I feel like i guess on 50% of the questions and I am very "mark" lenient if I dont know the answer for sure..and I had 130 checked by the end!

I have no clue what I walked in on yesterday but I hope the curve is generous.

I felt the same way- mine wasn't neuro heavy, but my last two NBMEs were 245-255 range, and I walked out feeling like I failed that test (6/18). Didn't even feel like I had a chance to reason through anything on most of the questions because so much time was wasted reading the novella question stem. Absolutely NOTHING like UW or NBME forms (11, 13, 15) I took.

 

[Phloston]

I definitely don't think it's realistic to expect the real exam to be as simple as the NBMEs. I did forms 6-15 and they are 75% really simple and 15% thinking and 10% really difficult. Real exam is more 50% simple 40% thinking and 10% crazy. As long as the scoring works out similarly in the end it'll be fine. Just don't get freaked out and expect to breeze through the actual exam like the NBMEs.

The earlier NBMEs are a lot easier.

I felt my real deal (Dec. 2012) was very similar to an average of the NBME11-13 forms, which were a bit harder than earlier forms.

Early NBMEs are 90% joke-easy, 5% okay and 5% WTF.

Later NBMEs are probably about a 75-20-5 split.

 

[999999]

Phlo are u done with step2 also?

 

[Stingarov]

The earlier NBMEs are a lot easier.

I felt my real deal (Dec. 2012) was very similar to an average of the NBME11-13 forms, which were a bit harder than earlier forms.

Early NBMEs are 90% joke-easy, 5% okay and 5% WTF.

Later NBMEs are probably about a 75-20-5 split.

Agreed on the numbers here. Average about 14 wrong on NBMEs 11-15, 8 wrong on NBME 1-7. Avoid NBME 5, what a waste of time that was.

 

[Phloston]

Agreed on the numbers here. Average about 14 wrong on NBMEs 11-15, 8 wrong on NBME 1-7. Avoid NBME 5, what a waste of time that was.

If you mean that people shouldn't look to that one as highly predictive of the real deal, then possibly, but the concepts remain important and it should still be completed. Questions from the old NBMEs repeat on the current Step1 forms.

 

[Phloston]

Phlo are u done with step2 also?

Not until December 2014. I'll be contacting you for advice over a year from now, most likely. 😉

 

[Phloston]

I did some Kaplan Qbank questions on drug resistance. I don't feel very comfortable. Sometimes they state multi-drug resistance is coded by transpososn, sometimes vancomycin resistance is through bacteriophage. Is there a good reference to understand and memorize all that crazy resistance stuff?

This stuff is actually important.

Resistance is typically plasmid-mediated, but fluoroquinolone-resistance is chromosomal (this is in FA btw).

Kaplan was solid in that it clarified that the encapsulated organisms tend to generate resistance via transformation. S. pneumoniae is a natural transformer, for instance.

-----

Beyond what I've written above is entering 270+ territory, particularly that vanc detail.

 

[999999]

Not until December 2014. I'll be contacting you for advice over a year from now, most likely. 😉

sure phlo, but then your level will become my level! 😍

 

[MDSlacker]

Taking it today. If I have the courage, I'll post about it afterwards.

 

[Legally Insane]

I took the beast on Tuesday and agree that the majority of the stems were ridiculous. After wading through a number of needlessly long stems only to find a simple question lurking at the end, I started glancing at the question first, which enabled me to scan or even skip over some of the stems. The question writers truly are sadistic bastards. Good luck to all.

 

[BP87]

Man this is so depressing. I write mine next week n i already feel like im gonna blow it up n run out of time 🙁 the sucky part is we dont get to find out how u guys did so this could just be a postexam panic or a brutal reality. I guess ill find out next week,

 

[FIREitUP]

The earlier NBMEs are a lot easier.

I felt my real deal (Dec. 2012) was very similar to an average of the NBME11-13 forms, which were a bit harder than earlier forms.

Early NBMEs are 90% joke-easy, 5% okay and 5% WTF.

Later NBMEs are probably about a 75-20-5 split.

form 13 was a joke compared to my exam. 11 was slightly harder and closer to the real thing but still barely comparable. the new step 1 is a new caliber of test that has strayed from the style of the nbme's

 

[hardee17]

form 13 was a joke compared to my exam. 11 was slightly harder and closer to the real thing but still barely comparable. the new step 1 is a new caliber of test that has strayed from the style of the nbme's

 

[FIREitUP]

😛

 

[21385]

form 13 was a joke compared to my exam. 11 was slightly harder and closer to the real thing but still barely comparable. the new step 1 is a new caliber of test that has strayed from the style of the nbme's

I guess they want to do something to target the rising scores. So I suppose it's harder than UWorld as well now too?

 

[BP87]

I guess they want to do something to target the rising scores. So I suppose it's harder than UWorld as well now too?

Those "rising scores" are only reported on this forum. The national average is in the 220s so i guess "basic ppl" dont hang out here which makes me wonder if i belong here...🙄

 

[FIREitUP]

I guess they want to do something to target the rising scores. So I suppose it's harder than UWorld as well now too?

much harder and longer than uworld with answer choices that are more difficult to eliminate

 

[CDI]

Those "rising scores" are only reported on this forum. The national average is in the 220s so i guess "basic ppl" dont hang out here which makes me wonder if i belong here...🙄

They don't report the national average mid-year though.

It may have in fact rose (courtesy of Pathoma - I see this as the only major resource development), and they were doing something to "correct" it.

 

[FIREitUP]

Funny enough, I actually thought I had a hard form. There's also a person on SDN who had the same exact test as I (at least ten of the same questions appearing at the same locations throughout the test), and we both agreed that it was a difficult version, meaning there were quite a few ambiguous questions that we could imagine may appear to a lesser extent on some other Step1 versions; for example, NBME12 has ambiguous genetics, but NBME5 is extremely easy. I'd say my test closely matched an average of NBMEs11-13 in terms of structure and difficulty.

I'm aware of five crushing errors I had made and still pulled a 262. But honestly, this is fair, because I hadn't made any errors on NBME12 and had a 266 on that one, and on NBMEs6+7 I made a surfeit of errors and only got 252/254 on those.

That being said, the lesson to be learned is that if you make genuine errors on the NBMEs and still score well, know that that will reflect your real exam, and if you make errors, you'll still be okay.

i just noticed this post, my bad for not replying earlier. its hard to assess difficulty because it's such a subjective thing, but I can tell you without a doubt that my question stems were consistently longer (many more than 5 sentences long) on the real thing, more involved, and even the "straightforward" questions were asked in a way that caused me to fumble on them. i found timing to be harder than on the nbme, where you can oftentimes get the answer within seconds of reading the vignette, in my form they would lead you to a diagnosis with three sentences and then add some fact that would rule that diagnosis out. i also had a bunch of wtf questions mixed in there for good measure. the more recent forms seem to have changed.

 

[21385]

They don't report the national average mid-year though.

It may have in fact rose (courtesy of Pathoma - I see this as the only major resource development), and they were doing something to "correct" it.

Obviously, there are no official numbers here but I believe that the national average from last year was in the upper 220s (228-229ish). Also, if you look up a lot of medical schools, they all say that their school's Step 1 average has been "rising" and contributing it to new changes in curriculum, etc. Logic tells you that if a lot of medical schools are saying this, the national average has also been rising.

 

[CDI]

Obviously, there are no official numbers here but I believe that the national average from last year was in the upper 220s (228-229ish). Also, if you look up a lot of medical schools, they all say that their school's Step 1 average has been "rising" and contributing it to new changes in curriculum, etc. Logic tells you that if a lot of medical schools are saying this, the national average has also been rising.

The national average was a 224-225 SD +/- 21. I'm sure the IMG scores are also to be taken into account.

There's no official scores released for IMGs, which never made sense to me, but its said to still be 215-220 range, and many more failures overall than AMGs.

 

[preDoGuy24]

Obviously, there are no official numbers here but I believe that the national average from last year was in the upper 220s (228-229ish). Also, if you look up a lot of medical schools, they all say that their school's Step 1 average has been "rising" and contributing it to new changes in curriculum, etc. Logic tells you that if a lot of medical schools are saying this, the national average has also been rising.

A crap ton of people take the USMLE though, restricting the data to only american md schools you are probably correct, but including everyone else I would say the average is increasing at a slower rate then SDN says. I haven't seen anything that says the average last year was nearly a 230, I have only seen (wikipedia albeit) averages around 225. The nbme site only gives a range of 210-230 for US md schools with a standard deviation of 20.

 

[CDI]

A crap ton of people take the USMLE though, restricting the data to only american md schools you are probably correct, but including everyone else I would say the average is increasing at a slower rate then SDN says. I haven't seen anything that says the average last year was nearly a 230, I have only seen (wikipedia albeit) averages around 225. The nbme site only gives a range of 210-230 for US md schools with a standard deviation of 20.

Right, and actually our Step 1 score reports still shows the US mean as being a 224 or 225.

 

[coreytayloris]

I find it difficult to believe the whole exam has just been completely redesigned. Maybe this is just selection bias

 

[CDI]

I find it difficult to believe the whole exam has just been completely redesigned. Maybe this is just selection bias

I don't think its been 're-designed'. I do think they could simply remove some (more) gimme questions out of the pool though. That's been happening ever since FA came out, I would guess. They could just remove a couple of those 85-90% of students get this correct type of question.

 

[Kal EI]

I find it difficult to believe the whole exam has just been completely redesigned. Maybe this is just selection bias

Yeah, not so much redesigned. But possibly different. Compare the older NBMEs to the newer ones. There's a drastic difference. The test keeps evolving and I think it is evolving today with all the resources available to students.

 

[g8orlife]

Obviously, there are no official numbers here but I believe that the national average from last year was in the upper 220s (228-229ish). Also, if you look up a lot of medical schools, they all say that their school's Step 1 average has been "rising" and contributing it to new changes in curriculum, etc. Logic tells you that if a lot of medical schools are saying this, the national average has also been rising.

False. LooK Back On These Threads & You'll Find A Couple People Who Posted Screen Shots Of Their Score Reports. On Those Reoprts, It States The Average. The Ones I've Read Had The Average At 224.

The national average was a 224-225 SD +/- 21. I'm sure the IMG scores are also to be taken into account.

There's no official scores released for IMGs, which never made sense to me, but its said to still be 215-220 range, and many more failures overall than AMGs.

True.

 

[operaman]

tl;dr: avg score not rising; exam NOT getting "harder" per se; example of how questions have evolved over past 10-15 years.
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The scores are NOT rising because the NBME keeps the 3 digit score constant and claims a 6 point error, so 224-229 is certainly within that range.

That said, they are eliminating older questions from the pool that were no longer performing well. Performance is not just measured by % that answered correctly, but also by how well that % correlates with overall performance. Put simply: if 20% answer it right, you want those same people to be your top 20% of scores. If only 20% get it right, but those people have an equal chance of being a 190, 230, or 260 scorer, then that question isn't telling you anything.

There are a number of questions that 80-90% of people get right; these are part of how you discern between pass and fail. Then there are many that perform between that and those that only the top 15% are getting correct. Every test gets a relatively similar distribution of questions (of those that actually count anyhow) to maximize its ability to distinguish between scores, and a little recentering is done to keep the 3 digit score constant over time.

Now, imagine you have a highly-performing question that 40-50% of people get right and those are also the top 40-50% of scorers. If this question makes it into FA in such a way that now 80% get it right, it is no longer performing as intended and needs to be revised or thrown out. Those 80% are not the top 80% of scorers, but merely the original 40-50% plus a smattering of whoever else remembered the factoid from FA. Many people in the bottom 20% maybe be answering it correctly.

Every year, we can expect to see more and more familiar questions get replaced or revised to maintain the performance of the exam. It may appear the exam is getting more difficult, but in truth it's simply adjusting to the new reality of ubiquitous prep materials.

Here's an example:

Mid/Late 1990s question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows bilateral lymphadenopathy and a biopsy reveals non-casseating granulomas. Which of the following values is most likely to be elevated in this patient?
a) Bradykinin
b) Angiotensin I
c) Calcium
d) Potassium
e) Magnesium

So, in response to this, FA includes a section on Sarcoid reminding everyone of the "bilateral lymphadenopathy" and "noncaseating granulomas" buzzword as well as increased calcium. Over 2-3 more years, this question stops performing so now it gets revised:

2003 question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows lymphadenopathy and a biopsy reveals granulomas. Which of the following is most likely to be elevated in this patient?
a) Potassium
b) Angiotensin converting enzyme
c) Magnesium
d) Sodium
e) Bradykinin

Now the next FA amends its Sarcoid section to include that examiners love to ask about elevated ACE levels in Sarcoid, so once the question stops performing well they change it again:

2008 question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows adenopathy and a biopsy and immunostaining reveals clumps of activated macrophages. Which of the following is most likely to be elevated in this patient?
a) Angiotensin I
b) Serum calcium carbonate
c) Potassium
d) 1-alpha hydroxlase
e) IFN-alpha

Here again, FA adds that the mechanism of hypercalcemia in Sarcoid is due to TH1 activation of macrophages via IFN-gamma --> increased 1-alpha hydroxylase expression and ultimately vitamin D.

2013 Question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows possible adenopathy and a biopsy with immunostaining shows groups of cells positive for CD14. Which of the following is most likely to be DECREASED in this patient?
a) Angiotensin II
b) TGF-beta
c) Total Serum Calcium
d) Free Serum Calcium
e) 25-OH Cholecalciferol

Now we're still talking the same concepts, but you have fewer buzzwords in the stem and must understand the pathway of Vitamin D activation, namely that the increased 1-alpha hydroxylase will most likely convert more of your 25-OH Vit D into the active 1,25-OH form and thus deplete the former (choice E). The question isn't really "harder," but is rewritten to make sure you have to think and can't just respond with straight recall from FA.

 

[Stingarov]

tl;dr: avg score not rising; exam NOT getting "harder" per se; example of how questions have evolved over past 10-15 years.
-----------------------
The scores are NOT rising because the NBME keeps the 3 digit score constant and claims a 6 point error, so 224-229 is certainly within that range.

That said, they are eliminating older questions from the pool that were no longer performing well. Performance is not just measured by % that answered correctly, but also by how well that % correlates with overall performance. Put simply: if 20% answer it right, you want those same people to be your top 20% of scores. If only 20% get it right, but those people have an equal chance of being a 190, 230, or 260 scorer, then that question isn't telling you anything.

There are a number of questions that 80-90% of people get right; these are part of how you discern between pass and fail. Then there are many that perform between that and those that only the top 15% are getting correct. Every test gets a relatively similar distribution of questions (of those that actually count anyhow) to maximize its ability to distinguish between scores, and a little recentering is done to keep the 3 digit score constant over time.

Now, imagine you have a highly-performing question that 40-50% of people get right and those are also the top 40-50% of scorers. If this question makes it into FA in such a way that now 80% get it right, it is no longer performing as intended and needs to be revised or thrown out. Those 80% are not the top 80% of scorers, but merely the original 40-50% plus a smattering of whoever else remembered the factoid from FA. Many people in the bottom 20% maybe be answering it correctly.

Every year, we can expect to see more and more familiar questions get replaced or revised to maintain the performance of the exam. It may appear the exam is getting more difficult, but in truth it's simply adjusting to the new reality of ubiquitous prep materials.

Here's an example:

Mid/Late 1990s question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows bilateral lymphadenopathy and a biopsy reveals non-casseating granulomas. Which of the following values is most likely to be elevated in this patient?
a) Bradykinin
b) Angiotensin I
c) Calcium
d) Potassium
e) Magnesium

So, in response to this, FA includes a section on Sarcoid reminding everyone of the "bilateral lymphadenopathy" and "noncaseating granulomas" buzzword as well as increased calcium. Over 2-3 more years, this question stops performing so now it gets revised:

2003 question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows lymphadenopathy and a biopsy reveals granulomas. Which of the following is most likely to be elevated in this patient?
a) Potassium
b) Angiotensin converting enzyme
c) Magnesium
d) Sodium
e) Bradykinin

Now the next FA amends its Sarcoid section to include that examiners love to ask about elevated ACE levels in Sarcoid, so once the question stops performing well they change it again:

2008 question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows adenopathy and a biopsy and immunostaining reveals clumps of activated macrophages. Which of the following is most likely to be elevated in this patient?
a) Angiotensin I
b) Serum calcium carbonate
c) Potassium
d) 1-alpha hydroxlase
e) IFN-alpha

Here again, FA adds that the mechanism of hypercalcemia in Sarcoid is due to TH1 activation of macrophages via IFN-gamma --> increased 1-alpha hydroxylase expression and ultimately vitamin D.

2013 Question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows possible adenopathy and a biopsy with immunostaining shows groups of cells positive for CD14. Which of the following is most likely to be DECREASED in this patient?
a) Angiotensin II
b) TGF-beta
c) Total Serum Calcium
d) Free Serum Calcium
e) 25-OH Cholecalciferol

Now we're still talking the same concepts, but you have fewer buzzwords in the stem and must understand the pathway of Vitamin D activation, namely that the increased 1-alpha hydroxylase will most likely convert more of your 25-OH Vit D into the active 1,25-OH form and thus deplete the former (choice E). The question isn't really "harder," but is rewritten to make sure you have to think and can't just respond with straight recall from FA.

Post of the week.

 

[Zuhal]

The question isn't really "harder," but is rewritten to make sure you have to think and can't just respond with straight recall from FA.

You're the man.

 

[Zuhal]

True.

False. The national 224-225 average only reflects AMGs performance, IMGs are NOT included in this calculation. In fact, the average score for IMGs is about 10 points below the national average.

 

[stronghold]

2013 Question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows possible adenopathy and a biopsy with immunostaining shows groups of cells positive for CD14. Which of the following is most likely to be DECREASED in this patient?
a) Angiotensin II
b) TGF-beta
c) Total Serum Calcium
d) Free Serum Calcium
e) 25-OH Cholecalciferol

I really like every word operaman says! I know that the choice E is the most pertinent, but why not TGF-beta too? The granuloma inflammation is TH1, so decrease in TH2, we already know that TGF-beta is part of of TH2 system and actually suppresses the TH1. TH1 active so no suppression. Is this over-analyzing or what?

 

[Zuhal]

Is this over-analyzing or what?

Yes it is.
As far as immunity is concerned, TGF-B's main role is to induce B cells to proliferate and make IgA and repair tissues. You're right that it is involved in immune response regulation but its not a direct effect (expression of B7/MHCII etc).

 

[Bonne Chance]

My exam was today. Since this thread has greatly helped me, here is my experience/advice/thoughts.

NBME6: 207 {Before study period}
NBME7: 221
NBME11: 235
NBME12: 250 - ~2.5 weeks ago
NBME15:235 {Too cocky on this pass, since my score kept increasing, thought I would be in the 250's-260s; knew something was wrong when I had 8-10 mins extra on every block} ~1.5 weeks ago
NBME: 13: 247 {Took it after a free150@testing center and an exhausting day beforehand} ~1 week ago

Free150: 245 ~Estimated score

UWorld: 55% - 1st run; not very predictive, didn't go over a lot of it, did it throughout the year before I even started a course just to see what types of questions were involved
UWorld: 78% (all random/timed) - 2nd run; went through it in-depth
USMLERx: Only completed 28% of it, not sure what my average was, low-70s% (Not the best bank to use as a learning tool but great tool overall for question exposure. I just did some of these questions inbetween UWorld/when I was bored/or just wanted to look at the answer to some picture-based questions - for some questions, didn't even read, just literally scanned for buzzwords)

Exam:
-I felt that my "form" was a difficult one
-Easier blocks were inbetween UWorld/NBME in difficulty
-A lot of anatomy, i.e. 4-5 per block {I wouldn't necessarily change your study habit to focus on Moore's or anything like that, I spent 30 mins the day before flipping through some blue boxes, wasn't that helpful unless you incorporate it early into your study.} - Besides, I felt that I couldn't have really studied for these anatomy questions overall; I pretty much based my answers off logical reasioning =/
-Not that heavy neuroanatomy ~8 questions
-Biochemistry - ~5-8 questions
-Cellular biology ~12 questions - mostly based on "understanding" the material instead of rote memorization
-Pharmacology was underrepresented, sucked because it is one of my strong points; had one question w/ drugs that I've never even heard of before
-Biostats ~10-12; 2x calculations, some were logic-based, others were...
-Pathology: Lots and lots - Pathoma went too in depth in some areas albeit it was a great tool; did the course throughout the year and once more 1.5 weeks ago before my exam; i.e. I had like 1-2x renal questions. Very helpful/handy for Heme/Onc.

Overall:
-Did well 2nd year; felt that helped me the most
- A lot of questions were based off of logic {I think a good portion of the examination is I.Q. based to a certain degree}
-Time is CRUCIAL - During my 2nd pass of UWorld I would always have ~25-30 mins left; NBME's I would have about 6-8 mins left, during the actual examination I had about 8 questions that I had to go back to and answer b/c I skipped and a few more that were marked. No time to go back to re-check my answers
-Expect obscure stuff that your Professor went on a tangent on or was on a slide during your 1st/2nd year or even if you read something somewhere; you'll just end up making random associations and will be surprised as to how you remembered such an obscure fact

Advice:
-To incoming 2nd years: Your best resource: UWorld. Avoid getting a 12 month subscription, get a 6 month one December-January. At the beginning, get either Rx to slowly/indirectly review FA content or even Kaplan (never used it).
-The best thing you can do at this time is to study for your 2nd year. A lot of the stuff from 1st year is low yield. If you focus on your classes, do a ton of questions for the class/organ system that you are in, that will pay off loads in the future (during the test and during the actual study period). I did not believe others when they told me this; but the test is changing in a way where it is geared more towards understanding instead of memorizing buzzwords

To those taking it in a few weeks/months: Questions, questions, questions. If I could turn back time I would have done more questions following it alongside First Aid. I think if someone does UWorld/Rx/Kaplan/All NBME's; this would be a great prep since you are used to seeing patterns which would be very helpful I mean it's cool if you read First Aid through, but personally I feel it would stick more if you were exposed to a certain/specific side-effect of a drug or media of a bug in question format, personal opinion albeit.

Take my opinion w/ a grain of salt. It's just my personal opinion after going through these last few weeks and actually seeing the beast in person.

Rough test, difficult form. I felt very rushed and felt that it was literally a race against time. I only had about 3-4 gimmies per block. Being optimistic and hoping for a good score. After the 1st block I felt that this was doable and a great score was in reach and towards my 5th block I just wanted to pass to avoid having to do this all over again. Thanks to all those that provided me w/ advice either in posts or via PM's. If you have any questions, toss me a PM.

To those taking it soon. The test is difficult, in an appropriate way. It is extremely doable (hopefully, if I passed!) and don't let some of these other posts guide you in the mindset that it is impossible. Wish ya the best of luck!

 

[CDI]

tl;dr: avg score not rising; exam NOT getting "harder" per se; example of how questions have evolved over past 10-15 years.
-----------------------
The scores are NOT rising because the NBME keeps the 3 digit score constant and claims a 6 point error, so 224-229 is certainly within that range.

That said, they are eliminating older questions from the pool that were no longer performing well. Performance is not just measured by % that answered correctly, but also by how well that % correlates with overall performance. Put simply: if 20% answer it right, you want those same people to be your top 20% of scores. If only 20% get it right, but those people have an equal chance of being a 190, 230, or 260 scorer, then that question isn't telling you anything.

There are a number of questions that 80-90% of people get right; these are part of how you discern between pass and fail. Then there are many that perform between that and those that only the top 15% are getting correct. Every test gets a relatively similar distribution of questions (of those that actually count anyhow) to maximize its ability to distinguish between scores, and a little recentering is done to keep the 3 digit score constant over time.

Now, imagine you have a highly-performing question that 40-50% of people get right and those are also the top 40-50% of scorers. If this question makes it into FA in such a way that now 80% get it right, it is no longer performing as intended and needs to be revised or thrown out. Those 80% are not the top 80% of scorers, but merely the original 40-50% plus a smattering of whoever else remembered the factoid from FA. Many people in the bottom 20% maybe be answering it correctly.

Every year, we can expect to see more and more familiar questions get replaced or revised to maintain the performance of the exam. It may appear the exam is getting more difficult, but in truth it's simply adjusting to the new reality of ubiquitous prep materials.

Here's an example:

Mid/Late 1990s question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows bilateral lymphadenopathy and a biopsy reveals non-casseating granulomas. Which of the following values is most likely to be elevated in this patient?
a) Bradykinin
b) Angiotensin I
c) Calcium
d) Potassium
e) Magnesium

So, in response to this, FA includes a section on Sarcoid reminding everyone of the "bilateral lymphadenopathy" and "noncaseating granulomas" buzzword as well as increased calcium. Over 2-3 more years, this question stops performing so now it gets revised:

2003 question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows lymphadenopathy and a biopsy reveals granulomas. Which of the following is most likely to be elevated in this patient?
a) Potassium
b) Angiotensin converting enzyme
c) Magnesium
d) Sodium
e) Bradykinin

Now the next FA amends its Sarcoid section to include that examiners love to ask about elevated ACE levels in Sarcoid, so once the question stops performing well they change it again:

2008 question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows adenopathy and a biopsy and immunostaining reveals clumps of activated macrophages. Which of the following is most likely to be elevated in this patient?
a) Angiotensin I
b) Serum calcium carbonate
c) Potassium
d) 1-alpha hydroxlase
e) IFN-alpha

Here again, FA adds that the mechanism of hypercalcemia in Sarcoid is due to TH1 activation of macrophages via IFN-gamma --> increased 1-alpha hydroxylase expression and ultimately vitamin D.

2013 Question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows possible adenopathy and a biopsy with immunostaining shows groups of cells positive for CD14. Which of the following is most likely to be DECREASED in this patient?
a) Angiotensin II
b) TGF-beta
c) Total Serum Calcium
d) Free Serum Calcium
e) 25-OH Cholecalciferol

Now we're still talking the same concepts, but you have fewer buzzwords in the stem and must understand the pathway of Vitamin D activation, namely that the increased 1-alpha hydroxylase will most likely convert more of your 25-OH Vit D into the active 1,25-OH form and thus deplete the former (choice E). The question isn't really "harder," but is rewritten to make sure you have to think and can't just respond with straight recall from FA.

*slow clap*

Well done.

 

[FIREitUP]

tl;dr: avg score not rising; exam NOT getting "harder" per se; example of how questions have evolved over past 10-15 years.
-----------------------
The scores are NOT rising because the NBME keeps the 3 digit score constant and claims a 6 point error, so 224-229 is certainly within that range.

That said, they are eliminating older questions from the pool that were no longer performing well. Performance is not just measured by % that answered correctly, but also by how well that % correlates with overall performance. Put simply: if 20% answer it right, you want those same people to be your top 20% of scores. If only 20% get it right, but those people have an equal chance of being a 190, 230, or 260 scorer, then that question isn't telling you anything.

There are a number of questions that 80-90% of people get right; these are part of how you discern between pass and fail. Then there are many that perform between that and those that only the top 15% are getting correct. Every test gets a relatively similar distribution of questions (of those that actually count anyhow) to maximize its ability to distinguish between scores, and a little recentering is done to keep the 3 digit score constant over time.

Now, imagine you have a highly-performing question that 40-50% of people get right and those are also the top 40-50% of scorers. If this question makes it into FA in such a way that now 80% get it right, it is no longer performing as intended and needs to be revised or thrown out. Those 80% are not the top 80% of scorers, but merely the original 40-50% plus a smattering of whoever else remembered the factoid from FA. Many people in the bottom 20% maybe be answering it correctly.

Every year, we can expect to see more and more familiar questions get replaced or revised to maintain the performance of the exam. It may appear the exam is getting more difficult, but in truth it's simply adjusting to the new reality of ubiquitous prep materials.

Here's an example:

Mid/Late 1990s question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows bilateral lymphadenopathy and a biopsy reveals non-casseating granulomas. Which of the following values is most likely to be elevated in this patient?
a) Bradykinin
b) Angiotensin I
c) Calcium
d) Potassium
e) Magnesium

So, in response to this, FA includes a section on Sarcoid reminding everyone of the "bilateral lymphadenopathy" and "noncaseating granulomas" buzzword as well as increased calcium. Over 2-3 more years, this question stops performing so now it gets revised:

2003 question:
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows lymphadenopathy and a biopsy reveals granulomas. Which of the following is most likely to be elevated in this patient?
a) Potassium
b) Angiotensin converting enzyme
c) Magnesium
d) Sodium
e) Bradykinin

Now the next FA amends its Sarcoid section to include that examiners love to ask about elevated ACE levels in Sarcoid, so once the question stops performing well they change it again:

2008 question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows adenopathy and a biopsy and immunostaining reveals clumps of activated macrophages. Which of the following is most likely to be elevated in this patient?
a) Angiotensin I
b) Serum calcium carbonate
c) Potassium
d) 1-alpha hydroxlase
e) IFN-alpha

Here again, FA adds that the mechanism of hypercalcemia in Sarcoid is due to TH1 activation of macrophages via IFN-gamma --> increased 1-alpha hydroxylase expression and ultimately vitamin D.

2013 Question
"A 43 year old African-American Female presents with weakness and persistent cough for the past 5 months. She denies hemoptysis and her PPD shows no induration at 48 hours. Her EKG shows normal sinus rhythm and shows no pathological Q waves. CXR shows possible adenopathy and a biopsy with immunostaining shows groups of cells positive for CD14. Which of the following is most likely to be DECREASED in this patient?
a) Angiotensin II
b) TGF-beta
c) Total Serum Calcium
d) Free Serum Calcium
e) 25-OH Cholecalciferol

Now we're still talking the same concepts, but you have fewer buzzwords in the stem and must understand the pathway of Vitamin D activation, namely that the increased 1-alpha hydroxylase will most likely convert more of your 25-OH Vit D into the active 1,25-OH form and thus deplete the former (choice E). The question isn't really "harder," but is rewritten to make sure you have to think and can't just respond with straight recall from FA.

the exam is getting harder, and the question you formulated takes more time and integration, therefore making it intrinsically more difficult. furthermore, this isn't even the extent to which the nbme is changing the exam. the vignettes are longer, have more confounding variables and are more nuanced.

 

[Jamiu22]

I went in to slay the beast today.. but unfortunately.. it may have slayed me! my exam seemed to have focused on Neuro, Micro, Biochem, Immunology and Gen path... it seemed like everything else was sparingly represented.

there was definitely a lot 's a lot more Neuro (lucky for me I love neuro)... no lie, I had at least 30 question on this subject... and at most 10 cardio question (2 were listening to heart sounds)... I also had a lot of obscure physio on things were rarely covered (like turbulence in blood vessels with arrows)...

Even though, I loved micro.. the ones on there today where a little more difficult than I anticipated.

I felt like my first 4 blocks were experimental... while the last 3 were more like NBMEs...

I'm just glad to be done!!!!

 

[basketball3312]

Just took it.

NBME15: 226 (2 wks out)
NBME7: 250 (10 days out)
NBME13: 240 (1 wk out)
Uworld First Pass: 66%
(timed random blocks only)
My 2nd pass of incorrects only I averaged between 75-80%

Resources in my Dedicated Month:
* BRS Phys
* First Aid
* Pathoma (videos & book)
* Uworld
I also used Kaplan qbank throughout the year. Not sure how much that helped.

I have to agree with everything said previously.. What helped me the most was learning the material well through my first two years of med school. First Aid definitely got me a lot of points, but many questions just go a lot deeper than what's in there. Pathoma was a great addition too, especially the earlier chapters. Reading the Uworld explanations really helped too! I had many questions that were similar to Uworld & the NBMEs I took.

I have no idea how I actually did on the exam though, total mixed feelings.. I didn't feel like it was totally impossible, but I was pretty pressed on time which was never an issue for me with NBMEs/Uworld. I had a few really long stems but for the most part they were about the same as the longer Uworld questions. I had a lot of neuro and micro on my test, hardly any biochem...but they're all different so I guess that doesn't matter.

There were a decent amount of questions on things I had literally never seen before, and couldn't find the answers anywhere online either. It's not that they were hard concepts, just straight up facts that I've never seen.

Right now there's nothing drastic I would have done to prepare differently, but we'll see if that'll change in 3 weeks =/

 

[glossoph]

Looking for some advice, I have about a week to go till my exam, I'm about to finish First aid again for the last time probably but mid nxt week. I have re-started uworld but only done about 10% of it. I've done both UWSA ~235. No NBMEs yet.
I just don't know what would benefit my most, I kind of want to do uworld, for the pictures which I am awful it (Histo/CT's/MRI's i'm bad at all of it) but I don't think I can realistically get more than half of it done.
What would you guys do

 

[operaman]

I really like every word operaman says! I know that the choice E is the most pertinent, but why not TGF-beta too? The granuloma inflammation is TH1, so decrease in TH2, we already know that TGF-beta is part of of TH2 system and actually suppresses the TH1. TH1 active so no suppression. Is this over-analyzing or what?

Haha yes maybe a little overanalyzing, but good thinking. My general impression of TGF-B is that it plays a role in fibrosis and wound healing, so my thinking was that it would likely be increased in Sarcoidosis and therefore a good distractor. Good distractors seem plausible enough but just don't quite fit, and TGF-b isn't emphasized in review materials so some people would be more likely to pick it if they didn't catch the vitamin D pathway concept.

That said, I just looked it up and while some references show dramatically increased TGF-beta locally in lung biopsies for sarcoid pts, others are more ambiguous. These sort of things are why the NBME has its questions reviewed by multiple authoritative sources whereas I just made the question up on the spot! If I had to revise the question now, I would make the duration of symptoms a little longer which would make TGF-b definitely a wrong answer.

 

[operaman]

the exam is getting harder, and the question you formulated takes more time and integration, therefore making it intrinsically more difficult. furthermore, this isn't even the extent to which the nbme is changing the exam. the vignettes are longer, have more confounding variables and are more nuanced.

I think the original questions may have been harder before those factoids were in every review book out there. Now they seem like obvious ones, but 15-20 years ago maybe not. Back then, the calcium question would have required you to understand the process of granulomatous inflammation, the effect of IFN-gamma on MPs leading to increased vit D and ultimately Calcium. Today it just requires you have the fact memorized while the newer questions still make us have to think more.

You are, however, spot on about the length. My post was already long so I tried to abridge the vignettes a little to highlight the evolution, but you can easily imagine how I could have given you some lab values, vitals, more history, etc., with each new iteration.

My thinking on the length is that they are trying to hit a sweet spot where you really have to think fast and think well. Maybe the prep materials are allowing people to finish questions in less time -- I'm sure they track average time spent per question by all test takers -- and they're lengthening some of them to keep things more consistent over time.

 

[g8orlife]

False. The national 224-225 average only reflects AMGs performance, IMGs are NOT included in this calculation. In fact, the average score for IMGs is about 10 points below the national average.

Right... I thought that was what CDI was getting at when he/she said:

There's no official scores released for IMGs, which never made sense to me, but its said to still be 215-220 range, and many more failures overall than AMGs.

 

[g8orlife]

tl;dr: avg score not rising; exam NOT getting "harder" per se; example of how questions have evolved over past 10-15 years.
-----------------------
The scores are NOT rising because the NBME keeps the 3 digit score constant and claims a 6 point error, so 224-229 is certainly within that range.

Great post!
But, why is your range 224-229 instead of 221-227 since the average is 224?

 

[operaman]

Great post!
But, why is your range 224-229 instead of 221-227 since the average is 224?

Those were just some of the national average scores I'd seen in this thread so far. Just wanted to suggest that some of these fluctuations may be more statistical noise than an actual trend.

On a side note, I made this same "statistical noise" suggestion to one of our deans who was talking about our school's increasing board scores, and it was not well received.

 

[FIREitUP]

I think the original questions may have been harder before those factoids were in every review book out there. Now they seem like obvious ones, but 15-20 years ago maybe not. Back then, the calcium question would have required you to understand the process of granulomatous inflammation, the effect of IFN-gamma on MPs leading to increased vit D and ultimately Calcium. Today it just requires you have the fact memorized while the newer questions still make us have to think more.

You are, however, spot on about the length. My post was already long so I tried to abridge the vignettes a little to highlight the evolution, but you can easily imagine how I could have given you some lab values, vitals, more history, etc., with each new iteration.

My thinking on the length is that they are trying to hit a sweet spot where you really have to think fast and think well. Maybe the prep materials are allowing people to finish questions in less time -- I'm sure they track average time spent per question by all test takers -- and they're lengthening some of them to keep things more consistent over time.

back then all you had to do was memorize that increased calcium was associated with sarcoidosis, which is a one step knee jerk answer. now you have to know that there are granulomas that have histiocytes that have 1 alpha hydroxylase activity which activates vitamin D and increases calcium reabsorption, blah blah blah. it went from pattern recognition to having to know the physiology of vitamin D, and many other possible associated facts. whereas with one question all you had to know is one fact, they've made a similar question that requires you to know many times that.

with regard to length, that's not even the total issue. within these lengthy passages it is oftentimes difficult to separate the pertinent information from the distractors. i noticed that they oftentimes tried to lead you to a certain diagnosis only to have literally a couple words that would rule that aforementioned diagnosis out. this makes the test more difficult on many levels and leaves so much room for error.

 

[Kal EI]

the exam is getting harder, and the question you formulated takes more time and integration, therefore making it intrinsically more difficult. furthermore, this isn't even the extent to which the nbme is changing the exam. the vignettes are longer, have more confounding variables and are more nuanced.

I agree on these points. But time to move on anyway.

 

[preDoGuy24]

Those were just some of the national average scores I'd seen in this thread so far. Just wanted to suggest that some of these fluctuations may be more statistical noise than an actual trend.

On a side note, I made this same "statistical noise" suggestion to one of our deans who was talking about our school's increasing board scores, and it was not well received.

Hilarious, on my phone so can't bold the last paragraph. Well played sir, well played.



Sent from my HTC One using Tapatalk

 

[JP2740]

Looking for some advice, I have about a week to go till my exam, I'm about to finish First aid again for the last time probably but mid nxt week. I have re-started uworld but only done about 10% of it. I've done both UWSA ~235. No NBMEs yet.
I just don't know what would benefit my most, I kind of want to do uworld, for the pictures which I am awful it (Histo/CT's/MRI's i'm bad at all of it) but I don't think I can realistically get more than half of it done.
What would you guys do

Move on from uworld. You should've been doing NBMEs by now

 

[21385]

can anyone comment on the real test's pharm questions? It seems from the NBME that they only test the major drugs and stay away from the less used + more obscure drugs in FA (ex. memantine (NMDA receptor antagonist for alzheimer's), tetrabenazine (VMAT inhibitor for Huntington's).