NBME Subject Exams: Your Study Guide

What are NBME subject exams?

The NBME subject examinations aim to evaluate medical students’ knowledge and understanding of specific subject areas. These exams are written by the National Board Medical Examination (NBME) for medical schools and other institutions with a legitimate interest in the education of physicians or other health professionals. These institutions essentially use them as final exams after clerkships or courses to assess what the students learned. There are four main types of subject exams:

The cost of the exam will depend on the specific subject exam that you are taking and where you are taking it. Prometric centers don’t always offer all the subject exams, so you will need to check the NBME website or the center itself to find out if the exam you seek is available. In Prometric centers, the exam should cost between $101 and $147. If you take the exam with your institution directly, the cost is significantly lower. It ranges from $44 to $57, depending on the exam you are taking. 

Preparing for the USMLE Step 1 as well and not sure where to start with studying? Take a look at this infographic:

Why are NBME subject exams important?

The best part of the NBME subject exams is the feedback that it gives students. Medical schools rely on the Subject Exam Program because it allows them to compare their students' performance to other students across the country. The program provides national normative data that reflect students' performance from medical schools accredited by the Liaison Committee on Medical Education (LCME). This means that your results will show where you stand compared to your peers who took the same subject exam. 

Furthermore, the committees of content experts who create these exams also provide score reports that include actionable feedback. The scores and comments they give can go a long way into helping students identify their strengths and figure out what they need to work on.  

The exam’s format

The NBME subject exams can be taken in prometric administration centers or medical schools, so the exact circumstances of the exams can vary greatly depending on where you are taking them and which of the subject exams it is. Depending on the exam, it can last from two hours to four hours and fifteen minutes, and have anywhere between 90 and 160 questions.

The format of the exam itself, however, is pretty consistent. If you are familiar with USMLE step 1 and USMLE step 2, you can expect something similar here. The exams focus on testing knowledge application rather than just simple information recall.

Interested in tips for the USMLE Step 2 CK? Check out this video:

You can expect the following types of questions: 

One-Best-Answer

This is the most common type of multiple-choice question, and it is used in all the subject exams. These questions will have an item stem, usually a clinical vignette, and a lead-in question. The student will need to pick out the one correct answer from the list of options provided.

Here is an example of this question type for reference:

A seemingly healthy 18-year-old primigravida presents at 36 weeks feeling unwell and tired. Her CXR shows an enlarged heart and her brother died unexpectedly at the age of 19. While being admitted she developed increasing shortness of breath and died despite intensive resuscitation. Which of these options is the single most likely cause of maternal death:

1. Placental abruption
2. Cardiomyopathy   
3. Placenta praevia
4. Chest infection

Extended Matching Questions

These kinds of questions require the student "to match" the correct answers to each question. They will be given a list of possible answers (diagnoses, drug options, etc.) followed by short scenarios or clinical vignettes. They will have to choose the most appropriate answer from the list. In most cases, answers can be used more than once. 

Here is an extended matching question example for reference:

Select the single most likely cause of maternal death from the list of options below for each of the cases. Only one answer is applicable per case but you may use one answer for more than one case.

1. Placental abruption
2. Cardiomyopathy        
3. Placenta praevia
4. Chest infection           
5. Pulmonary embolism
6. CVA

A healthy 18-year-old primigravida presents at 36 weeks. She is feeling unwell and very tired. Her CXR shows an enlarged heart and while being admitted, she developed increasing shortness of breath and died despite intensive resuscitation. Her brother died unexpectedly aged 19 years.

Answer = 2

Unfolding: This particular type of question is mainly used during web-based examinations. It is a sequential set that unfolds with each answer as if the examinee was managing a patient over time. 

We can’t really show you an example for this question type. It could involve a case similar to the one we just mentioned above but the question would begin by asking you what tests you would order once you notice the shortness of breath and then a new question would present itself based on your answer.

How to prepare for the NBME subject exams

Much like with MCAT prep and prep for other exams, preparation is the key to success on the NBME exams. So now that you have a better idea of what the NBME subject exams are like, let’s talk about how you can prepare for them:

Have a study schedule

If your institution has chosen to use one of the subject exams, you will be notified ahead of time, and you will need to make sure that you’re using high-yield study techniques in medical school to get the best scores possible. Before you begin reviewing material, you should take the time to create a personalized medical school study schedule. A predetermined study schedule will save you lots of time and headaches later. Often, students spend time that they should be using to study, scrambling to find practice quizzes or the right books to use. If you already have a plan that includes all the necessary information, and you gather the necessary books beforehand, then you will be ready to take on each learning milestone as it comes. 

The first step in creating your schedule is figuring out precisely what you need to review, and then you can start deciding when to do it. You should take the time to carefully plan and write out all the information you need to learn or review and what resources you need to do it. If possible, you should try to obtain all of your study resources beforehand so that you only need to reach for them when the time comes. If this is not possible, you should remember to include the time required to collect those resources in your schedule. 

Remember to be realistic and honest with yourself when coming up with a schedule. Consider your other academic commitments, family obligations, extracurriculars, and so on. You should look at how much time you have to prepare and consider moving things around to allow you to prepare better. Decide on the amount of time you can dedicate to studying every week, start to craft a schedule based on that, and make sure that it is flexible.  

Once you’ve come up with a schedule, you should try to stick to it as much as possible but don’t be afraid to make changes and adapt as you go. There will most likely be topics that take you longer to study or days when something important comes up, and you miss a study day. Seize the opportunity to tweak your schedule and adapt it to your current situation whenever that happens.

TIP: If you find a topic challenging, put it on your schedule at least twice on separate weeks so that you can remember to review it multiple times. You could try using different study methods to review the same information.

Use a variety of active study methods

Reading your textbooks and reviewing your notes for hours on end is what most people think about when we talk about studying. It may work for some people but most of the time, it’s actually counterproductive. We recommend using a variety of active study methods to keep things interesting and get the most out of your studying.

Here are some highly effective study techniques that we recommend you incorporate in your NBME subject exam preparation:

Conclusion

The NBME subject exams can be challenging but if you have the tools and strategies to prepare, then you can ace them. You will be able to use the information provided in this post to prepare, even though the exact subject exam that you will take will depend on your medical school. Simply remember to create a study schedule ahead of time. Ensure that it includes different active study methods and seek help from medical school consultants if you feel that you need additional help or support. 

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Your friends at BeMo

BeMo Academic Consulting

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