Friday, October 5, 2007


The acronym has been thrown around a lot during my second year of medical school: "You have to study hard for your NBMEs," "Forget about the LCME, it's the NBME you should worry about."

So, what is the NBME?

The NBME is the National Board of Medical Examiners. Founded in 1915, it's the independent, not-for-profit organization that provides nationwide examinations so that medical licensing authorities have a standard they can use to judge candidates for, well, medical licensure. They're the nice folks that make second year hell. How? With administration of the USMLE (United States Medical Licensing Examination) Step 1 at the end of the second year of medical school. This sole exam determines whether you have the option of going into competitive specialties such as Plastic Surgery, Dermatology and Radiology, or are limited to a primary care specialty such as Family Medicine, Pediatrics, and Internal Medicine. Believe me, I'll be writing about Step 1 hell come April.

So, why am I bringing up the NBME now?

On Tuesday, I will be taking the first of six "Customized NBME Examinations." Beginning this school year, the NBME is offering 40 medical schools the opportunity to administer these web-based examinations to their students. My medical school choose to participate, making each Customized NBME Exam count for roughly 40% of my grade each unit. Since this has never been done before, I'm a bit nervous.

The process is as follows: (1) faculty sends NBME list of topics, (2) NBME sends faculty pool of questions related to topics, (3) faculty selects questions from pool, (4) NBME produces examination, (5) faculty reviews examination and makes any changes, (6) final examination produced. About a week later, students take the examination either in the computer lab or a lecture hall (a program has been installed on our laptops). Each student will get the same 100 or so questions, but in a unique, random order.

I'm looking at these new exams as a positive change. Clearly, the major benefit is that I will be very familiar with the format of Step 1 by the time June rolls around. I'll also be familiar with the style of questions asked on Step 1. Another clear benefit is that I won't have to deal with poorly worded questions written by faculty, or questions with multiple answers that are subsequently dropped. Also, I think it will be good for the faculty because they'll actually see what topics they should be focusing on in lecture. The pool of questions sent by the NBME will make it evident. If there are a lot of questions on Topic A and few on Topic B, but Dr. B spent most of his time on Topic B, then maybe he'll change that next year. (One can dream, can't they?)

Grades may dip on this first Customized NBME Exam because of the new online format and vignette-style questions with images and lab reports -- not to mention possible problems with computers and the internet connection -- but my hope is that overall we'll do well. And come June, when I break 240 on Step 1, I think I'll be grateful for these NBMEs.


Sid Schwab said...

And here's the bad news: it almost never stops. State boards (or nationals), specialty boards, recertification exams. It goes on for the whole career. The good news: in active practice, doing some reading, going to the occasional meeting, I always felt if I didn't know enough to pass an exam without studying, something was wrong. So when it came to specialty boards and recertifications, I didn't study and it seems to have worked out. (OK, I looked up a couple of arcana -- but only for a few minutes.)

The Lone Coyote said...

As you mention, this change may really help you on the boards. I found Step 2 CK a lot easier than Step 1 because I had been taking NBME shelf exams throughout 3rd year. I hope you rock Step 1 because your school is doing this.

stinky said...

Good luck with this. Sounds like a step in a positive direction, especially if it deemphasizes some of the crap exams the teachers write.

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