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For IMGs about to book Step 1, including the ones already scoring above 70%. Read this before you pick the date.
By Dr. Marish Asudani · Published
Do 3 things. Never give or attempt Step 1 unless you are above 68% on NBME 31, 32 and 33, whatever your friends say. Have an exact plan for the last 2 weeks, with nothing new. And give at least 1 or 2 full-length 280-question assessments, because 200-question NBMEs don't train the fatigue of the real exam.
Read this firstMost students who fail Step 1 didn't fail because they didn't study. They failed because of 3 decisions: when they booked, how they spent their last 2 weeks, and whether they had ever given a full exam day before the real one.
I'm going to be direct about all 3. This is not fear mongering, this is just the real truth.
You should never give Step 1 unless you have more than 68% on NBME 31, 32 and 33. No matter what your friends tell you. No matter what other people tell you.
None of these friends will come to save you when you fail your Step 1.
All 3 forms, not your best of 3. And read them as a trend, not 1 number:
Student A: 68, 70, 69, 73, then 65. Ready. 1 drop inside a steady trend is a bad day, not a collapse.
Student B: 65, 71, 64, 63. Not ready. 1 spike above the line while the rest stay at 63–65% is noise. It's the most common reason people book too early.
And those numbers only count if you took the NBMEs offline and timed. The online version gives you 50 questions in 75 minutes and inflates your score by about 4 to 6%. Why NBMEs are always offline →
Have a proper plan of what you're going to do in the 2 weeks leading up to the exam. I want you doing exactly what my students do. These are the exact things my students do in the 14 days leading up to the exam. Nothing on the list is new content. Every item is revision with a question attached.
And this is where those days fall in the last-month plan:
Every link, in 1 place: The final 14 days → · All 33 days: The last month, day by day →
Want a day-by-day schedule that tells you exactly what to study next? The Vault builds it around your exam date.
Build my schedule in the Vault →
You have to give at least 1 or 2 full-length assessments that make you practise your endurance for the exam.
The number 1 problem most students face: they've got 68% to 70%, and they believe they're ready. Then in the exam, the questions are so long, and their fatigue sets in so quickly, because they've only ever given 200-question NBMEs. Never a full 280-question assessment.
There are 2 ways to give one:
Tap the way you'll give yours
Mix NBME forms into 1 full day of 14 blocks of 20. You mix up NBME 33, the Free 120, and 32. On the Vault schedule, the 2 mock days are built like this:
Same wake time, same breaks as the real exam, offline and timed. On the Step 1 side, the Free 120 is here as realistic practice, not as a predictor: only the NBME 31, 32 and 33 trend carries the verdict.
Or give the Vault Assessment. 14 blocks of 20, 280 questions, 30 minutes a block. Vault Assessment 1 has much longer questions, just like the real exam. They're much longer than the NBME 30s.
Most of my students who give it say the questions felt so long that practising them built up their endurance for the real exam, and it helped them realise how to read the questions.
You get your raw percentage, a system-by-system breakdown and an honest pass verdict. No fake 3-digit score.
Start the Vault Assessment280 questions, 14 blocks of 20, real-exam stem length. Raw %, system breakdown, honest pass verdict.
Start the assessment →Assessment 2 is free for every signed-in student, so start there if you haven't taken it. Then give Assessment 1 in your final stretch: on the Vault schedule it's day 27 of the last 33.
His day-by-day, from his baseline NBME to a pass 34 days later: Dr. E's exact schedule →
All about the full-length day: The Step 1 assessments →
I wrote this thread on X after a student came to me who had failed while scoring above 75%. If you still believe that more than 70% on your NBMEs is all it takes to pass Step 1, you're sadly mistaken.
Just 2 months before I wrote this, a student came to me after failing her Step 1. She was scoring above 75% on the NBMEs. The grave error was that she gave her last NBME 15 days before the exam. Then she just focused on reading and got out of the habit of solving MCQs. Being out of practice, the MCQs hit her like a truck. She panicked and failed.
What I wrote then: give a complete mock 7 and 14 days before the exam, using NBME 31, 32, 33 and the Free 120. Give 1 block of NBME every day leading up to any mock. Stop solving blocks 2 days before the real exam.
How the Vault plan does it today: the same lesson, with 3 full 280-question days: Mock Exam 1 on day 18, Mock Exam 2 on day 23 and Vault Assessment 1 on day 27 of the last 33, about 15, 10 and 6 days before the exam. Timed, offline NBME blocks run in the days leading up to both mock exams. The final week is recall, and the day before is your bookmarks. You never stop solving 15 days out.
What the Vault Assessment is: a full Step 1 day. 14 blocks of 20, 280 questions, 30 minutes a block, with stems at real-exam length, longer than NBME stems on purpose. You get your raw percentage, a system-by-system breakdown and an honest pass verdict. It trains the 1 thing an NBME can't: how hour 6 feels. Assessment 2 is free for every signed-in student. How both assessments work →
Give your full day before the real oneStart the Vault Assessment: 280 questions, an honest verdict, and the fatigue of the real exam while you can still fix it.
Start the Vault assessment →Never overload yourself by reading First Aid again and again before the exam. You start remembering the pages, and you hit your maximum capacity 3 weeks before the exam. That's your peak. After the peak, it's only plateau or downhill.
I want you to hit your peak in the exam week. That's why you book the date in your uphill phase, not at the peak. In your uphill phase, watch the Neil Randy videos of all systems, and then 2 weeks before the exam, go to First Aid again, to prevent the burnout and gain a lot of high-yield Step 1 knowledge.
Today, the same idea is built into the last 2 weeks: the Neil Randy PDF instead of his videos, then First Aid again as Rapid Review (the First Aid Guide page by page if a system feels weak) and a full pass of the FA Foundation Anki in the final week. Recall, not re-reading.
A lot of you don't understand that the biggest strategy for your Step 1 is how to manage the time, and exactly how to give the NBME. I explain exactly how in this video.
▶How to manage time and give the NBMEMy walkthrough video.The written version: the NBME MCQ protocol →, taking an NBME offline → and why every NBME is offline → After every form: the NBME review protocol →
Tick a line only when it's true. Every line has its how-to in brackets. It saves on this phone.
How to know you're actually ready — the 5 conditions.
The final 14 days — the 5 resources, with links.
The Step 1 assessments — 280 questions and a pass verdict.
If you failed Step 1 once — find out why first.
The week before Step 1 — the 6 things.