How to Review NBMEs and Actually Improve Your Score (The Notebook System)

Marish Asudani
Jan 19
8 min read

Congratulations. You just finished your first NBME.

You're exhausted. You're anxious about your score. You want to know if you passed or failed.

Here's what most students do: they score their exam, see the number, feel either relieved or devastated, and then... nothing. They move on. They take another NBME in a week. They make the same mistakes. Their score doesn't improve.

This is why students plateau.

Taking NBMEs is not what improves your score. Reviewing NBMEs is what improves your score.

The NBME is not just an assessment tool. It's a Qbank of its own — roughly 1,800 questions across all forms. That's 1,800 opportunities to learn concepts that the actual exam creators think are important.

But only if you review correctly.

Here's the complete system.

The Same-Day Review Rule

This is non-negotiable:

Review your incorrects on the same day you take the NBME.

Not tomorrow. Not "when you feel like it." The same day.

Why? Because you will only remember WHY you made a question incorrect on the day you took it. By tomorrow, you'll start forgetting why you thought a certain option was correct. By the day after, you'll have no idea what your reasoning was.

The value of NBME review is understanding YOUR thought process and fixing YOUR specific errors. That requires fresh memory of what you were thinking during the exam.

Here's the ideal NBME day structure:

Morning: Take the full NBME (5-6 hours with breaks)

Afternoon: Take a 4-5 hour break. Relax. Eat. Don't think about the exam.

Evening (after 7 PM): Review all incorrects

Yes, you'll be tired. Yes, you'd rather just rest. But if you want to actually improve, you do the review while it's fresh.

If you're absolutely dead — truly cannot function — you can push review to the next morning. But same-day is always better. Your memory of your reasoning degrades rapidly.

The Scoring Process

Before you review, you need to score.

Step 1: Count your correct answers

Go through all 200 questions. Count how many you got right.

Step 2: Calculate your percentage

Correct ÷ 200 × 100 = Your percentage

136+ correct = 68%+ (approximately passing)
130-135 = 65-67% (close, keep pushing)
120-129 = 60-64% (need reinforcement)
Below 120 = Below 60% (significant work needed)

Step 3: Count incorrects by system

This is crucial. As you go through, tally how many you got wrong in each system:

Cardiology: ___
Pulmonology: ___
Renal: ___
GI: ___
Neurology: ___
Psychiatry: ___
Endocrine: ___
Reproductive: ___
Hematology: ___
Immunology: ___
MSK: ___
Dermatology: ___
Biochemistry: ___
Microbiology: ___
Pharmacology: ___
Biostats/Ethics: ___

This tells you which systems need the most attention. If you got 8 wrong in Cardio but only 2 wrong in Renal, you know where to focus.

The Notebook System (NBMEs 26-33 Only)

You will maintain a dedicated NBME review notebook.

Important: This notebook is for NBMEs 26-33 only. Not for NBME 25 (that's just acclimation). Not for Free 120 (that's too close to the exam to build a system around).

This notebook becomes your most valuable revision resource.

What goes in the notebook:

For each incorrect question, you write ONE line (maximum two lines) that captures:

What the question was testing
Why you got it wrong
What you should remember

That's it. One line. Not a paragraph. Not the full explanation. One line.

Why one line?

Because you'll have 50-70 incorrects per NBME. If you write paragraphs for each, you'll never finish. You'll never review the notebook because it's too overwhelming.

One line is reviewable. One line is memorable. One line is efficient.

Example entries:

❌ "Cardiac tamponade — look for pulsus paradoxus, not Kussmaul sign (that's constrictive pericarditis)"

❌ "Beta blockers contraindicated in cocaine toxicity — causes unopposed alpha"

❌ "p-value = probability of results if null is true, NOT probability null is true"

❌ "�արdelays presentation 2-4 weeks, not immediately"

Short. Specific. Captures your specific error.

The Review Process: Step by Step

Here's exactly how to review your NBME:

Step 1: Organize by system

Don't review question 1, then question 2, then question 3 randomly.

Instead, review all Cardiology incorrects together. Then all Pulmonology. Then all Renal.

Why? Because this keeps your brain in one system at a time. You'll see patterns. You'll connect concepts. And you can keep First Aid open to that system while reviewing.

Step 2: For each incorrect question:

Read the question again
Read why your answer was wrong
Read why the correct answer is correct
Read the educational objective
Find this concept in First Aid
If it's in First Aid → Highlight it (if not already highlighted)
Write your one-line entry in your notebook

Step 3: Categorize the mistake

For each incorrect, identify if it was:

A) Silly Mistake:

Misread the question
Knew the answer but clicked wrong option
Rushed and made careless error
Read "EXCEPT" as "which of the following"

B) Knowledge Deficit:

You genuinely didn't know this concept
You couldn't have gotten it right even reading carefully
This is a gap in your knowledge base

Track the count of each type separately.

Why this matters:

If you have 40 incorrects and 25 are silly mistakes → You need to slow down and read more carefully. Your knowledge is fine; your test-taking is the problem.

If you have 40 incorrects and 30 are knowledge deficits → You need more content review. Go back to First Aid and UWorld for those systems.

Different problems require different solutions.

Step 4: Review correct questions (briefly)

The next day, quickly go through your correct answers.

For most, you'll confirm: "Yes, I knew this, my logic was right."

But some correct answers you got right by luck — your reasoning was wrong but you happened to pick correctly.

For these, treat them like incorrects:

Find in First Aid
Highlight if needed
Add to notebook if it reveals a knowledge gap

This prevents false confidence from lucky guesses.

The Notebook Review Schedule

Your notebook isn't just for writing. It's for reviewing.

Before each subsequent NBME:

Review your entire notebook. Every entry from every previous NBME.

NBME 26 notebook → Review before NBME 27 NBME 26 + 27 notebook → Review before NBME 28 NBME 26 + 27 + 28 notebook → Review before NBME 29

And so on.

What this accomplishes:

The concepts you got wrong keep getting reinforced. By the time you take NBME 33, you've reviewed your NBME 26 mistakes seven times.

This is spaced repetition through your own errors. The concepts YOU specifically struggle with get repeated exposure.

Time required:

After NBME 26: ~50-60 entries, 20-30 min to review
After NBME 30: ~200-250 entries, 60-90 min to review
After NBME 33: ~350-400 entries, 90-120 min to review

This is your personalized rapid review. Every entry represents a concept you specifically got wrong. This is infinitely more valuable than generic review.

Interpreting Your First NBME (NBME 26)

NBME 26 is your baseline. Here's what your score means:

65%+ (130+ correct):

You're on track. You've done the work correctly during base building. Book your exam for 5 weeks out.

Your focus now: Continue NBMEs, review incorrects, strengthen weak systems identified by your system-wise incorrect count.

58-64% (116-129 correct):

You're close but not there. You need reinforcement.

Your focus: Identify your 2-3 weakest systems (highest incorrect counts). Go back to UWorld for those systems. Watch Mehlman if needed. Do Amboss 200 to find specific subtopic weaknesses.

Take another NBME in 7-10 days after focused review.

Below 58% (below 116 correct):

Something went wrong. You didn't follow the system correctly.

If you've done everything I asked in the timelines I gave, this score is not possible. Every student who follows my system scores above 60% on NBME 26.

If you're here, you either:

Took longer than 14 weeks for base building
Skipped systems or left UWorld questions incomplete
Didn't do the pre-NBME push correctly

Reach out for personalized help. Don't just keep taking NBMEs hoping the score improves.

What to Do Between NBMEs

The gap between NBMEs is where improvement happens.

If your score was 65%+:

Review notebook daily (15-20 min)
Continue highlighting First Aid
Do UWorld incorrects for weak systems
Take next NBME in 5-7 days

If your score was 58-64%:

Intensive focus on 2-3 weakest systems
Re-read First Aid for those systems
Do all remaining UWorld questions for those systems
Watch Mehlman for those systems if below 60% on related UWorld
Take next NBME in 7-10 days

If your score was below 58%:

Stop taking NBMEs
Go back to base building mode
Complete any incomplete UWorld systems
Solidify fundamentals before burning more NBMEs

NBMEs are a limited resource. Don't waste them when you're not ready to improve.

The Two-NBME Rule

Here's a critical rule:

If you score below 62% on two consecutive NBMEs, stop taking NBMEs.

This means your foundation isn't solid enough. Taking more NBMEs won't help — you'll just burn through your limited questions without improving.

Instead:

Go back to UWorld
Redo incorrects for your weakest systems
Watch Mehlman for struggling systems
Do Amboss 200 to identify specific weaknesses
Spend 2-3 weeks on intensive content review
Then resume NBMEs

Two consecutive below 62% = foundation problem, not test-taking problem.

Common Mistakes in NBME Review

Mistake 1: Not reviewing on the same day

Your memory of your reasoning fades rapidly. Same-day review is essential.

Mistake 2: Writing too much in the notebook

One line per incorrect. Not paragraphs. Not full explanations. One line you can review in 5 seconds.

Mistake 3: Not categorizing mistakes

If you don't know whether you're making silly mistakes or knowledge deficits, you can't fix the right problem.

Mistake 4: Not reviewing by system

Random review is inefficient. System-by-system keeps your brain focused and reveals patterns.

Mistake 5: Not reviewing the notebook before subsequent NBMEs

The notebook is useless if you only write in it and never read it. Review before every NBME.

Mistake 6: Skipping correct question review

Lucky guesses hide as correct answers. A quick scan catches false confidence.

Mistake 7: Taking NBMEs too frequently without review

Some students take an NBME every 3 days without proper review. They're just burning questions. Space them 5-10 days apart with quality review between.

The Power of Compounding

Here's what happens if you follow this system:

After NBME 26:

50 notebook entries
Weak systems identified
First Aid highlights growing

After NBME 28:

150 notebook entries
Patterns emerging in your mistakes
Knowledge gaps closing

After NBME 30:

250 notebook entries
Silly mistakes decreasing (you're reading more carefully)
Knowledge deficits narrowing

After NBME 33:

350+ notebook entries
You've reviewed NBME 26 mistakes 7 times
Your weak points are now strong points
You know exactly what YOU struggle with

Before your exam:

Review your entire notebook one final time
This is YOUR personalized rapid review
Every entry is a concept YOU got wrong
Maximum yield for minimum time

This is the power of systematic review. Your mistakes become your study guide.

The NBME Review Checklist

After each NBME (26-33), confirm:

☐ Scored the exam and calculated percentage ☐ Counted incorrects by system ☐ Reviewed all incorrects same day (or next morning) ☐ Categorized each as silly mistake or knowledge deficit ☐ Wrote one-line entry for each incorrect in notebook ☐ Highlighted tested concepts in First Aid ☐ Briefly reviewed correct answers for lucky guesses ☐ Identified 2-3 weakest systems for focused review ☐ Created plan for gap before next NBME

If any of these are incomplete, your review isn't finished.

What's Next

You now know how to take NBMEs and how to review them.

But even with the best system, students still make avoidable mistakes that cost them months of time or their entire exam.

In the next blog, I'll reveal the 5 biggest mistakes IMGs make on their Step 1 journey — mistakes I've seen repeatedly that destroy progress and lead to failure.

Then we'll cover:

What to do when scores plateau
Exam day strategy (the complete guide)

Your NBME review starts tonight. Your notebook starts now.

If you want personalized analysis of your NBME performance — someone identifying your patterns, diagnosing your specific weaknesses, creating your custom improvement plan — https://meetings-na2.hubspot.com/marish.

Every incorrect is an opportunity. Let's make sure you're using them.

Dr. Marish Asudani Co-Founder, P2A Consultancy PGY-1 Internal Medicine | USMLE Mentor