How to Take NBMEs for Step 1 (The Offline 40-Question Method)

Marish Asudani
Jan 19
9 min read

Almost everyone takes NBMEs wrong.

They go online. They click start. They do 50 questions per block in 1 hour 15 minutes. They feel good about their timing. They get their score.

Then they walk into the real exam and get destroyed.

Why? Because the real exam isn't 50 questions per block. It's 40 questions in 1 hour. The timing is completely different. The rhythm is completely different. The pressure is completely different.

Students who practiced 50 questions with 1:15 suddenly have 40 questions in 1:00 and panic. They run out of time. They guess on the last 5 questions. They fail.

I've seen this happen to students scoring 70%+ on NBMEs. They had the knowledge. They didn't have the timing.

This is why you must do NBMEs offline, with 40 questions per block, exactly simulating the real exam.

Here's the complete method.

Why Offline, Not Online

Let me be very clear about this:

Doing NBMEs online is a mistake.

Here's why:

Online NBMEs:

4 blocks of 50 questions each
1 hour 15 minutes per block
Total: 200 questions in 5 hours of testing

Real Step 1 Exam:

7 blocks of 40 questions each
1 hour per block
Total: 280 questions in 7 hours of testing

The online NBME doesn't simulate the real exam. Not even close.

You have more margin for error online. You have 1.5 minutes per question online versus 1.5 minutes per question on the real exam — but the psychological experience is completely different.

When you have 75 minutes for 50 questions, you feel like you have time. You can spend 3 minutes on a hard question and still recover.

When you have 60 minutes for 40 questions, the pressure is real. One hard question that takes 3 minutes and you feel the clock pressing.

The rhythm is different. The pacing is different. The stress is different.

If you don't practice the real rhythm, you won't perform under the real pressure.

I've had students scoring 70-75% on online NBMEs fail the real exam because they couldn't handle the timing difference. I've had students scoring in the low 60s on offline NBMEs pass comfortably because they were conditioned for the actual exam experience.

Offline NBMEs with 40 questions per block. Always.

How to Get Offline NBMEs

There are two ways:

Option 1: Telegram

Go to Telegram. Search "NBME Step 1." You'll find groups with all the offline NBMEs (25, 26, 27, 28, 29, 30, 31, 32, 33) available as PDFs.

Download them all.

Option 2: IMD App

The IMD app has all NBMEs uploaded and ready to use offline.

Either method works. The key is having the questions as a PDF or in an app where YOU control the timing, not the NBME website.

The Setup: Converting 4 Blocks of 50 to 5 Blocks of 40

Each NBME PDF has 4 sections of 50 questions (200 total).

But the real exam has 7 blocks of 40 questions.

For practice, we convert the NBME into 5 blocks of 40 questions.

Here's exactly how:

Your Block 1: Questions 1-40 (Section 1, Questions 1-40)

Your Block 2: Questions 41-80 (Section 1 Q41-50 + Section 2 Q1-30)

Your Block 3: Questions 81-120 (Section 2 Q31-50 + Section 3 Q1-20)

Your Block 4: Questions 121-160 (Section 3 Q21-50 + Section 4 Q1-10)

Your Block 5: Questions 161-200 (Section 4 Q11-50)

You now have 5 blocks of 40 questions each — much closer to the real exam structure.

The Physical Setup

Before you start, you need:

5 sheets of blank paper

On each sheet, write numbers 1-40 in two columns:

Left column: 1-20
Right column: 21-40

This is where you'll mark your answers.

3 timers on your phone

Timer 1: Set to 1 hour (your block time)
Timer 2: Set to 6 hours (your total exam time tracker)
Timer 3: Set to 55 minutes (your pace checker)

I'll explain how to use each timer below.

A pen

For marking answers on your paper.

Sugary drinks and snacks

Gatorade, lemonade (no caffeine), chocolate. You'll use these during breaks.

The Three-Timer System

This is crucial. Most students just set one timer and hope for the best. That's not strategy.

Timer 1: Block Time (1 hour)

Start this when you begin each block. This is your hard deadline — when it hits zero, your block is over.

Reset to 1 hour at the start of each new block.

Timer 2: Total Elapsed Time (counts up)

Start this when you begin Block 1. Let it run continuously through the entire exam, including breaks.

This tracks your total testing time. By the end of Block 5, this should show approximately 5 hours (5 blocks) + break time.

Timer 3: Break Time Tracker

You get 48 minutes of total break time.

With 5 blocks, that's roughly 6 minutes per break (between blocks).

Start Timer 3 when you begin a break. Stop it when you resume. This tracks how much break time you've used.

How to use them together:

Start Timers 1 and 2 when you begin Block 1
Watch Timer 1 constantly while solving questions
When Block 1 ends, stop Timer 1, start Timer 3
During break, Timer 2 keeps running, Timer 3 tracks break time
When break ends, stop Timer 3, reset Timer 1 to 60:00
Start Timer 1 for Block 2
Repeat

By constantly monitoring Timer 1 during blocks, you train yourself to maintain proper pacing.

The Two-Pass Method for Solving Questions

This is the most important timing strategy you'll learn.

The Problem:

Students go question by question, spending 2-3 minutes on hard questions, and suddenly have 10 questions left with 5 minutes remaining. Panic. Guessing. Wrong answers.

The Solution: Two-Pass Method

First Pass (40-45 minutes):

Go through ALL 40 questions making quick decisions.

For each question:

Read the question
If you know the answer → mark it, move on
If you're unsure between 2 options → circle the question number on your paper, write "A/B" (your two best guesses), move on
If it's a biostat question → circle it, skip it for now, move on

Do NOT spend more than 1.5 minutes on any question during first pass.

Your goal: See all 40 questions within 40-45 minutes.

Second Pass (10-15 minutes):

Now go back to your circled questions.

First, do all biostat questions (take 5-6 minutes for these)
Then, revisit your "A/B" questions with fresh eyes
Make final decisions
If still unsure, pick one and move on

The Key Insight:

After first pass, you've already answered all the questions you definitely know. Those points are locked in.

Second pass is for the uncertain ones. You're working with house money now — the easy points are secured.

This eliminates the panic of "I have 15 questions left and 10 minutes remaining." You've seen everything. You've answered the easy ones. Now you're just refining.

The Time Remaining Rule

Here's what separates students who pass from students who fail:

You must have 10-15 minutes remaining after your first pass.

Not 5 minutes. Not 2 minutes. Not zero.

10-15 minutes.

Why? Because the real exam questions are longer, more complex, and more stressful than practice NBMEs. If you're finishing first pass with only 5 minutes to spare on NBMEs, you'll have NEGATIVE time on the real exam.

I've seen this pattern repeatedly:

Student A scores 68% on NBMEs, finishes with 15 minutes remaining per block → Passes real exam comfortably
Student B scores 72% on NBMEs, finishes with 3 minutes remaining per block → Fails real exam

Student B had more knowledge but worse timing. The real exam's pressure and complexity ate up their tiny margin.

Train yourself to finish first pass in 45 minutes, leaving 15 minutes for second pass.

If you can consistently do this on NBMEs, you'll have 5-8 minutes remaining on the real exam. That's your safety margin.

Pacing Check

Here's how to check your pace during first pass:

After 10 minutes: You should have completed 8-10 questions

After 20 minutes: You should have completed 16-20 questions

After 30 minutes: You should have completed 24-30 questions

After 45 minutes: First pass complete (all 40 questions seen)

If you're at the 20-minute mark with only 10 questions done, you're too slow. Speed up. Skip confusing questions faster. Move.

This is why Timer 1 stays visible during the block. Constant awareness of time = constant awareness of pace.

The Break Strategy

Between each block, take your full break. You've earned it.

Break duration: 6-8 minutes (48 minutes total ÷ 5-6 breaks)

What to do during break:

Use the restroom — Every single break. Even if you don't feel like it. You don't want to feel the urge during a block.
Hydrate with something sugary — Gatorade, lemonade, juice. Your brain runs on glucose. Feed it. Avoid caffeine if you're prone to anxiety.
Eat a small snack — Chocolate, granola bar, something quick. Keep energy stable.
Don't review questions — The block is over. Don't think about what you might have gotten wrong. Clear your mind.
Stand up and stretch — Get blood flowing. Sitting for hours destroys your focus.

What NOT to do:

Don't skip breaks to "save time"
Don't use breaks to cram First Aid
Don't check your phone for messages
Don't calculate your score mid-exam

Breaks are for recovery. Use them for that purpose only.

NBME Day Structure

Here's what a full NBME day looks like:

Morning:

Wake up at the time you'll wake up on exam day
Light breakfast, nothing heavy
Arrive at your study spot ready to start

The Exam:

Block 1: 60 minutes
Break: 6 minutes
Block 2: 60 minutes
Break: 6 minutes
Block 3: 60 minutes
LONGER Break: 15 minutes (restroom + snack + walk)
Block 4: 60 minutes
Break: 6 minutes
Block 5: 60 minutes

Total time: ~6 hours including breaks

After completion:

Take a 4-5 hour break
Do NOT score immediately
Relax, recover, eat

Evening:

Score your exam (count correct answers)
Review your incorrects (more on this in the next blog)

Which NBMEs, In What Order

You have NBMEs 25, 26, 27, 28, 29, 30, 31, 32, 33, and Free 120.

NBME 25: Not a real assessment. Use this for acclimation — do one block per day during your pre-NBME push to get used to the question style. Don't take it as a full exam.

NBME 26-30: Your early assessment NBMEs. Take these first. They're less predictive but good for baseline and building stamina.

NBME 31-33: Save these for your final weeks. They're the most recent, most predictive, and most similar to the real exam. Don't waste them early.

Free 120: Take this 7-8 days before your exam, combined with NBME 31 for a full simulation (4 blocks NBME 31 + 3 blocks Free 120 = 7 blocks, exactly like the real exam).

The Order:

NBME 26 (first full assessment, ~Week 15)
NBME 27
NBME 28
NBME 29
NBME 30
NBME 31
NBME 32
NBME 33 + Free 120 (final simulation, ~7-8 days before exam) (Some students even take NBME 31{2 blocks} + 32{5 blocks} before NBME 33 + Free 120. Free 120 give Offline, so you can listen to Divine's breakdowwn of the free120. Here's the links for offline Free120 and Divine's Free 120 series 1- Free 120 PDF https://www.usmle.org/sites/default/files/2021-10/Step_1_Sample_Items.pdf 2- DIP Step1 Free120 Series : https://divineinterventionpodcasts.com/2025/03/12/dip-ep-580-2025-usmle-step-1-free-120-discussion-part-1-q1-10-super-helpful-for-step-2-and-3/

Interpreting Your Scores

Raw Score Calculation:

Count your correct answers out of 200.

130+ correct (65%+): On track, book exam for 4-5 weeks out
120-129 correct (60-64%): Close, need reinforcement in weak systems
110-119 correct (55-59%): Need significant work, don't book yet
Below 110 (<55%): Something went wrong, reassess your approach

The 68% (136 correct) Mark:

This approximately correlates with a passing score on the real exam.

Your goal: Hit 68% on two consecutive NBMEs with 10-15 minutes remaining per block.

Once you achieve this, you're ready.

What If You're Not Improving?

If you take 2 NBMEs and score below 62% on both, STOP.

Don't waste more NBMEs.

Go back to UWorld. Strengthen your weak systems. Do Mehlman for struggling areas. Do Amboss 200 to find specific weaknesses.

NBMEs are a limited resource (~1,800 questions total across all forms). Don't burn them when you're not ready to improve.

The Mistake That Fails Students

Here's the pattern I see constantly:

Student takes NBME 26 online. Scores 65%. Feels good.

Student takes NBME 27 online. Scores 67%. Feels great.

Student takes NBME 31 online. Scores 70%. Thinks they're ready.

Student walks into real exam. 40 questions per block. Different rhythm. More pressure. Runs out of time repeatedly. Guesses on 5-8 questions per block.

Fails.

The student had the knowledge. They didn't have the timing.

They practiced 50 questions in 75 minutes and expected to perform at 40 questions in 60 minutes. Those are completely different skills.

Don't be this student.

Offline NBMEs. 40 questions per block. 60 minutes. Two-pass method. 10-15 minutes remaining after first pass.

This is how you train for the real thing.

What's Next

You now know how to TAKE NBMEs correctly.

But taking them is only half the battle. Reviewing them correctly is what actually improves your score.

In the next blog, I'll show you:

The same-day review method
The notebook system for NBMEs 26-33
How to stratify mistakes (silly mistakes vs. knowledge deficits)
How to use your incorrects to improve

Then we'll cover:

The 5 biggest mistakes IMGs make
What to do when scores plateau
Exam day strategy

NBMEs are assessments AND learning tools. Let's make sure you're learning from them.

If you want personalized guidance on your NBME performance — someone analyzing your patterns, identifying your weaknesses, keeping you on track — https://meetings-na2.hubspot.com/marish

Your timing starts now.

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