What to Do When Your USMLE Step 1 NBME Score Plateaus (Break Through the Plateau)
- Marish Asudani
- Jan 19
- 8 min read
You've done everything right.
You completed First Aid with UWorld. You took NBMEs offline with 40 questions per block. You reviewed your incorrects same-day. You built your notebook.
NBME 26: 62% NBME 27: 63% NBME 28: 62% NBME 29: 64%
You're stuck.
Four NBMEs. Same range. No breakthrough. The 68% passing threshold feels impossible to reach.
This is a plateau. And it's one of the most frustrating experiences in Step 1 preparation.
You're doing the work. You're putting in the hours. But the number won't move.
Here's the truth: plateaus happen. They're normal. They don't mean you're failing. They mean you need a different approach.
If you keep doing exactly what you've been doing, you'll keep getting exactly what you've been getting. Something needs to change.
Here's exactly what to do.
First: Diagnose the Problem
Before you try solutions, you need to understand WHY you're plateaued.
Open your NBME review notebook. Look at your incorrects across the last 3-4 NBMEs.
Question 1: Are you making the same mistakes repeatedly?
Look for patterns. Are you getting Cardiology wrong on every NBME? Missing the same pharmacology concepts? Struggling with the same biostat question types?
If yes → You have specific knowledge gaps that aren't closing. You need targeted content review for those specific areas.
Question 2: Are you making silly mistakes or knowledge deficits?
Count them across your recent NBMEs.
If 60%+ are silly mistakes → Your knowledge is fine. Your test-taking is the problem. You're rushing, misreading, making careless errors.
If 60%+ are knowledge deficits → Your test-taking is fine. Your content foundation needs strengthening.
Question 3: Are you running out of time?
If you're finishing with less than 5 minutes remaining per block, timing is killing your score. You're rushing through questions, making errors, and not having time for second-pass review.
Question 4: Are your weak systems the same or changing?
If the same 2-3 systems are always your weakest → Those systems need intensive, focused review.
If different systems are weak each time → Your overall foundation is shaky. You need broader reinforcement.
Diagnose first. Then apply the right solution.
Solution 1: Mehlman Medical Videos
When to use: When specific systems are consistently weak (below 60% on related NBME questions)
What it is: Dr. Mehlman's video series covers high-yield content in a unique, memorable way. His teaching style is different from First Aid or UWorld, which means concepts that didn't stick before might click now.
How to use it:
Identify your 2-3 weakest systems from NBME analysis
Watch all Mehlman videos for those systems
Take notes only on things that are NEW to you or explained differently
After each video, find those concepts in First Aid and highlight
Do 20-40 UWorld questions for that system to reinforce
Expected result: Concepts that were fuzzy become clear. Different teaching angles create new neural pathways. Those systems stop being your weakest.
Time investment: 2-3 days of focused Mehlman for 2-3 systems
Solution 2: Divine Intervention Podcast
When to use: When you need high-yield reinforcement across multiple topics, especially close to your exam
What it is: Divine Intervention is a podcast by a physician who breaks down high-yield concepts in digestible episodes. It's particularly good for topics that appear repeatedly on exams.
How to use it:
Identify topics you're consistently missing
Search Divine Intervention for those specific topics
Listen during commute, workout, or downtime
After each episode, find the concepts in First Aid and review
Divine's Rapid Review Free 120 series is essential after you take Free 120
Expected result: High-yield concepts get reinforced through a different medium. Passive learning during downtime adds to your active study.
Time investment: 30-60 minutes daily during activities you're already doing
Solution 3: Neil Randy Videos
When to use: When specific concepts aren't clicking despite multiple exposures
What it is: Neil Randy creates concise, focused videos on specific USMLE topics. When a concept just won't stick, a different explanation often makes it click.
How to use it:
Identify specific concepts (not whole systems) that you keep getting wrong
Search Neil Randy for those exact topics
Watch the video, then immediately do 5-10 UWorld questions on that topic
Highlight relevant First Aid sections
Expected result: That one concept that's been killing you finally makes sense.
Time investment: 15-30 minutes per concept, as needed
Solution 4: Amboss 200 Questions Asked in Every Step Exam
When to use: When you can't identify specific weak areas — you're just generally stuck
What it is: Amboss has curated 200 questions representing the most commonly tested concepts across all Step exams. After completing them, Amboss analyzes your performance and identifies specific subtopic weaknesses.
How to use it:
Go to Amboss → Study Plans → High Yield Exam Prep → 200 Questions
Complete all questions (can be done over several days)
After completion, go to Analysis
Amboss will show you exactly which subtopics are weak
Go to Amboss Qbank and do questions for those specific weak subtopics
Cross-reference with First Aid and highlight
Expected result: You discover specific weaknesses you didn't know existed. Targeted practice closes those gaps.
Time investment: 3-5 days to complete 200 questions + targeted follow-up
Solution 5: Amboss Risk Factors
When to use: Closer to your exam, when you need rapid high-yield review
What it is: Amboss has a dedicated section on risk factors — which conditions are associated with which risk factors. This is frequently tested and often missed.
How to use it:
Go to Amboss → Study Plans → Risk Factors
Work through the module systematically
Make a one-page cheat sheet of risk factors you keep forgetting
Review this sheet daily in your final 2 weeks
Expected result: Risk factor questions become free points instead of missed opportunities.
Time investment: 1-2 days for initial completion, then daily 10-minute review
Solution 6: Amboss 5 Questions Per Day
When to use: 30 days before your exam
What it is: Amboss sends you 5 high-yield questions daily. Over 30 days, that's 150 questions covering the most important concepts.
How to use it:
Enable the 5 Questions/Day feature 30 days before your exam
Do them every single day without exception
Review incorrects immediately
Find concepts in First Aid and highlight
Expected result: 150 super high-yield questions keep you sharp and fill small gaps in the final stretch.
Time investment: 15-20 minutes daily
Solution 7: Your NBME Notebook (Intensive Review)
When to use: When you've been building the notebook but not truly learning from it
What it is: Your notebook contains every concept you've gotten wrong across NBMEs 26-33. This is your personalized weakness map.
How to use it:
Instead of just reading your notebook before NBMEs, do intensive review:
Take each notebook entry
Find that concept in First Aid
Read the entire First Aid section around that concept (context helps retention)
Do 5 UWorld questions related to that topic
Only move to the next entry after you feel solid
Expected result: Concepts you've gotten wrong 3+ times finally stick because you're actively engaging, not passively reading.
Time investment: 2-3 hours daily for 4-5 days
Solution 8: UWorld Incorrects Round 2
When to use: When you've completed first pass of UWorld but scores aren't improving
What it is: Going back through your marked/incorrect UWorld questions, but strategically.
How to use it:
Filter UWorld to show only Incorrect questions
Filter by your weakest systems (from NBME analysis)
Do these questions in tutor mode
For each question, don't just remember the answer — understand WHY
Highlight any new First Aid connections
Expected result: Concepts you missed before get second exposure. Patterns become clearer. Gaps close.
Time investment: 40-50 questions daily for 5-7 days
Solution 9: Biostats and Ethics Intensive
When to use: When you're consistently losing 5-10 questions per NBME to biostats and ethics
What it is: Many students neglect biostats and ethics, losing easy points. A focused intensive can turn these into strengths.
How to use it:
Expected result: Biostats and ethics become reliable points instead of consistent losses. Easy 5-8 point improvement.
Time investment: 2-3 days of focused work
Solution 10: Reach Out for Help
When to use: When you've tried everything and you're still stuck
Here's the truth: some plateaus need external perspective.
You're too close to your own preparation. You can't see your blind spots. You don't know what you don't know.
A mentor who has seen hundreds of students can diagnose your specific problem in one conversation. They can see patterns you can't see. They can prescribe solutions you haven't considered.
If you've genuinely tried the solutions above and you're still stuck after 2-3 weeks, it's time to get help.
I offer free consultations specifically for this. Let me look at your situation, analyze your NBME patterns, and tell you exactly what's wrong and how to fix it.
No matter what your situation is, there is always a solution. I have never encountered a student whose plateau couldn't be broken with the right approach.
[Book a free consultation with P2A Consultancy]
What NOT to Do During a Plateau
Don't panic and take more NBMEs rapidly.
If you take NBME 28, 29, and 30 in one week hoping something changes, you're just burning questions. Space them out. Review properly. Apply solutions between them.
Don't abandon your system and try something completely new.
Plateaus don't mean your system is wrong. They mean you need targeted adjustments. Don't throw away 12 weeks of work to start over with a Reddit stranger's advice.
Don't convince yourself you're "just bad at tests."
Test-taking is a skill. Skills can be improved. If you're making silly mistakes, that's fixable. If you have knowledge gaps, those are fillable. There's no such thing as being inherently bad at tests.
Don't keep doing exactly what you've been doing.
Einstein's definition of insanity: doing the same thing and expecting different results. If you're plateaued, something needs to change. Pick a solution from above and implement it.
Don't push your exam hoping the plateau magically breaks.
Booking an exam date when you're stuck at 62% and hoping you'll somehow hit 68% by test day is gambling with your career. Break the plateau first, then book.
The Plateau-Breaking Protocol
Here's a concrete 2-week protocol if you're plateaued:
Days 1-2: Diagnosis
Analyze all recent NBME incorrects
Categorize silly mistakes vs. knowledge deficits
Identify top 3 weak systems
Identify any recurring specific concepts
Days 3-7: Targeted Attack
Mehlman videos for weak systems
UWorld incorrects for weak systems
Amboss 200 to find hidden weaknesses
Biostats/Ethics intensive if those are costing points
Days 8-9: Consolidation
Intensive notebook review
First Aid review of newly highlighted sections
Divine Intervention for high-yield reinforcement
Day 10: Assessment
Take next NBME (offline, 40 questions per block)
See if score improved
Days 11-14: Adjust and Continue
If improved → continue with new approach
If still stuck → reach out for personalized help
Two weeks of focused, diagnostic work beats two months of blind repetition.
The Mindset Shift
Plateaus feel like failure. They're not.
Plateaus are information. They're telling you something specific about your preparation. Your job is to listen and respond.
Every student I've mentored who eventually passed went through at least one plateau. The ones who passed quickly diagnosed the problem and applied solutions. The ones who struggled longer either ignored the plateau or panicked and made bad decisions.
You will break through. The question is whether it takes 2 weeks of smart work or 2 months of frustrated repetition.
Choose the smart path.
What's Next
You now know how to diagnose and break through plateaus.
The final piece of the puzzle: exam day itself.
In the next blog, I'll give you the complete exam day strategy — from 2 days before, to the morning of, to what to eat and drink during breaks, to the mindset that carries you through 7 hours of testing.
This is where all your preparation comes together. Let's make sure you execute when it matters most.
If you're currently plateaued and want personalized guidance on breaking through —
https://meetings-na2.hubspot.com/marish
Your breakthrough is waiting. Let's find it.
Dr. Marish Asudani Co-Founder, P2A Consultancy PGY-1 Internal Medicine | USMLE Mentor
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