The Mini Step 1

For around $35 a pop, your medical school can pay the NBME to let you and your classmates take the Mini Step 1 (“Comprehensive Basic Science Examination”), a 200 question multi-subject basic science test. The grading and its relationship to Step 1, according to the NBME:

The subject examination score is [was originally] scaled to a mean of 70 and a standard deviation of 8. A CBSE score of 70 is approximately equivalent to a score of 200 on the United States Medical Licensing Examination® (USMLE®) Step 1. The vast majority of scores range from 45 to 95, and although the scores have the “look and feel” of percent-correct scores, they are not…For this examination, the SEM [standard error of measurement] is approximately 3 points.

However, according the sample score report, the following is the scoring breakdown using the scores from 2008-11 (mean of 64; std 10 on the CBSE score scale):

 

CBSE Score Percentile Step 1 Equivalent
54 (or less) 18 160
62 50 180
70 77 200
78 92 220
86 98 240
94 (and above) 99 260

 

So it’s hard. Without doing any Step preparation (outside of attending to the usual coursework), I felt absolutely confident on only a handful of questions.

That said, and perhaps it’s just an extra year of medical school talking, the questions seem more doable and slightly less minutia-dependent than those found on the NBME Shelf subject exams. On this run, for example, the demanded anatomy is fairly basic—reserved for the highest yield topics like major artery and nerve distributions & common injuries and syndromes—especially compared to the anatomy shelf I “took” last year. While I assuredly failed this exam with soaring colors, it seems slightly less intimidating then before (edit: I did not fail. Goes to show that taking a lot of board-style questions in a row feels worse than it actually is). Still frightening, quiver-in-your-boots hard, but potentially doable. For most topics, it’s breadth, not depth. Only for key topics (basic metabolism, common bacterial and viral pathogens, big-name diseases like CF, CAD, MI, DM, Crohn’s, Addison’s, etc) is minute detail demanded.

For the question style itself, I was surprised overall with the frequency of first-order questions and the amount of useless writing. If you read Kaplan style questions too much, you see a lot of long vignettes with this scenario:

Long-winded clinical presentation of  Strep throat (without identification). The question might ask, what should the patient’s physician ask before administering the therapy of choice? As we use Penicillin for Strep, we need to ask about a Penicillin allergy.

The ID of the bug is a first-order question. The drug of choice is a second-order question. The common adverse side effect of the drug of choice is yet a third-order question. On the Mini Step, most questions were actually first-order questions. Third order was much much rarer. Most frequently—and annoyingly—the long vignettes end with a diagnosis or ID, thereby negating the need to read the vignette at all! My advice: if you’re the type to run short on time, read the last sentence or two before reading the whole vignette. My other piece of advice is that you shouldn’t let Kaplan or other sample tests scare the crap out of you. They pick the most ridiculous questions they can find in order to frighten you into buying their product.

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