Free USMLE Step 1 Questions

No matter how much money you spend on books, every medical student needs to do a ton of practice questions for the USMLE Step 1. Questions are an excellent way to learn the useful tip-offs and keywords, and—depending on the source—get a better feel for the board format. They’re also a form of active learning, unlike trying to self-induce a coma with the universally-utilized First Aid for the USMLE Step 1. I believe USMLEWorld is the best question bank out there—despite its draconian efforts to prevent IP theft—and there is no free source out there that matches it (especially for the final marathon push before the big day). That said, there are other ways to study, especially during the basic science years.

For question books, post-Step MS3s and your local Half-Price Books are always good resources to buy study materials on the cheap. But free is better, and the internet is undeniably convenient and portable. I scoured the web to find free question banks online (updated May 2018):

  • The NBME offers its own small set of free practice materials for the Steps 1, 2, and 3. You see the most recent set here, which includes a browser-based software version that mirrors the actual program Step uses (Fred V2), a tutorial, and 100+ question practice test. A must do. A pdf file is also available from the above link, which contains the same questions for your offline viewing pleasure. I’ve written answers/explanations to the past several sets, which are linked here.
  • Pastest is a 2300 question commercial qbank that happens to be temporarily free as they polish their product.
  • WikiDoc has a 696 question board-style USMLE Step 1 qbank. Robust, very nice. Qbank appearance approximates the USMLE Fred software. Totally free but requires a login.
  • Lecturio has a free 400 100 question USMLE question bank in clinical vignette format with explanations organized by subject (you can “unlock” additional questions on a per-month basis). No registration required. If you’re interested in buying their video lecture/qbank product, you can get a 25% discount through this link.
  • MedBullets has a 1000+ question Step 1 qbank in clinical vignette style. Registration required, pretty robust software (tutor mode, tracks prior questions, etc).
  • USMLE Sapphire is a free online qbank (registration required), currently with 520 questions. Style is more concise/abbreviated/clinical-flashcardy than the real clinical vignettes and the software handles the explanations in an annoying way, but the site keeps your test history, lets you review prior answers (no tutor mode), and pick questions based on subject and body system. Some of the bits I saw were a bit obscure, particularly given its size.
  • Osmosis is a completely free big (>5000 question) qbank and video product. Many questions are more on the Step 2 side of things, but an impressive collection nonetheless.
  • USMLEQuickPrep is a large (~4500 questions) and entirely free qbank. It’s the largest and most exhaustive free source out there. The questions are a mixed-bag, and not all are in Step-style, but most have explanations, the site isn’t too clunky, and it certainly stands out for its sheer volume. [site is down again]
  • Lippincott’s 350-Question Practice Test for USMLE Step 1 is solid, but you must register (for free) before using it. [now defunct]
  • MedMaster (makers of the “made ridiculously simple” series) has a USMLE Step 1 qbank (among others). The questions are not step-style but rather content review. It’s a good foundational accompaniment to book learning, as it clearly highlights key facts and distinctions that are crucial for the Step 1, but it does not prepare you for the exam proper. There are also no puns or goofy diagrams like the book series.
  • Test Prep Review has a USMLE practice self-assessment section. There are 20 modules of 20 questions for 400 questions. They’re mainly fact-recall and not vignette-based, but it’s easy to use and accessible.
  • Wiki Test Prep [now defunct, but with questions available as a pdf for download] is was a student-written qbank with over 900 questions with explanations. The site is great, and you can browse questions by keyword, flag questions, and create your own tests. It also lets you know what percentage of students answer the question correctly, which is interesting. The questions are in clinical-vignette board format.
  • MDLexicon has a bunch of vignette questions organized by category, it’s hard to tell exactly how many. The site design is bit odd, but it works.
  • 4tests.com hosts an old 60 question Kaplan diagnostic exam. Answers can be exposed during the test if desired and do contain explanations. (Mom MD also has the identical sampler, only organized in six 10-question pages with answers directly below questions)
  • ValueMD has a large question bank divided up by subject. The site also requires a free registration. The questions are straightforward fact-recall type and the site itself is clunky and hideous, but it’s still decent review.
  • Kaplan lets you try one 48-question section for free after signing up.
  • Learntheheart.com has 50 cardiology USMLE Step 1 questions, with plans to add more.

Enjoy. I can’t vouch for the quality of these resources, but WikiDoc, Lecturio, MedBullets, Sapphire, and Wiki Test Prep together are about 3500 questions, bigger than UW (though assuredly with lots of overlap between sources). Osmosis, a new free player, adds in a lot as well. Add in the past few years of official practice questions (the “Free 150”) and you’ve got even more.

There are also several free questions sources for the MRCP (The UK’s version of the Step), for which this is considerable overlap:

(For more information on how I personally would recommend studying, feel free to peruse my post: How to Approach the USMLE Step 1. You can also find my compilation of free study resources for the basic sciences here.)

NBME Shelf Exam scores, with a grain of salt

The NBME Shelf exams are enjoyable standardized tests that every first year looks forward to with almost unbearable glee. Each tests a single subject (“Anatomy”) and is (for the preclinical years)  made up from the old or junior varsity questions from the USMLE Step 1, a test that makes the MCAT look like the GRE and the SAT look like building with Lincoln logs.

Some schools force their students to take a variety of Shelf exams (spending/wasting $30 a pop) to help measure how well their students have mastered the material (AKA how they are doing compared to their national counterparts). What is a bit amusing and misleading about the whole ordeal is that the national norms are probably a big crock.

Different schools use the “shelves” differently. Some use them as a just-for-fun intellectual exercise, others as extra-credit, and still others as a true final exam. Don’t get me wrong, it’s not a bad thing to get some USMLE Step 1 experience, but it’s highly dependent on the environment: if you take five shelf exams in a single week, you are clearly not going to be prepared or even particularly focused. If it’s your final exam, you are going to do your best to rock it.

So if the national average is computed from all of these groups together, then it’s going to have a huge unseen left tail: if people are taking the exam who don’t care how they perform, they’re going to be dragging the average down from where it would otherwise be. So while the test is technically normalized, it’s not the same normal as a regular standardized test: Unlike the MCAT, not every student has something riding on the exam. I personally knew people who filled out all C’s on an exam that was for extra-credit only.

While your school receives the group’s average and your grade relative to your test group (classmates), the theoretically more interesting numbers a student receives are the grade based on the national average and corresponding percentile. I’m curious as to how far off the scores really are. If all those people who weren’t making a good faith effort actually tried (as they do on the USMLE Steps 1, 2, 3), then I’d wager it’d be a different ball game. It’s essentially an unstandardized standardized test.

Further reading: How NBME Shelf Scores Work