I Failed USMLE Step 1: How to Get Back Up & Excel - Medlearnity (2023)

“I failedUSMLE Step 1.” These are words that you didn’t want to utter. We understand your disappointment. However, we also want you to know that you are not alone. A few hundred students from America’s top medical schools fail the Step 1 exam at every administration. Whether you are an MD or DO student from a U.S. medical school or an IMG, failure on the USMLE exam is not the end of the road. Be confident that you can and will get back up and succeed by improving your Step 1 exam score. However, you need a plan and a strategy to ensure you are on track to pass and conquer USMLE Step 1 this time around with an effective study schedule.

How to Improve USMLE Step 1 Results

Over the last eight years, Medlearnity has helped hundreds of repeat test-takers pass USMLE Step 1 and improve their test scores. We are extremely familiar with the disappointment that you feel. And we also recognize that you have to be focused and strategic in the work you need to do. This will ensure that your next attempt is exactly what you’d like it to be.

Your Immediate Next Steps

First, the technicalities. The passing score for the USMLE Step 1 is 196. The average score in 2018 was 230, with a standard deviation of 19. So what happens if you fail Step 1?

It’s important to reassure yourself that you have more chances to pass afterfailing Step 1. You don’t have to be too hard on yourself. Still, it’s common for people to feel down. If you’re in need of some motivation and encouragement, talk to someone you trust to help restore your drive. Take this first test as a learning opportunity and prepare for your next attempt.

Next, find out what the process is forretaking Step 1and how many times you can attempt theUSMLE Step 1 retake.

I Failed USMLE Step 1: How to Get Back Up & Excel - Medlearnity (1)

Can You Retake The USMLE Step 1?

You can retake USMLE Step 1 up to six times if you’ve failed. You can take Step 1 a maximum of three times withina span of 12 months.

Your fourthattemptand any beyond thatmust be at least 12 months after your first attempt. Also, they must be at least six months after yourthirdattempt. This means that after your first failed attempt, you may retake the exam twice within one year.

If you don’t pass on your third attempt, you will have to wait six months to retake the exam. Your fourth attempt must be more than a year after you first took USMLE Step 1. It’s important to keep these technicalities in mind as you plan your test prep to pass the Step 1 exam on your next attempt.

Can You Retake The USMLE Step 1 Even If You Pass?

If you’ve passed,you cannot retake it except to comply with state board requirements.

Contact Your Medical School

If you’ve failed USMLE Step 1, you should contact your medical school if you haven’t already. Each program has different policies and next steps for students who need to retake Step 1. You might need to meet with an administrator at your medical school. You may also be required to retake and pass your exam by a certain date. We have had many students in this situation. What you need more than anything is asolid plan of attack for your USMLE Step 1 retake.

Below you will find some general testing advice and study tips for your retake. This advice comes straight from expert tutors who have helped students ace their USMLE Step 1 retake, with truly incredible success stories.

How to Prepare for USMLE Step 1

Ready to retake USMLE Step 1? Follow these four steps to help you prepare.

1. Get Over the Emotional Hurdle and Increase Your Confidence

Understandably,you might be disappointed or even embarrassedofthe thought of “I failed USMLE Step 1.” Still, this is not somethingyou should try to keep inside or hide from your family or friends. You should share the news with those close to you. Talking about your situation with loved ones will help you to feel emotionally lighter. It is important to keep your mental health in mind. Your family and friends will help you to keep things in perspective and provide encouragement for the long road ahead.

2. Evaluate What You Did in Your Last Exam Sitting

We don’t want your thoughts to be dominated bythoughts of failure.Take some time to sit down and assesswhat you did to study last time. The best way to get over yourmental blocksis to be brutally honest with yourself. Evaluate the study materials that you used the last time around. Consider whether they fell shortor whether it was your use of them that fell short.

Did you cover enough material? Did you go through all ofUWorld? Also, did you conduct a thorough review of all the questions you got wrong during your prep? Do you understand exactly why you got them wrong? Do you think there was a problemwithyour test-taking skills? Or, did you suffer from test-taking anxiety and the pressure that comes with USMLE Step 1?

This is the most important part of your recovery because it helps you to understand where you may have gone wrong. And half the battle is acknowledging that doing the same thing the second time around isn’t going to work if it didn’t work the first time. Taking ownership of the situation you are inwillhelp you conquer your USMLE Step 1 retake. Success really is within your control—as long as you are honest, forthcomingand willing to be vulnerable.

3. TakeanNBME Self-Assessment Exam

This is the most critical step in getting study prep going again. This assessment will help you to:

  • Have a baseline to assess your progress as you continue studying.
  • Gauge how much time you need to reach your score goal.
  • Assess your weaknesses and show you what areas you need to focus on.

We suggest that you compare this NBME self-assessment score report with your official USMLE score report. You will then see ifany patternsjump out at you. This will be helpful as you decide what subjects and systems to prioritize as you study.

Also, don’t be alarmed if you score 10-15 points lower than you did on your actual exam. By the time you take this assessment, it’s been at least a few weeks since you last sat for USMLE Step 1, so this is to be expected. Nevertheless, taking this initial NBME practice exam will tell you where you stand. You will know what you need to work on going forward as you prep for your retake.

4. Don’t Rush In Without a Solid Plan of Action

Take your time and do not hurry to do your next retake. For the past eight years, we’ve worked with hundreds of medical students who are retaking Step 1 on a second or third attempt. The biggest mistake we have seen is rushing to do the next take without allowing enough time to prepare to achieve the goal score.

We cannot stress this enough. You need to allow yourself the time to learn the right study methods to prepare for this exam. Ensure that you are maximizing your learning and knowledge retention. According to the2018 NBME Administrations Performance Dataon Step 1 repeat test-takers, 67% of U.S.MD, 76% of DO and 41% of International Step 1 repeaters passed the exam.

I Failed USMLE Step 1: How to Get Back Up & Excel - Medlearnity (3)

You need to make sure that you are thoroughly reviewing every question you get wrong so you can recognize knowledge gaps and focus on the most important practice questions. Also, you need to understand exactly why the wrong answers are wrong and why the right answer is right. You need a structured plan of action. This plan means setting realistic goals for yourself every day and sticking to them. Once you can see your plan of action coming into fruition, then you can schedule your new USMLE Step 1 date with confidence.

Once you have scheduled your date, the wheels will start turning even faster. Make sure that you continue to stick to your plan, stay focusedand get tutoring help when you need it. We’ve often had our students tell us how incredibly helpful it is toreview questions with their tutor. A tutorwill tell you exactly where you are going wrong and how to work on targeting your weaknesses so that they don’t hinder you on test day.

When Should I Schedule My USMLE Step 1 Retake?

How much time will you need to prep, you ask? It depends on a lot of what we’ve already said. Once you evaluate what went wrong on your last take, you will probably be able to answer this better.

The most important thing is to assess how much time you need to discover what went wrong in the first place. Do you need help with this? Please reach out,andour team would be happy to helpyou troubleshoot. If you missed a lot of points from content, improving content mastery will be key. On the other hand, if you felt like you knew the core material well, then you have to see why your application of the content fell short.

We believe in an organic process where you attack your weaknesses and reassess your progress. So you should complete anNBME assessment every 1-3 weeks. This is dependent on your anticipated test retake date and residency application timeline. Use these assessments to make sure you are addressing the fundamental issues you need to strengthen your USMLE Step 1 test score.

Things to Consider When Scheduling Your USMLE Step 1 Retake

Below are some guidelines — that are to be used with caution. Choosing your new test date depends on your individual situation and target score, among other factors. We often witness sudden shifts— such as from a 170 to a 200—after addressing core issues with test-taking. So also keep that in mind when considering these guidelines.

1.A Score of 180+

You need an additional 4-5 weeks of dedicated study. Your medical knowledge is solid, but there are some gaping holes. And you need to target them and work through them so that they do not hinder you on exam day.

2.A Score in the 170s

You need about 6-7 weeks of additional dedicated study time. Your score reflects a weak foundation—nothing that can’t be worked on with some solid study time. But, you need to make sure that you aretaking steps towards targeting the right subject areas and systemsand that you have some expert guidance from a tutor pointing you in the right direction. A tutor will help youefficiently cover material that you need to know and retain to succeed on your retake.

3.A Score of 160 or Less

You need 10-12 weeks of dedicated study time. Your score reflects foundational weaknesses in knowledge, and you’llrequire a longer time for you to learn and retain effectively. While you shouldn’t be discouraged—you need to be honest with yourself. You also need to do a serious evaluation of what you need to fixand take it head-on. We strongly recommend that youseek outprofessional tutoring servicesto make sure that you are on the right track.

How Your USMLE Score Matters to Specialties

It’s helpful to look over the NRMP’s data regarding USMLE Step 1 Scores and U.S. MD Seniors to see where your score needs to be to achieve your preferred specialty. Gathering all of the information from this chart and everything you should know before taking theUSMLE Step 1 percentilescan help get you in the right mindset before retaking the test.

See How Medlearnity Can Help YouSucceed in Your Medical Career!

The best thing you can do for yourself at this point is to get tutoring from professionals. These pro tutors will help you create a focused and structured plan of study. You deserve to have a team of expert tutors and doctors on your side. They have seen students go through a similar USMLE Step 1 retake process and helped them succeed.

AMedlearnity tutorcan do the same for you.Our tutors take a personalized approach to identify and improve on weaknesses to make a significant impact.We invite you toreach out to our teamwith any questions you may have. Let us help you ace your USMLE Step 1 exam and excel in your medical career!


How do I study after failing Step 1? ›

What are the next steps after failing Step 1?
  1. Contact your school. ...
  2. Analyze your performance to figure out what went wrong. ...
  3. Ask for help. ...
  4. Solidify your study approach. ...
  5. Make a bulletproof study schedule. ...
  6. Take any and all Self-Assessments you can find.
Sep 22, 2022

Do residencies see if you failed Step 1? ›

What Do Residency Programs Do When You Fail Step 1. I won't sugar-coat it. There are a fair number of programs that will reject an application that has a USMLE fail. That said, many programs will still consider you if you do better on a subsequent attempt.

Why are so many people failing Step 1? ›

It's common for students who fail to try to use every single Step 1 resource available. The level of understanding required for the USMLE is challenging to achieve and will require dedication and plenty of hard work. For example, using flashcards is a great study resource, but creating too many makes it useless.

How much do I need to study for Step 1 pass fail? ›

Most USMLE Step 1 test-takers suggest you should begin studying at least 3 months before the exam to get the best results, but 6 months is optimal.

Is Step 1 harder after pass fail? ›

The passing score for USMLE Step 1 will increase from 194 to 196 on January 26, 2022. Changing from a numerical score to pass/fail result is expected to decrease the pressure and anxiety students have associated with this test. The test itself will not become more difficult.

How do you study when you are failing? ›

Resist the urge to agonize over the test

Fixating on what you think you missed will not help you after the exam is over. Let it go. Focus on moving forward with your day rather than conjecturing how miserably you failed or ruminating over every conceivable ramification of an unsatisfactory test grade.

Can an IMG match after failing Step 1? ›

An non-US IMG who fails step 1 is unlikely to match into a U.S. medical residency training program in any medical specialty. A US IMG might match in an IMG-friendly program, if they completed an elective rotation at that program, and had a few good publications on their CV. It will take extra effort.

Will residencies still look at Step 1 scores? ›

As of January 2022, however, this will no longer be the case. USMLE Step 1 will be graded as pass/fail and will no longer be the primary determinant of one's competitiveness as a residency applicant.

Do residencies see Step 1 score? ›

Until the USMLE® Step 1 changes to pass/fail (earliest in January 2022) is officially in effect, your Step 1 score will carry its previous weight as a deciding factor on your residency application. Step 1 scores are currently used as an objective metric for cutoff into (or out of) certain specialties or programs.

What percentage of people don't pass Step 1? ›

USMLE Step 1 pass rates have decreased since

According to the AMA, 98% of DO and MD students passed the exam on their first try in 2020. In 2022, the USMLE Step 1 pass rate for first-time takers was 93% in the United States.

How many people actually fail Step 1? ›

2022 USMLE Step 1 Overview

Allopathic students' passing rate dropped from 95% in 2021 to 91% in 2022. DO students' passing rate dropped from 94% in 2021 to 89% in 2022. IMG students' passing rate dropped from 82% in 2021 to 74% in 2022.

Is Step 1 the hardest exam ever? ›

Traditionally, Step 1 has been thought of as both the most difficult and most important USMLE Step exam. There are several reasons for this. Firstly, this exam is the first in the series, and students taking it will have had less experience with the types of questions that the USMLE asks.

Can you pass Step 1 with UWorld only? ›

Is UWorld Enough to Pass Step 1? UWorld alone is not enough. You should use UWorld along with these tips to effectively prepare for Step 1: Combine UWorld with other resources, such as First Aid and NBME self-assessments.

Is 60% enough to pass Step 1? ›

The percentages of correctly answered items required to pass varies by Step and from form to form within each Step. However, examinees typically must answer approximately 60 percent of items correctly to achieve a passing score.

What happens if you fail Step 1 4 times? ›

The total number of attempts allowed per Step is four (4). Examinees who have attempted any USMLE Step (including Step 2 CS) four or more times and have not passed are ineligible to apply for USMLE Steps.

How bad is failing Step 1? ›

Failing Step 1 will impact a student's application strategy, but it doesn't usually mean their pathway to becoming a physician is over. These students may want to consider additional specialties where they will be more competitive and should speak with their advisors about their individual circumstances.

How will pass-fail Step 1 affect residency? ›

Any impact on residency selection has yet to bear fruit. Students typically take the exam up to three years before applying to residency, so a cohort of applicants with pass-fail outcomes has yet to go through the process of applying to programs.

What percentage is 196 on Step 1? ›

Assuming Step 1 is scored similarly to CBSSA 25-30, you would need somewhere between 63 to 65% correct to attain the passing score of 196.

Why do I study so much but still fail? ›

The problem: You procrastinate studying, not leaving yourself enough time to absorb the material before test day. The solution: Create a routine that involves reviewing your notes regularly. Each night, take a few minutes to go over your notes from class.

How do you bounce back from failure? ›

4 ways to bounce back stronger after a setback
  1. Take a deep breath. Everything will be okay. ...
  2. Evaluate and identify what caused the failure. Before you can dust yourself off and try again, you need to take some time to identify the causes of your failure. ...
  3. Create a plan. ...
  4. Take advantage of the resources available to you.
Oct 31, 2022

How do you recover from a failed exam? ›

Failed an Exam? 5 Essential Steps to Take
  1. Don't Panic. If you've always done well in school — or even if you haven't — a failing grade can come as a shock. ...
  2. Carefully Review Your Exam. When I failed my chemistry exam, I barely looked at the test. ...
  3. Make a Plan. ...
  4. Go to Office Hours. ...
  5. Prepare for the Next Exam.

What is the average Step 1 IMG? ›

IMGs: Average Step 1 Scores by Specialty (2022 Match)
Step 1, US IMG (Matched)Step 1, Non-US IMG (Matched)
Internal Medicine225238
Internal Medicine/Pediatrics220230
Interventional Radiology261250
Neurological SurgeryN/A246
18 more rows

Is 6 months enough for Step 1 IMG? ›

For IMGs who have just completed second year of medical school, 4-6 weeks of dedicated preparation time will be enough. However, for those who start late, 4-6 months of dedicated preparation will allow them to do well on the exam.

What happens if you fail Step 1 3 times? ›

If you fail the exam on your first try, you can take it again two more times within one year. However, if you do not pass on your third try, you must wait at least six months before attempting it again. Additionally, if you want to make a fourth attempt, it must be at least 12 months after your initial try.

How do I get residency with low USMLE scores? ›

Strategies & Suggestions
  1. Pick medical specialties that are more flexible about low USMLE scores such as Psychiatry or Family Medicine.
  2. Research residency programs carefully to ensure you qualify for their minimum passing score requirements.
  3. Consider taking the USMLE Step 3.
  4. Try to score higher on subsequent exams.

Does Step 1 scores matter anymore? ›

In late January, the influential Step 1 of the United States Medical Licensing Examination (USMLE) changed from numerical to pass-fail scoring. Program sponsors wanted to shift the emphasis away numeric scores but preserve the exam for determining physician licensure eligibility.

What is the average Step 1 score for a dermatologist? ›

According to the 2022 NRMP Charting Outcomes in the Match report, the top 5 specialties with the highest Step 1 score were plastic surgery in first with an average score of 251, followed by ENT in second at 250, and dermatology, neurosurgery, and orthopedic surgery tied for third at a score of 248.

Do residencies see shelf scores? ›

While your NBME Shelf Exam scores are not directly reported to residency programs, they can still impact your application. Some medical schools use Shelf Exam scores to calculate class rank or determine honors designations, which can influence your residency application.

Is the Step 1 exam curved? ›

Note that the USMLE examination is not scored “on a curve”. Students are not scored against each other, but relative to a per-set annual standard. This standard is constant for the year. Both US medical students and IMGs are scored using the same standard.

How many questions can you miss on Step 1? ›

Remember, there are 200 scored items on Step 1. But you have to answer 60% of them correctly to pass. That's 120/200. That leaves only 80 questions left to assign scores across the rest of the passing range.

How many questions on Step 1 are not graded? ›

Remember, there are 200 scored items on Step 1. But you have to answer 60% of them correctly to pass. That's 120/200. That leaves only 80 questions left to assign scores across the rest of the passing range.

How do I make sure I pass Step 1? ›

How to Pass USMLE Step 1
  1. Understand the Exam Content. ...
  2. Develop a Process to Answer Questions. ...
  3. Download Study Material. ...
  4. Consider Taking a Practice Session. ...
  5. Take an Online Self-Assessment. ...
  6. Enroll in a Review Course. ...
  7. Utilize the Resources Offered By Your Medical School. ...
  8. Be Familiar With the Format Changes.

Can you pass Step 1 in 4 weeks? ›

With a 4-week USMLE Step 1 study schedule, you will have enough time to complete a substantial study block, but as the saying goes, preparation is 90% of the outcome. Here's how you can develop a 4-week Step 1 schedule to ace your exam.

Which NBME is most predictive for Step 1 2023? ›

Based on informal student reporting, NBME 28 and UWSA 2 are the most correlated with Step 1 performance. Given this information, it might be a good idea to take these two exams when you are further along in your dedicated study and closer to your actual test day.

Which is the toughest exam in the world for medical students? ›

United States Medical Licensing Examination

A pass in USMLE is a must if one has to practise medicine in USA. USMLE (United States Medical Licensing Examination) is said to be a very tough test. No wonder it is considered one of the top 20 toughest exams in world.

What is world's toughest exam? ›

1. Gaokao. The Gaokao is a college admission exam in China that is famed for being one of the top ten most difficult exams in the world. Due to the difficulty of the exam, some European and American colleges have begun to accept Gaokao marks.

Is 60% on UWorld bad? ›

58-60% is OK, a good sign is being consistently above the average scores. The Uworld package I bought came with 2 assessment exams.

What is the minimum UWorld score to pass Step 1? ›

The current minimum score to pass Step 1 is 196, so if you pass, you at least scored 196 or higher.

How many questions a day should I do on UWorld? ›

If you're making/doing excellent Anki cards, you might top out at doing 80-120 questions/day. However, while you will find people who (productively) do more than 120 UWorld questions in a day, they are often not doing Anki.

What score is 50% on Step 1? ›

Until the scoring system for Step 1 changes to Pass/Fail, the scores on Step 1 can be interpreted based on historical percentiles. While 194 represents the 5th percentile, the average (50th percentile) falls between 230 and 235. Scores at or just above the mean are good scores!

What is a 70% on Step 1? ›

Subject Examination Scores

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.

How can I improve my Step 1 score in 2 weeks? ›

Improve Your USMLE Step 1 Performance in 2 Weeks
  1. Plan. It is crucial to simulate the testing environment as closely as possible in these last two weeks. ...
  2. Prioritize. We've all heard it: Work smarter, not harder. ...
  3. Test yourself. ...
  4. Review. ...
  5. Take Care of Yourself. ...
  6. Relax. ...
  7. Believe in yourself!

What percentage of people fail Step 1? ›

2022 USMLE Step 1 Overview

In 2021, 88% of test-takers passed; in 2022, just 82% passed. Additionally, Allopathic students' passing rate dropped from 95% in 2021 to 91% in 2022. DO students' passing rate dropped from 94% in 2021 to 89% in 2022.

What happens if you barely pass Step 1? ›

You can retake USMLE Step 1 up to six times if you've failed. You can take Step 1 a maximum of three times within a span of 12 months. Your fourth attempt and any beyond that must be at least 12 months after your first attempt. Also, they must be at least six months after your third attempt.

Is Step 1 as tricky as UWorld? ›

The frequently updated content ensures you learn and master the most relevant material that helps confront your individual USMLE Step 1 strengths and weaknesses. UWorld may be harder than Step 1, with some questions above the actual test's difficulty level.

What is the lowest Step 1 score possible? ›

The current minimum passing score for Step 1 is a 194. The score you might want to get, however, could be somewhere between 238 or as high as 251, depending on the competitiveness of your desired specialty.

How many questions can you miss on Step 1 and still pass? ›

Remember, there are 200 scored items on Step 1. But you have to answer 60% of them correctly to pass. That's 120/200. That leaves only 80 questions left to assign scores across the rest of the passing range.

How will pass fail Step 1 affect residency? ›

Any impact on residency selection has yet to bear fruit. Students typically take the exam up to three years before applying to residency, so a cohort of applicants with pass-fail outcomes has yet to go through the process of applying to programs.

How to pass Step 1 in 2 weeks? ›

Improve Your USMLE Step 1 Performance in 2 Weeks
  1. Plan. It is crucial to simulate the testing environment as closely as possible in these last two weeks. ...
  2. Prioritize. We've all heard it: Work smarter, not harder. ...
  3. Test yourself. ...
  4. Review. ...
  5. Take Care of Yourself. ...
  6. Relax. ...
  7. Believe in yourself!

What year did Step 1 become pass fail? ›

On January 26, 2022, USMLE Step 1 score reporting shifted from a three-digit score to a simple pass-fail. The intent behind the change was to address concerns about student well-being and to promote the evaluations of students for residency programs in a more holistic way.


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