I Failed USMLE Step 1: How to Get Back Up and Excel

“I failed USMLE 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 a MD or DO student from a US 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. However, you need a plan and a strategy to ensure that you are on track to pass AND conquer USMLE Step 1 this time around.

How to Improve USMLE Step 1 Results

Over the last eight years, Medlearnity has helped hundreds of repeat test-takers on USMLE Step 1. We are extremely familiar with the disappointment that you feel. But, we also recognize that you have to be focused and strategic in the work that 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 194. The average score in 2018 was 230 with a standard deviation of 19.

Can You Retake The USMLE Step 1?

You can retake USMLE Step 1 up to six times if you’ve failed. If you’ve passed you cannot retake it except to comply with state board requirements. You can take Step 1 a maximum of three times within a 12-month period. 

Your fourth and subsequent attempts must be at least 12 months after your first attempt. Also, they must be at least six months after your most recent attempt. 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.

Contact Your Medical School

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 a SOLID PLAN OF ATTACK for your USMLE Step 1 retake.

Below is some general testing advice 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

1. Get Over the Emotional Hurdle and Increase Your Confidence

It is understandable that you might be disappointed or even embarrassed the thought of “I failed USMLE Step 1”. But, this is not something that you 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. 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 by: “I failed USMLE Step 1”. Take some time to actually sit down and assess EXACTLY what you did to study last time. The best way to get over your “I failed USMLE Step 1” frame of mind is to be brutally honest with yourself. Evaluate the study materials that you used the last time around. Consider whether they fell short, or whether it was your use of them that fell short.

Did you cover enough material? Did you go through all of UWorld? 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 problem in your 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 in is going to help you conquer your USMLE Step 1 retake. Success really is within your control – as long as you are honest, forthcoming, and willing to be vulnerable.

3. Take a NBME Self-Assessment Exam

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

  1. Have a baseline to assess your progress as you continue studying;
  2. Gauge how much time you need to reach your score goal;
  3. 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 if there are any patterns that jump 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 self-assessment 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.

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 the 2018 NBME Administrations Performance Data on Step 1 repeat test-takers: 67% of US MD, 73% of DO and 44% of International Step 1 repeaters passed the exam.

You need to make sure that you are thoroughly reviewing every question you get wrong. 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 real 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. But, make sure that you continue to stick to your plan, stay focused, and get tutoring help when you need it. We’ve often had our students tell us how incredibly helpful it is to review questions with their tutor. A tutor will 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 and our team would be happy to help you 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 an NBME 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.

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 (i.e. from a 170 to a 200) after addressing core issues with test-taking. So also keep that in mind when considering these guidelines.

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.

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 are making steps towards targeting the right subject areas and systems, and that you have some expert guidance from a tutor pointing you in the right direction. A tutor will help you to efficiently cover material that you need to know and retain to succeed on your retake.

A Score of 160 or Less

You need 10-12 weeks of dedicated study time. Your score reflects foundational weaknesses in knowledge. This requires 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 fix – and take it head on. We strongly recommend that you seek out professional tutoring services to make sure that you are on the right track.

You Can Still Succeed in Your Medical Career!

Now you have a new take on: “I failed USMLE Step 1”. 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. A Medlearnity tutor can do the same for you. We invite you to reach out to our team with any questions you may have. Let us help you ace your USMLE Step 1 exam and excel in your medical career!

About the author 

Akshay Goel MD

Dr. Goel is a body-trained radiologist and an expert in medical education and imaging informatics. He completed his Radiology Residency at Columbia University Medical Center and his fellowship at Weill Cornell Medicine. Dr. Goel has guided several students and doctors into successful careers over the past decade. He continues to help Medlearnity tutors optimize their educational methodology to drive the highest tutoring and admissions impact possible.

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