Failing USMLE Step 1: What to Do

Elite Medical Prep
  • Jul 11
  • 14 min

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Failed USMLE Step 1? Next Steps

What if I don’t pass the step 1?

When should I get a USMLE tutoring help?

These are the questions that most medical students contemplate at some point in the months (or years) before their USMLE Step 1 test day finally arrives. Maybe you’re someone stressing about failing, or maybe you’re someone who didn’t pass on their first try– but either way, you are definitely not alone. According to the official statistics from the USMLE website, 96% of test takers typically pass in a given year on their first try at Step 1. If you’re someone who hasn’t taken the exam yet, that is a pretty reassuring statistic. If you’re someone who falls within that 4% and didn’t pass on your first try, you should know that each year over 20,000 people take USMLE Step 1. That means even within that 4%, you are certainly not alone. In fact, there are at least 800 other students in your exact same situation. So, what do you do?

First, take a deep breath. While there’s no getting around the reality that the USMLE is an enormously consequential set of exams, it’s not the be-all and end-all of your medical existence. The USMLE Step 1 isn’t intended to be an ultimate judgement on your ability to be an effective physician. Simply, the USMLE is a standardized test and does what all other standardized tests are intended to do, create and hold students to a standard of knowledge. For medical students and the USMLE, said “standard of knowledge” tends to be quite high. This being said, every year students and medical graduates fail the exam for a multitude of reasons. In many cases, these students re-group and eventually go on to pass and have rewarding careers. In fact, there are many, many, stories you can find across the internet of highly successful doctors that didn’t pass the USMLE on their first attempt. 

If you are someone that didn’t pass on their first try, take time to recognize your feelings and understand that an element of emotional release is in order. Chances are that you likely committed a great deal of time and energy to the process of preparing for USMLE Step 1. Maybe you prepared effectively but your mind was elsewhere when it came time to sit for the test, maybe you thought you knew a couple topics better than you actually did, maybe you spent months studying overly specific information that wasn’t high yield, the list goes on. However, one thing remains constant. Waiting those three to four long, anxious weeks between test day and score release day, only to be confronted by a failing score, is devastating. The first step to bouncing back from that intense disappointment is understanding that this is neither a permanent defeat nor a reason to be despondent. Allow yourself some time to release these negative feelings and then get motivated to try again. 

*If you have recently failed USMLE Step 1 and need help understanding where you went wrong, we can help. Should you need it, our USMLE tutors are also available for emotional support, planning, and coaching to help get you moving in the right direction after a failed exam.

USMLE Step 1 – Study Strategy and Schedule

After you’ve put to rest all the often complicated and negative feelings that surround a failed Step 1 exam, it’s time to put a plan in place. Do you have a definitive date that you must retake Step 1 by, or do you have flexibility in selecting a retake date? Will you have dedicated study time until retaking the exam, and if not, how busy will you be with other commitments? How many hours can you realistically dedicate toward studying? If you’re a current medical student, you’re likely already in contact with medical school administrators. They may lay out many of the parameters regarding time off and your retake timeline and can also be a good resource in terms of suggestions about preparing and what other students in similar situations have done. 

We want to note here however that some students need more help than others and USMLE prep for a retake is definitely not one size fits all. While many schools like to recommend a Step 1 prep class or online independent learning portal, it is important here to get real with yourself and understand objectively why you failed in order to determine the best study method for you. Was your real score significantly and consistently different than reliable practice test scores, such as the NBME Comprehensive Basic Science Self-Assessment (CBSSA) available for purchase online or the Comprehensive Basic Science Examination (CBSSE) administered by medical schools? If so, it’s possible that your failing score was an outlier, and a quick re-take with reversion toward the mean of those previous scores may be enough for you to pass Step 1. (However, be cautious when assuming this. In our experience, this is uncommon. It is more often the case that there are substantive USMLE-related issues underlying most failing Step 1 scores.) Maybe you struggled during the basic science years of medical school or who have a history of prior difficulty with standardized test taking? You may have not known it, but you fall into a category of students statistically at risk for those problems to carry into Step 1.

Here you may want to strongly consider a private USMLE tutor or small group course to coach you through test anxieties and provide you specialized basic science help. In some cases, personal issues are even reflected in a failing Step 1 score, but more often we find that problems stem from poor foundational basic science preparation during medical school. Here we typically recommend students to speak with a Step 1 test specialist in order to assess if the cause for failure truly was a personal issue or if it was something else. In other cases, bad independent study choices are in part to blame. For example, using too many resources incompletely, moving through question banks or reviewing materially too quickly in the name of “getting through a question bank” or “watching all of the Pathoma videos” and as a result understanding materially too superficially, not completing a sufficient number of practice questions and focusing instead on pure content review, are all common factors that we have identified as contributing to test-takers’ failing scores. In all of these situations our tutors recommend either a USMLE Step 1 course or private USMLE tutoring or coaching.

The bottom line is that there are many different reasons students don’t pass USMLE Step 1 on their first try. Be honest with yourself and know that pinpointing the honest and exact reasons you failed on your first try can be the difference between a successful retake and another failed attempt. As we outlined, the reasons for struggles or success with USMLE Step 1 are specific to you and your situation. That means preparing for the retake must also be unique to you. If you need help deciding what course of action is best for you based upon why you failed in the first place, feel free to contact us. We would be happy to help.

All in all, identifying your weaknesses and the problems with your prior preparation are at the heart of successfully conquering Step 1 the next time around. While it can be comforting to ignore or downplay the reasons for your failure, being proactive and putting a plan in place that honestly addresses your Step 1 preparation needs is the most important thing you can do. For many students who fail Step 1, particularly those who feel overwhelmed by the process of preparing for Step 1 following a past failure, a tutor from a company such as ours, Elite Medical Prep, that specializes in identifying reasons for past exam failures and constructing and implementing aggressive plans to address problems and maximize scores may be extremely helpful. Lastly, even if it requires time off, delaying entry to the Match, or otherwise negotiating with your school for additional time off, make sure you give yourself enough time to implement your retake success plan fully. While the extra time may not be necessary, this is the time to get Step 1 right and walk away with a score that reflects your abilities.

Good luck from everyone at Elite Medical Prep and we are always here to help if you with USMLE Step 1 Tutoring!