Home » Most Common Reasons for Failing USMLE Step 1

Most Common Reasons for Failing USMLE Step 1

Young lady covering face with hands after failing USMLE Step 1


Failed USMLE Step 1?


Failing USMLE Step 1 is not uncommon. 2022 NBME performance data show that the passing rate for 1st time test takers with a US or Canadian MD degree was 93%; with a US or Canadian DO degree was 89%; and for non-US or Canadian degrees was 74%. These passing rates have gone down from the 2021 data across the board.


If you have failed Step 1, realize that you are not alone! Some simple calculations reveal that in 2022 over 7,800 students who attempted Step 1 for the first time failed. Many students who have failed Step 1 on their first attempt will go on to repeat the exam after making some changes to their study strategy.


If you are in this position, know that you will need to make some significant changes: students who are in the position of repeating a failed Step 1 exam are less likely to pass again than first-time examinees. In 2022, the passing rates for repeaters with a US or Canadian MD degree was just 71%; for repeaters with a US or Canadian DO degree was just 67%; and for international medical graduate repeaters was an abysmal 45%.


Thinking critically about how to study for a second (or third, or fourth) attempt at Step 1 is absolutely essential prior to attempting to take the exam again. Perhaps most important in this process is recognizing what went wrong the first time. We’ve listed what we believe are the top reasons for failing USMLE Step 1 here. 



Reason 1: Trying to Cram for USMLE Step 1


USMLE Step 1 is a marathon, not a race. Ideally, students should begin studying for the exam during their first day of class in their first year of medical school. Admittedly, this probably doesn’t happen with most students. However, by the time that students are halfway through their pre-clinical time (which can vary from 1 year into the program if your school has 2 years of pre-clinical class time; or down to 6 months if your school has just 1 year of pre-clinical class time), students should definitely be studying for USMLE Step 1.


This has become all the more important as more and more medical schools adopt pass-fail grading criteria for the pre-clinical years. While this grading scheme can lower stress and anxiety, for students who do the minimum amount of work to pass their preclinical years will not be ready to pass USMLE Step 1 without a significant amount of work. Students who try to cram all of their studying for the exam into their dedicated period of time (which for some students is as short as 5 weeks) is a recipe for disaster. If you have failed Step 1, recognize that you will need plenty of time to study prior to attempting again. 



Reason 2: Using Too Many Resources


Commonly, students who fail Step 1 have tried to use all the Step 1 resources available, but haven’t used the 2 primary resources thoroughly (namely, First Aid and UWorld). An additional primary resource should also be flash cards to help with that spaced repetition learning.


Getting distracted with lower-yield resources can detract from the usefulness of First Aid, UWorld, and flashcards. UWorld is a gold-mine of information, and First Aid should be understood completely. Students should acknowledge that getting to this level of understanding is difficult (if it were easy, everybody would be a doctor!), and will require significant dedication and lots of hard work. Using flashcards to reinforce difficult-to-remember facts is key, but getting through a pre-made deck with 1000’s of cards is next to impossible, and is often a reason that students will become exasperated with flashcards and not use them properly. 



Reason 3: Not Using NBME Practice Exams to Keep Track of Study Progress


NBME exams are excellent predictors of the actual Step 1 passing rate. Students who have failed Step 1 often have not used NBME exams appropriately to predict if they were ready to take USMLE Step 1. An NBME exam should be taken at the beginning of the study period to get a sense of where you are, then approximately every 1-4 weeks thereafter (depending on the length of your dedicated study period of time). See our 10-week and 6-week study planners to get an idea of how to appropriately spread out your practice tests.



Reason 4: “Stuff Got in the Way”


Lastly, many students hesitate to push back their Step 1 dates due to personal reasons even in situations where they should. If there is a family emergency, or you haven’t been able to dedicate the appropriate amount of time to studying for whatever reason, don’t feel bad about pushing the exam back! It is better to delay the exam than to take it prematurely and fail. If you know that you haven’t had time to prepare properly for the USMLE Step 1 and your NBMEs aren’t where you want them to be, do not take the exam “just to get it over with.” No matter how stressful the other things in your life are making you feel. Everyone wants to get Step 1 over with, but rushing into it and hoping for the best is not a good idea.

If you have already failed, only re-attempt the exam when you (and your stuff) are ready. Also, if you need help making a failure retake plan we can help!


If you avoid these 4 common pitfalls that are often responsible for student failures on USMLE Step 1, you will better set yourself up for success by knowing what to avoid. Best of luck studying and as always, contact us for professional 1-on-1 tutoring guidance!

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About the Author

Karolina Woroniecka, MD/PhD

As a former Howard Hughes Medical Institute Student Fellow, Karolina Woroniecka graduated Phi Beta Kappa from Brown University with a B.S. in Biology and Hispanic…

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