What if I fail? Bouncing back on the USMLE


What if I don’t pass?
It’s a question that most medical students contemplate at some point in the months (or years) before their USMLE Step 1 test day finally arrives.  If you find yourself trying to answer that question, this blog post is intended to help you.
Take a deep breath. Step 1 is an enormously consequential test. There’s no getting around that reality. However, 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. Every year, students and medical graduates fail the exam but re-group and eventually go on to rewarding careers. Take time to recognize your feelings and understand that an element of emotional release is in order. You likely committed a great deal of time and energy to the process of preparing for the exam. Waiting those three to four long, probably anxious weeks between test day and score release day, only to be confronted by a failing score, can be devastating, but it’s neither a permanent defeat nor a reason to be despondent.

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 be a good resource in terms of suggestions about preparing and what other students in similar situations have done. Regardless, in evaluating when to retake and what is appropriate for you, its important to be honest with yourself and understand that regardless of the advice you may read or be given, the reasons for success or struggles with Step 1 are specific to you and your situation.

Take time to reflect. Why did I fail? This can be a hard question to confront, but, it’s a singularly important one that ultimately must be answered. 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 on a re-take, you can benefit from a reversion toward the mean of those previous scores. Be cautious when assuming as much. 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. Students who struggle during the basic science years of medical school or who have a history of prior difficulty with standardized test taking are especially at risk of those problems continuing with Step 1. In some cases, personal issues were reflected in a failing Step 1 score, but more often we find that problems stem from poor foundational basic science preparation during medical school. In other cases, bad study choices are in part to blame. 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 common factors that we have identified as contributing to test-takers’ failing scores.

Be honest with yourself. 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 are the most important thing you can do. If you need help get it. 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 Elite Medical Prep that specializes in identify reasons for past exam failures and constructing and implementing aggressive plans to address problems and maximize scores may be helpful. And 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 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! And as always, if you find yourself in need of a tutor, Elite Medical Prep is here to help!