Home » Without Active Learning, You Could Fail USMLE Step 1

Without Active Learning, You Could Fail USMLE Step 1

10 min


A group of medical students studying for the USMLE Step 1.


Why Active Learning is so Important for Medical Students


To pass (and nail) USMLE Step 1, memorizing the facts is just not sufficient—you must be able to apply that knowledge. While you may feel accomplished reading 50 pages of First Aid in a day, the real concern is how much of that knowledge you can actually apply. You may now be able to recognize and understand the material, but have you mastered it? The answer is no. Mastery takes time, it takes effort, and it takes active learning to successfully pass the USMLE.


The reality is that heavily using passive learning techniques in your USMLE studies put you at serious risk for a failed Step 1. Let’s be honest— just reading through First Aid may be boring, but it is also easy. Watching a USMLE Step 1 video series is even easier and it might even be enjoyable. However, these are both forms of passive learning. Passive learning, by definition, does not require students to draw connections, ask questions, or develop their own answers. All you’re doing is reading, watching, or listening to something and hoping that you’re going to magically be able to retain the information. As with most exams, passive learning just isn’t sufficient to help you avoid a failed USMLE. In  fact, the easier and the more passive the studying is, the less likely you are to benefit. 


Enter active learning. Active learning was first touted in the 1990’s with the development of the constructivist learning theory. This theory emphasized that individuals learn best by actively participating in their own learning: building their own knowledge, identifying their own connections between topics, and associating their existing knowledge to form an enhanced understanding (3). As such, active learning is defined as activities done by students to construct knowledge and understanding. They require higher order thinking, also known as, “metacognition.” These activities can range from tutoring peers on a tough concept to challenging your knowledge through question sets, to taking notes and making flashcards while going through First Aid for USMLE Step 1. Active learning is the best chance you have at passing Step 1– rather than failing.


Additionally, there is a mountain of evidence supporting the benefit of active learning that stretches back thirty years. In one metanalysis of 225 studies comparing passive and active learning, they found students in traditional lectures were 1.5x more likely to fail than students engaged in active learning (4)! Another benefit of active learning is it mitigates the drop-off in concentration often seen after just 15 minutes of passive learning. 



So how do you integrate active learning into your Step 1 schedule? Here are just a few strategies:

  1. Summarize hard concepts– e.g., after answering a uWorld, summarize the question in one sentence with the salient details and the answer choice in one or two sentences (1)
  2. Retrieve practice– e.g., after reviewing half of the endocrine section of FirstAid, take 10 minutes and physically write down everything you can remember, then compare. Another way is to produce an answer to a USMLE question without scanning the answer choices (2) 
  3. Generate your own questions– e.g., after continuing to get questions on the micturition reflex wrong, develop your own questions and answers to cover the concept
  4. Develop concept maps– e.g., create your own concept trees to identify what clinical characteristics and diagnostics tests distinguish different autoimmune arthropathies (5,6)
  5. Interweave subjects- e.g., learning about hypersensitivity reactions by studying the pathophysiology of Goodpasture’s disease. This technique converts important information from short- to long-term memory


*Of Note:

In the context of studying for USMLE Step 1, active learning is not enough—it must be paired with spaced repetition. Spaced repetition is the idea of learning a bundle of material once, and then reviewing it a designated time later in your study period so you don’t “lose it.” For example, learning how to read an EKG for one hour, reviewing that material for 30 minutes the following day, reviewing it for 15 minutes the next week. This ensures long-term retainment of knowledge.  


It is also worth noting that the above strategies are especially relevant moving into the future as USMLE Step 1 goes pass/fail. As schools and students alike may regard Step 1 as “easier” after January 2022 due to its shift away from a numeric score, it is critically important that studying is still taken seriously. A failed Step 1 exam has always had potentially serious consequences. This is not to say that it’s impossible to bounce back from a failure, however, successfully passing the USMLE on your first attempt is in important step in landing the residency of your dreams. Even if a numberic Step 1 score will no longer exist, meaning you don’t have to go crazy trying to get a 260, you are sorely mistaken if you think that Step 1 is set to become an exam you can pass by just flipping through First Aid.


Further, integrating the strategies above into your study schedule may feel tedious or like extra work, but they are worthwhile. Step 1 is important, so make your studying productive and effective!



  1. Bonwell, C. C., and Eison, J.A. (1991). Active learning: creating excitement in the classroom. ASH#-ERIC Higher Education Report No. 1, Washington, D.C.: The George Washington University, School of Education and Human Development. 
  2. Brame, C.J. and Biel, R. (2015). Test-enhanced learning: the potential for testing to promote greater learning in undergraduate science courses. CBE Life Sciences Education, 14, 1-12. 
  3. Bransford, J.D., Brown, A.L., and Cocking, R.R. (Eds.) (1999). How people learn: Brain, mind, experience, and school. Washington, D.C.: National Academy Press
  4. Freeman, S., Eddy, S.L., McDonough, M., Smith, M.K., Okoroafor, N., Jordt, H., and Wenderoth, M.P. (2014). Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences USA 111, 8410-8415.
  5. Handelsman, J., Miller, S., and Pfund, C. (2007). Scientific teaching. New York: W.H. Freeman.
  6. Novak, J.D. and Canas, A.J. (2008). The theory underlying concept maps and how to construct and use them. Technical Report IHMC.

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About the Author

Danielle Marshall, MD

In 2012, Danielle Marshall graduated from the University of California, Berkeley with a BA in Cellular Biology and a minor in Global Poverty. Shortly after,…

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