USMLE Step 1 is a major test that can have a serious impact on your chances of matching into your dream residency program. You know this, which is why you hit the books for months in preparation for it… But the test didn’t go the way you hoped. So, what happens if you fail USMLE Step 1?
In 2022, 91% of students passed Step 1, leaving nearly 10%, 1489 students, to retake the test. While failing Step 1 certainly isn’t ideal, it could happen, but it doesn’t have to kill your hopes of becoming a doctor or matching into your ideal residency program. In this post, we break down what happens if you fail Step 1, what to do next, and how to avoid failing a major medical school exam.
What Happens If You Fail USMLE Step 1?
If you fail Step 1, all hope is not lost—you can retake the test. Technically, you are able to take Step 1 a total of four times, but only three times within a 12-month period. If you want to take the test a fourth time, it must be at least 12 months after your first attempt and at least six months after your most recent attempt.
While a single failure doesn’t necessarily negatively impact your chances of being accepted, it’s the time you lose that really matters. It takes a tremendous amount of time and effort to prepare for Step 1, and if you fail, you’ll have to go through that process all over again. Your time in medical school is extremely limited as it is. If you need to retake Step 1, it’s going to dramatically pull from the time you could be spending on your studies and extracurriculars.
Matching into the residency program of your dreams takes a lot more than good test scores. You need an impressive and varied list of longitudinal extracurricular experiences, impeccable grades, and strong letters of recommendation. If you need to dedicate your time to retaking tests, it puts you at a serious disadvantage compared to the medical students you’re up against.
To state the obvious, failing any of your Step exams isn’t good. You can recover, but it’s important to keep in mind residency programs can see how many times you’ve taken the test. Residency admissions committees see their students as investments. If you fail Step 1, it makes you a much riskier investment compared to someone who passed the first time.
What to Do If You Fail Step 1
1 | Acknowledge Your Emotions
Failing Step 1 is a major gut punch. All that hard work, all those hours studying, and you failed. It’s a serious disappointment, but before you book another test or immediately jump into more studying, take a moment to acknowledge your emotions.
You’re likely feeling some combination of sadness, anger, and shame. This is perfectly understandable, and it’s nothing to be embarrassed about. This is a setback, and you will feel emotional about it.
If you don’t recognize and process these feelings, you’re likely to lash out at those around you. Take some time to yourself to focus on your breathing. Don’t unleash your bitterness on social media, don’t get behind the wheel of your car, don’t do anything but process this unfortunate turn of events.
This time is critical. Very soon, you’re going to need to decide on some next steps, and if you don’t process your emotions, you’re much more likely to make irrational decisions you’ll later regret.
Keep in mind that time to yourself doesn’t have to be time alone. We all process our emotions differently. If you want to be alone, be alone. If you want a friend to lean on, reach out. Do whatever feels most comfortable to you—just make sure you give yourself time to process these difficult emotions. If you don’t, they’ll bottle up, and they could be unleashed at the slightest perceived provocation, which is not a good look for an aspiring doctor.
2 | Let Your Program Know
You’re not the first person this has happened to. If you fail Step 1, contact your school and academic advisor as soon as you have processed your emotions. If you don’t know who to contact, reach out to upper year students and ask them.
Your program will want to help you succeed as best they can. If their students fail Step exams and don’t match into residency, it looks bad on the school too, as it negatively impacts their match statistics. Depending on the school, they may have additional resources, like tutors, or they may be able to help you rearrange your schedule to free up study time before your next test.
Learn more about USMLE Step 1 Tutoring options.
3 | Assess the Situation
It’s essential to contextualize why you may have failed. Did you suffer a personal tragedy? Did you use the right resources? Did you get through all of UWorld or AMBOSS? Did you stick to your schedule? Did you use as many practice questions and exams as possible? Answering these questions will help you determine where you went wrong so that you can succeed next time.
The NBME will let you know how far off you were from passing. If you only missed the mark by a hair, you may only need to dedicate a few more weeks to studying and retake the test after that. If you weren’t close to passing, you’ll need to extend your study period. You may need to take a leave of absence to focus on your studying or start delaying things so that you can make up clerkships post Match.
Pick yourself up, dust yourself off, and reset your mindset. Focus your efforts on your weak areas to make the most impact. Yes, this failure will be a hit to your confidence, but be reassured that 71% of the people who retake Step 1 pass. You are in the majority.
Next time will be different.
4 | Make a Concrete Plan of Action
Do not simply hope that the next test will yield a different result. You can’t afford to fail the second time around, so build a concrete plan of action. How will you alter your study strategies? What time of day will you study? Which resources will you use? Do not make your plan without thoroughly reflecting on your own strengths, weaknesses, and habits. Your plan needs to be one you can and will stick to.
If possible, develop your plan with a tutor to ensure it’s effectively tailored to your areas of weakness, or seek advice from a mentor who knows you well.
Once you build a solid plan, have confidence in it, and stick to it as best you can. Make adjustments to that plan as needed based on your progress and the strengths and weaknesses that evolve.
5 | Learn From the Experience
Take what you learned from this failure and apply it to your study strategies moving forward for future Step exams. With Step 1 now pass/fail, coupled with failing Step 1, crushing Step 2 CK is paramount.
Learn more: USMLE Step 2 CK Guide: Resources and Strategies.
At the end of the day, when it comes time to apply to residency programs, you can use your unfortunate experience with Step 1 to speak about your resilience and ability to adapt to a negative outcome. You can spin this failure into a growing experience that demonstrates your grit and dogged determination in the face of failure.
Attack this failure head-on in your residency application, and explain your unique circumstances. It’s only by not moving forward that you truly fail.
How to Avoid Failing Step 1
Take Pass/Fail Seriously
We cannot stress this enough: Take Step 1 seriously. The change from a numerical score to pass/fail does not alter the impact of failing Step 1. Residencies have full access to how many times you’ve taken your Step exams, and admissions committees consider failing Step 1 to be a major red flag.
Residency programs want to see if you can put your nose to the grindstone for an allotted amount of time to get a specific outcome. They use it as a proxy to see how you would function on a busy hospital or surgery circuit where you’re on call and admitting and you have to remain at the hospital for a fixed amount of time.
Don’t risk slacking off on this test. Get it done right the first time so you don’t have to do it again.
Strategically Pick Your Resources and Study Strategies
Do not over-resource. While UFAPS (UWorld, First Aid, Anki, Pathoma, and Sketchy) are the tried-and-true Step 1 resources, you do not need to use all of them—especially if you’re taking Step 1 for a second time.
Choose a few core study resources, and stick with them. For example, stick to AMBOSS and Anki or UWorld and Anki. This is because many resources are redundant when used together. Trying to get through as many resources as possible is an impractical use of your time, and you’ll just be going over the same material.
Your time is very limited. Zero in on your weak areas and thoroughly review the content you got wrong on the real test, as well as on practice tests. Utilize as many practice questions and practice exams as possible.
Your study strategies this time around will largely depend on how you performed on Step 1 the first time. If you were extremely close to passing, it’s unlikely you need to make too many changes to your study strategies or resources. You simply need to redouble your efforts on your weak areas.
If you missed the mark by a large margin, and it was not caused by a personal or family tragedy, you’ll need to rethink how you study. Seek Step 1 tutoring, and read our comprehensive guides on Evidence-Based Study Strategies and Active Learning.
Build a Routine That’s Designed for You
Don’t base your study strategies on others. It doesn’t matter how many or how few hours your roommate put into studying for Step 1. Succeeding on this test requires you to intimately know your own strengths and weaknesses, which can be masked if you’re always studying in a group. Study alone to determine what works for you.
Put yourself in the right environment physically and mentally, and make time for breaks that rejuvenate you. This could be going for a hike, starting your day with exercise, or cooking with your significant other at the end of a study day. It’s vital that you find something you can continue to look forward to beyond just ending the study period. You need a light at the end of the tunnel to preserve your focus and mental health.
This is where your passion for becoming a physician needs to be reinforced with perseverance. Building a routine tailored to your personal habits, strengths, and particularly your weaknesses is essential to your success on Step 1 and beyond.
Optimize Your Prep With a USMLE Step 1 Tutor
Regardless of how many times you can technically take Step 1, failing this monumental test for a second time is not an option. Guarantee yourself a pass with Med School Insiders. We offer customizable, one-on-one USMLE Step 1 Tutoring with a tutor who aced their Step 1 exam by applying our Med School Insiders methodology. This means you’ll be learning from the best.
We believe every student is different, which is why we have developed a diagnostic process to assess where you can make the greatest improvements and tailor our approach to specifically suit your personal habits, strengths, and weaknesses.
Being accepted to residency is about a great deal more than your Step 1 score. We can help you prepare a residency application that stands out and will ensure a match at one of your top programs. We have a range of **Residency Admissions Consulting Services that are customized to your needs, including personal statement editing, interview prep and mock interviews, and overall ERAS application editing. We’ll show you how to spin this failure to demonstrate your resilience, grit, and perseverance.
If you found this article helpful, check out What I Wish I Knew Before Taking USMLE Step 1 and be sure to save our comprehensive USMLE Step 1 Guide.
