I Failed My First NBME for USMLE Step 1… Now What?

  • /Reviewed by: Amy Rontal, MD
  • Around this time every year our inboxes become flooded with emails from anxious students who have just taken their first NBME for Step 1.

    Very few people attain the score they were expecting or hoping for on their first NBME, and many will have scores significantly below the passing mark.

    Naturally, this can be a cause for panic, particularly since most students expect to at least pass their first NBME. Furthermore, it can be incredibly daunting when realizing how far off your target score you may be.

    First things first: Breathe. You’re not alone in this.

    The first thing I tell students is that they need to put things into perspective. Remember, your NBME score is curved based on everyone who has taken the test—this includes people who are a week away from their USMLE and have been actively studying for quite some time, as well as students who are just now taking an NBME to obtain their baseline.

    Additionally, think about how much you actually studied for your first NBME. Most students who take an NBME to establish a baseline spend little to no hours preparing for the test. As such, it has likely been over a year since they have been exposed to subjects like physiology and biochemistry; so it’s no surprise that they might struggle on their first NBME.

    What’s more, for most students, the NBME represents their first significant exposure to USMLE style questions. It takes time and practice to master the necessary test taking strategies for this exam.

    So what should you take away from that first NBME?

    Most importantly, a lower score than you’d prefer should be a motivator to start studying now. Just because you scored a converted 160 does not mean that you cannot improve to a 240 or 250 on the actual exam—it just means that you have to work. A low NBME score should tell you that your baseline might not be nearly as high as you think it is and should motivate you to start studying while you are completing the remainder of your second year classes. Moreover, the score breakdown can show you where you might need to spend more effort than you originally thought. If you only have a limited amount of time to devote to Step I studying while in classes, these breakdowns should be a guide to where you focus your energy.

    In Conclusion:

    RELAX. This first NBME is nothing more than a starting point. Everything is still possible if you are willing to put in the work necessary for success.