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Retaking Step 1: How to Recover from a Step 1 Failure

  • by Dr. Brian Radvansky
  • Jun 06, 2022

A four letter F-word on your Step 1 report is earth-shattering.  Although the overall pass rate on Step 1 is anywhere between 86-92% (according to 2017-2020 statistics), thousands of applicants have found themselves in the same position as you. 

I’m not going to tell you how everything happens for a reason, and how you should learn and grow from this (miserable) experience. The purpose of this article is to help you move to the sunny side of the line between P and F. 

Begin with a self-analysis to figure out where it all went wrong

First, think about the possible reasons for your failing score. Did you just “go for it” after not studying enough? Or were you fully prepared – but test anxiety overtook you in the test center? Or did you get bogged down by the minutiae and miss the big picture concepts?

Since you’ve graduated from college and have been accepted to medical school, you’ve already shown how intelligent and determined you are. Nothing is missing in terms of your ability or acumen; the only thing missing is a passing score. The thousands of test takers who have passed Step 1 over the decades represent a simple case study: hundreds of hours of dedicated cramming,  efficiently applied on a test day, can and will lead to success. 

Once you understand what caused your lackluster performance, you will know the changes you need to make next time. 

Not sure how to assess your own performance and test-taking skills? Take advantage of our free download, A Hero’s Guide to Defeating the USMLE, which has action items and exercises to help you with this essential process. It’ll pay dividend beyond Step 1 though the rest of your life as a learner.

Get some help

If you were intimidated by the thousands of pages of material you needed to master, a professional dedicated to your success can help you plan out a schedule so that you will know exactly what you should be studying each day. If test anxiety is standing between you and your passing score, a medical (or testing) professional can help you assemble a toolbox to deal with the negative emotions that creep in and foil your efforts. Schedule a free phone consultation with our senior advisors and get personalized, expert guidance to help you ensure your success.

Make a bulletproof study schedule

If you are unable to get professional help, it will be up to you to go through the process of creating a study schedule and sticking to it. In reality,  making your own study schedule is not as hard as it seems, and it will pay huge dividends in the future.

In the old days, creating a study schedule was a huge pain requiring hours of work breaking up the resources you want to study and mapping them out on a calendar or spreadsheet. Then the moment you fall behind or need to make a change, you have to spend hours moving your assignments around. Let Cram Fighter do the work for you and create a detailed, personalized plan in minutes. A great study schedule is your map to get you where you want to go.

Give yourself due time to study

After learning that you failed, you  probably will benefit from an initial  study-free period just to clear your mind and to formulate your new plan of attack. Then, you’ll need to make sure you’ll have ample study time to prepare: a combination of enough hours per day and enough days before your test day.  The further you were from passing, the more time (and larger overhaul) you will need for studying. Missed it by a hair? Repeat the study period you followed  last time, and make some changes to your approach. A few standard deviations away from passing? Slot yourself with multiple months of studying while reworking your entire approach. 

Another important factor is how long it’s already been since your last attempt. You might be coming off a long hiatus. If you failed the test more than a year ago, start completely fresh. You will need to update your resources: buy the latest copies of the books you will use to study, and sign up for a full year of your chosen question bank. You might experience some inertia when you first fire up your studying. Starting is always hard, but a body in motion will stay in motion; gather momentum and keep moving forward.

If you are coming off a very recent failing score, your resources are likely up to date. Still, you might want to switch gears for freshness. Consider changing question banks, reference books, and/or video series in order to breathe new life into the material. In this case, change is good. 

Remove any distraction 

Today’s world often feels like a never ending stream of distractions. Some of them are unavoidable. If you are in the middle of a question block and your baby starts crying, you will have to get up and give your undivided attention to your child. What you don’t have to do right away is check notifications, send text messages, watch a quick YouTube video, etc. 

Diverting your attention away from studying by giving yourself mini-rewards of dopamine will impede your learning and retention. Instead,  free yourself from needless distractions, and devote yourself to the task at hand.

Take any and all Self-Assessments you can find

You will need to determine if your new approach to studying is creating positive changes. The best way to check this is by using Self-Assessment exams along the way – and NBME Self-Assessments are your greatest ally here. Take them frequently (once every 2-3 weeks) and take them seriously. You should give these tests the same effort and dedication you will give to the real Step 1. Nothing else will better prepare you for what it feels like to sit and answer NBME/USMLE questions for hours and hours at a time.

Your question bank might also include a long self-assessment or two as part of the package. Take them all! The more questions you answer during your study period, the better your chance of success will be. 

If you are coming up short on your assessments, use the reports to see if a particular subject or type of question is giving you a hard time, or if it’s the testing setting in general. 

Believe in yourself

A failure on Step 1 doesn’t mean you are a failure or that you will fail again. Here’s some data from the NBME: US MD’s had a 67% pass rate, DO’s had a 74% pass rate, and IMGs – 50%. With a dedicated plan and absolute focus, you can get a passing score. Many have done it before; you are not alone.

Summing it all up

The entire Step 1 process is intimidating to face on your own, and it becomes even more intimidating after failing the exam. Utilize all available resources, as your career hinges on being able to pass this test. Don’t repeat exactly what you tried to do last time – you already know it doesn’t work! Make a major change in your approach, and get someone on your team to help you through the prep process. Work with a Step 1 tutor, whether from your medical school or any tutoring company. Enlisting the assistance of your medical school Dean’s office is useful as well. Your dream and career are certainly worth the investment of time and money! 

Photo by Attentie Attentie on Unsplash