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USMLE Step 1: Take 2

As a medical student, your life centers around plans, both big and small. Your daily plan is usually pretty simple, and probably looks a lot like this: go to lecture, study, eat, study, work on research/other project, study, leisure-time (maybe), read, sleep. If things go awry, that’s fine. There is always tomorrow to catch up on sleep, work, or time spent with loved ones.

It’s the big plans that are a bit more complicated, and can really throw us off kilter. There are few more difficult situations to bounce back from than a failure of a USMLE exam. But it happens, and it is not a rare event. Somewhere around 5% of test-takers will fail to achieve a passing score and will be left wondering… where do I go from here? If you find yourself in this predicament, do your best to stay calm. You are not alone, and there is a path out of the woods that can get you where you need to be. Let us take you on that path.

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Get your catharsis out early.

If you find yourself in this predicament, you will undoubtedly experience some negative feelings. You might be in despair, have feelings of worthlessness, and even question your desire and your right to become a doctor. Was this the purpose of the test? To weed you out?

These feelings are normal and all right. You are entitled to have them and express them. What you don’t want to do is be controlled by them, or overly wrapped up in them. It is okay to grieve, but don’t become a recluse. Do what you can to get through the stages of coping, and when you have made it through as best you can, get ready to move on, as the road ahead will be one that will require your full attention and focus.

Don’t go it alone.

When it is time to move on, you will need to enlist the help of a team. Who to recruit? Start with your dean or a contact person in the academic affairs department. They have almost certainly helped usher students through the process of rallying after a failed USMLE exam. Though it might be hard to “come clean” and share your tough news with others, especially those who have invested in your success, the sooner that your deans know about this, the better. Your academic affairs department can also help you academically with tutoring or remediation of necessary subjects to give you the best chance of success. If extenuating circumstances (personal or family illness, etc.) have contributed to your struggles, your school can also be of service to help you work through coping with professionals.

Realize why you did poorly.

To repeat an experiment and expect different results is foolish. The most common reason for a poor performance, more so than “lack of academic strength,” is inadequate preparation. Students who do not give the test the complete attention that it deserves are usually the ones to suffer. In formulating a new plan for the second go-around, it is absolutely essential that you create an in-depth study calendar to take you from Day 0 to Test Day. While this is a necessary step for any test taker, it is even more important in those who didn’t pass the first time around. Maybe you had a bulletproof study plan, but failed to do enough UWorld questions (anything less than all of them is too few!), and instead spent time reading so that you could do better on UWorld blocks. Perform a root cause analysis looking at your NBME performances (you took a few NBMEs, right?), your UWorld, your previous study calendar, and whatever was going on in life during your study and test periods to see what stood between you and passing. If there were ever a time to be honest with yourself, it is now.

Deal with any “testing” issues.

Labeling yourself as a poor test taker or chalking your performance up to “test anxiety” will not score you any more points. However, using that insight and actively working through these challenges can score you more points. If you suffer from unchecked anxiety when it comes to these high-pressure testing scenarios, consider speaking with a professional to help you develop strategies to get you through.

Realize where you did poorly.

Between your UWorld reports, NBME score reports, and the actual USMLE test, you should have an idea of what subject(s) are holding you back. Hone in your efforts during your repeat study period to patch these holes in your knowledge. If you did poorly across the board, that can be more difficult to address; you likely have a global issue that’s affecting you (test anxiety, not adhering to a schedule) rather than a subject deficiency.

Be realistic.

It is important to realize that a Step 1 failure will make it very difficult to match into a competitive residency; many programs will not rank a student who has failed this test. That said, there is still hope, if you are realistic with your expectations. Matching to a top orthopedic or radiation oncology program is all but off the table at this point, and you will have much better success focusing your efforts on where you are more likely to match. While the goal for your test should be to score as high as possible, jumping from a failing score to a 240+ is very unlikely, and setting your benchmark too high will cause you undue stress. Focus on passing the test, and doing whatever it takes to do so.

Life will be full of challenges and speedbumps, and if you don’t pass a USMLE exam, let it be just another hurdle to get over. With focused efforts, self-realization, and a little help from others, you can make it happen the second time around.