Why Med Students “Fail” USMLE® Step 1 (and How to Make Sure You Pass the First Time)

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Every year, students fail exams... including the USMLE Step 1. Though a vast majority (95% of US med students taking the exam) do pass Step 1 on their first try, for some it is just by the skin of their teeth. There are so many reasons why someone might "fail" - inadequate preparation, test anxiety, or other circumstances both in- and outside of their control. 

After receiving the news, many students then take to Reddit or Student Doctor Network or other such forums to ask which is worse for their career: not passing at all and having to retake Step 1 or scoring so low they almost failed? There is no one answer to this question, but there is a way to make sure you're not the one asking it. 

The USMLE Step 1 exam is like a puzzle with a timer - you need to be able to fit a lot of different pieces together in a relatively short amount of time. If you don't know the information you need to know backwards and forwards, it is nearly impossible to get the high score you want. Therefore, having a solid plan and great resources to prepare for Step 1 is absolutely essential. While everyone's study habits, schedules, and preferences are different, the mark of a good study plan is that it includes the following elements: 

Time - as much as you can get

Make sure you give yourself enough time to not only get through the material to check it off your to-study list, but rather to commit it to memory. Most people can not read something once or twice and remember it for life, so you need to make sure you have time to review. As you build your study schedule, make sure there is time to not only review the content you learned or studied that day, but also to continuously reintroduce old concepts into your daily study routine. Create a daily schedule that gives you time for review AND time to concentrate fully on the day's topic. 

A solid study technique

How do you learn best? Some students like to draw endless diagrams. Some like to read textbooks. Some like to watch high-yield videos. Some like to reverse-engineer a Qbank to use it as a study tool rather than just as an assessment tool. If you've never done this, give it a try: first, establish a basic knowledge base through your med school classes, online videos, or your preferred method of learning. Next, start reviewing with a Qbank. Do a block of questions (say, 40, like on Step 1), practice test-style. Take a little break then go back and review the content of the block you just completed. Learn why your incorrect answers were incorrect, and why the correct answers are the right ones. Supplement this other study material (e.g. First Aid® or video lectures) to enhance your understanding. Now you're simultaneously assessing your progress, simulating a test situation, and reviewing the content you need to know to ace Step 1. In addition to reverse-engineering a Qbank, you can also rapid-fire review with quiz questions every day. Write your own as you learn material, or use a Step 1 resource like Lecturio, which automatically includes Spaced Repetition quiz questions after you've watched a video. 

High-quality study resources

There are a multitude of study resources available for medical students, and they all offer different perks and features. What works best for you is of course the most important factor in selecting which resource(s) you use. The combination of a Qbank, high-yield video lectures, and more make all-in-one Step 1 study resources a popular option for students as everything you need is in one place. Some like to use multiple resources and combine the best of all worlds in their preparation. Ultimately, the resource(s) that help you learn best is what is best for you. 

Assessment 

Even if you're regularly doing Qbank question blocks as part of your preparation, having an additional assessment resource is beneficial. For Step 1, the NBME self-assessments are a popular option. While the Comprehensive Basic Science Self-Assessment (CBSSA) won't necessarily predict your score, doing such self-assessments throughout your dedicated study time will help you keep track of what you need to review and evaluate your readiness for taking the exam.

Of course, many other factors contribute to your success on Step 1 - but making sure these elements are included in your study plan will definitely put you on the path to success.