For many medical students, the journey to residency training can come with some unexpected turbulence.
If your time as a medical student includes a past misstep, it doesn’t reflect the physician you will be in the future. Still, some of those adverse results are communicated to residency programs with the information that is included with your residency application.
The good news? If an applicant earns an interview invitation, a residency program has seen enough strength in the rest of the application to keep that candidate in contention.
For applicants who get the interview, the challenge becomes explaining a setback with honesty, perspective and a growth mindset while also showing how they would be a strong future colleague. Here’s how to think about the medical school missteps that may draw attention and how to address them effectively in residency interviews.
Will suboptimal medical school results come up during interviews? If so, how should you address them? A deep dive into data and experts on the Match process offer insights on those questions.
What applicant information do residency programs see?
Residency programs see the application a medical student submits through the application platform—such as one’s educational history, experiences and personal statement—letters of recommendation, medical school transcripts, standardized test schools and the Medical Student Performance Evaluation, commonly referred to as the dean’s letter.
Residency program officials will see any failed attempts at board exams or courses a student fails during their training. Gaps in training—though generally not frowned upon the way they were in the past—will also appear on your transcript. Another potential area of concern could include professionalism violations that are mentioned in a Dean’s Letter.
PD views on professionalism incidents, failed courses
In a 2022 Cureus study, researchers sent electronic surveys to U.S. allopathic medical school deans and residency program directors (PDs) to assess how disciplinary actions are used and how they are perceived in the Match. The study included responses from 33 medical school deans and 158 residency program directors who were asked how strongly different remediated academic or professionalism-related issues might affect a student’s chances in the residency match. Among residency program directors, perceptions of risk varied by the type of incident.
A history of professionalism probation was viewed most negatively, with 83.9% of responding PDs saying it was very or extremely likely to increase the risk of failing to match. Academic probation was next at 67.1%, followed by failed coursework at 41.2%.
What it means if you failed a Step exam
A failed attempt at Step 1 or Step 2 of the United States Medical Licensing Examination (USMLE) series can impact your Match chances, but it tends to carry more weight in interview invites.
Data drawn from the most recent edition of a biennial survey of residency program directors conducted by the National Resident Matching Program (NRMP) in 2026, 73% of responding program directors said any failed USMLE attempt was a factor in determining applicants to interview. Failed Step exams were the seventh most cited factor in determining which applicants to interview.
The picture shifts considerably when program directors decide whom to rank. At that stage, 49% cited a failed Step exam as a factor, making it the 17th-most cited criterion in the Match process. Several interview-related and interpersonal factors were cited more often, including interpersonal skills (89%), interactions with faculty during the interview and visit (84%) and feedback from current residents (74%).
While Step 1 fails are up following the exam’s move to pass-fail scoring, the affect a failure has on one’s residency prospects varies significantly by physician specialty.
“If you had a failed Step exam and you're still getting an interview, I would say that there's something that you've done that demonstrates your resilience and to focus on that and to focus on how you adjusted and then overcame that obstacle,” said Liz Southworth, MD, a third-year urogynecology and reconstructive pelvic surgery fellow at the University of Texas (UT) Southwestern Medical Center.
UT Southwestern Medical Center is a subscribing institution to the AMA GME Competency Education Program, which delivers education to help institutions more easily meet Accreditation Council for Graduate Medical Education (ACGME) common program requirements. Program subscribers have access to award-winning online education designed for residents on the go. It’s easy to use and saves time with simple tracking and reporting tools for administrators. Learn more.
How to explain an application red flag
Dr. Southworth recommends addressing medical school challenges with emotional intelligence, showing mature reflection on the circumstances and on what was learned from the experience.
“It’s all about how you articulate what you've learned from that experience,” said Dr. Southworth, an AMA member who has interviewed residency applicants as resident, chief resident and most recently as a fellow.
“Two people could both have failed Step, both get interviews. One person says, ‘Oh, I was on a really hard rotation. They weren't giving me any time to study.’ The other person might have been on that same rotation and they may say, ‘I was on a challenging rotation, and I really reflected on my studying skills and my ability to prioritize my time, and I adjusted that and I was able to pass the next time.’ That’s two people with the same exact scenarios, but how you present—how you overcame it—is the difference.”
A medical school misstep certainly should not be the centerpiece of any conversation on residency-interview day, Dr. Southworth said.
“If an interviewer doesn't really mention a red flag, I don't think you necessarily need to belabor that point, she said. “If it is something that the program really needs you to explain, someone will ask it and it likely will be a member of the program leadership like a program director.”
“Show how you adjusted and overcame an obstacle,” Dr. Southworth concluded. “Mostly, you should be focused on showing who you are and how you’ll fit as a resident. Interviewers are looking to learn how you work as part of a team not how good you are at taking standardized exams.”
