Why failing Step 1 exam shouldn’t end your dream of being a doctor

Brendan Murphy , Senior News Writer

Most students who take Step 1 of the United States Medical Licensing Examination (USMLE) achieve a passing score. But sometimes it’s just not your day.

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When you don’t make the number that qualifies as passing—which had a two point increase to the standard along with the exam moving from numerical scoring to pass-fail—what does it mean for your future in medicine? In many cases, it is a detour on the road to a successful career as a physician.

David A. Marzano, MD, is an associate professor and director of the ob-gyn residency at Michigan Medicine. He has worked with students and residents who have failed Step 1.

“There’s some people that just have a bad day,” Dr. Marzano said. “We are all human. We’ve all had our bad days.”

If you do fail your first crack at Step 1, the path to recovery is an important one. Here’s how you can take it.

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The reasons for failure could be numerous. You could have circumstances away from med school—Dr. Marzano spoke of students having a family tragedy in the lead up to the exam—that cause a failure. But if your failure is related to a deficit of medical knowledge, it requires a firm plan.

When a student fails Step 1, they are given specific feedback about the content areas in which they underperformed.

Alex J. Mechaber, MD, is vice president of USMLE. He had previously been the senior associate dean for undergraduate medical education at the University of Miami Miller School of Medicine.

“The USMLE offers students, when they fail, specific content-area feedback,” Dr. Mechaber said. “From a program perspective we anticipate this to be useful. As a former dean advising students, certainly, that would be useful.”

Dr. Mechaber said the reality is that students often didn’t utilize resources tailored for their learning style or dedicate the right amount of time to areas of weakness. That might mean refining your study strategy. To do that, contacting the academic support staff at your medical school for guidance is a vital move.

Follow these tips for your final weeks of Step 1 study.

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One USMLE failure isn’t going to preclude you from obtaining a residency position. Two will make it very difficult. There is some encouraging trends on that front; data from the NBME indicates that repeat test-takers passed the exam about two-thirds of the time in 2019 and 2020, the most recent year data was available.

“I will say, as a former dean, we had many students that matched just fine with one failure,” Dr. Mechaber said. “Multiple failures become another issue. Multiple failures on a Step 1 exam can be an issue to obtaining a residency position.”

Dr. Marzano believes a failing score on Step 1 is likely to make residency programs take a closer look at an applicant’s Step 2 score.  

If you fail Step 1, “the Step 2 becomes a more important number because it shows where your medical knowledge is,” he said. “It will show the baseline for your performance level.”

Make sure you’re up to speed with our all-time Step 1 stumpers.

Related coverage

4 essential tips for your final weeks of Step 1 study

Know this: One failing score on a Step exam doesn’t preclude you from being a physician.

“Someone who failed Step 1 and went on to successfully pass it and do well—one of the things we look for in resident candidates is resilience and that’s pretty good evidence of resilience,” Dr. Marzano said. “Someone who can go through that, redirect, prepare and overcome it is a good measure of someone is going to have the traits of a good resident that we would be looking for.”   

Dr. Marzano also said that a well-rounded application, including explaining what may have been behind the failing Step 1 score somewhere in your application, will also help an applicant in that situation.

“We are looking at the whole picture,” he said. “We are looking at grades and clinical evaluations and letters of recommendation and all those things together.