Failing USMLE Step I and how to get beyond it.
For many second year medical students, the prospect of taking USMLE Step 1 is looming “large” on the horizon. You have completed three semesters of pre-clinical science and the first step toward licensure as a physician rapidly approaches. Along with the exam and its preparation comes the thought of what will happen if you fail this exam. Statistics show that somewhere around 1/4th of people who take this exam, will not pass on the first try. While failing this exam happens, it’s better to consider that 3/4ths of the people who take this exam will pass.
So what happens if I fail?
If you fail, you generally have the option of re-taking the exam. Most medical schools in this country will have you do some remedial work and will have you sit for the exam a second time with little consequences (from the school’s standpoint) other than damage to your ego. If you fail Step I once, you can still practice medicine and you can still graduate from medical school. You have likely knocked yourself out of the moderately competitive to competitive specialties but you can still have a very satisfying career in the less competitive specialties.
The first thing that you have to do, if you open your test score report and find that you have not passed, is immediately figure out where you were deficient. The USMLE score report comes with a breakdown of where you lost points. You should immediately start your review in your weakest subjects/items. The next thing that you want to do is speak with your Dean of Education so that you can get an idea of the time frame that you have to submit a passing score. Some schools want a passing score on Step I before you can begin third year clinical rotations and some will allow you to complete a rotation that you have started.
Don’t make the grave mistake of attempting to do clinicals and study for Step I. If you failed this exam once, you need to put your entire attention into a thorough and adequate preparation for this exam. You can’t afford two failing scores here and thus, drop/delay your clinical rotations until you have passed Step I. It’s not going to be easy or quick in terms of preparing for a retake so don’t try to rush this process. As bad as one failing score looks, two failing scores can really kill your chances for a solid residency match.
Get the idea out of your head that you “are not good at standardized tests” or “that your career in medicine” is over. You just cannot afford this type of thinking. Your whole attitude needs to be focused on the task at hand, which is, passing Step I. If you cannot focus for a couple of days, then take that time to relax and let yourself come to terms with your circumstances but, depending on your school’s schedule, you likely need to get back into the study mode fairly quickly. Take some time to come to terms with your non-passing score but don’t let a non-pass set you into a “tail-spin” that prevents you from doing your best on a second attempt.
The other mistake that many medical students will make is believing that because they were able to do well in their medical school coursework, they are a “cinch” to pass Step I. This is not always the case for as I have been involved in academic medicine, it’s not always the students with the weaker academic records that fail but those who have a “false sense of security” because of their academic record. Make no mistake, Step I takes some preparation and review no matter how you scored in your coursework. Be prepared to give Step I, the attention that it needs no matter how much you want to enjoy your time off from coursework.
Another thing that you likely need to do is enlist the assistance of your Dean of Academic Affairs. There is no medical school in this country that has never had a student fail Step I. Your Dean of Academic Affairs can offer some assistance in getting your study methods on track. There may be great resources available at your school that you will be able to access since you have a failure on Step I. Be sure to find every resource (many likely free) that is available to you.
Another mistake that many students make is looking at the pass rates of a previous class and thinking that there is no way that you can fail. If the Class of 2008 has a 100% pass rate and you are the only member of the Class of 2009 that fails, that 2008 pass rate hasn’t helped you much. Passing or failing Step I is a personal matter and not class (or school) dependent. Either you have prepared well and performed well or you have not. These are individual characteristics and not school characteristics.
What kind of residency can I get with a failure on Step I?
If you pass on the second try, score some solid performances in your clinical rotations and perform well on Step II, you have a shot at a very good residency. No, you are likely not going to match into Derm, Ortho, Rads and Ophtho but you have a shot at solid programs in just about everything else if you post a good performance in things after your failure. Sure, it’s not the best situation that you have failed this very important exam but your career is not over. There is still a substantial amount of “medical school” in front of you that will provide an ample opportunity to show that a non-pass on Step I (on your first attempt) was an aberration rather than a characteristic of how you perform. Some options may not be there for you but more options exist than you would believe. You simply have to get this behind you and move on with what you have left.
Getting and keeping your head together
Again, your first priority is to do whatever you need to do to pass this exam. You cannot afford to wallow in blame but need to gather your reserves and get busy. Sure, it seems like everyone you know passed without difficulty but you didn’t pass and you have to pass this exam. The thing “is what it is”. The reality is that while this hurts; it’s not fatal. You can take this opportunity to learn what kind of reserve you have and how to thrive in adversity. These are characteristics that any residency program director would be happy to have in an incoming resident. Get your thinking together; enlist the help of your Deans and get this exam behind you. Performance on one license exam does not define your entire medical career unless you allow this performance to define your and your career. Sure, it’s important but in terms of percentages, most people pass comfortably on the next try and move on to good clinical rotations and residency spots.
Final Thoughts
If you find that you failed Step I, get your resolve together to:
- Get in contact with your academic Dean and Dean of Students.
- Find out what options are there for you to allow you to focus on getting ready for your retake.
- Put that non-pass into perspective and behind you; what have you learned “not” to do?
- Get the idea that your “medical career is over” and that you can’t match into a good residency program out of your head.
- Prepare efficiently and properly so that you do not find yourself failing your re-take (or any other licence step ) exam.
This is not about you as a person, physician or anything else. You simply didn’t pass Step I and you resolve to prepare and pass with a significantly better score on the retake.
Last year I failed the USMLE step one and I posted a comment on this site. I was very depressed and upset and this was the only forum where people seemed able to share their experiences. A sobering moment, one thing that was consistently mentioned was the need to work very hard on the next attempt. I always wanted to work in America and do obgyn. As a foreign national, my hopes were already poor before I got the news that I had failed.
That was a year ago. Since then I worked my hide off. I passed my repeat exam with a very respectable score. I applied to lots of programs (>80). I messaged chiefs and directors. I did a sub-I and got a good letter of recommendation. I worked hard to make my application stand out.
I hope someone who finds themselves in the same terrible situation I was in a year ago sees this message. It takes a lot of work, a huge amount of work, but it pays off and it is worth it.
Six weeks from now I start my residency in obgyn.
Hello, I was wondering if a 207/78 is good enough for Psychiatry
To Thierry:
It depends on where you are applying and what else is in your application. Licensure exam scores are only part of the residency application process.
Hi,
I am a graduate and an IMG. I have a full time job and I a currently run behind with studying – I am approximately half way through everything. I am to take step 1 on 23rd of March 2013. I cannot formally choose another eligibility period because of the way my paperwork was processed last year. On one hand, I do not want to appear the exam without having finished everything properly. On the other hand, it took ECFMG 9 months to process my Certification of Identification form last year and I had a very difficult time getting the matter sorted.
So, here are my questions:
1. What happens if I don’t show up for the exam? Will this count against me and will I have to submit another Certification of Identification form?
2. What happens if I show and then pull out before the time is up? Will this stay on record/count against me?
Any input will be highly appreciated. Many thanks.
Alan
To Alan:
You should contact the ECFMG for answers to your questions. I am affiliated with an American medical school and residency programs but we do not deal with the mechanics of ECFMG or USMLE until the exams are taken. Contact that agency quickly so that you have the information that you need.
I m a US medical student. I have failed step II twice due to my depression and anxiety . I was on leave of absence for one year. I came back for the 4th year rotation and have failed step II second time. I am very concerned that if I fil step II 3rd time, I do not know what will be my options. I am very scared . Please advise.
To Sonu:
You should not take Step II until you are completely ready for the exam. This may mean that you have to get your illness completely under control and then do a thorough review before you can do a retake. In terms of options, you would need to consult one of the deans at your medical school. Some schools have limits on the number of retakes for Step I and Step II, thus you need to know what your school’s policy is. You should also consult with your Dean of Students who should be completely familiar with your illness and its effect on your studies. Your Dean of Student Affairs will be the one who “explains” your situation to any prospective residency program that you may be applying to.
Your job right now is to:
1. Get your illness under complete treatment and control.
2. Know your school’s policies in terms of USMLE Step retakes and graduation.
3. Make sure that your Dean of Student Affairs is completely informed and ready to be your advocate in terms of applying for residency.
You can’t afford to be “scared” in this type of situation. Your future career depends on your getting all of the treatment that you need and getting your studies back on track so that you can complete school successfully and enter residency. Mental illness in 2013 is treatable even if it’s chronic (much like diabetes mellitus). You need to get moving and not be side-tracked which is quite difficult when your mental illness is not well-controlled. Make an appointment with your Dean of Student Affairs and take a copy of this response with you if need be, so that you can get moving forward. Good luck.
Sonu, Please look into________________. It has worked wonderfully for me. I am functioning 100% normally with no side effects since last July._____________ covered by blue cross so it
is a great option.
To Tim:
I have edited your comment as this blog is not for medical advice of any type. There are many treatment options out there and persons should seek the assistance of a licensed practitioner in their location who can perform a through evaluation and recommend the best therapy. I know that you are attempting to render assistance but that is beyond the scope of this blog.
I asked a question but it appears that it was deleted. I do not know why. My question is this, is PM&R out of reach for a US IMG with a 207/78 Step 1 score? I plan to improve on my Step 2 CK. Thanks
To Thierry:
You can look at the Results and data from the 2012 Match where there were 86 positions offered in PM & R. Of that 86, only 4 were filled by Non American IMGs and 9 were filled by American IMGs. There were no positions in the Scramble. You can access that information by going to the nrmp.org website and looking at at the Results and Data publication. You might also look at the Program Directors survey which offers information on what they look for in applicants. In that same publication, you might also look at Table 8 which gives the percentage of positions filled by American graduates broken down by year and specialty. On that website, you can look at Charting Outcomes in the Match (2011) which gives the characteristics of Applicants who matched to their preferred specialty. From these documents, you can get an idea of what you need for a successful match. It’s also a good idea to speak with some Program Directors or Coordinators to get some idea of what you need to present on ERAS for a successful match. Good luck.
I am not getting alot of information on PM&R. What is the prospect of an IMG matching in that specialty with a 207/78 Step 1 score? Thank you
To Thierry:
You can look at the Results and data from the 2012 Match where there were 86 positions offered in PM & R. Of that 86, only 4 were filled by Non American IMGs and 9 were filled by American IMGs. There were no positions in the Scramble. You can access that information by going to the nrmp.org website and looking at at the Results and Data publication. You might also look at the Program Directors survey which offers information on what they look for in applicants. In that same publication, you might also look at Table 8 which gives the percentage of positions filled by American graduates broken down by year and specialty. On that website, you can look at Charting Outcomes in the Match (2011) which gives the characteristics of Applicants who matched to their preferred specialty. From these documents, you can get an idea of what you need for a successful match. It’s also a good idea to speak with some Program Directors or Coordinators to get some idea of what you need to present on ERAS for a successful match. Good luck.
Hi, Dr,NJB,
I’m an IMG, just received my scores, 165/70 on Step 1. Wat’s troubling is the breakup is extreme, I’ve scored above borderline in Behav. Science, Micro & immuno & done Ok in Pharm. In Physio, it looks like I’ve done the worst, I doubt I got any Q correct @ all, Biochem & Genetics were bad too, Anatomy was bad but better than those 3. I felt very bad after the exam, I felt that I’d done well only on the last block. I want to crush the exam & have put up a tentative study plan that takes 12 weeks, studying 24/7, my friends say that’s too long. But here’s the hitch, I might take much longer as I will be attending grad school 2 weeks from now & will be occupied @ college 9am -5 pm every day for 5 days of the week. Given my circumstances, what would you suggest.
I forgot to add, most of my Qs in Biochem were from Mol.Bio & I felt that I’ve never seen any of those types of Qs ever during my Prep, inspite of concentrating on Mol.Bio.
To Doc_ss:
Once your graduate studies begin, you will not have as much time therefore, you need to set a systemic study schedule (not too tight) and stick with it. You might need to get more than a review book for Molecular Biology. Lippincott’s Biochemistry should be dense enough to get you up to speed on the Molecular Biology and what you need for Genetics. You should look into Costanza for Physiology and make sure you know the things in that book cold. You don’t want to study 24/7 under any circumstances as you will be studying long hours but your efficiency will not be good. Set 50-minute time slots and 10-minute breaks. Do a combination of reading, questions and then review.
Check off subjects as you cover and review them starting with the areas where you performed poorest. Again, don’t sit and stare at materials for hours on end. Break up your studies regularly and put your failure behind you. If you are not getting much accomplished, take a day away from study and then come back but don’t take more than one day away. Reward yourself at the end of the week with something that is non-academic like a movie or a nice dinner. You need to have something to look forward to.
Above all, don’t rush this process. You don’t want to attempt this exam until you are thoroughly prepared even if you have to teach yourself material. Take your time and do quality study and review. Good luck.
Hi,
I just looked @ Firecracker which is really Gunner Training v.2.0 & I feel comfortable with the style of the flashcards & the studying is going on well.I also will go through FA + DIT Workbook that I already completed. Also I’ve decided to go in for BRS Physio,Study Kaplan Genetics, Molecular Biology portions of the Biochem Textbook again as well as Pathoma (all of which i’ve already used). I will redo the entire Usmle World. Do you think Firecracker would help me. Also is the material I’ve written too dense for repeat study. My feeling is that I know most of the info./have the knowledge.My problem is Question Practice.
To Doc_ss:
I am a bit concerned that you feel the need to redo the entire USMLEWorld as I feel you may be focusing too much on memorizing those particular questions/answers than on integrating material that you need to master for the exam. If you knew “most” of the material, you likely would not have failed the test. Your score does indicate that you have some knowledge gaps that need to be closed before a second attempt. Flashcards are great for review but my suspicion is that you need some basic “learning” in some key areas (Physiology and Molecular Biology/Genetics). USMLE Step I does not allow memorization of review books/materials and a strong performance. The exam required a solid knowledge base + ability to apply that knowledge base under a variety of types of situations. The exam is very geared to the type of knowledge base that is taught in US medical schools where curricula are very integrated and detailed. If you are on path for a retake of USMLE Step I, you can’t afford another failure if your goal is any residency position in this country. Be wary of just using review items for the subjects that you performed poorly in. Good luck.
Hi Dr. Drnjbmd.
I’m US senior who is struggling with med School curriculum and USMLE steps. Passed step1 after 2nd attempt with 194/79 and CK 194/75 1st attempt, ranked bottom 5% of class, with all grades being mostly satisfaction. I have finished all my school requirements for graduation that is scheduled in December, but It is with deep regret that I’m writing this to inform you my failure of passing CS on my first attempt. This means I won’t be graduating in December anymore. It is a big setback on my application for residency and graduation from the school of medicine. Currently I don’t know what the school of medicine can do to help me pass the test. My plan is to stop interviewing to focus on passing the test first in order for me to graduate in May. I’m also planning to schedule test sometime around mid January. the school did everything to help me pass this test and I felt well prepared for test but the result turned out to be a failure. I still have 3 internal medicine interviews coming up in December(California, Maryland, and Washington DC) and 2 in January mostly in Midwest. I would like to cancel all them as I don’t see myself as viable candidate anymore. I’ve done 3 interviews so far in my school at 2 different programs and one community hospital affiliated with my school( Anesthesia and IM). At every single interview I will be asked about my academic outlier performances. I feel this CS failure will be just a ground for those programs not to rank me and am currently thinking about focusing my energy to studying for successful retake vs traveling for interviews and get hammered about failures while I know they won’t rank me anyway. Byway I haven’t released my CS score to ERAS for programs review yet. I Know they can actually see that I have taken the test. Do you think it’s a good Idea to keep the score for myself up until I got passing mark sometime before SOAP if I actually retake the test in mid January? Because I’m planning to rank only the 3 programs that I have interviewed with since these are my home school programs and cancel the other interviews out of my reach now. Your insight would be strongly appreciated to proceed with my plan.
To Reddick:
If you have a good reason for your academic troubles(test anxiety for example), and you can convince programs that you are getting help, you need not apologize for your academic problems. I suspect that you have some degree of test anxiety when it comes to these board exams or you wouldn’t have been able to get through the pre-clinical work at your medical school. The truth of the matter is that someone is going to graduate in the bottom half of the class but those folks, with some trouble-shooting, go onto excellent careers. Unless you are interviewing at a very high-powered IM program (Harvard/Hopkins), you are not actually out of the running for IM. What you have going for you is that you are an American graduate which puts you miles ahead of IMG/FMG grads as far as IM programs are concerned. I would encourage you to work diligently on your clinical skills (I am sure that you have some letters that highlight what you do well) and use the time that you have left, to work on your test-taking skills but don’t cancel interviews. You would not have been invited for interview if the program didn’t think that you had something positive. You can’t undo your non passes but you can learn from them and move forward. Anesthesia might be a stretch for you (unless you have done a rotation in that program and wowed them) but IM is viable since the program at your school knows you and your clinical work. Rank every program that offered your an interview that you attended. You can go to your interviews, explain that you are working on your test-taking problems and interview your best (nice professional demeanor, smile and upbeat). Don’t turn down any interviews because you don’t want to find yourself in a position where you have to scramble. If you haven’t released your CS score, then don’t release it and don’t volunteer that you have a non-passing grade. Many places are looking for positive, energetic and enthusiastic applicants who want to practice primary care medicine. They are looking for people who are not afraid of hard work and people who are absolutely dedicated to patient care and contributing to the team. Be that person, walk into your remaining interviews with your head held high (you have completed most of your medical school work which is no simple feat). I would also speak with any clinical faculty member in IM at your school and get their opinion on quitting the interviews at this point because a clinical faculty member would be more objective that you are at this point. IMHO, I don’t believe that you should “toss in the towel” because you are stronger than you think you are. You have more successes than failures and likely have some test-taking anxiety problems that are plaguing you on these board-type exams. These types of problems have solutions and are not career enders. As long as you graduate before you have to start your PGY-1 year, then graduating in May versus December is a non-issue. There have been programs that have waited for matched candidates who had to complete degree requirements as long as it’s something like board exams that are the delayer.
Thank you for the prompt response Dr. Drnjbmd, I strongly appreciate your thoughtful insight on my issues. I’ll just use your suggestions since they have shown to be helpful in the past on my first setback in step1 and I’ll keep you posted with new update.
hello drnjbmd,
I am an IMG and I recently took step 1 and got a score of 183 due to testing anxiety. My scores on the NBME forms
were 200+. The main problem with me is I completed basic sciences on April 2011 and only took the exam on October
8, 2012 due to Generalized Anxiety Disorder and Clinical Depression. After trying several medications, I was able to achieve remission on July 2, 2012 with TMS therapy. I was advised by the physician that I may need to get the procedure done every year. Can I still get residency despite the long layoff, past medical history, and failure on my 1st step 1 attempt? Also should I disclose my past medical history to residency programs even though it is not on my
record?
To Tim:
The residency that you are able to get into is very dependent on specialty. Most, if not all, of the surgical specialties do not want any gaps between medical school graduation and application for residency. For other specialties such as IM, FM and peds, you need to do some research into specific programs. Some will not care about your gap but others may find it problematic. I would not disclose any medical problems to a potential residency program. You can state that your layoff was due to personal demands that are now over and that is enough. Your medical history should have no bearing on your potential residency program thus don’t make it an issue. Will the failure on Step I be an issue? Yes for some programs but others especially FM and peds will not have as much of a problem with it. Good luck.
hello drnjbmd, I was wondering how I would go about researching whether programs care about large gaps? What websites should I use and whom should I contact? Also even though my generalized
anxiety and depression has been resolved for at least a year(i was able to focus and study very efficiently following
TMS and still feel ok even after I failed because I am 100% healthy), the testing anxiety issue is still problematic.
Is there any medication that I can take that will keep me calm without making me drowsy perhaps a low dose beta
blocker? Lastly is there any truth to the rumor that allopathic students will be able to apply for osteopathic residencies
in 2015? Thanks for your help.
To Tim:
I do not give medical advice on a message board. I encourage you to seek the advice of a qualified licensed practitioner in your area that can advise you on medication for any circumstances. I also encourage you not to seek medical advice from anyone other than a qualified licensed practitioner and especially do not seek medical information through any website. I also encourage you to figure out which specialty you wish to pursue and contact some individual programs with an explanation of your circumstances (do not include medical information). Many programs are seeking applicants especially Family Medicine. You need to do some e-mail or phone inquiries after doing some research on line. Most program websites will list their requirements for applicants which you can look at. I do not know the status of application of allopathic physicians to osteopathic residency programs. Since there are far fewer osteopathic residency programs in this country and the fact that osteopathic residency programs will likely require that one is versed in osteopathic manipulations (not taught at allopathic medical schools), it isn’t likely that many allopathic applicants will meet the requirements for application to osteopathic programs.
Is it ok for me to disclose what happened on test day and that I was scoring 200+ on the NBME forms?
Thank You.
To Tim:
I don’t know how you can disclose this information without it becoming an “excuse” for you not getting a higher score. If asked, state that you had some personal matters that are now resolved and leave this alone. With licensure exams in this country, either you pass or you don’t. If you do not pass, you correct your weaknesses and pass on the retake. Don’t try to “explain” why you didn’t pass as there are very few reasons that do not end up being excuses for a poor performance. Again, you want any prospective residency program to see you in a very positive light with no excuses for anything.
Hi drnjmd, I have emailed 400 family medicine program directors and have received only 38 replies. 23 out of 38 program directors indicated that my chances are still good as long as I pass step one on the next attempt with a score of at least 200 and pass step 2 CS and CK on the 1st attempt with similar scores. I am encouraged that I still have a
chance, but at the same time I feel that the sample size is too small for me to make a decision. Please Advise.
Thank You, Tim.
To Tim,our
Right now, rather than be distracted by “sample size”, your immediate task is to pass Step I with a score that is significantly above the minimum pass. You have not done that. You also need to pass Step II (both parts). You need to focus on the tasks at hand which need to have your total attention. If you e-mailed over 400 program directors and only 38 replied, you should know that you have a significant hill to climb in terms of getting into any program. Right now, any chances that you might have will depend on you getting your licensure exams passed and behind you. Please focus on that and nothing else at this point. Every day that you delay doesn’t help you get closer to your goals. You have a uphill battle, that’s a given. The question for you is, “Do you want to fight that battle or do you want to give up?”. “Sample size” has nothing to do with this.
Many program directors are currently out of their office(I received many automatic replies) If I assume that
non replies mean “no” then even though it is my dream to be a physician it would be ill advised to spend two more years in clinical rotations and accumulate $100,000 more debt since I currently have 26 positive replies, 15 negative replies, and 359 people yet to respond. I am currently applying to pharmacy school as a contingency plan, but I am
hoping for bigger sample size(200) in order to make an informed decision. One PD told me that if I get a 220 on my next attempt and pass step 2 CS/CK with a decent score then I would still have a very good chance at most FM residencies. Is one PD’s opinion enough or should I start calling the programs? I do want to fight the battle but
I need a clear idea of what I am up against.
Thank You.
hi drnjbmd, I wanted to ask you a question privately. Is their any way I can contact you via email?
Thank You, Tim.
To Tim,
I do not answer private questions. If you can find a way to ask your question in a general manner, I will try to help you as much as possible.
hi drnjbmd, … but it is hard for me to give up my dream and passion due to something I had no control over. Please Advise.
To Tim:
Follow the plan as you have stated as you are ready to enter residency. This is a non-issue and won’t affect your performance in residency. At this point you can only deal with the things that you can control. Get your letter and don’t look back but look forward. [I edited your question but do the things that I removed]. Good luck.
Hi I am an IMG. I failed my step 1 twice. First attempt 175/72, second attempt 185/74. I am devastated, I do not know what to do. I am in the middle of step 2 CK at Kaplan right now. I passed my step 2 CS. Please advise me what to do. Should I continue study step 2 CK and take the test and retake step 1 the third time? Should I keep pursuing this path and try to get residency? and what program do you think will be available for me? Please help.
To YRT:
Since you are in the middle of Step 2 CK, your time might be best spent finishing your study and taking that exam. Just be sure that you are completely ready for Step 2 CK before you take it. You can’t afford another failing score on any more attempts at any of the USMLE steps. After you are done with Step 2 CK, you can revisit your Step I studies and get the material for this exam mastered. As an IMG, with two previous failed attempts, you are likely looking at non-competitive specialties such as Family Medicine or perhaps Peds/Psychiatry. Don’t delay too much because you won’t competitive for Family Medicine if you are too many years out of medical school. Many FM programs do not accept applicants that are more than 4 years out. In any event, slow down and make sure that you are completely ready for these exams before you take them. Good luck.
You need “Pass Program” videos. The exam is made for students who have failed multiple times. I am one of those students who has passed Step 1 on third trial and I did well. Contact me if you need more info about the program.
To Vanessa:
While I can’t vouch for any specific video program, I can say that no video review is going to work without a strong knowledge base in the first place. If one would simply watch videos and be guaranteed a pass on on any of the USMLE steps, there would be no reason to attend medical school. If anyone attempts to “memorize” any types of review materials for any of the steps, they are most likely going to be multiple repeaters which is quite problematic in today’s climate of fewer residency slots available for more applicants graduating.
Hey Dr NJB MD. ,
Just got my score back this past wednesday.. 178/72.
Very disappointed in myself, especially after the time and effort I put in, but I have to admit after reading this and some of the comments that were written below.. you do know how to call it out dead on..
I am an IMG, and yes, I admit, I thought I could pass this beast of a test with just straight memorization and recall, without fully understanding how to critically think on the exam. I have noticed on the comments below, that most individuals are just asking about what their chances are in residency after their failed attempts which really isn’t helping at all in answering my question on how to tackle the critical thinking side of this and what resources to use for it..
I’ve noticed you haven’t spoke about any specific sources to use, unless there’s a part of this blog that I’m missing out on.. what do you think we should do to help us face the critical thinking side of this exam?
After taking this thing I’ve noticed that this exam is straight split in the middle.. there’s 50% straight recall from facts in first aid and the other 50% is all critically thinking and being able to integrate one subject to another..
I saw a comment where you posted taking classes on study skills, but I feel that is not my weakness.. I do not think I have test anxiety, or am studying inefficiently.. I just feel I’m using the wrong resources to get myself to master certain subjects..
What killed me on this exam included almost every question with a picture (e.g CT’s/X-Rays/Gross Anatomy Pictures/Histo) and let me tell you, I had a shi*t ton of pictures.. almost 15-20 per block.. and almost all of those questions were marked..
To just get to the point.. What resources should we use?? I obviously don’t feel its necessary to go back and read all of Lippincott’s Pharm (I swear I had like maybe 25 pharm questions on the exam, and almost every answer you could learn from first aid.. and I sat there watching kaplan video after video on pharm..).. but what can we do to help us face our weaknesses on things like CT’s and X-rays? not to mention those crazy murmurs and heme slides? My school really poorly taught us on these subjects, as they were mostly straight from the book.. Any ideas would help though, Thanks!
To Mohammed:
If you are speaking of Step I (since you didn’t say which exam was a problem), the subject matter fall along the lines of Pathology, Physiology and Pharm being most represented with Biochem, Anatomy, Micro/Immuno , Behavioral Med/Biostats being less represented. This doesn’t mean that one can ignore those subjects because not have a strong knowledge base in more than one of the less represented subjects can be fatal. It sounds like your weaknesses were largely knowledge based thus a very strong review course with plenty of background reading/study in your weak areas might do. I would find a good anatomy book (Moore’s Essentials of Anatomy is a good start), Wheater’s Atlas of Histology is excellent for micro anatomy could provide a solid knowledge base in a relatively short time. The CTs/radiographs in the Netter atlas are nice to compare with the cross sections if your base is weak. Again, you likely need to pick up a background and then take a course like Kaplan’s online which will help you review and focus. Many of my colleagues recommend the BRS Anatomy and BRS Cell Biology & Histology series for review (has online material too). Rapid Review of Pathology by Goljan can get you up to speed on things that deal with Pathology.
My only concern for you is that review books might not be enough if you need basic knowledge and that you won’t have enough time to get the solid grounding that you missed in terms of your coursework in your school. Any of the resources can be rote memorized but as you mentioned in your post, being able to critically apply the knowledge might be problematic. In any event, don’t redo the the things that you believe you know well (do a minimal review of these) and focus solidly on your weaker subjects by first going to the main texts (Moore, Wheater etc). After solidly reviewing the smaller texts (we use Moore’s Clinically Oriented Anatomy but that is far more than you can master- clinical boxes in this book would be great for you to know), you can go to a review book such as the BRS books. One of my colleagues also counsels Step I reviews to make sure that they read and review all of the picture/diagrams in Robbins Pathology (Big Robbins) before the exam-can be done in a reasonable amount of time. For you, I would focus on learning the hematology pathology (and any other path weaknesses) from Big Robbins and reviewing the rest of path from BRS.
The problem with just watching Kaplan videos over and over without a solid base is that you tend to be too focused on learning rather than review. If you are going to rely on the Kaplan videos, you need a knowledge base before you view them. The Kaplan videos are excellent but alone without high quality coursework, they are not enough. If you look at your score report and do small text learning for your worst subjects + solid review for the ones where you scored well, you may be able to get your prep done and this exam passed. I would caution you not to rush this process because two failing scores will be very problematic for an IMG in terms of any residency in the United States if that is your goal.
I just applied for psychiatry residency, but I passed both the Step I and II on second attempt (i.e. failed both the first time). The truth is – I have major test anxiety problem that I kept ignoring but after failing the second time I had to address it, which I did with an educational counselor and therapist and did pass. I have a great CV and currently working on a publication too but I am totally losing sleep over how am I going to address this in interviews. I try to keep my head high but these failures have taken a hit on my self-esteem.
To Annie:
The major question that any residency program will want to know is “Can you pass your in-training exams and specialty boards?” If you can confidently say that you have resolved your “test anxiety” issues and moved on, then most residency programs won’t have a problem. Residency interviews are one more step in professional training. If you have chosen medicine for your vocation and psychiatry for your specialty, then you move forward and stop giving any step in the training process more deference than it deserves. Do you “lose sleep” over starting your car every morning, yet, if your car doesn’t start and you have a major test, this could impact you. You simply state that you have addressed your problems and are now ready to move forward. That’s the truth and that’s what is going to work for you. There isn’t a single resident or residency applicant out there that has not failed at something. One learns from failures and moves forward or else, the fear of failure becomes paralyzing. If you have an interest in psychiatry, you must have some understanding of this???
Hi Dr.drnjbmd, first off I wanted to say thank you for answering all these questions I may sound like a broken record but yes I too have failed usmle step 1 twice. First attempt was with a 155 and the 2nd attempt is 180/73. I have gone through a vast amount of material for both tries. I went through kaplan books and videos extensively! I did Usmle World Kaplan Qbank & UsmleRx. Went through each question/explanation and annotated everything nto first aid. I made sure I completed every NBME before I took my last usmle exam I got 205 on NBME 13 and NBME’s 5-13 I had a range of 205-225. I felt I was ready this last try I had favorable topics on the exam and felt fairly comfortable but to my schock I received a failing score!
The topics that killed me were behavioral, genetics, reproductive & Renal. These were on the lower performance end. I want to know should I just focus on strengthening my weak spots? Should I go back to the basic sciences and do everything but put more attention to my weak areas. I realize with my two fails the only hope for me is family practice which I don’t mind in this economy any job would do.
Thanks for your time. I look forward to your reply!
To David Paulson:
You need to make sure that you KNOW why you are failing this exam. A three digit score of 155 is extremely troubling on any attempt of any USMLE step. What generally happens is that people who use test question banks for prep (memorize review books), generally don’t have enough of a knowledge base to apply that knowledge base to the actual USMLE exam if they have not kept a good knowledge foundation from coursework. If you use questions, you need to know why the right answer is right and why the other answers are wrong-not just those facts but the material behind those facts in relation to how the material is tested. Test review books do not give enough material- you can’t review what you haven’t mastered in the first place- because they just can’t cover enough material. If one could simply memorize review books/ Kaplan books/question banks, the pass rate for USMLE would be much higher. In short, memorization is not the key to success on USMLE but a solid knowledge foundation backed up by an ability to do some critical thinking is the key.
I suspect that you have been able to memorize enough material to take your course exams but you didn’t get that material in your long-term memory so that you could apply it to an exam such as USMLE (any step). I say this because your list of poor performance subjects is pretty extensive. You have loads of work to do but you need to look into why you have not mastered this material No prep test back service will prepare you if you do not have a solid grasp of how to get information into your long-term memory.
I can suggest that you look into a study skills course such as the one at Marshall University, that does extensive analysis of learning problems for professional students. These types of programs can provide key analysis and coaching so that you do not keep failing your licensure exams. Even if you were to make it through Step I and Step II and into a Family Medicine residency, you still have to take inservice exams and pass specialty boards (much less forgiving than USMLE). At this point, before you find that you have another failure, look into some extensive learning/study skills analysis programs and get yourself on track. You can’t afford another failure on this exam. Good luck.
Thank You for your insight. I will look into a study skills course. What do you suggest I do to fill the holes in my medical knowledge? Should I go back to the cores of Medicine? I am planning on doing the Costanzo Book for physiology then doing Guyton. I have been doing Goljan Rapid Review along with pathoma for pathology. For pharmacology and biochemistry I am going to reference lippinncott. For embryology I will follow along with Lang’s embryology. Any other suggestions that you may have? If I want to learn medicine from the very core where do I start? Right now I am applying to another school for step 1 sponsorship I am willing to do anything and everything it takes. I appreciate your advice!
To David Paulson:
You need to focus on what the exam focuses on. In short, subjects do not matter as much as integration of the material. For example, pathology is the most represented subject on Step I but it’s not in isolation. Your knowledge of pathology may be tested in a scenario that actually asks a physiology question. You also need guidance from your professors rather than trying to do this work on your own. Use your course notes, syllabi and consult with your professors who taught you the material in the first place. Most schools do not “win points” by having students repeatedly fail board exams thus your faculty should be willing to assist you on your preparation. Again, beware that things like review books are for review and are not learning resources. Good luck.
Hi I am a student at a US medical school. I failed step 1 on my first attempt with a 187. I retook several weeks later and got a 222. I really don’t know what happened the first time. How is the best way to address this with residency programs? I am considering psych or internal medicine at the moment. So far I have received a high pass on my first rotation and will try to get a high score in step 2. Any advice would be greatly appreciated!
To Zamo 28:
You have to figure out why you failed on the first attempt and take ownership for that failure. Don’t address your USMLE step problems in your residency personal statement but have an answer prepared should be asked in an interview. You definitely NEED to take Step 2 CK early and score well. You also need honors in IM, Surgery, Family Medicine and Peds in addition to Psych as far as rotations are concerned. You can’t afford to “slack off” in the more important rotations. You also need to be sure that you have strong letters from your IM professors (especially the chair) at your school. After that, apply to a broad range of programs and make sure that you get plenty of solid interviews. Good luck.
I got my score on wednesday, i failed step 1 with 180/73. Im really close. my dilemma is that, this is my 4th attempt, which means im getting closer to the 6 attempts limit. im really scared. I was really confident, i took the nbme 7, i got 480 and i took uwsa- 201. I did the free 130 questions on the usmle.org website, and i got 85%, my uworld average was 75% and kaplan was 75%-85%. I dont know what happen, the exam was fairly written. what should i do? should i study for another 3mths and retake it or start preparing for step 2ck, instead of jeopardizing the 2 remaining attempts left for mw. I have passed my step 2cs.
To drb:
You cannot keep taking this exam without correcting your problems. See my answer below to Lilywhite888 as it outlines a frequent traps that test-takers fall into.
I suspect that you are putting too much emphasis on memorizing questions from the question banks which are poor approximations of the actual exam at best. USMLE (all steps) test your application of knowledge from the subject matter that they cover. You have to be savvy in terms of knowing how to read, critically the questions on the actual exam and figure out exactly what they are asking so that you can answer the question before you even look at the answer choices. Too many people make the mistake of doing hundreds of questions but not improving their underlying knowledge base which is their true weakness. This is especially problematic for IMGs who have not attended medical school in the United States.