10 Common Reasons Why Students Fail The USMLE Step 1 Exam

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There’s no secret to the fact that the USMLE Step 1 exam is the toughest, and probably the most important test you will write throughout the entirety of your medical career.  For this reason, you need to take your USMLE Step 1 prep very seriously.

Most students decide that in order to eliminate any guessing-game, taking a USMLE Step 1 prep course is the right idea for them. If it’s right for you, click the following link after you finish reading through this article: USMLE Step 1 Prep Course

This test takes everything you’re supposed to learn in your first two years of medical school and crams it all into a seven hour window – and this seven hours can make or break your career. For this reason, we’ve created the following article to show you some of the most common causes of failure on the Step 1 exam, so that you know what they are and can avoid them in your own USMLE Step 1 prep.

It’s important that first and foremost you understand that the Step 1 exam is simply a way to get your foot in the door and get yourself Residency program interviews. Becoming a great Physician after you get into Residency will depend on how hard you work during those few precious years.

The Step 1 Exam Gets Your Foot In The Door

This is the main reason why you need to do well on the Step 1 exam… Want to get into Surgery?  Get a certain score or you might fail to get interviews.  Want to get into Dermatology?  Get a high score or it doesn’t matter how much research you’ve got or how many publications you’ve been a part of, you’re less likely get interviews.


Why do they use Step 1 instead of anything else?  

Because all medical students take the same exam, it’s an easy way to measure everyone on an even playing field.  Is it fair?  Perhaps not… Some students are stronger test-takers than others, but those are the rules and you have to live by them and adjust to meet your goals.

And here’s a harsh truth that happens as a result of this:

  • Many poor or average students with good Step 1 scores get Residency positions
  • Many strong students with poor Step 1 scores don’t get residency positions

It’s an extremely sad and unfortunate fact, but that’s how it goes.

A poor Step 1 score will put you at an instant disadvantage and will force you to have to fight hard for a Residency position from that day forward.  Residency programs will question whether you have what it takes to deal with patients – even if your clinical preceptors write good LOR’s.

Residency programs will question whether you’ll be able to pass the Step 3 and the subsequent required licensing exams – even if you’ve got a rock-solid scholastic record and have passed all other required exams.

You see, the fact is that this test is make-or-break for many students, especially those who are Foreign Medical Graduates (FMGs) or International Medical Graduates (IMGs).


The one factor that can often times rectify a failed Step 1 attempt is coming back and getting a great score the next time around.  If you can accomplish this, it may appear as though you just had an ‘off day’ and that your new/high score is the real you.


Now I don’t tell you this to scare you, in fact, I tell you to motivate you to do well.

There’s a fairly long list of reasons why some students do poorly on their Step 1 exam, but below are some of the most common causes we see in those students who come to us for the USMLE Step 1 prep:


Failure Cause #1: Lack of taking the exam as seriously as it should be taken

It’s hard to believe that with all the talk of competitiveness, some students still dismiss the difficulty of this exam, but this is one of the major causes of failure.

Students who simply aren’t studying their hearts out and instead treating it like a medical school exam often find that the exam is much more difficult than they could have anticipated.

This test should be approached with extreme caution and taken very seriously.  Aiming to simply pass is in our experience a recipe for disaster as students tend to only study hard enough to put them near the passing range.

Instead, you want to aim very high and work as though your goal is to get perfect on that exam. With this approach, even if you fall short of your highest goals, you’ll still end up with a great score.


Failure Cause #2: Taking the advice of other students 

For many incoming medical students, senior students are willing to advise about how to get ready for the Step 1 exam – what books to use, how much to study, etc, etc.  The problem is that most students don’t know how to properly prepare for the Step 1 exam, so listening to them is not in your best interest.

The problem with following everybody else’s advice is that everybody learns and masters material differently.  If you love learning by listening, but your advisors (senior students) are telling you to bury your head in any number of the study guides out there, you might run into some problems.

Now… you should realize there are three main things you absolutely must have in your Step 1 preparation arsenal on top of doing well in medical school:  1. A review course, 2. A question bank, and 3. NBME exams

This combination is of course what the USMLE Success Academy uses for all of its students and there is no strategy more powerful than this in getting yourself ready for the Step 1 exam.

If used correctly, these three tools are all you need in order to put your best foot forward during your USMLE Step 1 exam prep.


Failure Cause #3: Failing to practice as you would for the main event

It always frustrates us when a student comes to us saying they failed the Step 1 exam, and then when we ask how they did their questions, they say in and un-timed mode.

This exam is brutal… and in order to build your stamina you absolutely have to do questions as  you’ll experience them on the Step 1, in full question blocks in timed mode.  There’s no excuse for this one – just do it!


Failure Cause #4: Studying ‘passively’ instead of ‘actively’

One of the biggest reasons why people fail is simply because their preparation process was nothing more than reading through a review book.

Sitting at a desk and reading the material is what we call “passive learning”, and when you aren’t actively engaged in your learning process then you run the risk of retaining very little of the information you’re studying.

A good way to avoid ‘passive’ studying is to write notes, create charts and diagrams, and draw images. These strategies ensure that you are being ‘active’ in your learning, which is shown to significantly increase one’s retention of the material.

Another excellent way to be ‘active’ in your studies is to use a question bank. By doing a QBank, you’re using what you know to actively answer questions. This is an excellent way to improve your learning, identify weaknesses, and better prepare yourself for the exam.


Failure Cause #5: Using question banks incorrectly

This is something that you can’t blame yourself for, simply because nobody is really actively teaching you how to use the question banks for maximizing your results.

Many pieces of advice heard during medical school are to simply do as many questions as possible… However, if you aren’t doing them correctly or know how to learn from them, you’re wasting a lot of time.

Ideally, your medical schools would be teaching you the right way to use question banks for your USMLE Step 1 preparation, but most aren’t.

For this reason, the USMLE Success Academy’s Step 1 Preparation Programs will show you how to use question banks for your Step 1 preparation so you’re using them the right way.


Failure Cause #6: Not using question banks at all

This is probably the biggest mistake you can make while preparing for the exam.

We’ve experienced dramatic improvements in our students’ success since requiring that they implement a question bank into their preparation.

Additionally, since implement shorter questions before, throughout, and after all lectures, our students’ results have also improved.

You need to do questions if you want to reach your maximum potential… period.

Not only do you want to do USMLE-style vignettes, but also short one-liner questions to test your recall. The more questions you are asked and can answer, the better shape you’ll be in come exam day.


Failure Cause #7: Using First Aid before actually learning/mastering the information 

One of the biggest mistakes you can make when studying for your Step 1 exam is using the First Aid as your primary source of review before mastering the material.

Don’t get us wrong… the FA book has its place in your Step 1 prep, however it needs to be implemented the right way.

So, what is the ‘right way’ to implement the First Aid you might be asking?

From our experience, it is best used in the last few weeks prior to your exam, after you’ve done more intense preparation using a variety of different tools.

First and most importantly, you need to master the large volume of information that may show up on the exam… which isn’t accomplished by using the FA book alone.

The first step of learning the large volume of information requires that you have a couple months of intense immersion in all of the information…

This is difficult, which is why many students use a Step 1 prep program such as ours. Whether you use the USMLE Success Academy or not, do yourself a favor and join a structured Live Step 1 Prep Program or Online Step 1 Prep Program.

Step 1 preparation programs make your life easier by presenting you with a structured environment and cover the most likely to be tested information so that you don’t have to sift through two years of notes trying to figure out what’s most important.


Failure Cause #8: Not setting a date for your exam

When you don’t set a date for your exam, you fail to create that sense of urgency that you really need to motivate yourself.

Figure out how much time you realistically need to prepare, then set the date in stone and DO NOT change it… unless of course your NBME exams tell you that you need more time.

You want to use that date as a hard deadline so that you can structure your USMLE Step 1 prep time to meet the goal…


Failure Cause #9: Not creating a strict study schedule for yourself

Some students work their USMLE Step 1 prep around their social schedules… But they should be making their USMLE Step 1 prep the only task at hand for those precious few months.

Treating your preparation as if it’s not the top priority is a dangerous game and if you’re serious about success on the exam, you need to carve out time each and every day to cover the material.

The best way to do this is to create a daily, weekly, and monthly schedule and figure out what you will do during each hour of each day… It may seem excessive, but the more structure you create while preparing for the exam, the easier time you’ll have getting through everything.

A study schedule is so important in fact, that we include them into our Premium Step 1 Online Preparation Program.


Failure Cause #10: Studying for longer than is necessary

An ideal study schedule depends on your initial pre-preparation NBME exam results.

For most students, a few months is the ideal timeframe to study for the Step 1 exam.

Once you’ve created your schedule and worked through it, you’ll take a post-preparation NBME exam… If you get the results you need, take the exam. If you’re not yet where you want to be, delay only long enough so that you can improve your weak areas.

If you continue to study once you’re adequately prepared for your exam, you run the risk of forgetting information and actually regressing in your readiness.

Final Thoughts…

There you have it! The top 10 reasons why we see students failing the USMLE Step 1 exam.

As you can see, these are all controllable causes of failure, which means that if you follow the right advice and prepare correctly, you will put yourself in a good position for success.

If you’ve failed your exam or you’re not sure that you can prepare on your own, don’t sweat it!

We’ve prepared both Live and Online Step 1 Preparation Programs that will ensure you are doing everything the right way, so that you don’t have to worry about anything except for studying.

Check out our Online Step 1 Preparation Program or Live Step 1 Preparation Program if you’re ready to take your Step 1 preparation seriously and maximize your chances for a great score.

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