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Failed Step 1 Three Times and Matched - Steps to Retake it

We understand your feeling of dismay. Nevertheless, we wish to inform you that you are not the only one in this situation. At each Step 1 exam session, several hundred students studying at America's most prestigious medical schools do not pass the test. 


No matter if you are a medical student studying to be an MD or DO in America, or an IMG, it's not the end of the world if you fail the USMLE exam. Believe in yourself and your ability to improve your Step 1 exam score, and you can get back on track and succeed. 


It is important to have a well-designed study schedule as part of your plan and strategy in order to successfully pass and excel in USMLE Step 1 on your next attempt.


The Need for a Plan and Strategy to Improve Scores

At present, it may seem like the world is coming to an end. However, if one adopts the appropriate method, the inability to succeed in Step 1 can lead to significant career transformation. The tasks that were postponed due to prior knowledge of their necessity will now be approached with renewed vigor and determination.


In this article, You will be taught strategies to reduce your continued feeling of fear, along with various other pieces of information.


Immediate Next Steps

To start with, there are some technical aspects to consider. The minimum score needed to pass the USMLE Step 1 exam is 196. In 2018, the mean score achieved was 230, and the deviation from that average was 19.


So what happens if you fail Step 1?


What to Do If You Fail Step 1?

It is important to keep in mind that failing Step 1 at first does not mean the end of the road for success, as there are still chances to achieve it. You shouldn't be too harsh on yourself.  Still, it’s common for people to feel down. If you’re in need of some motivation and encouragement, talk to someone you trust to help restore your drive. Regard this initial examination as a chance to gain knowledge and get ready for your subsequent endeavor.


Next, find out what the process is for retaking Step 1 and how many times you can attempt the USMLE Step 1 retake. 


You may be wondering if it is possible to obtain a residency if you do not pass Step 1. The answer is yes! According to a study conducted by JAMA, over 99% of graduates were able to enter graduate medical education or start practicing in the United States within six years after graduation. 


To put it differently, while around 3% of individuals were not able to find a match in a particular year, the majority eventually secured a position in residency or practice. In an American allopathic school, out of 64 students who were unsuccessful in the USMLE exam, 92% (59 students) were able to secure a match.


Is it possible to take the USMLE Step 1 again?


Preparation for USMLE Step 1 Retake

If you do not pass the USMLE Step 1 exam, you have the option to retake it up to six times. However, within a 12 month period, you can only take the exam a maximum of three times. 


If you fail the exam on your first try, you can take it again two more times within one year. However, if you do not pass on your third try, you must wait at least six months before attempting it again. Additionally, if you want to make a fourth attempt, it must be at least 12 months after your initial try.


If you are unable to pass the exam on your third try, you will have to wait for six months before attempting it again. Your fourth attempt must be made after a year has passed since you first took the USMLE Step 1. You should be aware of these specific rules when planning your test preparation strategy to ensure that you pass the Step 1 exam on your next try.


Are you ready to take the USMLE Step 1 again?, you can use the following six steps to help you get ready.


6 Steps to Help Improve USMLE Step 1 Score


1. Emotionally overcoming the hurdle and increasing confidence

It is understandable if you feel disappointed or ashamed after failing USMLE Step 1. However, it is not advisable to keep this to yourself and hide it from your family and friends. It would be better to share the news with the people close to you as discussing your situation with them can help you feel emotionally relieved.


Being mindful of your mental wellbeing is crucial. Your family and close friends will provide you with encouragement and inspiration to keep you on track and motivated as you face the difficult path ahead.


2. Evaluating previous exam sitting and study materials

Take some time to assess your past studying habits to avoid thoughts of failure. Be honest with yourself and evaluate the study materials you used. Determine if they were effective, or if it was your use of them that fell short. This will help you overcome any mental blocks you may be facing.


Have you studied enough? Did you finish everything in UWorld? Did you look over all the questions you answered incorrectly during your preparation? Do you know why you got them wrong? Were you having trouble with test-taking skills? Or, did you feel anxious during the USMLE Step 1?


Understanding where you went wrong is important for your recovery. Acknowledging that doing the same thing again won't work is also crucial. Taking ownership of your situation can help you pass the USMLE Step 1 retake. Success is in your control if you're honest and willing to be vulnerable.


3. Taking an NBME self-assessment exam to identify areas to focus on

The most important stage in restarting the preparation for studying is this. The evaluation will assist you in:

  • It is important to establish a starting point in order to monitor and evaluate your advancement while you pursue your studies.

  • Estimate the amount of time required to achieve your desired score.

  • Evaluate your shortcomings and identify the specific domains that require your attention.


Compare your NBME self-assessment score report with your official USMLE score report to identify patterns. This will help you prioritize what subjects and systems to focus on as you study.


After a few weeks since you completed the USMLE Step 1 exam, don't be worried if you score 10-15 points lower on the initial NBME practice exam. This is normal. It will show you what you need to practice for your retake, so you know where you stand.


4. Creating a solid plan of action and avoiding rushing into retake

It's important to take your time and not rush when retaking a test. We have worked with many medical students who have retaken their test multiple times, and the biggest mistake we've seen is not allowing enough time to prepare for the next attempt. It's important to give yourself enough time to achieve your goal score.


It's important to take the time to learn the right study methods to prepare for an exam. This will help you learn and remember the material better. On a recent exam, a high percentage of repeat test-takers passed by using effective study strategies.


5- Reach out to administration

Current med students should contact their school administration, such as an academic advisor or dean. It's important to let them know about any concerns or issues you may have. In some cases, the school may already be aware of the situation.


It's important to keep your school informed because there may be practical and administrative consequences that you need help with.


If you failed Step 1, you may have to delay or withdraw from clerkships. Some schools require students to pass Step 1 before beginning clerkships. Other schools may give you time to study for the exam. It's important to let your school know about your situation.


6- Find ways to tackle exhaustion and stress

If you're studying but not actually learning anything, you might be burned out or anxious. This can lead to poor performance on Step 1 tests. A study found that anxiety is strongly linked to lower scores on Step 1 exams.


Anxiety and burnout can make it more likely for someone to fail Step 1. Stress and burnout can make it hard to focus when studying. It's important to take care of yourself to avoid feeling like an empty shell while studying.


Do you sometimes read without understanding? Do you have to read a paragraph multiple times before you get it?


If you're feeling burnt out or anxious, it's okay to ask for professional help. They can help you develop ways to deal with these feelings so they won't hold you back. Don't be afraid to ask for help - it can even help you do better next time.


What is The Appropriate Time for Me to Schedule a Retake of Step 1?

When you need to retake the Step 1 exam?, there's no one right time to do it. However, there are some guidelines to follow when deciding when to schedule your retake.


You can improve your score by focusing on mastering material instead of just memorizing it. The amount of improvement will vary depending on why you didn't do well before. However, if you study well, you can expect to improve your score by around 10 points per month of effective, full-time studying.


You can definitely improve your test score by more than 10 points per month if you haven't studied much before. But if you've already made an attempt on the test, it may be harder to improve quickly. While it's possible to improve more than 10 points per month, it's not guaranteed.


To meet our goal of around 10 points per month, we have provided some general recommendations for organizing your Step 1 exam retake.


Here we go!


A score lower than 170 on Step 1

If you have received such low scores, it's important to reconsider how you're studying. You might know the information, but not really understand it. At this level, memorizing is common. It might take about 4-6 months to feel confident enough to take the test again. The amount of time might change based on how well you can figure out and fix the reasons for your first failure.


A score ranging from 170 to 179.

You may still be struggling with memorization, rushing, anxiety, or burnout at this level. But you probably have some areas where you feel more confident and can use those to help with learning other things. It may take you 2-4 months to feel comfortable passing at this level if you stay positive and keep working hard.


A score that is 180 or more

If you failed Step 1, it may not be too late to still pass. If your scores were in the range of 180s-190s, you may only need a month or two to study and prepare. Just remember, how you prepare is very important for your success.


A score that is 160 or lower.

To improve your score, you need to study for 10-12 weeks. Your score shows where you need to learn more, and it takes time to understand and remember things well. It might seem frustrating, but it's important to be truthful with yourself and figure out what you need to work on. You can do it if you take the challenge and put in the effort to get better.



If you do not pass Step 1, you might think that your possibility of matching is over. Nonetheless, this is not true. Failing Step 1 may limit some options, but it can lead to self-analysis and personal growth that you would not have experienced otherwise. According to some of the students we have assisted, failing Step 1 turned out to be a blessing in disguise.

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