What happens if you fail step 1?

What happens if you fail step 1?

What happens if you fail step 1 of the USMLE? This is a question that many students worry about, and for good reason. This important exam can determine your future career path. If you’re not prepared and you don’t pass, the consequences can be serious. In this article, we will discuss what happens if you fail step 1 and what you need to do to make sure it doesn’t happen. Come up with a new study plan and hit the books hard!

What is Step 1

The USMLE Step 1 is a one-day, eight-hour exam that is taken by medical students during their 2nd/3rd year of medical school. The exam covers a wide range of topics including anatomy, physiology, biochemistry, microbiology, immunology, pharmacology, and pathology.

This test used to be a three digit score, but it is a pass/fail exam now, which can make things more difficult in terms of program directors and residency placement through the national resident matching program (NRMP).

Nonetheless, this test focuses on what a medical student will learn in the first 2 years of med school. This is a beast of an exam and the focus is not only on the breath of information, but also on test taking skills.

You really want to do well on that first attempt. To do this you focus on practice tests, question banks, and test taking skills/stamina that will help you on the actual exam.

Why is Step One Important?

The Step I exam is important because it is used as a screening tool by residency programs, the three digit score used to be a gold standard, but now the important will be on passing or failing. They want to see how you do on this important exam as it correlates with how you will do during your residency training.

If you fail, you will have a hard time getting into the residency of your choice. Some programs may not even consider your application if you have failed Step I.

It is a great gauge of your test taking skills as well your ability to learn a lot in a short period of time.

Options if you have a first failed attempt

This isn’t the end of the road. This is a point to meet with your academic advisor in med school and get their opinion on it.

It is also a time to reflect on how you prepared. Which can be tough, because this test is taken right before the transition into clinical education, so many students are excited for that.

If you failed, it is time to look at what you did and what you can do differently.

Maybe you need a different study method. Maybe you need to spend more time on certain subjects.

Whatever it is, you need to have a plan for what you’re going to do differently when you retake the exam.

You also want to make sure that you’re taking care of yourself during this process. This can be a very stressful time and it is important to take care of your physical and mental health.

Really focus on each and every practice test you take, these are hands down the best way to prep!

One good method I recommend for students is to do the following:

  • Find you weak points
  • Do practice questions on them
  • Watch Pathoma/BNB/ Sketchy to help with those
  • Do multiple practice tests!

That is a great outline to get you started on doing better with your second and even third attempt if needed.

Is it common to fail Step 1?

No, it is not common to fail Step I. In general, most students who take the exam will pass on their first attempt.

However, there are a small percentage of students who do fail. The reasons for this can vary, but it often has to do with incorrect study habits or unrealistic expectations.

If you have failed Step I, you are not alone. There are many resources and people who can help you through this process.

The most important thing is to come up with a plan and stick to it. You can pass Step I, but you need to be dedicated and put in the work.

Certain schools, such as those in the Caribbean have a higher fail rate than US based MD/DO schools.

Do residencies see if you fail Step 1?

Yes, residencies see this and it can be a make or break for your application. They will get an official USMLE score report, that will let them know if you passed or failed.

If you have failed Step I, it is important to be honest about it during your residency interviews. You will need to have a good reason for why you failed and what you did to change things for your second attempt.

Be confident in yourself and your abilities. Remember that you are not the only one who has gone through this and you can overcome it.

In most cases there is a good reason for failing Step 1, and this simply needs to be explained in detail to residency programs. So make sure prior to your interviews that you have this explanation down good.

What is the failure rate for Step 1?

The failure rate is about 5-7%.

This number has been increasing over the past few years as more and more students are taking the exam. The average score on Step I is a 222.

Not that many students of US based MD/DO schools fail the USMLE.

You might see a rate sometimes reported of up to 20%, this typically includes foreign schools, which have a higher fail rate in general.

How many times can you fail USMLE?

Technically you can only take the USMLE Step 1 6 times, meaning you could theoretically fail it 6 times.

This is very rare, and if you have failed it this many times you might want to consider a different career path.

Most students that fail it the first time will pass on the second or third attempt.

If you have failed, don’t stress, just buckle down and come up with a good plan to make sure you pass it the second time around.

How important is Step 1 score for residency?

This used to be a lot more important than it is now. In the past, your Step I score was really what determined what residency you would match into.

Nowadays, there are many other factors that come into play when it comes to matching into a residency.

That being said, your Step I report is still an important part of your application and will be looked at by residency programs.

Be sure to try and pass it on that initial exam, but if it doesn’t happen it isn’t the end of the world.

How will pass/fail Step 1 affect residency?

This likely means that USMLE Step 2 CK will become more important and you will need to score well on that exam.

It is important to note that Step I is not the only factor that goes into residency applications.

There are other things such as your clinical rotations, letters of recommendation and what type of medical school you attended that all play a role.

Step 1 is just a part of the whole thing, so be sure the rest of your application is up to snuff! Also, pro tip, be sure to take plenty of time and make your personal statement a solid piece of art!

Can you Match if you fail step 1 three times?

Failing this exam 3 times would make it difficult to match into a residency.

It is important to pass Step I on your first or second attempt, as most programs will not look favorably upon applicants that have failed it multiple times.

Take your time during your dedicated study time and really focus on techniques of test taking if you find that you have test taking anxiety or lack good testing skills. Your medical career hangs on this exam, so make sure you pass it on the first or second attempt.

Can I retake Step 1 if I pass?

Yes you can retake it up to six times, but this is very rare and not recommended.

If you have taken it 3 or more times and continue to fail, this can make it hard to get into a residency program, so if this happens then it is important to really decide if you want to continue on your path to becoming a physician.

How to Pass Step 1 after Failing

Focus on your weak areas, and do a ton of practice questions and practice tests before your next attempt.

I highly recommend going through pathoma, sketchy, BNB, and doing around 8-10,000 practice questions prior to tackling this beast of an exam.

This would make it so that you are better prepared for what is to come, and more likely to pass on your next attempt.

I wish you the best of luck in your journey to becoming a physician! stay positive and don’t give up on your dreams.

Helpful Step 1 Resources

Hands down my favorite resources for Step 1 are:

These are amazing resources and if you use each one of them to their full ability, it would be hard to not do well on the Step 1 exam.


This is what happens if you fail Step I of the USMLE. While it is not the end of the world, it can be difficult to come back from multiple failures. Be sure to focus on your weak areas and use high-quality resources to help you prepare for retaking the exam. With a little bit of hard work, you will be able to pass Step I and continue on your journey to becoming a physician! Thanks for reading.

I hope this was helpful. If you have any questions, please feel free to reach out to me at sean@comprepmed.com or leave a comment below. Good luck!

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