USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (2023)


Most med students pass USMLE Step 1 and COMLEX

USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (2)

The Federation of State Medical Boards and the National Board of Medical Examiners recently announced that the United States Medical Licensing Exam will be pass/fail for Step 1. Until the new scoring system takes place in January 2022, there will still be a numeric score for Step 1 (and the numeric score will remain for Step 2) that will factor into residency “match” decisions. For most medical students, simply passing the USMLE Step 1 isn’t good enough.

If you have any hopes of going into a competitive specialty or the field of your choice, then you need to pass the USMLE Step 1 with flying colors. The first time.

You can’t retake the step component to simply improve your score. Once it’s done — it’s done. So you have to make the most of your Step 1 opportunity.

Merely passing isn’t good enough. A low passing score can be just as damaging as failing outright.

And unfortunately, in most cases, medical students are their own worst enemy, because the most common reasons for poor performance and low memory recall on exam day are self-inflicted.

Here’s what med students like you might be doing when you study for Step 1, and what you should be doing instead.


USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (3)
The Most Common Reasons for Low USMLE Step 1 Scores

The goal of USMLE Step 1 is to evaluate a med student’s ability to apply key concepts and fundamentals to medical practice.

By the time you take it, the material isn’t necessarily new. There’s just a lot of it.

The difficulty of this medical licensing exam comes down to the sheer breadth and volume of information. And the prospect of regurgitating everything during a single, 8-hour day is daunting. Especially because you only get about one minute per question.

(Video) How to EASILY Pass USMLE Step 1 in 2022 (Resources + Study Tips)

Preparing to master so many different areas, and being forced to recall and apply them quickly – under pressure – is challenging.

But it’s even more challenging when your preparation is misspent. Poor study habits like multitasking, social studying, and a distracting environment sabotage your memory faster than you can improve it.

Many of you are familiar with the 10,000-hour rule (made infamous by Malcolm Gladwell). However, everyone has lives. You can’t simply lock yourself away for a few years to focus on a single medical licensing exam.

The number of hours you study can only get you so far. To succeed with a limited time frame and numerous other extracurricular commitments, we need to focus, prioritize, and use that time wisely.

And we need to kill passive studying.


USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (4)
How to Study for the USMLE Step 1 Like a Chess Grandmaster

“Grandmaster” is the highest attainable title in the chess world, and rightfully so. Very few people make it to this status in their lifetime, but here’s the most surprising thing:

Studies have shown that chess grandmasters don’t necessarily spend more time studying the game than their counterparts. They just make better use of that time.

Outside of chess, their memory recall is just like your average person. The reason they excel at chess is because of (among other things) their deep understanding of how the pieces fit together.

They “chunk” their domain expertise down – like how different individual pieces fit together to form patterns and strategies – and can quickly recognize, recall, and apply that information.

And they develop this ability cumulatively, over time, through countless hours of deliberate practice.


USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (5)
Improve Memory Recall by Making Studying More “Active”

Passive techniques like copying notes as written, sticking to one studying method, and relying on rote memorization can only get you so far. Presented with too much information and a short time frame, it quickly starts to break down. That’s because there’s no engagement with the material, there’s no context for how it fits together. Your application and recall of the information will be limited at best.

The key to mastering information recall is to add context and improve engagement with the material. Active studying techniques like writing in your own words, rewriting, creating flowcharts of related concepts, self-testing, and using multiple approaches like Picmonic’s audio and visual can significantly improve retention.

(Video) How USMLE Step 1 Pass/Fail is Changing Medical School

Underneath most active studying approaches is deliberate practice, a concept coined by Anders Ericsson and his colleagues. Whereas “the mere number of years of experience with relevant activities in a domain is typically related to performance,” deliberate practice is a more focused approach to quickly improve how we learn.

And deliberate practice has some unique characteristics that set it apart from most other techniques:

  • The information is specifically designed by a mentor, coach, or expert.
  • The format is highly structured and is easily repeatable.
  • Feedback on your results is consistently available.
  • Studying requires complete immersion, is highly demanding, and typically painful to sustain.

Unlike sitting in a coffee shop, casually discussing Step 1 principles with your friends, deliberate practice is not fun. It’s strenuous and mentally draining. And it’s usually solitary, focused work.

Step 1 studying can typically only be practiced for a few hours a day, for only 60-90 minutes at a time. But if you’re doing it correctly, that should be all the time you can handle.


USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (6)
How to Apply Deliberate Practice to Studying for the USMLE Step 1

The goal of deliberate practice is to stretch and focus on improving areas you’re not very good at.

And there’s an old saying about how memory relates to engagement. For example, you may only remember 10% of something you read, but that number goes up significantly when you can hear it, see it, say it, and do it.

So let’s take a look at the steps of studying processes that incorporate deliberate practice characteristics and as much interaction with the information as possible.

  • Step 1. Overview: Get a big picture overview of all the material and concepts. This information should be administered by an expert, tutor, or teacher to prioritize what to include and what to leave out.
  • Step 2. Outline: Begin delineating where certain topics begin and end so you’re able to create more structure and get a quick understanding of how it all works together.
  • Step 3. Organize: Now start to deconstruct each topic and dive deeper into the specifics of each subject. Carefully prepare all of the material so it’s concise, prioritized, and repeatable.
  • Step 4. Memorize: Rigorously go through each topic or subject, one at a time. This step is all about repetition, repetition, repetition. Make sure you’re also getting instant feedback to know where and when you make mistakes.
  • Step 5. Apply: Finally, reconstruct all of the information back together to make connections between how everything relates and fits together. Again, repeat the process while benchmarking against external feedback like a timer or coach to improve your speed and accuracy.

A strategic approach to studying for Step 1 like this will help you get a better return on your studying efforts. But the application is difficult because there are different solutions which address one or two steps, but not the others.

Mind mapping or diagrams help you outline and structure information. But not memorize it. While flash cards may help you organize and memorize, but not apply it.

Picmonic can help you every step of the way.

The visual learning content was developed by former students with first-hand exam experience – there’s your expert input. The information is organized in a way that cuts down your studying time by only presenting the most relevant content you need – while leaving everything else out. From basic science to bugs and drugs, Picmonic’s structured to give you an efficient study plan for Step 1, and provides constant feedback along the way.

The use of audio and visual mnemonics to master difficult subjects has been proven to be one of the most effective forms of memorization and recall.


And most importantly, picture mnemonics have been proven to aid the application of information, because your memory can retrieve accurate information in less time.

So you’re not just cramming information to regurgitate one day and forget forever. You’re improving neural pathways to acquire expert performance.

And you’re drastically improving your odds of excelling at the USMLE Step 1, and Step 2 as well. And your professional medical practice after medical school, too.

Picmonic has a free trial! Check it out now with no strings attached.


Download our mobile app and take Picmonic on the go!

USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (7)USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (8)

  • Author Details

USMLE Step 1 Tips: Reasons Why Med Students Fail & How to Pass [Updated for 2022] (9)

Ron Robertson

Ron Robertson, Co-founder & CEO, Picmonic Inc.

Ron Robertson founded Picmonic as a 3rd-year medical student at the University of Arizona. He’s at the helm of Picmonic’s mission to lead and inspire a new era of learning through innovative and effective educational solutions. Ron holds a Bachelor of Science in Biochemistry from the University of San Diego with a focus on memory science, is the product visionary behind Picmonic, and is involved in every aspect of the company.

(Video) How to fail the USMLE step 1 exam in 11 steps.

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(Video) "Failed USMLE Step 1. How do I pass when re-taking it?"

md med-school medical-school ms2 passing USMLE step-1 studying for usmle studying for USMLE step 1 usmle usmle step 1


Why is Step 1 pass fail now? ›

The goals in switching Step 1 of the United States Medical Licensing Examination® (USMLE®) to pass-fail were manifold. Among the chief aims was reducing the burden of exam preparation for medical students and creating a more holistic residency-application selection process.

How many people failed Step 1 2022? ›

2022 USMLE Step 1 Overview

The USMLE recently released its full report on the 2022 performance data for the Step 1, Step 2 CK, and Step 3 exams, which shows the Step 1 passing rate in 2022 dropped significantly compared to 2021. In 2021, 88% of test-takers passed; in 2022, just 82% passed.

Why are so many people failing Step 1? ›

It's common for students who fail to try to use every single Step 1 resource available. The level of understanding required for the USMLE is challenging to achieve and will require dedication and plenty of hard work. For example, using flashcards is a great study resource, but creating too many makes it useless.

How many questions to pass Step 1 2022? ›

Increased Passing Standard for Step 1

The Step 1 pass/fail transition beginning on January 26, 2022, coincided with an increase in the exam's minimum passing standard from 194 to 196.

What percent of people don t pass Step 1? ›

How Many People Fail Step 1 Every Year?
Step 1 Passing Rates20172020
IMG Fails*4,6452,230
Total Step 1 Exams42,42038,734
Overall Step 1 Pass Rate86%92%
Total Step 1 Fails6,1193,104
11 more rows

What happens if you barely pass Step 1? ›

You can retake USMLE Step 1 up to six times if you've failed. You can take Step 1 a maximum of three times within a span of 12 months. Your fourth attempt and any beyond that must be at least 12 months after your first attempt. Also, they must be at least six months after your third attempt.

How common is it to fail Step 1? ›

Here is how many people fail Step 1 every year. The passing rate of people who are re-taking Step 1 is lower. However, despite that, the majority of people who take Step 1 again will pass. For example, in 2020, of the 1985 re-takes of Step 1, 55% passed.

What is the average Step 1 score 2022? ›

IMGs: Average Step 1 Scores by Specialty (2022 Match)
Step 1, US IMG (Matched)Step 1, Non-US IMG (Matched)
Family Medicine211219
General Surgery236238
Internal Medicine225238
Internal Medicine/Pediatrics220230
18 more rows

Is Step 1 the hardest exam ever? ›

Traditionally, Step 1 has been thought of as both the most difficult and most important USMLE Step exam. There are several reasons for this. Firstly, this exam is the first in the series, and students taking it will have had less experience with the types of questions that the USMLE asks.

How DO I make sure I pass Step 1? ›

How to Pass USMLE Step 1
  1. Understand the Exam Content. ...
  2. Develop a Process to Answer Questions. ...
  3. Download Study Material. ...
  4. Consider Taking a Practice Session. ...
  5. Take an Online Self-Assessment. ...
  6. Enroll in a Review Course. ...
  7. Utilize the Resources Offered By Your Medical School. ...
  8. Be Familiar With the Format Changes.

Why am I not improving Step 1? ›

Memorizing, Not Mastering. By far the most common reason for students scores to stall is that they don't understand the material. A lack of understanding of content is almost always the reason that students can't pass Step 1.

What happens if you fail Step 1 3 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.

Is 60% passing on Step 1? ›

The percentages of correctly answered items required to pass varies by Step and from form to form within each Step. However, examinees typically must answer approximately 60 percent of items correctly to achieve a passing score.

How many questions can you miss on Step 1 and still pass? ›

Remember, there are 200 scored items on Step 1. But you have to answer 60% of them correctly to pass. That's 120/200. That leaves only 80 questions left to assign scores across the rest of the passing range.

What should you be scoring on Uworld to pass Step 1? ›

While the number of questions per block may vary, they will not exceed 40. The total number of questions in Step 1 will not be more than 280. The current minimum USMLE Step 1 score to pass Step 1 is 196, and the maximum possible score is 300.

What is the lowest Step 1 score possible? ›

The current minimum passing score for Step 1 is a 194. The score you might want to get, however, could be somewhere between 238 or as high as 251, depending on the competitiveness of your desired specialty.

What percent correct is a 196 on Step 1? ›

Assuming Step 1 is scored similarly to CBSSA 25-30, you would need somewhere between 63 to 65% correct to attain the passing score of 196.

What is the average Step 1 score overall? ›

The USMLE® Step 1 passing score is 194, and the national average score is approximately 232. The USMLE® Step 2 passing score is 209, with an average score of 245. The following summarizes the typical average score required to match in most specialties.

Can you still be a doctor if you fail Step 1? ›

Failing Step 1 will impact a student's application strategy, but it doesn't usually mean their pathway to becoming a physician is over. These students may want to consider additional specialties where they will be more competitive and should speak with their advisors about their individual circumstances.

How long does it take to study for Pass fail Step 1? ›

After preclinical years, students take an average of 6-8 weeks of “dedicated” study time to prepare for Step 1. The amount of time you need will depend on your own weak points and your foundation of knowledge.

What happens if you fail Step 1 4 times? ›

The total number of attempts allowed per Step is four (4). Examinees who have attempted any USMLE Step (including Step 2 CS) four or more times and have not passed are ineligible to apply for USMLE Steps.

How many times can you retake Step 1? ›

1. What are the rules regarding retakes? You may take the same examination no more than three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt at that exam and at least six months after your most recent attempt at that exam.

Is the Step 1 exam curved? ›

Note that the USMLE examination is not scored “on a curve”. Students are not scored against each other, but relative to a per-set annual standard. This standard is constant for the year. Both US medical students and IMGs are scored using the same standard.

Can you pass Step 1 in 4 weeks? ›

With a 4-week USMLE Step 1 study schedule, you will have enough time to complete a substantial study block, but as the saying goes, preparation is 90% of the outcome. Here's how you can develop a 4-week Step 1 schedule to ace your exam.

Will residencies still look at Step 1 scores? ›

As of January 2022, however, this will no longer be the case. USMLE Step 1 will be graded as pass/fail and will no longer be the primary determinant of one's competitiveness as a residency applicant.

What score is 70 on Step 1? ›

A CBSE score of 70 is approximately equivalent to a score of 200 on the United States Medical Licensing Examination® (USMLE®) Step 1.

Will Step 1 scores be reported after 2022? ›

All scores for Step 1 exams taken on or before January 25, 2022 will continue to be reported as a numeric score and pass/fail outcome on all USMLE transcripts. If a Step 1 exam on a transcript was taken on or after January 26, 2022, only a pass/fail outcome will be reported.

Is Step 1 as tricky as UWorld? ›

The frequently updated content ensures you learn and master the most relevant material that helps confront your individual USMLE Step 1 strengths and weaknesses. UWorld may be harder than Step 1, with some questions above the actual test's difficulty level.

Which is the hardest step paper? ›

STEP I is meant to be the easier of the three Cambridge STEP papers. STEP II and III are meant to be equivalent in difficulty, mainly differing in the topics they tests. However, as STEP III contains more challenging topics anyway, it would be considered by most as the hardest paper by far.

Which is the toughest exam in the world for medical students? ›

United States Medical Licensing Examination

A pass in USMLE is a must if one has to practise medicine in USA. USMLE (United States Medical Licensing Examination) is said to be a very tough test. No wonder it is considered one of the top 20 toughest exams in world.

What is the Step 1 break strategy? ›

Step 1 Break Time Strategy

Do 2 blocks back-to-back, then 10 min break (if necessary, 3-minute “sit-down” break in front of computer in-between first two blocks) 2 blocks, then 10 min break. 1 block, then lunch break (20-30 minutes; variable, can choose to take a lunch break at any time)

Can your Step 1 score change? ›

For all Steps, a highly rigorous process is used to ensure the accuracy of scores, including a parallel scoring method involving independent scoring systems. Therefore, a change in your score or in your pass/fail outcome based on a recheck is an extremely remote possibility.

How can I improve my Step 1 score in 2 weeks? ›

Improve Your USMLE Step 1 Performance in 2 Weeks
  1. Plan. It is crucial to simulate the testing environment as closely as possible in these last two weeks. ...
  2. Prioritize. We've all heard it: Work smarter, not harder. ...
  3. Test yourself. ...
  4. Review. ...
  5. Take Care of Yourself. ...
  6. Relax. ...
  7. Believe in yourself!

Can an IMG match after failing Step 1? ›

An non-US IMG who fails step 1 is unlikely to match into a U.S. medical residency training program in any medical specialty. A US IMG might match in an IMG-friendly program, if they completed an elective rotation at that program, and had a few good publications on their CV. It will take extra effort.

What score is 50% on Step 1? ›

Until the scoring system for Step 1 changes to Pass/Fail, the scores on Step 1 can be interpreted based on historical percentiles. While 194 represents the 5th percentile, the average (50th percentile) falls between 230 and 235. Scores at or just above the mean are good scores!

Is free 120 predictive Step 1? ›

The Free 120 does not generate a three-digit score. It does give you a percentage correct, which some people have tried to correlate to a Step 1 score, but there isn't any real data about how predictive it is. Anecdotally, I can say that if a student gets a 75% or higher on the NBME Free 120, they pass Step 1.

What is the best NBME predictor for Step 1? ›

Based on informal student reporting, NBME 28 and UWSA 2 are the most correlated with Step 1 performance. Given this information, it might be a good idea to take these two exams when you are further along in your dedicated study and closer to your actual test day.

What is the average step exam score? ›

The USMLE Step 1 passing score is 194, and the national average score is approximately 232. The USMLE Step 2 passing score is 209, with an average score of 245. These two exams are considered the most important exams a medical student will complete as they advance through their medical career.

Is 60% on UWorld bad? ›

58-60% is OK, a good sign is being consistently above the average scores. The Uworld package I bought came with 2 assessment exams.

What is a 65% on UWorld Step 1? ›

Scoring 65% in UWorld Step 1 Qbank is considered a good average especially for anyone who has taken it for the first time. Meanwhile, having 75% and above will most likely get you a 250+ in the exam! To learn more tips to get a 250+, check out our free Step 1 Masterclass here!

Is 65% on UWorld good? ›

The UWORLD site itself says 65% is about average for those who are going through it the first time for prep. They tell you not to worry, they design the test this way, reasoning that it means at least 45% that you got wrong using their bank, is all helping you grow as a learner for the real thing.

When did Step 1 change to pass-fail? ›

On Jan. 26, Step 1 scoring will change from a numeric grade to pass-fail, so the big question is, “Now what?” How should students shift their thinking and preparation for the residency program applications that determine where they'll spend the next several years of their medical training?

What year did Step 1 become pass-fail? ›

On January 26, 2022, USMLE Step 1 score reporting shifted from a three-digit score to a simple pass-fail. The intent behind the change was to address concerns about student well-being and to promote the evaluations of students for residency programs in a more holistic way.

Is it common to fail Step 1? ›

Not surprisingly, many students who fail Step 1 feel overwhelmed and fearful of the future. However, a failed Step 1 doesn't mean you are a failure or that you will fail again. According to the 2021 USMLE pass rates, U.S. MDs who retook Step 1 had a 66% pass rate, while U.S. DOs who retook the exam had a 75% pass rate.

Does Step 1 scores matter anymore? ›

In late January, the influential Step 1 of the United States Medical Licensing Examination (USMLE) changed from numerical to pass-fail scoring. Program sponsors wanted to shift the emphasis away numeric scores but preserve the exam for determining physician licensure eligibility.

How many weeks to study for Step 1 pass fail? ›

Studying for step 1 can a three-to-four months or four-to-six weeks. How rigorous your study plan is will determine how much time you spend preparing for the USMLE overall. Although, even with a rigorous study plan, you'll want to take breaks and quiz yourself on materials throughout.

What percentage is 196 on Step 1? ›

Assuming Step 1 is scored similarly to CBSSA 25-30, you would need somewhere between 63 to 65% correct to attain the passing score of 196.

What is a safe score to pass Step 1? ›

On the three-digit score scale, the passing standard is 196. Future reviews of the Step 1 passing standard will not be reported in terms of a three-digit score.

What is the lowest Step 1 score? ›

The current minimum passing score for Step 1 is a 194. The score you might want to get, however, could be somewhere between 238 or as high as 251, depending on the competitiveness of your desired specialty.


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