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

FAQs

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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)

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.

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.

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!

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.

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.

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.

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

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.

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?

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.

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.

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.

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.

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.

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.

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.