What to Do if You Fail the USMLE® Step 1

fail usmle step 1

While it may be disappointing to fail the USMLE® Step 1, the good news is that you are not alone. Failing the exam does not mean you won’t match into a residency program. 

Approximately 4,000 do not pass each year and the American Association of Medical Colleges (AAMC) reports that failing Step 1 on your first try does not mean you cannot secure a medical residency. According to AAMC’s July 2020 report, based on data from 2017, 72% of U.S. applicants who failed Step 1 on the first attempt went on to a residency, compared to 94% of applicants who passed on the first attempt. 

You can reschedule and retake the examination. You may attempt Step 1 up to six times but you can only take it no more than three times within a 12-month period. However, the USMLE® Attempt Limit Policy will change to a maximum of four attempts beginning no earlier than July 1, 2021. In addition, while the examination is currently graded with a three-digit minimum passing score of 194, Step 1 will become Pass/Fail starting in January 2022.

Inform your medical school

Each medical school has its own retesting procedures and regulations for students who need to retake Step 1. You may have to make an appointment with your academic advisor to discuss remediation/study plans. 

Digest and Rest

It is understandable to feel disappointed or embarrassed. Talk with close friends or family to help provide the encouragement you need to get over this hurdle. Take some time to come to terms with your test results. This is what Dr. Erica Howe, a hospitalist and founder of Women Physicians Wellness Conference, and CEO, The Medical Educator, said about in a KevinMD blog post her experience failing Step 1: 

Time let me see that this situation was not personal to me (other people failed too), nor was it permanent (I had a second chance to take the test) or pervasive (the rest of my life was still pretty great). With this new vantage point, I was able to start refocusing my efforts on passing the test the second time around.” – Dr. Erica Howe


Assessing your past preparation and test performance will optimize performance. Figure out what went wrong the first time so you don’t do the same thing the second time around. Look over your USMLE® Score Report and use it as a tool to help you identify which content areas you should focus your future studying on. Why do you think you did not pass Step 1 on your first try? Time management? A knowledge deficit in a particular clinical area? Test-taking anxiety? If you studied alone, would studying in a group be better? 

In a Reddit post on failing Step 1, one user found that what went wrong on their first Step 1 attempt was getting stuck inside their own head and missing what the question was asking.

I was stuck thinking about questions from two blocks ago. I missed subtle hints and probably a fair amount of giveaway buzzwords, simply because my head was somewhere else. So I identified my problem, worked on it, hammered it into oblivion, and set out with a new study regimen. Figuring out what you need to change is paramount to your success this time around. If you hop back in the same vehicle without fixing your flat tire, you won’t get very far.” – u/made_for_1_reason

Get professional help

If your exam results have you rattled, don’t be afraid to seek help from a mental health professional. See if your medical school has a student health counselor. Together, you that can identify the issue and come up with a solution. Don’t lose faith. Take this experience as a learning and growth opportunity.  

Study smarter for your next USMLE® Step 1 Attempt

Find out if your medical school offers a USMLE® preparation program. Alternatively, you can find a peer study group or a physician mentor who can offer you expert tips.

At BoardVitals, we recommend at least two months of study before your next retake. Use BoardVitals as a remedial tool. Try the USMLE® Step 1 Question Bank with a FREE trial or get full access to 3,250+ USMLE® questions with a subscription. Or get back in the game and boost your confidence by taking this quiz of four sample USMLE® questions

Know the latest USMLE® Step 1 information and changes

Before and after you schedule your Step 1 retake, read the most recent USMLE® Bulletin of Information for any possible changes to this and other board examinations, including the 2022 switch to Pass/Fail grading for USMLE® Step 1. While the examination is currently graded with a three-digit minimum passing score of 194, Step 1 will become Pass/Fail starting January 2022.

Remember, if you fail the USMLE® Step 1, you are not alone, and you will bounce back from this.