Hi there, I'm a U.S medical student; I successfully completed my first 2 years of med school without failing any exam or repeating any course. I took Step 1 for the first time last summer (July 2009) and found out I failed (161) in August while on my first third year rotation Pediatrics. I fell into depression, but was allowed to continue on with Peds and the next rotation Surgery, both of which I also failed and have to retake . The plan was for me to take time off earlier this spring semester between Jan-March 2010 (2 months) to study and retake the exam. But I was struggling with depression, anxiety and other personal issues (relationship, family) so I decided to take the entire spring semester off on a leave of absence to deal with my issues, study and retake the exam at a later time. I really started studying for the exam in the last week of March and retook it on June 11. Throughout the study period, I continued to struggle with depression, often had difficulty concentrating, felt demoralized, discouraged and defeated at times, constantly questioned my decision to keep trying/wondered whether it's worth continuing med school since my academic record is pretty much screwed by my Step 1 failure and residency options limited (even for primary care that I originally wanted to do). I just checked my score today-- I failed again (173) . Looking back, I can honestly say that on some days, my studying was not efficient and I didn't always stick to the plan. I mainly used FA, UWorld, BRS Phys & Path, HY Neuro (Goljan RR Path was too thick for me and I'm a slow reader). My schedule was: 8-9am Wake up, shower, eat breakfast 9-1pm Study 1-2pm Lunch 2-4pm UWorld 25-30 Qs focused, tutor mode 4-6pm Study 6-8/9pm Dinner, Relax, Exercise 3x a week 9-11pm UWorld 25-30 Qs random, tutor mode 12midnight Sleep! I only got through 60% of UWorld Qbank, didn't finish reading Biochem, Anatomy and Neuro, skipped Embryo. Mostly focused on Phys, Path, Micro and Pharm. Towards the end of May, I started to burn out and didn't do a good thorough wrap-up review in the last few days. Brief background on me-- I'm not a good standardized test-taker, struggled with the MCAT, took it 4 times, highest score on last attempt was 25 . My school's policy is that you must pass USMLE Step 1 in order to move on to 4th year. At this point, I'm not even sure I want to or can practice medicine anymore/do primary care-- my confidence has been shattered and my academic record is severely weakened by failing Step 1 twice, I don't know if any residency program will take me, even family med or psych. I just want to at least graduate with my M.D. degree because I'm in a lot of debt (out-of-state student $70k/year)-- As of right now, I'm $175,000 in debt from 2.5 yrs of med school. If I complete the remaining 2 years to graduate, I'll be at least $315,000 in debt... before interest!). If I quit med school now, I won't earn enough with just a Masters degree to pay back my enormous debt. I have a strong interest in Public Health and am leaning towards potentially getting an MPH degree afterward to add to the M.D. degree if I can at least make it to graduation. I wish my school would exempt me from having to pass USMLE Step 1 & 2 to graduate if I decide not to pursue residency or residency is not a viable option for me in light of my academic struggles. After all, why take a licensing exam if you no longer wish to be a licensed physician? I heard some med schools like UPenn allow this for students who change their minds about doing residency/practicing medicine, does anyone know or have experience with this? I would like to attempt Step 1 one more time and continue on with my rotations but I also have doubts/fears. I guess my questions for you guys are: 1) Do you think it's worth it to continue med school? dig myself into more debt when there's a chance I may not practice clinical medicine? 2) What are my alternative career options if I decide to quit med school? I just have a Bachelors' in Biology 3) What would you do if you were in my shoes? Also, any Step 1 study advice would be appreciated especially from those who've had similar struggles/had to retake the exam. When I restart third year this fall 2010 semester, my schedule would be: Internal Medicine - 3 months Psych - 6 weeks OB/GYN - 6 weeks (but split over winter/Christmas break: 2 weeks before break and remaining 4 weeks after). Our winter break is about 2 weeks. I'm thinking of pushing OB/GYN to 4th year and studying to retake Step 1 for the third/last time during that 6 weeks block... it will suck having to study intensely over my winter break but I'm worried I'll be too burned out after Internal Medicine to study for Step 1 during the Psych block instead. Sorry for the long post, I'm just trying to figure out what to do and unfortunately, I don't feel my school admin is sympathetic or helpful-- I think they've given up on me, and would probably be happy if I just quit med school already! I feel like such a loser and failure Thanks for reading.