Failed Step 1... twice :( Need advice ASAP!

[Slow N Steady]

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.

---

Members don't see this ad.

 

[littlealex]

---edited--- double post error.

 

[littlealex]

Can you do it? Yes. You need to get it together though. You had MONTHS to study for step1 and failed to finish UWorld questions? wtf is that. And don't take the exam if your NBME scores aren't at your target. I never quite figured out why people do that. You should had delayed it. DO NOT MAKE THAT MISTAKE AGAIN.

You may not be a good standardized test taker. That's okay. Practice will make you better. Before you make your next attempt at Step1, because of these extraordinary situations, you must complete the following:

1. Do ALL of the Kaplan questions in tutor mode. Read the explanations and take notes in First Aid.
----Take an NBME practice test to see where you are----
2. Do ALL of the UWorld questions in timed, random blocks. Read the explanations in detail and take notes into your First Aid.
----Take an NBME practice test to see where you are----
3. Do ALL of UWorld questions AGAIN in timed, random blocks. Read explanations.
----Take an NBME practice test to see where you are----


I know this seems like a lot (around 6000 questions total). But I feel like you NEED it. Think of it this way: your earning potential as an MD vs some college grad with a science degree is probably near 2 million dollars in your lifetime. This is someone paying you TWO MILLION DOLLARS to do practice questions and secure your future.

Do the damn questions until you're good at them. Until repetition itself makes you remember it.

Do at LEAST 150 questions a day, preferably 200 a day. At 200 a day you can complete all the questions in 30 days. Stop slacking off and study harder. It's time to bring it up a notch.

 

[Eudjinn]

I must agree with previous poster. Your fundamental mistake were that you did not finish UWorld - how could you anyway by only doing 60Q a day? It is not enough. You only had ~1100 practice questions under your belt. If you attempt this again, I would recommend stepping up your study schedule to include more questions. When I studied, I spent a week or two doing strictly Qs (~200-250 a day with going over) and made sure to get through UW at any cost. Supplement with FA/GOljan and that is the ticket. It's tough, but doable. Best of luck to you.

 

[Domenech]

If depression is still bothering you, you should not be afraid to seek psychiatric help and first of all, deal with that thing. It'd simply hurt you a lot more if you're shy to admit it.

Next try to limit how many books you want to study. You need to just stick with First Aid and First Aid and only that. The more books you dig into, the more confused you'd become and first aid almost has everything that would win you a passing score. Dig all the way through it, make your own notes, annotate it or do whatever you want but try and learn the max out of it.

Once you're done with that, follow the schedule already laid out above. You simply cannot stress enough how critically important questions are for your practice + learning from explanations. Keep at it, on daily basis. The NBME exams are your real bet to guide where you're headed to so mix them in. But just keep doing questions, as many as you can possibly manage. Make your own notes from their explanations and keep revising it, on daily basis.

But remember you need to get rid of your anxiety and depression issues. It's no use if you prepare for your Step1 with these problems because lack of concentration and motivation won't do you any good. Identify your problems, make your list and make an appointment with the physician and discuss them. He'd know whether or not medications would help.

If I was in your shoes, I would have done whatever I have stated above. Of course it's really easy to just say these things; doing them in real life is a different matter but that's where your family would pop in. Share your problems with them and their sympathies would ease you off a bit. Definitely give Step1 another shot. If you have to take time out of school, most definitely do it.

And throw away HY BRS and other stuff. Limit your focus to First Aid and Qbanks only. Last but not the least, good luck with your ambitions! My prayers would be with you!

 

[PokerDoc]

I think its most important to get your life in order before you start worrying about the test again. The advice from the previous 2 posters are good from the preparation standpoint. but its pretty clear to me that your battles with depression have as much if not more of an impact than simply not finishing UW (some people dont use UW at all). I think Step I is so mentally draining and abusive by itself that trying to prepare for and taking the exam while not in the right frame of mind.

My advice to you is threefold

1) Get yourself right.. do whatever you feel you have to do to get to a happier place.. that is first and foremost, until you do that, you will continue to battle the same problems you did the first two times

2) Leave all your doors open. Don't give up too soon and go another route. Finish your degree, pass the steps and get your license to practice. If you decide at that point you want to do public health instead, you can pay your debt off then pursue that avenue, and who knows.. after rotations, your entire mind may change again.

3) intellectually you obviously have what it takes, you did well in your first two years, you didnt magically become inadequate as a medical student. You had a condition which is well known to inhibit cognitive function. I really believe that is the key here, I don't want to delve into your personal life but only you can seek out the proper help you need. Be vocal and remove things from your life that cause these feelings in you, ESPECIALLY during the months before you take the exam again.

best of luck to you

 

[Ookluh]

My attention span is pretty short right now after a long day, but I didn't see any previous posters mention this (though I may have missed it).. even if you end up deciding you don't want to practice medicine, there's always the option of still getting your MD (once you beef up your study regimen like I know others have already suggested).

Who knows? Maybe once you're back on the floors you'll decide you love it again. If not, there are still other careers that MDs can pursue.. I haven't really researched it, but I'm positive that you could find careers in business and consulting and things like that - ESPECIALLY if you were patient enough to get an MBA, but I bet you could do it even in lieu of that (but research that, because I'm just basing that off nothing but my own reasoning).

 

[buckeye12]

I like the advice in this thread. You have to sort out your attention problems and your desire. You're looking at Step 1 as an impediment to just getting out of medical school. I'm not sure that's the attitude to have. Try to reconnect with whatever made you go to medical school in the first place.

Some good advice someone told me is to stop thinking about stuff and just study. Stop worrying about planning a massive study schedule. Just find a few good resources (First Aid, USMLEWorld, RR Path, BRS Physio are more than enough) and use ONLY THEM. Make sure you get through all of them. Disconnect from the internet. Get out of your comfort zone and find new places to study.

Also, 25-30 questions in UW should NOT take you 2 hours. You should be able to easily squeeze in 48 questions in that time, and my advice is to do at least 144 questions a day. Don't think about how much that is. Just freaking do it. If you're taking that long for 25-30 questions, it's very possible your study habits are incredibly inefficient. There are probably study advisers at your med school -- find them.

Also, quit stressing out about it. Yeah, you failed twice. What are you going to do about it now? Give up? Screw that. From your post, you're well aware of what's holding you back, and you're just being tentative about fixing it. Stop wallowing and worrying. Instead, pull a Nike.

In your case, you already know the areas of the exam you're deficient in. Hit those hard.

I don't know why I'm giving this advice. You already know what's wrong. You just need someone to kick your ***** into making it right!

 

[Mr hawkings]

Rising M2 here but i have had friends who failed it 2x as well and i have to agree with the advice being given here.
I have to say too that your school has been more understanding than a lot of schools would. At least they were willing to allow you to do some of the rotations. Some schools wont let you come close to starting a rotation without a passing step1 score.

I really hope you get the depression thing figured out. Please get treatment for it. Its not something you just "get over" because you want to. You need to take steps to make sure that you dotn fall into a deep depression 2 week before your next attempt

 

[SuperSlacker]

To the OP, I too was diagnosed with major depressive disorder - near the end of first year. I never failed any classes and even honored some of them, but since I was supposed to be a scholarship student, people noticed my relatively sub-par performance.

I lied to my dean the first time around, and told him I simply wasn't studying. I blew all my money gambling online (so I can understand the financial implications of quitting med school as well). I actually got a license to teach abroad because I was convinced that I hated life, medicine, our country - everything. I was weeks away from finishing first year when I had a crisis and I'm lucky a classmate texted me to ask me where I was (I stopped attending class, even mandatory meetings). I sought help, and I had to take an immediate leave.

I started school again the next year and like you, I still had attention and mood problems. However, I was fortunate to remain away from the breaking point this time. My grades still suffered and oscillated from honors to barely passing. I didn't start studying early because I had to make up for lost time (days when I just couldn't leave my bed, let alone the house, etc.).

OK, now that you have some background about me...I think it's important for you to:

1. BE HONEST ABOUT YOUR ABILITIES IN THE PRESENT STATE.

Have you dealt with your depression in a sufficient manner? Can you still fulfill your responsibilities as a med student and in the future, as a physician?

2. BE HONEST ABOUT YOUR GOALS.

My goal was a 240 the whole time because I knew I had to "compensate" for my low class rank. I knew I had to work hard because I have a weak background. I told my friends and family about my goals so they knew what I was facing.

3. FIND A SUPPORT SYSTEM AND DO THE WORK.

I went through UWorld 1.8x (READ THE ANSWER EXPLANATIONS AND REFER BACK TO FIRST AID), and most of Kaplan (USE THIS AS YOU GO THROUGH FIRST AID AS SECTION REVIEW)...I read First Aid 2.5x...I read BRS physio and path once (I would have read Rapid Review Path in retrospect). I believe this is the bare MINIMUM if you don't have a strong background from the coursework.

Unlike most of my classmates that walled themselves up in the library, I went home to my family and my dog (by the way, dog >> therapy, SSRI's for me). I studied 6-8 hours a day almost every day for 5.5 weeks with a friend who was studying for MCATs. I GAVE MYSELF TIME OFF WHEN I ABSOLUTELY NEEDED IT. I took several Sundays off and watched every single Laker game of the NBA playoffs.

4. BE REALISTIC ABOUT YOUR OPTIONS IF YOU STILL HAVE DOUBTS ABOUT MEDICINE.

I still think you should try AT ALL COSTS to finish your degree. It opens a lot of doors for you even if you choose not to practice, and I also saw it as a personal challenge (i.e. if I could finish med school while being severely depressed, then I could do anything besides win a ring...and even then I'd have something in common with LBJ). However, you know yourself best.

Best of luck to ya...and if you have any other questions PM me (I won't troll the step1 forum as often now).

 

[Rikkye]

Slow & Steady, your story brought me out of my many years of lurking SDN without posting.

I can relate with you about depression, it's very difficult to deal with and very difficult for ppl who haven't gone through it to understand. So I won't tell you to buckle up or all that useless ****.

However, your study plan is flawed. you just need to:

1. limit your books, I only use 3
First Aid - MEMORIZE the book. I'm freaking serious. MEMORIZE MEMORIZE MEMORIZE. I went back to this book 100x. I read this book probably 20x.
Gojlian - excellent supplement, but it's just SUPPLEMENT. To be honest, I didn't even finish reading it.
BRS physiology - the only BRS you will ever need.

2. FINISH USMLE World, Kaplan optional (their explanation sucks)
depends on your schedule, you should try to at least squeeze in 100 questions per day and READ THE EXPLANATION

3. go at a steady pace from subject to subject in FA and build momentum before increase in intensity. Keep going and doing it over and over again.

4. leave 1.5 week before the exam to go over FA AGAIN!!!! MEMORIZE!!! and do 50 questions per day.

5. in between, take NMBE when you feel you have made some progress. don't waste money if you feel like you haven't change much in between NMBEs. take the step when you see your score stabilizing with NMBE.

---

that was basically my schedule and i really hope you do well
whatever you decide to do from here on out, best of luck
you might feel like you're hitting rock bottom, but i can tell you, it's just a stumble on the road, because rock bottom is when you lose things you never even think you can lose

 

[Slow N Steady]

Thanks everyone for replying to my post and for the advice. Just wanted to update:

-- My school admin/deans have refused to give me more than 4 weeks to study and retake the exam, because I took it just 5 weeks ago on June 11. They feel I should still remember things from my previous study period which by the way was for 10.5 weeks (March 28 to June 10)!!!

-- I got back my Step 1 score on July 14, wrote my dean the next day and they notified me at 8am on Friday July 16 that I should start studying to retake it now and that they expect me back in school restarting third year on August 16, which leaves me with only 22/23 days from today until August 12 or 13 when I'll be retaking the exam

-- I'm very worried that I won't be adequately prepared to retake this exam: There are 430 pages of First Aid 2009, divided by 20 days = 21.5 pages/day. There are 2078 UWorld Questions, divided by 20 days = 103.9 Qs/day. There is no way I can realistically accomplish all this in 20 days (even with 12 hrs of study/day) and review in 2 days!

-- So, I'm very stressed and feel kinda defeated right now but trying to keep my head up. I'll do the best I can in this circumstance and hope for the best. Whatever happens, happens! Will keep you guys posted on the outcome.

Keep me in your prayers and thanks again

 

[2012mdc]

Thanks everyone for replying to my post and for the advice. Just wanted to update:

-- My school admin/deans have refused to give me more than 4 weeks to study and retake the exam, because I took it just 5 weeks ago on June 11. They feel I should still remember things from my previous study period which by the way was for 10.5 weeks (March 28 to June 10)!!!

-- I got back my score on July 14, wrote my dean the next day and they notified me at 8am on July 16 that I should start studying now and that they expect me back in school restarting third year on August 16, which leaves me with only 22/23 days from today until August 12 or 13 when I'll be retaking the exam

-- I'm very worried that I won't be adequately prepared to retake this exam: There are 430 pages of First Aid 2009, divided by 20 days = 21.5 pages/day. There are 2078 UWorld Questions, divided by 20 days = 103.9 Qs/day. There is no way I can realistically accomplish all this in 20 days and review in 2 days!

-- So, I'm very stressed and feel kinda defeated right now but trying to keep my head up. I'll do the best I can in this circumstance and hope for the best. Will keep you posted on the outcome.

Thanks again

Don't have the defeated attitude. Figure out exactly what you need to do improve your score and do it.

If you put your mind to it you can definitely accomplish it. During my study period I did 96 questions a day and took 10-14 days to do 1 pass through FA and Goljan RR (modified Taus method)

 

[knuckles]

You can definitely do it. Do all the sections individually, eg read through Endocrine in First Aid and then do all the endocrine questions in UWorld that day, and annotate the chapter in First Aid as you read the explanations. I think a system by system approach works really well. If you do this for every section, you'll undoubtedly pass.

 

[Ana1982]

Don't worry honey. EVERYONE goes through a rough time at some point in med school. Plus, failing Step 1 doesn't mean you're stupid - just that you got an unlucky batch of questions.

This time around FORGET what happened in the past. COVER ALL BASES. Ignore what people say about only doing First Aid, or only doing USMLE World. Take a look at ALL the resources...and figure out which ones feel comfortable to you. Do a good, thorough review of all the subjects, then attack and murder all the questions you can. Each test prep company has SOMETHING to offer, at least it'll give you a few 5-10 extra points. I mean, you're in the 170s so it's not impossible for you to get at least 188 right? It's not like you failed with 130 or something...lol

Study hard, clear your mind, have CONFIDENCE - you can AND WILL DO IT! There are people whose parents have passed away in the middle of their step 1 study and they made it.

Good luck and take care Ana

 

[Ana1982]

By the way...I could be wrong about how this test is scored...but I am guessing that if you got 15, 20, 25 more questions right you could have passed...so I think you can do it You're not TOO far from passing if you think about it. Take your share of practice tests, and don't take the exam until you get scores you like on your practice tests

 

[Slow N Steady]

Don't worry honey. EVERYONE goes through a rough time at some point in med school. Plus, failing Step 1 doesn't mean you're stupid - just that you got an unlucky batch of questions.

This time around FORGET what happened in the past. COVER ALL BASES. Ignore what people say about only doing First Aid, or only doing USMLE World. Take a look at ALL the resources...and figure out which ones feel comfortable to you. Do a good, thorough review of all the subjects, then attack and murder all the questions you can. Each test prep company has SOMETHING to offer, at least it'll give you a few 5-10 extra points. I mean, you're in the 170s so it's not impossible for you to get at least 188 right? It's not like you failed with 130 or something...lol

Study hard, clear your mind, have CONFIDENCE - you can AND WILL DO IT! There are people whose parents have passed away in the middle of their step 1 study and they made it.

Good luck and take care Ana

Thanks a lot Ana (and everyone else) for the support-- I am working very hard and trying not to have a defeated attitude, I really believe I can do this

My school only allowed me 4 weeks to study and retake the exam so I don't have a lot of time on my hands and can't postpone if I don't like my score on practice tests-- the most I can do is my best and hope that's enough to secure a passing score so I can continue on with medical school.

You're right Ana, I'm not too far behind-- just need 15 more points from 173 to pass, not sure how many more questions I need to get right but I imagine not too many

Will keep you posted!

 

[slowbutsteady]

Thanks a lot Ana (and everyone else) for the support-- I am working very hard and trying not to have a defeated attitude, I really believe I can do this

My school only allowed me 4 weeks to study and retake the exam so I don't have a lot of time on my hands and can't postpone if I don't like my score on practice tests-- the most I can do is my best and hope that's enough to secure a passing score so I can continue on with medical school.

You're right Ana, I'm not too far behind-- just need 15 more points from 173 to pass, not sure how many more questions I need to get right but I imagine not too many

Will keep you posted!

Keep those lunch and dinner breaks SHORT!!!! Good luck!!!

 

[Ana1982]

I hope you read my private message SlowNSteady!!! It will help you TREMENDOUSLY!

Do NOT give up. Yes I actually know someone who took Step 1, failed with 170, took it again, AND GOT 250!!!!!!!! This person really went crazy though....doing about 20,000 questions or something.

but hey it can happen. Even if it only happens 1% of the time. BE THAT ONE PERCENT!!!

 

[futIDdoc]

Wow...did you say you failed two rotations? The might be as big of a hurdle as your step I scores. At my school that is an auto-dismiss. Hate to be the contrarian on the thread, but I think you need to sit down with your an academic advisor (after your step I of course, that should be your #1 priority) and map out some kind of career path.

Good luck.

 

[BrianUM]

best of luck to you buddy

no one said it was easy

i think the best thing to do is to talk to a counselor and get your mind straight first....then attack the test like a machine...no tv, no internet for however long you need...6-8 weeks....

heck, you can even talk about how all this experience was life-changing in your personal statement down the line

you're not alone, lots of ppl fail step 1 and/or shelf exams or school exams...take a deep breath, relax...your in med school, youve come so far...dont give up now

 

[jackieMD2007]

A lot of good advice has been given to the OP:

I recently studied for Step 2 (so I know how much it sucks to do questions all day)...
If you have already done two blocks of 44 and the third is really dragging, do it in tutor mode. If you get tired just pick the first answer choice and read the answers. At least you read through the question and the answer.

It is most important to just see how the questions are written.

I also hope that you saught treatment/support for your depression, just as important as First Aid and UWorld

 

[Staryy]

.

 

[Medstudent1201]

Thanks a lot Ana (and everyone else) for the support-- I am working very hard and trying not to have a defeated attitude, I really believe I can do this

My school only allowed me 4 weeks to study and retake the exam so I don't have a lot of time on my hands and can't postpone if I don't like my score on practice tests-- the most I can do is my best and hope that's enough to secure a passing score so I can continue on with medical school.

You're right Ana, I'm not too far behind-- just need 15 more points from 173 to pass, not sure how many more questions I need to get right but I imagine not too many

Will keep you posted!

I know this was a long time ago. Just curious how things turned out? I am in a very similar situation. I think the biggest thing people don't realize is that the anxiety and depression leading to difficulty focusing makes doing 150-200 questions a day almost impossible. I've tried getting help but nothing has been sustainable. Beginning to think I'm just not cut out for med school which is even more depressing after all the time, energy and sacrifices I have made to be where I am. Hope things turned out well for you! All the best!

 

[queendenteena8]

I know this was a long time ago. Just curious how things turned out? I am in a very similar situation. I think the biggest thing people don't realize is that the anxiety and depression leading to difficulty focusing makes doing 150-200 questions a day almost impossible. I've tried getting help but nothing has been sustainable. Beginning to think I'm just not cut out for med school which is even more depressing after all the time, energy and sacrifices I have made to be where I am. Hope things turned out well for you! All the best!

What did you end up doing?

 

[Taxonomy]

What did you end up doing?

Just wanted to chime in about number of questions per day. In dedicated mode it's very hard to do more than 120 questions per day - given that you are using UW as a learning tool, NOT as a test to see how much you score (for that you can use nbme). Using it as a learning tool - means reading through and thinking through ALL answers, all explanations and even making some notes along the way. That's the proper way - and it's unrealistic to do more than 120 per day. Those who say they did 200-250 - just run through them - that's NOT using it as a learning tool, but rather as a question set to quickly run through and see what % you got correct - that's entirely different and IMHO useless. That run through can be done for when you are doing 2nd pass, but definitely not during 1st pass.