Just found out I failed Step1 and I'm in complete shock. Does anyone have any advice?

[whitetopaz]

Took a leave of absence to better prepare for Step1 after undergoing surgery during dedicated.

US MD at mid/low-tier school. NBME's were 230-240 in the last month, UWSA2 was a 247 ~2 weeks out, 97% on the free120 a few days out. Got a 185 on the real deal. WTF???

I felt awful coming out of Prometric, but I NEVER in a MILLION years thought I would fail.

I was originally thinking of doing Gas, IM, or Neuro, but now I have no idea if I can even match.

Does anyone have any advice? Should I take a semester off, or just a few weeks? I want to believe it's a fluke, but I've lost pretty much all confidence in myself.

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[Dantes]

Don't lose confidence. Your practice numbers show you're capable of an above average score. If anything NBMEs underpredict. I'm assuming your practice tests were taken under testing conditions. Anything unique happen on testing day?

I haven't heard of this ever working, but for such a large discrepancy I would at least entertain the idea of paying for a re-score while you keep studying.

 

[M&L]

Don't lose confidence. Your practice numbers show you're capable of an above average score. If anything NBMEs underpredict. I'm assuming your practice tests were taken under testing conditions. Anything unique happen on testing day?

I haven't heard of this ever working, but for such a large discrepancy I would at least entertain the idea of paying for a re-score while you keep studying.

Wait what’s re-scoring ?

 

[whitetopaz]

Don't lose confidence. Your practice numbers show you're capable of an above average score. If anything NBMEs underpredict. I'm assuming your practice tests were taken under testing conditions. Anything unique happen on testing day?

I haven't heard of this ever working, but for such a large discrepancy I would at least entertain the idea of paying for a re-score while you keep studying.

Yes, all tests were taken under testing conditions. However, I feel the practice tests were heavy on subjects I'm especially strong in, whereas my particular Step1 form tested on ALL of my weaknesses. Seriously, I wondered if USMLE just looked at my UWorld strength/weakness breakdown and created a form based on my weakest subjects.

The only possible difference was fatigue towards the end of the exam because I had never done 7 straight blocks, but I can't fathom how that would account for a 60-point drop. It's not like marathon runners practice by running 26.2 miles everyday leading up to the real deal.

I've considered paying for a re-score, but USMLE states that there has never been a score change after a re-score, so I feel the $80 would just be a donation to line USMLE's pockets even more.

 

[Captain_Falcon]

Yes, all tests were taken under testing conditions. However, I feel the practice tests were heavy on subjects I'm especially strong in, whereas my particular Step1 form tested on ALL of my weaknesses. Seriously, I wondered if USMLE just looked at my UWorld strength/weakness breakdown and created a form based on my weakest subjects.

The only possible difference was fatigue towards the end of the exam because I had never done 7 straight blocks, but I can't fathom how that would account for a 60-point drop. It's not like marathon runners practice by running 26.2 miles everyday leading up to the real deal.

I've considered paying for a re-score, but USMLE states that there has never been a score change after a re-score, so I feel the $80 would just be a donation to line USMLE's pockets even more.

How bad are your weaknesses though? Normally students who have practice scores like you have a few weaknesses for sure but if tested strictly on those they'd still pass

 

[DrStephenStrange]

Wait what’s re-scoring ?

You can request to have your score rechecked, but that never actually changes anyone's score.

 

[voxveritatisetlucis]

My best advice is to take practice standardized tests at 15% reduced time to simulate the stress of actual testing,

 

[whitetopaz]

How bad are your weaknesses though? Normally students who have practice scores like you have a few weaknesses for sure but if tested strictly on those they'd still pass

That was my impression as well, so I kept reassuring myself that I would at least pass...

 

[operaman]

I think I would definitely do the recheck. They said the same thing about no score ever being changed about my specialty written boards and yet a friend of mine was apparently the first. He suspected something was up when he not only failed but his weakest section was the area in which he had just completed a fellowship.

Going from 240s to failing is a similar kind of disparity that warrants a second look. did your score report look as expected with respect to your known strengths and weaknesses? If not, yet another suggestion of a possible error.

There’s no way a test form being weighted toward a weakness could result in failing unless you were already borderline (<200). Most of the time this is simply a recall bias and the questions were all evenly distributed according to the usmle bulletin. Sometimes there are additional questions if they are experimental questions but obviously those don’t count

 

[thatchemguy]

I would also agree with getting it re-scored; even if it doesn't get changed it will give you peace of mind instead of wondering "what if?"

 

[whitetopaz]

Going from 240s to failing is a similar kind of disparity that warrants a second look. did your score report look as expected with respect to your known strengths and weaknesses? If not, yet another suggestion of a possible error.

There’s no way a test form being weighted toward a weakness could result in failing unless you were already borderline (<200). Most of the time this is simply a recall bias and the questions were all evenly distributed according to the usmle bulletin. Sometimes there are additional questions if they are experimental questions but obviously those don’t count

In all honesty, the score report did not REMOTELY reflect my strengths/weaknesses.

Across my last 3 NBMEs, both UWSAs 1/2, and UWorld itself, my best systems were behavioral health, renal, immunology, and biostatistics. By discipline, my strengths were in physiology, biochemistry, microbiology, behavioral sciences, immunology, and genetics. The practice test score reports all stated that I was "above average" compared to all test-takers in those specific areas. Hell, I'm even published in several of these fields.

On my actual score report, my performance on all subjects/disciplines are listed as "same," implying that I had no strengths. The ONLY subject listed as "higher" was behavioral sciences AKA ethics/communications, which has always been my best subject (>95% on UWorld).

My medical school advisors "strongly discourage" score re-checks. The process also takes several weeks, so I wonder if I should just focus on doing well on the retake. If I don't pass Step1 in the next few months, I won't be able to graduate on time.

 

[drducky.]

In all honesty, the score report did not REMOTELY reflect my strengths/weaknesses.

Across my last 3 NBMEs, both UWSAs 1/2, and UWorld itself, my best systems were behavioral health, renal, immunology, and biostatistics. By discipline, my strengths were in physiology, biochemistry, microbiology, behavioral sciences, immunology, and genetics. The practice test score reports all stated that I was "above average" compared to all test-takers in those specific areas. Hell, I'm even published in several of these fields.

On my actual score report, my performance on all subjects/disciplines are listed as "same," implying that I had no strengths. The ONLY subject listed as "higher" was behavioral sciences AKA ethics/communications, which has always been my best subject (>95% on UWorld).

My medical school advisors "strongly discourage" score re-checks. The process also takes several weeks, so I wonder if I should just focus on doing well on the retake. If I don't pass Step1 in the next few months, I won't be able to graduate on time.

Why would your school strongly discourage rechecks? Dont they want you to pass too?

 

[whitetopaz]

Why would your school strongly discourage rechecks? Dont they want you to pass too?

USMLE states that there has never been a score change after a re-check, so the $80 fee would just be a donation. Students from my med school have previously requested score checks with no luck, so admin is speaking from experience, I suppose.

 

[xffan624]

In all honesty, the score report did not REMOTELY reflect my strengths/weaknesses.

Across my last 3 NBMEs, both UWSAs 1/2, and UWorld itself, my best systems were behavioral health, renal, immunology, and biostatistics. By discipline, my strengths were in physiology, biochemistry, microbiology, behavioral sciences, immunology, and genetics. The practice test score reports all stated that I was "above average" compared to all test-takers in those specific areas. Hell, I'm even published in several of these fields.

On my actual score report, my performance on all subjects/disciplines are listed as "same," implying that I had no strengths. The ONLY subject listed as "higher" was behavioral sciences AKA ethics/communications, which has always been my best subject (>95% on UWorld).

My medical school advisors "strongly discourage" score re-checks. The process also takes several weeks, so I wonder if I should just focus on doing well on the retake. If I don't pass Step1 in the next few months, I won't be able to graduate on time.

Why can't you do both? Do the recheck for peace of mind given that you don't quite believe the results but recognize the odds of anything changing is slim. At the same time also start studying for your retake.

ETA, I'm sorry this happened to you OP. Seems like it was just bad luck.

 

[mrbreakfast]

NBMEs 230s-240s down to a 185 is almost hard to believe - typically NBMEs underestimate score, not overestimate - and makes me wonder whether you struggled either with timing or with stress. Previous to this, the biggest score drop from practice -> real test I had seen was in a friend who experienced what they later realized was a panic attack during the test.

OP, you're clearly very smart and I'm certain you'll smash the retake. I think the fields you're interested in would be willing to overlook this with a strong retake.

 

[Ho0v-man]

Rescore. That discrepancy makes zero sense.

 

[whitetopaz]

NBMEs 230s-240s down to a 185 is almost hard to believe - typically NBMEs underestimate score, not overestimate - and makes me wonder whether you struggled either with timing or with stress. Previous to this, the biggest score drop from practice -> real test I had seen was in a friend who experienced what they later realized was a panic attack during the test.

OP, you're clearly very smart and I'm certain you'll smash the retake. I think the fields you're interested in would be willing to overlook this with a strong retake.

I finished each block with 5-10 minutes to spare, so I feel timing probably wasn't the issue. Several people suggested test anxiety as a potential cause, but I get test anxiety before EVERY test, including the SATs, ACT, MCAT, and all the in-house med school exams, and it's never affected my performance.

Thank you for your kind words! Here's hoping 2nd time's the charm.

 

[hebrewBAMmer]

I don't think I can give you any advice than what was already listed here, but I just want to say I'm sorry this happened to you. I wish you the best of luck on your retake, and know there are people who still very much matched despite not passing step the first time

 

[Lawpy]

The drop is way too extreme. Something went major wrong on test day (like illness/severe anxiety/breakdown levels wrong). Rescoring is an option but honestly i'm lost what contributed to that drop since that's important to prevent another catastrophe in retake

 

[DOcSto]

It's not like marathon runners practice by running 26.2 miles everyday leading up to the real deal.

You'd be surprised.

 

[keepoptimism]

Hi OP - first off I'm sorry to hear about the failure itself in addition to the shock on top of it especially with the solid practice exam scores you were getting.

When you mentioned your strength and weaknesses you mentioned how you performed compared to other exam takers in your typically strength areas, but what about your weaknesses? Did you score significantly lower compared to other test takers? This might be something to really target while you study again for retake.

I agree with other posters, exam fatigue is real thing and Step 1 is so damn long. The anxiety of Step 1 too was more intense than any exam I ever took. You may need to consider taking full length exams just for pacing and endurance, and try to recreate exam settings (taking the test in an empty room, bathroom breaks, water/food breaks, having everything locked away except for your scratch paper). How was your sleep the night before? How did you feel on the morning of the test? Would you consider doing some performance/test taking anxiety therapy?

I failed step 1 back in 2012, retook it and passed after taking a rotation off. It was brutal, and even almost 10 years later, I can still feel the hurt of the failure. I did end up matching to residency and moved on to pediatric fellowship, but it seems the landscape of residency matching has changed a lot, so I can't speak to what matching in the fields you want to will look like.
But I can tell you that it's going to be ok no matter what. You will find your path, even if it's not what you thought it was going to be. After throwing my soul into medicine for 10+ years, growing through it, and having some of my own life changes, I'm breaking away from clinical care and will be working for a pharmaceutical company.

 

[deleted1100659]

Take a deep breath, dont hold the failure against yourself, remove any associated emotional attachment and push forward.

Failing step one is highly unfortunate, but the good thing is you're still a US MD and that still continues to be a nice advantage in the match. Ive seen many people match with failed board scores.

 

[whitetopaz]

When you mentioned your strength and weaknesses you mentioned how you performed compared to other exam takers in your typically strength areas, but what about your weaknesses? Did you score significantly lower compared to other test takers? This might be something to really target while you study again for retake.

I went through all of my old practice test score reports, and here's the gist: for my strengths, I scored above average across the board compared to other exam takers. For my weaknesses, I scored average across the board compared to other exam takers. The only times I scored below average in my weak areas were on the earlier NBME's, taken near the beginning of dedicated.

Although the score reports supposedly offer objective feedback, I personally feel that my weaknesses should put me below average, because there are some organ systems/disciplines in which I truly feel like I know nothing. Everyone said to trust my test scores though, so I convinced myself that being average (according to NBMEs) in my weak areas was okay and that I should just accept the fact that I won't know everything.

I agree with other posters, exam fatigue is real thing and Step 1 is so damn long. The anxiety of Step 1 too was more intense than any exam I ever took. You may need to consider taking full length exams just for pacing and endurance, and try to recreate exam settings (taking the test in an empty room, bathroom breaks, water/food breaks, having everything locked away except for your scratch paper). How was your sleep the night before? How did you feel on the morning of the test? Would you consider doing some performance/test taking anxiety therapy?

I never sleep well the night before any sort of exam, so even though I felt a little tired the morning of the test, it wasn't unusual for me. I actually slept surprisingly well the few days leading up to test day, so I wasn't a zombie walking into Prometric either.

I failed step 1 back in 2012, retook it and passed after taking a rotation off. It was brutal, and even almost 10 years later, I can still feel the hurt of the failure. I did end up matching to residency and moved on to pediatric fellowship, but it seems the landscape of residency matching has changed a lot, so I can't speak to what matching in the fields you want to will look like.
But I can tell you that it's going to be ok no matter what. You will find your path, even if it's not what you thought it was going to be. After throwing my soul into medicine for 10+ years, growing through it, and having some of my own life changes, I'm breaking away from clinical care and will be working for a pharmaceutical company.

Thank you for your kind words! Good for you for knowing what you do and do not want, and best of luck!

 

[Lawpy]

I went through all of my old practice test score reports, and here's the gist: for my strengths, I scored above average across the board compared to other exam takers. For my weaknesses, I scored average across the board compared to other exam takers. The only times I scored below average in my weak areas were on the earlier NBME's, taken near the beginning of dedicated.

Although the score reports supposedly offer objective feedback, I personally feel that my weaknesses should put me below average, because there are some organ systems/disciplines in which I truly feel like I know nothing. Everyone said to trust my test scores though, so I convinced myself that being average (according to NBMEs) in my weak areas was okay and that I should just accept the fact that I won't know everything.


I never sleep well the night before any sort of exam, so even though I felt a little tired the morning of the test, it wasn't unusual for me. I actually slept surprisingly well the few days leading up to test day, so I wasn't a zombie walking into Prometric either.


Thank you for your kind words! Good for you for knowing what you do and do not want, and best of luck!

Did you make sure you actually answered every question and your answers weren't accidentally omitted?

I don't know man. That drop is huge and clearly if what you're saying is true, you should've passed with a 230-240. Something isn't adding up here, and it's absolutely necessary for you to find out what caused this to prevent failing in the retake.

 

[whitetopaz]

Did you make sure you actually answered every question and your answers weren't accidentally omitted?

I don't know man. That drop is huge and clearly if what you're saying is true, you should've passed with a 230-240. Something isn't adding up here, and it's absolutely necessary for you to find out what caused this to prevent failing in the retake.

Believe you me, I'm racking my brain to come up with ANY explanation for the drop. I generally have a pretty good gauge of how well I do on an exam, so I knew I wasn't going to get my projected 240-250 coming out of Prometric. But actually FAILING? The thought never even occurred to me.

I remembered ~120 questions from my form. Of those questions, I know I got 40 incorrects, 20 unsures, and ~60 corrects. These 120 questions don't even include all the ones that tested on my strengths (renal, genetics, behavioral science, biostatistics, immuno, etc.), which I had assumed that I did fairly well on given my track record. I know ~80 questions are experimental, but come on, how the hell did I not at least pass if the estimated passing percentage is ~60% AKA 120/200 non-experimental questions? Did I happen to get all the experimental questions correct and missed all the non-experimental questions? Did I somehow skip over entire blocks? I don't even know.

To add insult to injury, I did a few 40-question blocks (random, timed) of UWorld and Amboss yesterday and today to warm myself up for another dedicated period (reset both qbanks; didn't remember any answers bc I hadn't looked at them for almost a month), and I scored above average on all the blocks. Theoretically, that should put me at ~230 at the very minimum, right? What the actual f**k.

I'm still in shock. My med school admin are all still in shock. I just can't believe this happened to me. "Devastated/crushed" doesn't even begin to describe how I feel right now. Part of me is honestly tempted to cut my losses and drop out entirely at this point. Maybe I'm just not meant to pass.

 

[Dral]

I'm still in shock. My med school admin are all still in shock. I just can't believe this happened to me. "Devastated/crushed" doesn't even begin to describe how I feel right now. Part of me is honestly tempted to cut my losses and drop out entirely at this point. Maybe I'm just not meant to pass.

Don't do that of course. You've invested so much already. It's ok to feel like you want to do it though. It's part of working through this.

Look at it this way. You have the opportunity to still rock this. Someone who fails after it becomes p/f will only get 'F' then a 'P'. You still have the opportunity to get a great score on this damn exam and prove yourself.

 

[Phloston]

Took a leave of absence to better prepare for Step1 after undergoing surgery during dedicated.

US MD at mid/low-tier school. NBME's were 230-240 in the last month, UWSA2 was a 247 ~2 weeks out, 97% on the free120 a few days out. Got a 185 on the real deal. WTF???

I felt awful coming out of Prometric, but I NEVER in a MILLION years thought I would fail.

I was originally thinking of doing Gas, IM, or Neuro, but now I have no idea if I can even match.

Does anyone have any advice? Should I take a semester off, or just a few weeks? I want to believe it's a fluke, but I've lost pretty much all confidence in myself.

Happens more often than you realize. It's understandably distressing, but you've gotta sorta regroup and be cortical about it. Sit again and pass. Do well on 2CK. And you'll match. Plenty of people fail Step 1 then go on to match.

 

[Redpancreas]

You'd be surprised.

Most amateurs running their first or second don’t. In fact, most amateur programs won’t even recommend a full 26.2 prior to race day. I think my longest run was a month out and it was only 22.

 

[Redpancreas]

Believe you me, I'm racking my brain to come up with ANY explanation for the drop. I generally have a pretty good gauge of how well I do on an exam, so I knew I wasn't going to get my projected 240-250 coming out of Prometric. But actually FAILING? The thought never even occurred to me.

I remembered ~120 questions from my form. Of those questions, I know I got 40 incorrects, 20 unsures, and ~60 corrects. These 120 questions don't even include all the ones that tested on my strengths (renal, genetics, behavioral science, biostatistics, immuno, etc.), which I had assumed that I did fairly well on given my track record. I know ~80 questions are experimental, but come on, how the hell did I not at least pass if the estimated passing percentage is ~60% AKA 120/200 non-experimental questions? Did I happen to get all the experimental questions correct and missed all the non-experimental questions? Did I somehow skip over entire blocks? I don't even know.

To add insult to injury, I did a few 40-question blocks (random, timed) of UWorld and Amboss yesterday and today to warm myself up for another dedicated period (reset both qbanks; didn't remember any answers bc I hadn't looked at them for almost a month), and I scored above average on all the blocks. Theoretically, that should put me at ~230 at the very minimum, right? What the actual f**k.

I'm still in shock. My med school admin are all still in shock. I just can't believe this happened to me. "Devastated/crushed" doesn't even begin to describe how I feel right now. Part of me is honestly tempted to cut my losses and drop out entirely at this point. Maybe I'm just not meant to pass.

This just sounds like bad luck to be honest. Perhaps the topics you tested were truly your weakest. I imagine a test full of localizing obscure eye lesions, ID’ing Histology slides, Weber/Rinne testing, Tetanus shot questions, and antimalarials would throw me off my game too.

You’re just wasting your life and mental energy reminiscing on this. Just find something to inspire yourself (ex. relearning everything will make your fundamentals especially strong) and just go through this a second time and move on.

As for the retest I don’t think it’s a big deal. You’re already going to be throwing tons at Step 1. May as well get a recheck because a point or two may flip you from a fail to a pass which literally changes everything.

 

[DOcSto]

Most amateurs running their first or second don’t. In fact, most amateur programs won’t even recommend a full 26.2 prior to race day. I think my longest run was a month out and it was only 22.

True true. Some of us are crazier than most lol.