How likely is it to fail Step 1 (4)

How Likely Is It To Fail Step 1?

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Almost all med students worry about how likely is it to fail Step 1. The USMLE Step 1 test is one of the most challenging exams in medical school, but should medical students lose sleep over their chances to pass this test?

This article will help guide you about the USMLE Step 1 passing rates, and how you can increase your chances to perform well. I hope I can assist you with your exam preparation and make it a smoother experience.

How likely is it to fail Step 1 (1)

Is It Possible To Fail Step 1?

Yes, it is possible to fail Step 1. You should consider the possibility that medical students could fail the Step 1 test. This exam is one of the most challenging tests you will take during medical school, as it covers several science topics and assesses your ability to apply these concepts.

You will spend eight hours taking the United States Medical Licensing Exam Step 1 test in your second year in medical school. The exam is divided into seven 60-minute segments with a one-hour break for lunch.

Medical students feel pressured to perform well on this exam. Sometimes, this stress can affect how students answer their tests.

How Likely Is It To Fail Step 1?

In 2022, approximately 91% of MD test-takers passed the Step 1 exam, as reported by the USMLE performance data. This implies that roughly 9% did not meet the passing criteria. Notably, this passing rate is lower compared to previous years, which ranged from 94% to 97% between 2013 and 2021.

The number of individuals failing Step 1 in 2022 increased to 9,700, a significant rise from around 5,700 in 2021, even with a higher number of test takers in 2022.

In 2022, a total of 29,000 medical students, including first-timers and those retaking the exam, participated. Some attribute the higher fail rate to an increased passing standard. For further insights into the results of the USMLE Step 1 test, you can refer to the official data.

Is Passing Step 1 Difficult?

Several medical students claim the USMLE Step 1 test is one of the most difficult exams in medical school. Several factors like the increased passing standard and the new pass-fail system may have contributed to the current increased failing rate.

The United States Medical Licensing Exam administrators raised the passing standard from 194 to 196 points. This minor change can significantly affect how medical students perform in their exams, and the new grading system doesn’t focus on your score value.

Why Is The Step 1 Exam Difficult?

Several factors determine why the USMLE Step 1 exam is challenging. The content, schedule, and time limit, all affect how students perceive this test.

The Exam Content

The Step 1 tests cover several science topics and gauge how to apply them in a real-world medical setting. These are some of the content you should review:

  • Immune System
  • Behavioral Health
  • Musculoskeletal System
  • Respiratory System
  • Urinary System
  • Gastrointestinal System
  • Endocrine System
  • Reproductive System
  • Multisystem Processes
  • Population Health
  • Interpersonal and Communication Skills

The Exam Schedule

Medical students usually take the Step 1 test at the end of their second year in medical school. You are already studying several things for your classes at this time, and you aren’t used to long and extensive tests yet.

The Exam Duration

You will take this exam in seven 60-minute segments, which can be exhausting for new medical students. Sufficient preparation, including mock exams, can help acclimate you to the intensity of the test. Before exam day, get enough rest and leisure time to be in an appropriate mindset.

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How Changing From A Pass-Fail System Affected Passing Rates

The scoring system for the Step 1 exams previously displayed the number of correct points attained. Several hospitals would choose their residency candidates from the highest-scoring students, so there would be significant pressure on the exam takers.

However, with the pass-fail system, students don’t have to think about their specific score. USMLE decided to do this to lessen the pressure on the examinees.

Unfortunately, the recent failing rate is much higher than in previous years. What are some possible reasons for this? Here are the possible reasons according to Brick Exchange:

The new passing standard

The previous passing standard was 194, but USMLE increased it to 196. This score factor may be a reason for the increased failing rates.

Pandemic disruptions

Medical school during COVID wasn’t easy. Missed classes and stressful times might have left some students with gaps in their knowledge.

Adjustment to the new pass-fail system

The new pass-fail system could be part of the reason. Without a score to aim for, some students might not have studied as hard.

The format change is still relatively new, and some students may not have adjusted their study habits or test-taking strategies effectively. This could lead to anxiety and underperformance on exam day.

If you want to understand what this pass-fail scoring mean, then check out this video:

What Percent On Step 1 Is Passing?

Step 1 examinees must answer approximately 60% of the items correctly to pass.

The Step 1 exam was previously a numerical test with a possible score between 1 to 280, and 196 was the passing standard. This focus on the score value pushed students to aim for the highest possible grade to earn a slot in residency.

Now, the USMLE Step 1 test follows a pass-fail grading system with the same items and the passing grade will not be reported in terms of a three-digit score.

What Was The Reason For Changing The Scoring System?

The reason for changing the system to pass-fail is to reduce the intense pressure and stress associated with aiming for a high score on Step 1.

The people who oversee the USMLE (Federation of State Medical Boards and National Board of Medical Examiners) noticed that choosing a residency was too stressful and too much importance was given to Step 1 scores.

They intended to encourage a more holistic approach to residency matching, considering additional factors beyond Step 1 scores.

The goal was to shift the focus towards learning and competence instead of just chasing a number, the Step 1 score.

The old score-based system was putting a lot of pressure on students, making them super stressed and anxious. The truth is, those scores weren’t even the best way to tell how well someone would do as a doctor later on.

Students ended up focusing more on memorizing tons of facts than actually understanding and thinking critically about medicine. Plus, those with more money could afford expensive test prep, giving them an unfair advantage.

The Debate

Switching Step 1 to a pass-fail system was supposed to reduce stress and encourage better learning, but there’s been debate because the passing rate in 2022 dropped compared to previous years.

Some people think students aren’t as motivated without a numerical score to aim for, while others blame disruptions from the pandemic. We don’t know all the reasons so far, and ongoing research is important to figure it out.

We’re not sure if the pass-fail system will be a total success yet, but the USMLE is actively working on it to make sure it improves medical education and produces high-quality healthcare professionals in the end.

What Happens If I Fail Step 1?

You are allowed to retake Step 1 a maximum of three times within a 12-month period. If you want to attempt it for a fourth time, you must wait for at least 12 months after your initial attempt and at least six months after your most recent try.

Several thousand medical students take the Step 1 exams annually, and some students may fail the test. You may feel worried about the implications these scores will have on your residency but don’t panic if you fail.

The USMLE Step 1 is a challenging exam, so failing is understandable. You can choose to retake the test next year and adjust some aspects of your study plan.

Dedicate study time as early as possible, and use various reviewers with flashcards, visuals, and practice questions. Develop a study schedule to balance your review and leisure time to avoid burnout.

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Most Common Reasons For Failing Step 1

Despite med students’ best efforts, some may encounter the disappointment of failing Step 1. However, it’s essential to remember that failing isn’t the end of the road — you can retake the exam. Understanding the common reasons behind this setback can empower future test-takers to strategize effectively and increase their chances of success.

Here are some common reasons why medical students fail the Step 1 exams:


Medical school can be hectic, so some students study for Step 1 a couple of weeks before the test. Unfortunately, sometimes this isn’t enough time to understand the reviewer’s content.

It’s essential to assess your own study needs and preferences and plan your preparation accordingly.

For more information, check out this article: How Early To Start Studying For Step 1?

Using low-yield study resources

Medical students should use high-quality review sources like UWorld and First Aid to ensure they study well. These reviewers also have spaced repetition flashcards to help the students memorize important information.

Not doing practice exams

National Board of Medical Examiner tests are extremely helpful to prepare for the Step 1 exam. The NBME test is also an excellent determiner of your performance on the actual exam.

Personal reasons

Sometimes family emergencies and personal problems can affect your exam performance, no matter how much you prepare. If you feel like you’re not in a good state for the test, you should postpone the exam for a later date.

How To Improve Your Chances To Pass The Step 1

You can follow some helpful tips to improve your chances of passing the Step 1 exam. Leave enough time to study and use high-quality review materials to ensure you do well.

Use a few, high-quality resources: Try to use First Aid, UWorld, Sketchy, or Anki for your review as these are resources with useful information and study tools like flashcards and question banks.

Do practice exams: NBME tests can help simulate what the actual exam questions are like, so you will know how to answer the exam day. Doing these tests can help determine how you will perform on the Step 1 test.

Make time for rest: It’s essential to schedule days where you rest and enjoy other aspects of your medical school life. You should avoid burnout to maintain a positive mindset and overall wellness before the exam.


The Shelf exams are usually challenging for medical students, and they always wonder how likely is it to fail Step 1 before the test. You should dedicate enough time to review the concepts and choose high-quality reviewers to perform well.

Fortunately, you can retake the test if you fail on the first try and perform better on the next. Determine what factors that contributed to your low performance the first time. Failing Step 1 isn’t the end, and you can always do better on your next try.

Whenever you’re ready, there are 4 ways I can help you:

1. The Med School Handbook:  Join thousands of other students who have taken advantage of the hundreds of FREE tips & strategies I wish I were given on the first day of medical school to crush it with less stress. 

2. The Med School BlueprintJoin the hundreds of students who have used our A-Z blueprint and playbook for EVERY phase of the medical journey so you can start to see grades like these. 

3. Med Ignite Study ProgramGet personalized help to create the perfect study system for yourself so you can see better grades ASAP on your medical journey & see results like these. 

4. Learn the one study strategy that saved my grades in medical school here (viewed by more than a million students like you). 

We hope this article helped you with exam challenges during medical school. If you liked this one, how about checking out some of our other content?

Until the next one, my friend..

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