Why Med Students “Fail” USMLE Step 1 Exam (And How to Make Sure You Pass The First Time) [Updated for 2020]


Most med students pass USMLE Step 1 and COMLEX

Why Med Students Fail the USMLE Step 1

The Federation of State Medical Boards and the National Board of Medical Examiners recently announced that the United States Medical Licensing Exam will be pass/fail for Step 1. Until the new scoring system takes place in January 2022, there will still be a numeric score for Step 1 (and the numeric score will remain for Step 2) that will factor into residency “match” decisions.  For most medical students, simply passing the USMLE Step 1 isn’t good enough.

If you have any hopes of going into a competitive specialty or the field of your choice, then you need to pass the USMLE Step 1 with flying colors. The first time.

You can’t retake the step component to simply improve your score. Once it’s done — it’s done. So you have to make the most of your Step 1 opportunity.

Merely passing isn’t good enough. A low passing score can be just as damaging as failing outright.

And unfortunately, in most cases, medical students are their own worst enemy, because the most common reasons for poor performance and low memory recall on exam day are self-inflicted.

Here’s what med students like you might be doing when you study for Step 1, and what you should be doing instead.

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The Most Common Reasons for Low USMLE Step 1 Scores

The goal of USMLE Step 1 is to evaluate a med student’s ability to apply key concepts and fundamentals to medical practice.

By the time you take it, the material isn’t necessarily new. There’s just a lot of it.

The difficulty of this medical licensing exam comes down to the sheer breadth and volume of information. And the prospect of regurgitating everything during a single, 8-hour day is daunting. Especially because you only get about one minute per question.

Preparing to master so many different areas, and being forced to recall and apply them quickly – under pressure – is challenging.

But it’s even more challenging when your preparation is misspent. Poor study habits like multitasking, social studying, and a distracting environment sabotage your memory faster than you can improve it.

Many of you are familiar with the 10,000-hour rule (made infamous by Malcolm Gladwell). However, everyone has lives. You can’t simply lock yourself away for a few years to focus on a single medical licensing exam.

The number of hours you study can only get you so far. To succeed with a limited time frame and numerous other extracurricular commitments, we need to focus, prioritize, and use that time wisely.

And we need to kill passive studying.

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How to Study for the USMLE Step 1 Like a Chess Grandmaster


study for usmle step 1 like a chess grandmaster

“Grandmaster” is the highest attainable title in the chess world, and rightfully so. Very few people make it to this status in their lifetime, but here’s the most surprising thing:

Studies have shown that chess grandmasters don’t necessarily spend more time studying the game than their counterparts. They just make better use of that time.

Outside of chess, their memory recall is just like your average person. The reason they excel at chess is because of (among other things) their deep understanding of how the pieces fit together.

They “chunk” their domain expertise down – like how different individual pieces fit together to form patterns and strategies – and can quickly recognize, recall, and apply that information.

And they develop this ability cumulatively, over time, through countless hours of deliberate practice.

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Improve Memory Recall by Making Studying More “Active”

Passive techniques like copying notes as written, sticking to one studying method, and relying on rote memorization can only get you so far. Presented with too much information and a short time frame, it quickly starts to break down. That’s because there’s no engagement with the material, there’s no context for how it fits together. Your application and recall of the information will be limited at best.

The key to mastering information recall is to add context and improve engagement with the material. Active studying techniques like writing in your own words, rewriting, creating flowcharts of related concepts, self-testing, and using multiple approaches like Picmonic’s audio and visual can significantly improve retention.

Underneath most active studying approaches is deliberate practice, a concept coined by Anders Ericsson and his colleagues. Whereas “the mere number of years of experience with relevant activities in a domain is typically related to performance,” deliberate practice is a more focused approach to quickly improve how we learn.

And deliberate practice has some unique characteristics that set it apart from most other techniques:

  • The information is specifically designed by a mentor, coach, or expert.
  • The format is highly structured and is easily repeatable.
  • Feedback on your results is consistently available.
  • Studying requires complete immersion, is highly demanding, and typically painful to sustain.

Unlike sitting in a coffee shop, casually discussing Step 1 principles with your friends, deliberate practice is not fun. It’s strenuous and mentally draining. And it’s usually solitary, focused work.

Step 1 studying can typically only be practiced for a few hours a day, for only 60-90 minutes at a time. But if you’re doing it correctly, that should be all the time you can handle.

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How to Apply Deliberate Practice to Studying for the USMLE Step 1

The goal of deliberate practice is to stretch and focus on improving areas you’re not very good at.

And there’s an old saying about how memory relates to engagement. For example, you may only remember 10% of something you read, but that number goes up significantly when you can hear it, see it, say it, and do it.

So let’s take a look at the steps of studying processes that incorporate deliberate practice characteristics and as much interaction with the information as possible.

  • Step 1. Overview: Get a big picture overview of all the material and concepts. This information should be administered by an expert, tutor, or teacher to prioritize what to include and what to leave out.
  • Step 2. Outline: Begin delineating where certain topics begin and end so you’re able to create more structure and get a quick understanding of how it all works together.
  • Step 3. Organize: Now start to deconstruct each topic and dive deeper into the specifics of each subject. Carefully prepare all of the material so it’s concise, prioritized, and repeatable.
  • Step 4. Memorize: Rigorously go through each topic or subject, one at a time. This step is all about repetition, repetition, repetition. Make sure you’re also getting instant feedback to know where and when you make mistakes.
  • Step 5. Apply: Finally, reconstruct all of the information back together to make connections between how everything relates and fits together. Again, repeat the process while benchmarking against external feedback like a timer or coach to improve your speed and accuracy.

A strategic approach to studying for Step 1 like this will help you get a better return on your studying efforts. But the application is difficult because there are different solutions which address one or two steps, but not the others.

Mind mapping or diagrams help you outline and structure information. But not memorize it. While flash cards may help you organize and memorize, but not apply it.

Picmonic can help you every step of the way.

The visual learning content was developed by former students with first-hand exam experience – there’s your expert input. The information is organized in a way that cuts down your studying time by only presenting the most relevant content you need – while leaving everything else out. From basic science to bugs and drugs, Picmonic’s structured to give you an efficient study plan for Step 1, and provides constant feedback along the way.

The use of audio and visual mnemonics to master difficult subjects has been proven to be one of the most effective forms of memorization and recall.

And most importantly, picture mnemonics have been proven to aid the application of information, because your memory can retrieve accurate information in less time.

So you’re not just cramming information to regurgitate one day and forget forever. You’re improving neural pathways to acquire expert performance.

And you’re drastically improving your odds of excelling at the USMLE Step 1, and Step 2 as well. And your professional medical practice after medical school, too.

Picmonic has a free trial! Check it out now with no strings attached.


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Ron Robertson

Ron Robertson, Co-founder & CEO, Picmonic Inc.

Ron Robertson founded Picmonic as a 3rd-year medical student at the University of Arizona. He’s at the helm of Picmonic’s mission to lead and inspire a new era of learning through innovative and effective educational solutions. Ron holds a Bachelor of Science in Biochemistry from the University of San Diego with a focus on memory science, is the product visionary behind Picmonic, and is involved in every aspect of the company.

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