Thorough Analysis of the Reasons for Failing USMLE STEP1

Hello I'm "R". No one can beat the lack of morning energy.

This time, I will thoroughly examine the reasons for my failure in the first attempt at the USMLE STEP1. Although calling it a thorough examination might sound like mere excuses, please bear with me.


Cause of Failure #1: Insufficient Preparation Period
Cause of Failure #2: Misjudgment Due to Financial Constraints
Cause of Failure #3: Underestimation of Fundamental Questions
Cause of Failure #4: Overconfidence


As the title suggests, I failed the USMLE STEP1 once but passed on my second attempt. While there are numerous success stories from accomplished individuals, detailed accounts of failures are relatively rare. Despite the embarrassment, I want to share my failure story, as failures always have underlying reasons, akin to the saying, 'There is always a cause for victory and a cause for defeat.

However, I doubt my experience will be of much use to anyone. Still, if this article provides even a slight insight, it would be gratifying.

Cause of Failure #1: Insufficient Preparation Period:

Firstly, it was the short preparation period from the start of studying to the exam. To be precise, I couldn't accurately assess my abilities and the difficulty of the USMLE, leading to prematurely setting an exam date. I began studying in June 2022 and took the exam in March 2023. This decision was born out of a strange insistence to pass within my fourth year, lacking any logical basis.

Moreover, during this approximately 9-month period, there were CBT and OSCE commitments. Additionally, in November and December, I worked around 25 days per month, and as the new year began, I had the initiation of practical training, contributing to an already demanding schedule.

While there are undoubtedly individuals who manage to pass with a similar schedule, I, unfortunately, misjudged my own abilities. Despite achieving borderline results in practice exams, I optimistically set an exam date. The lack of self-awareness in my self-analysis is quite disorienting in hindsight.

Cause of Failure #2: Misjudgment Due to Financial Constraints

In a nutshell, this can be attributed to scrimping on the subscription duration of study materials due to financial constraints. The question bank known as UWorld, a crucial resource for USMLE preparation, offers contracts for 1, 3, 6, 12, and 24 months. Naturally, the longer the duration, the more cost-effective it is per month, but the overall amount increases significantly.

Considering my proficiency, opting for the 12-month subscription was undoubtedly the right choice.

However, due to financial constraints, I chose the 6-month option. This decision led to a lackluster study routine in the three months following the end of the subscription, where I aimlessly went through practice exams and First Aid.

Ultimately, facing failure, I had to purchase an additional 3-month subscription to UWorld, costing around 1,500 $. It was truly a hellish experience—an extreme act of foolishness.

Cause of Failure #3: Underestimation of Fundamental Questions

A significant factor contributing to my failure was feeling like I understood basic concepts without truly grasping them.

For instance, details like whether ACE inhibitors dilate the afferent or efferent arterioles, or the specific pharyngeal pouch from which the parathyroid glands develop, were knowledge I thought I had learned effortlessly in university but had failed to solidify.

After the exam, I realized there were numerous mistakes due to misremembering. It made me acutely aware that the moments when you feel like you understand something vaguely after a broad study are precisely the times when it's crucial to thoroughly reinforce fundamental concepts.

Cause of Failure #4: Overconfidence


This is the root cause of all the judgment errors.
The fundamental issue underlying the previously mentioned causes #1 and #2 is this deep-seated overconfidence.

Setting an early exam date, skimping on the duration of study materials—all of it was driven by an overconfidence in thinking, "I'll surely pass."

To be frank, I've managed to overcome previous challenges with this level of confidence in competitions labeled as exams. However, I was a frog in a well, having only experienced success in competition among my peers on a small island.

It was the epitome of foolishness to believe I could compete with outstanding medical students and professionals worldwide, who are risking their lives to pursue a medical career in the United States.

Having confidence in oneself is indeed crucial, but that confidence must be grounded in substance.

Building that foundation requires more than sufficient "preparation," and that was exactly what was lacking in my case this time.


This time, I share my failure story with such sincerity.

For me, this failure isn't a simple matter of "I passed on my second attempt, so it's okay." Alongside self-reflection, I chose to analyze and publicly share my failure in the hope that it might be of assistance to everyone challenging the USMLE.

If anyone is interested in more specific details about my study materials or schedule, feel free to reach out.

Until then.

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