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Welcome to our exploration of resilience and perseverance in the journey of a medical career. I am Dr. Moss, a psychiatry resident, and I want to share my personal story of overcoming a USMLE Step One failure. This story is not just about failure; it’s about tenacity, introspection, and finding strength in adversity.
My USMLE Step 1 JourneyMy journey through medical school was fueled by passion, determination, and sacrifice, like many of you might experience. Amidst the pressures of the STEP One exam, compounded by the onset of COVID-19, I faced a significant hurdle. Despite preparation and determination, my first STEP One attempt ended in failure by just one point. Yet, this moment of despair became the foundation for my eventual success. Learning to Use UWorld practice questions and exam was key. Watch Video below to learn more how to use UWorld.
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Dealing with FailureFacing this setback, I learned an important lesson: pause, reflect, and regroup. It's easy to want to dive back into studying, but taking time to process emotions and reassess strategies is crucial. Managing emotional health, financial stress, and the pressure to succeed were pivotal challenges. I emphasize the importance of acknowledging these struggles and not letting them dictate your journey.
**Q: How did you overcome failure? How long did it take you to rewrite?**It took time to process my emotions. I had to acknowledge my disappointment before I could move forward. After taking a short break, I devised a new study plan and retook Step 1 in a few months, restructuring my study schedule and going through STEP accommodations, which takes 60 days to receive a response. This journey was painful but necessary for growth.
--> Check out this blog post and video on specifics on lessons learned from Failing STEP 1
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**Q: What do you think you needed to do differently in your prep to pass the STEP? Were you just rushing, or was there something missing in your revision?**Looking back, my mistake was focusing too much on passive learning—watching videos, taking notes—without enough active recall through QUESTIONS. For my second attempt, I prioritized UWorld (STEPH10 for 10% savings) used spaced repetition techniques, and took more practice exams. I also managed my test anxiety and health conditions with accommodations.
--> Check out this blog post and video on Applying for USMLE Accommodations
The second time I failed was because I was on LOA and working 40+ hours a week. For my third attempt, I was JUST STUDYING, which allowed me to finally pass.
Overcoming Red Flags in Residency ApplicationsThe journey to residency is not defined by past failures but by how you learn and grow from them. I advise applicants to maintain a holistic approach to applications and honestly address past failures as a learning experience. This approach builds a narrative of resilience and strength.
**Q: I passed Step 1 recently on my first attempt but worry about how my transcript will be perceived. I failed several exams while in medical school, which is a “red flag.” What should I do?**While I can’t provide specific advice without knowing your full application, failing exams can be approached like failing STEP. Explain what you learned from the experience and how you grew from it. There is a section on ERAS that asks about broad academic challenges, where you can provide this context.
**Q: A Latina here, with one failed Step 1, which has made me feel very demotivated about continuing on this path. I'm worried that one failure is a red flag. What extra things did you do to improve your app?**First, I acknowledged my failure in my application but reframed it as a learning experience. Then, I strengthened my resume with strong clinical evaluations and letters of recommendation, meaningful extracurricular activities, and associated research & publications.—> I have created a blog post on how to turn extracurriculars into research.**Q: Did they all ask about the STEP1 failure in interviews? Was there a place to explain within the app?**Good question! No, they did not all ask because not all interviewers have your full ERAS application. Only the PD and maybe APD have access to your scores. I would say about 50% of PDs asked about the failure, but it was more about the situation as a whole. They didn’t need to ask because I did a good job explaining it in different parts of ERAS.
There is a box for academic failures and another box on impactful experiences. Check out this blog post on how I used the Impactful Experiences box in ERAS App. Explain what you learned from the experience and how you grew from it. There is a section on ERAS that asks about broad academic challenges, and you can fill that out with this information.
--> Check out this blog post on how to Navigate & Prepare for Residency Interviews
**Q: Based on the fact you are in residency with two failed Step 1 attempts, I’m wondering why those in medicine convince us a failed Step 1 attempt makes matching impossible? What are the true consequences for people who fail Step 1 once or twice? Is matching into a specialty like Neurology, OBGYN, or Radiology out of the question? Does coming from a T10 med school help?**There’s no denying that failing Step 1 makes matching more challenging, but it doesn’t make it impossible. Certain competitive specialties (specifically surgical) may be more challenging to enter, but it depends on the entire application. A strong clinical performance, research, and networking can offset a Step failure. Coming from a T10 school can help because of strong institutional support and connections, but it’s still not a guarantee.
**Q: How would an LOA (Leave of Absence) affect the chances for residency?**An LOA can raise questions, but it depends on the reason. If the time was used productively—such as for research, personal growth, or health recovery—it can be framed positively. Transparency in explaining the gap is key.—> Check out my video and blog post on LOA & reframing for residency apps
**Q: What would you consider as something vital for being able to successfully match specifically in psychiatry? And in any specialty?**It’s important to show who you are as a person, including your values and personal strengths that you bring to a program and a specialty as a whole.
Check out this full blog post on my Guide on How to Prepare your Residency application.
I would definitely recommend dual applying because, for the past three years, it has become extremely competitive for US MDs. More people are interested in Psychiatry & mental health.
That being said, I helped multiple IMGs this match 2024 cycle with their apps. Those who applied only to Psych received 1-3 interviews. Those who applied to IM had more interviews (more than 3). Those who dual applied were most successful, receiving multiple invites, and we will see in March where they match.
ConclusionMy story exemplifies that setbacks do not define one's trajectory. With introspection, strategic planning, and leaning on support systems, you can overcome failures and find success in your medical career. Remember, you're not alone on this journey. Keep striving, and find strength in your resilience.
Click here to learn more about my Residency Workbook, my full residency application, meeting with me for 1:1 advising, or to get my full support with residency app advising.