7 Reasons Why Your Scores Aren’t Increasing in the USMLE Step 1 Exam

7 reasons why your scores aren't increasing in the usmle step 1 exam

The USMLE Step 1 exam is a crucial test for medical students and graduates who want to practice medicine in the US. It measures your basic science knowledge and its application to clinical scenarios. It also determines your eligibility and competitiveness for residency programs. If you are looking for guidance and support during your residency in the USA, consider a combination of live instruction and online resources. This approach can provide you with a well-rounded education and valuable tools to help you succeed. Therefore, you may spend much time and effort preparing for this exam, hoping to get your desired scores. 

However, your scores may not improve as you study for the exam. Your lack of progress may make you feel stuck, frustrated, or discouraged. You may wonder what you are doing wrong and how to overcome this plateau. In this article, we will identify and address some common reasons why your scores aren’t increasing in the USMLE Step 1 exam and provide tips on improving your performance and confidence. By understanding and avoiding these pitfalls, you can optimize your study strategy and achieve your full potential on the exam.

Reason 1: Lack of a clear study plan

A study plan is a roadmap that guides you through your preparation process. It helps you organize your time, prioritize your topics, and monitor your progress. With a study plan, you may feel overwhelmed by the vast amount of material to cover, save time on irrelevant or redundant resources, or lose track of your strengths and weaknesses.

Reasons Why Your Scores Aren't Increasing in the USMLE Step 1 Exam

To create and follow a realistic and practical study plan, you should:

  • Set SMART goals: SMART stands for Specific, Measurable, Achievable, Relevant, and Time-bound. Your goals should be clear, quantifiable, realistic, aligned with your desired outcome, and have a deadline. For example, instead of saying, “I want to score high on the Step 1 exam”, you can say, “I want to score at least 240 on the Step 1 exam by June 2023”.
  • Use spaced repetition: Spaced repetition is a learning technique that involves reviewing information at increasing intervals to enhance long-term retention. You can use spaced repetition software such as Anki or Quizlet to create and study flashcards regularly.
  • Review practice questions regularly: Practice questions are essential for testing your knowledge and application and integrating basic science concepts into clinical scenarios. You should review practice questions from various sources such as question banks (e.g., UWorld), review books (e.g., First Aid), and past exams (e.g., NBME) on a daily or weekly basis. You should also analyze your answers carefully, identify your mistakes and knowledge gaps, and review the relevant topics accordingly.
  • Schedule practice exams: Practice exams are simulated tests that mimic the exam’s content, length, and difficulty. You should schedule practice exams regularly during your preparation, especially during your dedicated study period. You should also take these exams under simulated conditions, following the same rules, time limits, and break schedules as the actual exam. You should also carefully review your scores and feedback and adjust your study plan accordingly.

Reason 2: Inadequate preparation for the exam format

The exam format differs from other exams in content, length, and difficulty. It consists of 280 multiple-choice questions divided into seven blocks of 40 questions each. The total testing time is eight hours, including a 45-minute break. The questions assess factual recall and applying and integrating basic science concepts to clinical scenarios.

To prepare for the exam format, you should:

  • Familiarize yourself with the test software: You should download and install the FRED software from the USMLE website(www.usmle.org), which simulates the test software used in the exam. You should familiarize yourself with the features and functions of the software.
  • Practice with sample test questions: You should practice with sample test questions from various sources such as question banks (e.g., UWorld), review books (e.g., First Aid), and past exams (e.g., NBME) regularly. You should also use the FRED software to practice with sample test questions from the USMLE website, which represent the content and difficulty of the actual exam.
  • Take full-length practice tests under simulated conditions: You should take full-length practice tests from reliable sources such as UWorld or NBME at least once or twice a month during your preparation period, especially during your dedicated study period. You should also take these tests under simulated conditions, following the same rules, time limits, and break schedules as the actual exam. You should also carefully review your scores and feedback and adjust your study plan accordingly.

Reason 3: Insufficient knowledge of basic science concepts

Reasons Why Your Scores Aren't Increasing in the USMLE Step 1 Exam

The exam covers various topics from various disciplines, such as anatomy, biochemistry, physiology, pathology, pharmacology, microbiology, immunology, genetics, and behavioral sciences. These topics are tested in isolation and concerning each other and to clinical scenarios. Therefore, having a solid grasp of basic science concepts is crucial for answering the questions correctly and efficiently.

To improve your knowledge of basic science concepts, you should:

  • Review the high-yield topics: High-yield topics are frequently tested or have a high impact on your score on the exam. You should focus on reviewing these topics first and foremost, as they will give you the most return on your investment of time and effort. You can use review books such as First Aid or Sketchy Medical to identify and summarize the high-yield topics for each discipline.
  • Use reliable resources: Reliable resources are those that are accurate, comprehensive, and up-to-date with the current standards and guidelines of the exam. Use these resources to supplement your review of the high-yield topics, as they will provide you with more details, explanations, and examples. You can use resources such as textbooks (e.g., Robbins Pathology), question banks (e.g., UWorld), videos (e.g., Pathoma), podcasts (e.g., Goljan Audio), or online courses (e.g., Kaplan) to enhance your learning of the basic science concepts.
  • Understand the underlying principles and mechanisms: Understanding the underlying principles and mechanisms of the basic science concepts is essential for applying and integrating them to clinical scenarios. You should memorize facts and formulas and comprehend how and why they work. You should also be able to connect the dots between different concepts and disciplines and recognize patterns and trends. You can use resources such as diagrams (e.g., Netter’s Atlas), tables (e.g., Rapid Review Biochemistry), charts (e.g., BRS Physiology), or mnemonics (e.g., Dirty USMLE) to help you visualize and remember the underlying principles and mechanisms.

Reason 4: Poor test-taking skills

Test-taking skills help you perform well on any exam, such as time management, question analysis, and elimination strategies. These skills are essential for the exam, as it is a long, complex, and competitive exam that requires you to answer many questions in a limited amount of time.

To improve your test-taking skills, you should:

  • Read the question stem carefully: The question stem is the part of the question that asks you what you need to answer or do. You should read the question stem carefully before looking at the answer choices, as it will tell you what type of question it is (e.g., recall, application, integration), what topic it is testing (e.g., anatomy, biochemistry), and what information it is giving or asking for (e.g., patient history, lab results). You should also pay attention to any modifiers (e.g., most likely, least likely) or qualifiers (e.g., except, not) that may change the meaning or direction of the question.
  • Look for keywords and clues: Keywords and clues are words or phrases that indicate or hint at the correct answer or eliminate wrong answers. Look for keywords and clues in both the question stem and the answer choices, as they will help you narrow down your options and focus on the relevant information.
  • Avoid overthinking or changing answers: Overthinking or changing solutions is a common mistake that students make on the exam, as they may need more clarification on their initial instincts or fall for distractors. You should only think or change answers if you are sure you made a mistake or found new information that contradicts your previous choice. You should also trust your knowledge and preparation and avoid guessing or relying on intuition.

Reason 5: Lack of confidence and motivation

Reasons Why Your Scores Aren't Increasing in the USMLE Step 1 Exam

Confidence and motivation are psychological factors that influence your attitude and behavior toward studying and taking the exam. Confidence is the belief in your ability to succeed, while motivation is the desire to achieve a specific goal. Low confidence and motivation can lead to negative emotions such as fear, anxiety, boredom, and poor habits such as procrastination, distraction, or avoidance.

To boost your confidence and motivation, you should:

  • Set realistic expectations: Realistic expectations are based on your current level of knowledge, skills, and resources, as well as the requirements and standards of the exam. You should set realistic expectations for yourself, as they will help you avoid disappointment, frustration, or resentment. You should also be flexible and adaptable, as your expectations may change depending on your progress and feedback.
  • Celebrate small achievements: Small achievements are meaningful for you, regardless of how big or small they may seem to others. You should celebrate your small successes, as they will help you recognize your efforts, appreciate your improvements, and reward yourself. You can mark your small achievements by giving yourself a compliment, a treat, or a break.
  • Seek support from peers and mentors: Peers and mentors share similar goals or experiences or have more knowledge or expertise than you. You should seek support from your peers and mentors, as they will help you feel less alone, more inspired, and more accountable. You can seek peer and mentor support by joining a study group, a forum, or a coaching program.

Reason 6: Stress and anxiety

Stress and anxiety are physical and emotional responses to perceived threats or challenges that can negatively affect your mental and physical health, as well as your concentration and memory during studying and taking the exam. Some familiar sources of stress and anxiety for students are academic pressure, personal issues, financial problems, or health concerns.

To cope with stress and anxiety, you should:

  • Maintain a healthy lifestyle: A healthy lifestyle involves taking care of your body and mind by eating well, sleeping enough, exercising regularly, and avoiding harmful substances such as alcohol, tobacco, or drugs. You should maintain a healthy lifestyle; it will help boost your immune system, regulate your hormones, and improve your mood.
  • Practice relaxation techniques: Relaxation techniques help calm your nervous system, reduce stress hormones, and increase positive emotions. You should practice relaxation techniques regularly, especially before or during stressful situations such as studying or taking exams. Some examples of relaxation techniques are deep breathing, progressive muscle relaxation, meditation, yoga, or music.
  • Seek professional help if needed: Professional help is assistance from qualified experts such as counselors, therapists, or psychiatrists who can diagnose and treat mental health issues such as stress or anxiety disorders. You should seek professional help if your stress or anxiety interferes with your daily functioning or affects your quality of life.

Reason 7: Burnout

Burnout is a state of physical, mental, and emotional exhaustion that results from prolonged exposure to stress and high demands during studying and taking exams. Burnout can manifest in symptoms such as fatigue, insomnia, irritability, depression, cynicism, or loss of interest or passion.

To prevent or recover from burnout, you should:

  • Take breaks: Breaks are periods when you stop studying or working and do something else that is relaxing, enjoyable, or refreshing. You should take breaks regularly, short-term (e.g., every hour or day) and long-term (e.g., every week or month), as they will help you recharge your energy, reduce stress, and improve your productivity.
  • Engage in hobbies: Hobbies are activities that you do for fun, pleasure, or personal satisfaction, such as reading, writing, playing games, or learning new skills. You should engage in hobbies different from your work or study, as they will help you balance your life, express your creativity, and enhance your well-being.
  • Find meaning and purpose in your work: Meaning and purpose are why you do what you do, such as helping others, contributing to society, or fulfilling your potential. You should find meaning and purpose in your work or study, as they will help you stay motivated, inspired, and committed to your goals.

If you’re looking for a comprehensive approach to tackling the USMLE Step 1 exam, consider enrolling in a reputable prep course. These courses offer a structured curriculum, expert guidance, and valuable resources to help you succeed. Whether you prefer live/physical classes or the flexibility of live online courses, there’s a learning option that suits your needs.

While preparing for the exam, it’s important to address various aspects that can impact your performance. From creating a solid study plan to enhancing your test-taking skills, every detail matters. Additionally, factors like maintaining a healthy lifestyle, managing stress, and finding meaning in your preparation journey play crucial roles in your success.


Proper preparation, practice, and perseverance can improve your USMLE Step 1 exam scores. However, there are some common reasons why students may need help improving their exam scores. By understanding and avoiding these pitfalls, you can optimize your study strategy and achieve your full potential on the exam. We hope that this article has provided you with some valuable tips and insights on how to improve your performance and confidence on the USMLE Step 1 exam. We wish you good luck on your exam!

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