Low Step 1 score? Read this first!


I scored 210 (or insert a score here) on my Step 1, what are my chances?

I screwed up my Step 1 score, should I quit now?

Sounds familiar? This is one of the most common question asked in any of the USMLE forums. My heart goes out to anyone who has poured their heart and soul into studying for Step 1 but ended up with a low score. Step 1 is the hardest test you will ever take in your life. It tests basic science topics that give most students nightmares, it is the first time that most IMGs have to take such a test, and you have to answer stressful questions for 7-8 hours with your life literally hanging in the balance (what if I screw this up!). I think they should have an award for those of us that walk away without a duodenal ulcer by the end of it. If you find yourself in the group of people with unfortunate scores on Step 1, I’m here to tell you that it is not the end of the world.

Is Step 1 score one of the most important factors that determines your success in the match? Probably. But is it the only one? Most definitely not. Would life have been much easier if you had score 20 points higher? Certainly. But does it mean that applicants with low scores do not match? Not at all.

If you look at the NRMP website, almost 272 applicants with Step 1 scores less than 220 matched into IM (Charting Outcomes for IMGs 2016, page 113). Almost 30% of all IMG applicants, with Step 1 scores less than 220, and that applied to IM, matched into an IM residency position. So if you have a low Step 1 score (<220), your job is to be in the top 30% of all candidates with similar scores in order to match. How do you do that?

  • Score well on Step 2 CK and Step 3
  • For the love of God, do not pay for USCE. It is a scam. More on this later.
  • Network, Network, Network! Reach out to seniors, friends, family friends, your uncle’s third cousin’s niece (you get the point), and let them know that you will be applying to their program. Your email/message should say something along these lines:


My name is ABC and I’m a friend of QRT. He/she recommended I get in touch with you for advice about applying to IM residency. I’m keen on applying to your program. Do you have any advice for me in terms of what I can do to stand out as an applicant at your program?

I would really appreciate your help.

Thank you.


Most people will respond to such an email. The worst case scenario is either they don’t reply or say that they cannot help you. Repeat this process as many times as you can. Eventually you’ll find atleast 5 people who will be willing to ask their program co-ordinators to take a look at your application.

That’s how you get your foot in the door. For more on things you can do to boost your application (besides scores), read my post here.

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Is there any way to boost up your USMLE step 1 score to 250+? I have been stuck up at 235+ in nbme. exams in 3 wks.

Is there any way to boost up your USMLE step 1 score to 250+? I have been stuck up at 235+ 

Answer by Alien, M.D.:

Well if you took the nbme tests you might have received a report about your relative strength and weakness in each section. If you didn’t pay for the extra analysis I’d suggest you do so now. Then divide your effort into 70/30 for the weaker sections vs revising the ones you’re already strong at. I’d say don’t review new material now but try to consolidate and memorize things you seem to forget. Keep solving one to two blocks in a random timed fashion from uworld. Take another nbme at the end of two weeks. I’m pretty certain you’ll have boosted your score. I do not claim to know by how much or if you’ll hit the 250 mark. But know that you’re doing really well with your current score. Anything above this is cherry on the top. Believe in your self, DO NOT sacrifice 8 hours of sleep for anything and don’t obsess over every question in the test. If you can’t answer it, just mark your best guess and move on to the next question. Try to attempt all the questions in the given time rather than getting every question right. This is a broadly accepted strategy.

Good luck.

Is there any way to boost up your USMLE step 1 score to 250+? I have been stuck up at 235+ in nbme. exams in 3 wks.

How much should I study for the USMLE step 1?

How much should I study for the USMLE step 1? 

Answer by Alien, M.D.:

I’m assuming you are a international medical graduate. In which case, I agree with some of the answers above. ATLEAST 6–8 months, using u-world and first aid as your primary tools, supplementing with kaplan notes/videos and a resource for pathology (pathoma is great/Goljan if you can digest that book).

Using NBME to judge your progress is a must. I suggest taking your 1st NBME test after you’ve completed reading first aid atleast once and have done atleast 90% of u-world questions atleast once. This will help you target weakness.

Don’t take the actual test until you’ve score atleast a couple of points above your target score.

All of this usually takes 6–8 hours of study everyday, and definitely take a day off or more in a week, if you need it. It should take about 6–8 months to get to the point where you’ve read everything atleast once and done u-world atleast once. Then you’ll need to study 8–10 hours a day REVISING stuff (not learning new things, because you can’t learn new stuff efficiently studying more than 6–8 hours a day), for about a month or two.

Ideally, you would have read the first aid (including the notes you’ve made from u-world) enough times to get a score of 70–75% on random timed blocks on u-world.

How much should I study for the USMLE step 1?