I failed USMLE Step 1! Now what?

Don’t panic! It is very important to focus on what you can do moving forward rather than worry about your past attempts. Also remember you are not alone. According to NRMP, in 2014 22% of first-time examinees from non-US or Canadian medical schools failed their USMLE Step 1. Although having even just one attempt on your USMLE exams can hinder your residency application, it does not mean matching in the NRMP Main Match is impossible. Here’s what you can do to improve your chances: 
 
Study Hard: 
Now that you have an attempt on your USMLE exams it will be extremely important to study hard and not only pass on your next attempt but aim for a competitive score. Many programs will still consider applicants with 1 attempt on their USMLE exams but a program director is less likely to take on a resident with multiple attempts for fear that they will not pass their board exams once in residency.  
 
Gain US Clinical Experience (USCE): 
It is important to remember that most applicants have a red flag somewhere on their application. Whether it’s an attempt, an old year of graduation, or gaps in their medical education, there are ways you can offset these red flags to program directors. By gaining more hands-on clinical experience you can give yourself the opportunity to gain valuable medical experience, improve your resume/CV, and obtain good letters of recommendation (LORS). There are many different forms of clinical experience but in a Program Director’s eyes the best form of USCE is a hands-on externship. 
 
Research can help! 
Obtaining a research position can also enhance your application for residency. Program Directors like to see applicants participate in medical research projects because research is the foundation for medical advancement. A research position under a program director of a residency program is also a way for you to get your foot in the door of a program you might not otherwise be considered for residency. In working side-by-side with a program director you have the opportunity to prove yourself and your skills as a doctor.  
 
Consider an unaccredited PGY-1: 
An unaccredited PGY-1 is another great option for those with many red flags on their application. Having multiple attempts, an older year of graduation, and limited or no clinical experience can also have a negative impact on your application for residency. An unaccredited PGY-1 gives these students the opportunity to work as a resident (for no credit) but prove to program directors that they are capable of the work it takes to be in a US residency program.