Are you struggling to boost your Step One, shelf, or Step Two scores? Or do you want to get it right the first time? If so, you’re not alone. The patterns that separate those who succeed from those who struggle aren’t about how smart you are or how hard you work. They’re about the approach.
And here’s what might give you the confidence that you can fix this: students who’ve been below average on Step 1 have climbed into the 260s on Step 2. We’ve even had someone who failed Step 1 score 262 on a practice test in less than two months before retaking and passing. That transformation is possible for you too once you stop making these three critical mistakes.
Mistake #1: Underestimating the Breadth and Depth
Medical school exams are deceptive. They focus on memorization, a narrow scope, and material from the past few weeks. You can study the night before, throw out facts on test day, and walk away with a good grade. The USMLE doesn’t work that way. It tests the application of key concepts across the entire spectrum of medicine with far more depth than you’ve ever encountered.
This difference became very obvious when Step 1 went pass/fail. Before the change, Step 1 failure rates were around 3% in 2020. In the first year after pass/fail, that number jumped to 6-9% roughly double or triple the previous rate. What happened? Students had done well on their medical school exams, felt confident, and underestimated just how different the USMLE would be. They went in with a false sense of security.
The biggest mistake these students made wasn’t that they weren’t working hard or weren’t smart enough. It was that they fundamentally underestimated how different the USMLE is from what they had seen before. They tried to apply the same study strategies that worked for medical school exams: cramming, memorizing slides, and focusing on isolated details, but those strategies failed them.
To overcome this mistake, you need a two-part plan. First, you need to understand the depth of concepts, not just what something is, but why it works the way it does. Second, you need a system for retaining the massive breadth of material across all of medicine. Without both, you’ll hit a wall no matter how hard you study.
Mistake #2: Avoiding the Uncomfortable
Here’s something researchers have discovered: we respond to psychological threats the same way we respond to physical threats. If you’ve ever had a terrible practice test or a really bad study block, you probably remember what happened next. Maybe you couldn’t bring yourself to study for days or even weeks afterward. That’s not laziness. That’s a normal psychological response to threat.
The problem is obvious: if you avoid your weak areas, skip practice questions, and put off practice tests, those weak spots never get fixed. You go into the exam with blind spots you don’t even know exist.
But here’s the counterintuitive part that can transform your preparation: take your first practice test as early as possible.
Most students delay their first test. They study for months, build up their confidence, and then take a baseline. They’re afraid of what a low score might mean about them. But that’s backwards. A low first score isn’t a failure, it’s valuable data.
Let me show you why. Say your first practice test is a 140 and your second test, two months later, is a 180. That’s a 40-point improvement in two months, which is actually quite solid. But now imagine a different scenario: your first test is a 180, and your second test two months later is also a 180. Same starting point in the second scenario, but zero improvement. That 180 in the first scenario is far more meaningful because you can actually measure progress.
An early baseline shows you whether your study approach is working. It tells you if you’re improving or spinning your wheels. Even if that first score is low, it gives you concrete information to guide your next two months of preparation. That uncomfortable moment of taking a test unprepared is far less uncomfortable than realizing three months in that nothing you’re doing is working.
Mistake #3: Focusing on “What” Instead of “How”
Ask any successful med student what they did to ace their exam, and they’ll probably list resources: “I used UWorld. I used First Aid. I used Sketchy.“ And you’ll think, “Okay, so if I use those same resources, I’ll do well too.“ Right?
Wrong.
Here’s the surprising truth: if you take the top 1% of test takers and the bottom 1%, they’ve used virtually the same resources. The same UWorld, the same First Aid, the same Anki decks. So if both groups are using identical resources, what’s the difference between them?
It’s not the what. It’s the how. Top scorers use resources differently from low scorers. They engage deeply. They understand concepts rather than memorizing facts. They space repetition strategically. Low scorers use the same resources passively, without real ownership over the material.
But here’s where most students go wrong. When their scores don’t improve, they assume the problem is their resources. So they switch. They see a friend using a different study guide, so they add it. They hear about another platform, so they grab that too. They end up with what I call a Frankenstein plan, a mixed bag of Anki, UWorld, First Aid, Amboss, Sketchy, and every other resource under the sun. The more resources they collect, the less time they have to actually use any of them well.
The solution isn’t addition. It’s subtraction. Pick fewer resources and use them brilliantly. Learn concepts deeply. Make sure you truly understand the material. When you learn something, use spaced repetition to lock it in forever. Make your own flashcards or modify pre-made ones so you own the material. That ownership that active engagement rather than passive consumption is what separates the top scorers from everyone else.
Conclusion
These three mistakes aren’t about effort. They’re about strategy. Stop underestimating how different the USMLE is. Stop avoiding the uncomfortable early practice test that will show you whether your approach is actually working. Stop collecting resources and start using them with real depth and intention.
Fix these three areas, and you won’t just improve your score. You’ll build the kind of genuine understanding that makes you a better doctor.
