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MST Tutors Dr. Christopher Carrubba and Dr. David Delnegro contributed to this post.

Let me start this post by telling you that you are not alone. Nearly every medical student I know has, at least once, considered pushing their USMLE test date back.

We spend years obsessing over this test, hearing that it is the key to our medical future, and fixating on our target score—so it is only natural that some doubt may creep in as the big day approaches. The challenge, however, is deciphering between unfounded doubt and objective evidence that you should consider pushing your exam back.

Before I get into my reasons and considerations for pushing an exam back, let me get one thing out of the way—if push comes to shove, you can absolutely push your test back. One of the most common arguments that I hear from students is that, “I cannot push my test back because of ________.” Whether there is a wedding, planned vacation, residency interviews, or a desire to start 3rd year rotations on time, I would always advise students that it is better to push their test back than to get a subpar, or worse, a failing score. Rather than focusing on the short term, if you are finding that you are at risk of failing the USMLE—push your test back. You can work out the other details later.

Now, with that being said, let’s get into the details about what you should consider when debating pushing your test back, and why you might want to do it:

1. Why do you want to push your test back? 

On one end of the spectrum, I think there are some absolute reasons to push your exam back. To me, these reasons include: NBME scores that are failing or less than 10 points above passing, having not completed even a first pass through the material, serious medical illness, or a major distractor like a death in the family. Elaborating on the NBME issue—it has been my experience that NBMEs are predictive of a student’s score within a range of +/- 10 points (assuming students have treated NBMEs like actual exams). With that in mind, if your test is 1-2 weeks away and you are consistently scoring at or below the passing range, it is very unlikely that you will make a significant jump in time for your real USMLE.

On the other end of the spectrum, I find many students that are far too hard on themselves and incorrectly assume that more study time will lead to a higher score. A student consistently scoring in the 230s or 240s on their NBMEs has likely found their peak and pushing their test back is just as likely to cause burnout that negatively impacts their score as it is to improve their USMLE performance by 10 points. 

2. What are you going to accomplish by pushing your test back?

Again, pushing your test back and getting some extra time does not magically equate to a higher score—so anyone considering delaying their test needs to have a good plan for what they will do with that extra time. I’ve found that students who push back due to more focused weaknesses typically end up doing better with that extra time. For instance, a student with unsatisfactory scores due to consistently poor performance on memorization-based content could improve their score with some extra time to devote towards flashcards. Likewise, a student struggling with cardiology could really improve his score by using some extra time to master this material. So if you are pushing back, then you need to have some identified targets for improvement and a feasible plan for how to make this happen.

3. How long are you going to push back?

This is going to be different for each person, but remember—everyone gets burnt out. If you are pushing your test back, then you need to have a realistic assessment of how much extra time you need and how much extra time you can feasibly commit without burning out. And one thing you should never do—take a break before starting over! You’ve put too much work getting to where you are; so, while starting over might recharge your battery, it will also cut in to the progress that you’ve worked so hard to achieve to date.

Making the decision to push your test back is never an easy one and should never be a decision that is made lightly. That being said, try to follow the advice above to ensure that you really need to push your exam back and that you can make the most out of that extra time. And, as always, don’t hesitate to reach out with any questions that you may have.

4. What are your goals?

Let me tell you a short story about two of my friends from medical school. One, a previous biomedical engineer, wanted to be at one of *the* top orthopedic programs in the United States, so much that she took a year off and researched with the hospital that serviced the Washington Redskins. The other wanted to be a psychiatrist and didn't really care too much about where, so much as he got a job. Now, put yourself into both of their shoes. Imagine if, hypothetically, they opened up their CBSE results and saw a 220 with three weeks to go until their exam. Naturally, you would think that their reactions might not be the same. The future psychiatrist might have a big smile on his face as he knew he was likely gliding into a score that would let him continue to his goal. The future orthopedist suddenly broke into a cold sweat, realizing that things could spiral quickly if she didn't make a change.

The point of this illustrated example is to show that it's important to take goals and values into the discussion of whether to move back your exam. Of course, students who are scoring 170 or 270 with two weeks to go already have their decision made for them, but those people aren't the people reading this column. Usually, if you are hamstrung between moving your test back or not, it's because you're somewhere in the middle, in a gray zone looking for advice specific to your situation. This is where it's important to think about what specialties you're interested in, how anchored or undifferentiated you are between specialties, and how much location and prestige matters to you. I wanted to go into emergency medicine from day one of year one. I cared little about prestige and location, only wanting to stay in the northeast, which houses dozens of programs. Some students wanted to be back in California with their families. Other students had absolutely no idea what they wanted to do, and were just simply terrified of having doors closed to them before they even got a chance to get into rotations. Whatever your situation, consider your situation before making a decision about your exam date.

5. What is your risk tolerance?

Sitting down to have an honest conversation with yourself and your advisors about these topics will help you develop your risk tolerance. For our psychiatrist friend who had a goal score of 225 and was okay at any program, his risk tolerance was very high. He assumed that in the last three weeks he would pick up a couple more points each week and likely settle into a score somewhere in the mid-220s or low-230s. Therefore, it wasn't overly important for him to demonstrate in multiple practice exams that he could score 225, so long as he thought he had a good shot. For our orthopedic friend whose goal was 250+, her risk tolerance was incredibly low. In this high stakes competitive world of orthopedic surgery, a 220 would make her an instant underdog at some of the programs she had her eye on. Therefore, it was imperative that she demonstrated the ability to score 250+ on multiple practice exams before she felt comfortable going into the real one. Where do you fit along this spectrum?

When you sit down with loved ones and advisers and ask the question, "Should I move my exam back?", It's very important to take your goals, values, and personal situation into account to develop your risk tolerance and make an informed decision about your exam.

If you found this post helpful, here are some other articles you may enjoy:

Three Ways to Get Ahead with First Aid for USMLE Step 1

How Do I Know I'm Learning What I Need to Know?

How to Study for USMLE Step 1 During Classes

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