Caribbean medical students are no lesser than American med students, but they undoubtedly experience unique challenges and realities that their stateside peers may not. Attending St. George's University, Saba University School of Medicine, or another Caribbean-based medical program can enrich you beyond imagination. However, your success depends on your preparedness for the hurdles of Caribbean medical school—including Step exam timing issues.
The medical professional imposes rigorous tests before allowing aspiring doctors to practice, and Step exams are perhaps the most critical.
Step Exams, Explained
The United States Medical Licensing Examination (USMLE) falls into three parts, each known as a Step exam. As the name suggests, medical students and residents must complete each Step exam before receiving their medical license.
USMLE (p.2) explains that Step exams gauge “knowledge of foundational science and clinical science.” Each step is unique, and students (or residents) may prepare differently for each Step exam. Step 1, for example, measures “basic science knowledge,” while Step 3 probes a resident's knowledge and skill as a physician in a real-world clinical setting.
The timing of Step examinations is not random. A medical student takes their Step examinations at times when they've been exposed to concepts and experiences the exams will cover. More specifically, medical students generally take:
- The Step 1 exam: At the end of their second year of medical school
- The Step 2 exam: In the fourth year of medical school
Aspiring medical professionals take their Step 3 exam following their first year of residency.
It is in all parties' interests for a medical student to succeed in Steps 1 and 2. Students who pass these exams can move to residency and a medical career. Those students can become distinguished alumni of their Caribbean medical school, positively reflecting upon the institution they graduated from.
If you believe that you are not ready for a Step exam or have any other issue related to these critical examinations, the Lento Law Firm's Student Defense Team can assist you.
How the Step Exam Grading System Works
Step 1 of the USMLE is now a pass-fail examination. As the American Medical Association (AMA) explains, this change from a 300-point grading scale to a pass-fail scale was meant to reduce stress on students and create “a more holistic resident-application selection process.”
Despite helping some students, changing to pass-fail increased the minimum passing score, which makes it more challenging for some students to pass Step 1. Therefore, Caribbean students should not assume that passing Step 1 is any easier now than it has been in the past—the grading scale is merely less specific than it used to be.
Step 2 of the USMLE remains, at least for now, graded on a 300-point scale. The minimum passing score on Step 2 of the USMLE is 214, while the average score generally hovers around 245.
Remember, the Step 3 exam applies only to medical residents, so we will skip that topic.
What Qualifies as a Failing Step Exam Grade?
What it means to fail a Step 1 exam has become more opaque since the USMLE switched to a pass-fail grading scale. The USMLE Management Committee weighs different sections of the Step 1 exam differently.
Though the specific number that qualifies as a failing grade is no longer as clear as before, you can review various content areas on the Step 1 exam and how they are weighted.
For your Step 2 exam, a score of 213 or lower will qualify as a failing grade.
First, Know That Failing a Step Exam Is Not the End of Your Medical Career
Medical students and residents hear from both peers and superiors that Step exams are critically important—and this is true. However, students who fail a Step exam should not assume their medical career is over because it's not.
The USMLE notes that, in 2022, 18% of medical students failed their Step 1 exam. Most of those students retook the test, at which time 71% earned a passing grade. These figures indicate that, even if you fail a Step exam, you are likely to pass upon re-testing.
However, you should do everything possible to avoid failing a Step exam. Our team can help you explore options if you feel unprepared for an upcoming Step exam, as a deferral of the testing date could be a viable option.
Understand the Consequences of Failing a Step Exam
Medical school remains a highly competitive environment, and the medical profession is even more crowded than your Caribbean medical school. Having “fail” on your record in any capacity is undesirable, and failing a Step exam means:
- Lowering your stock as a residency candidate: Matching with a strong residency program could be key to unlocking the medical career you dream of. If you fail one or multiple Step exams at your Caribbean medical school, your stock as a residency candidate will fall.
- Disrupting your graduation timeline: Having to retake a Step exam could extend your path to graduation. If you are going to prolong graduation, a deferral is preferable. At least if you defer your Step exams, you don't have a failing mark on your transcript.
- Diminishing your mental health: Failing any exam comes with a stigma, and nobody may be harder on you for failing a Step exam than yourself. While many medical students rebound from failed Step exams, others do not.
Our team helps those who have failed one or more Step exams and want to do everything possible to avoid another failing grade. We also assist those who have yet to take Step 1 or Step 2 and wish to get accommodations, defer their testing date, or secure other protections against failure.
Step Exam-Specific Challenges Medical Students Often Face
In many ways, you are just the same as a medical student receiving their education in the United States. You may be dealing with the same challenges that medical students face regardless of where they're studying, including:
- A hyper-competitive (and stressful) academic environment
- The demand that you learn, comprehend, and recite complex scientific and medical concepts at a rapid pace
- Deficits of sleep
- Mental health imbalances
- Personal issues that affect your performance as a medical student
While you may share these common struggles with U.S. medical students, you are receiving your education in the Caribbean—not the U.S. This means you may face additional challenges that disrupt your general studies and preparedness for Step exams.
Step Exam Issues Specific to Caribbean Medical Students
Spending years of your life studying in Saint Vincent and the Grenadines or Antigua can seem like perpetually studying abroad, and in many ways is an idyllic way to get your medical degree. However, Caribbean medical schools also present challenges to non-native students, including:
- Homesickness
- Lack of immediate familial support
- Lack of in-person social networks
- Unfamiliarity with local languages and customs
- Difficulty adapting to local cuisine, which could lead to nutrient deficiency that affects one's ability to learn
- Lack of access to American amenities, including a full array of pharmaceuticals
These challenges can affect how you perform as a student and a test-taker who must pass Step exams in order to pursue your medical dreams.
When a student experiences a loss in the family, has mental health struggles, or faces other serious consequences, being in the Caribbean (rather than at home) may exacerbate the challenges of Caribbean medical school.
Caribbean Medical Students Are Already Facing Longer Odds Than Most
There are many reasons why you may be attending a Caribbean medical program, including reasons that may have been beyond your control. There are also countless success stories of Caribbean medical school graduates who went on to complete fulfilling, accomplished careers in medicine.
However, the reality is that Caribbean medical students face longer odds than many of their counterparts studying in the United States. If you want to attain a strong residency position, you have little room for error—let alone one or multiple Step exam failures.
If you have concerns about an upcoming Step exam or need advice following a failed Step exam, accept help. The stakes are too high to try and figure this situation out on your own.
Timing Is a Key Factor in Your Success When Taking a Step Exam
The time at which you take your Step exams determines your performance. It may not be the right time to complete Step 1 or Step 2 if:
- You don't feel you've had enough time to study
- You don't feel that you've fully mastered one or more test-related concepts
- You're experiencing mental health issues
- You've been physically ill
- You've lost a loved one recently
- You're unprepared in any other way to excel on the Step exam
You should never “solder on” or “suck it up” when concerns arise over your Step exam performance. You have far too much to lose, so let us fight to protect you from a failing score and all that comes with it.
Some Schools Grant You the Option of Taking Step Exams Later, Even Without a Deferral
Some medical programs, including those in the Caribbean, are lenient about when students take their Step exams. For example, you may be able to take your Step 1 exam after your third year of medical school rather than after your second year.
These arrangements can be informal. You may speak with the Dean of your medical program and inform them of your intent to defer your testing date. We can assist you in this process.
Other Schools Make Passing a Step Exam a Prerequisite for Continuing Studies
Some Caribbean medical schools may be more rigid in their testing dates. In these circumstances, we will take all necessary steps to secure a formal deferral of your Step exam testing date(s).
For example, Ross University School of Medicine in Barbados (p.90) mandates that students cannot begin their Clinical Sciences curriculum until they complete USMLE Step 1. In such cases, the likelihood of a Dean informally granting a deferral of a Step exam may be less.
The Lento Law Firm's Student Defense Team will review your school's unique policies. We will work with decision-makers to secure a formal or informal deferral of your testing date. If another resolution is more appropriate for your case, we will work hard to ensure that resolution takes place.
Potential Remedies to Step Exam Timing Issues—Including a Deferral
We tailor our approach to the needs of the student we represent. Depending on the specific Step exam issues you're facing, a solution to the problem may include:
- A deferral: Our team will explore the possibility of deferring your exam date. While a deferral may affect the sequence of your learning at medical school, it may not. Each school has a unique policy, and you may be able to continue in your curriculum even if you delay your Step exam testing date(s).
- Testing accommodations: We may secure a private testing facility, extended testing time, or other accommodations that increase your likelihood of passing Step 1 or Step 2.
- A score recheck: If you have already taken one or more Step exams and received a grade you're not happy with, we can request that USMLE recheck the score. USMLE notes that it initiates score rechecks upon request, though it states that the likelihood of a recheck changing a score from pass to fail is “remote.”
- A reconsideration of a USMLE ruling: Receiving fair accommodations could be the difference between passing and failing a Step exam. USMLE allows students to appeal accommodations-specific rulings through the reconsideration process. Our team can lead this process for you.
There is no one-size-fits-all solution for Step exam timing issues or any Step exam issue. Let our team review your circumstances and find the ideal solution for you.
Call the Lento Law Firm Today for Help with Your Caribbean Step Exam Issue
Attorney-Advisor Joseph Lento and his Student Defense Team will negotiate with school officials, communicate with USMLE's leadership team, and fight for the best possible outcome to your Step exam issue(s). Student defense is what we do, so let us help you.
Call the Lento Law Firm today at 888-535-3686 or contact us online to discuss your case.
