Many students spend their entire lives working toward their dreams in the medical field. One of the earlier steps of that journey is surviving medical school.
There’s a stigma around “failing out of med school” because these medical students have spent their academic careers outranking their classmates and gaining admission to the most competitive programs.
Failing out of med school seems incongruous with the identities they’ve built for themselves and the expectations others have placed on them. It can seem like all their hard work was in vain. But it’s not.
If you’re worried about being kicked out or failing med school, you have options.
The First Year Of Medical School Is Often The Toughest
First, it’s important to take away some of the shame of struggling through medical school.
It is not uncommon to worry about failing out of medical school. For many medical students, the first year is one of the hardest transitions of their lives.
According to the National Resident Matching Program (NRMP) and the general consensus among healthcare professionals, the first year of medical school is known to be challenging.
First-year medical students have earned their undergraduate pre-med degrees and passed their MCAT exams only to find themselves surrounded by more competitive and educated peers, new instructors, and rigorous coursework.
Adjusting to new surroundings, spending extended time away from family, juggling an increased workload, and creating a new routine can have a significant impact on a medical student’s ability to earn a solid GPA in their first year.
On top of all these transitions, first-year medical students are beginning to think about the U.S. Medical Licensing Exam (USMLE) steps or the Comprehensive Osteopathic Medical Licensing Exam (COMLEX).
How Common Is It to Fail Out of Medical School?
Many students arrive at medical school and question if it’s the right choice for them and that’s a natural response to any major adjustment. But some med students may end up struggling through school for specific reasons.
Identifying these reasons can help you get the support you need to thrive at medical school or set you on the path to pursue a fulfilling career elsewhere.
Medical School Graduation and Attrition Rates
According to the American University School of Medicine (AUSM), graduation rates rise the longer a student is enrolled in a medical program. As such, the attrition rate is highest for medical students enrolled in four-year programs and these numbers drop significantly for five and six-year programs.
A 2018 study completed by the Association of American Medical Colleges (AAMC) found that about 80 to 85% of four-year medical students enrolled in MD programs graduated in the U.S. In the same study, researchers looked at medical students six years after matriculation and found that as much as 96% of students had completed their programs.
Programs outside the U.S. have widely different attrition rates. For example, in many Caribbean medical schools, the university counts on a 40% attrition rate to make room for its newest admissions.
A lot of people flock to Caribbean medical schools after struggling to get accepted into the more competitive American programs. These students may find themselves overwhelmed and without support at under-resourced universities.
Why Do People Fail Out of Medical School?
People fail medical school for a variety of reasons, including:
1. Imposter Syndrome
Sometimes failing or dropping out of medical school is the result of imposter syndrome and anxieties about whether or not you’ve earned your place at a prestigious institution.
You can work to train yourself out of imposter syndrome by using a three-point exercise:
- Acknowledge positive feedback and the doubts you have about it. By making space for both feelings, you may be able to better see how you discount the positive opinions other people have about you.
- Observe and examine the signals you receive about yourself from others. If negativity is coming from a particular source in your life, this practice will allow you to become more aware of it.
- Rehearse how you’d tell your mentors and peers how you have “fooled” them. This part of the exercise will bring your attention to your achievements and accolades, even if you’re struggling in the present.
2. Burnout and Mental Health Issues
Many medical students have outperformed their peers since high school with ease but once they enter medical school, the coursework and time requirements lead them to neglect their personal needs, which can lead to significant health issues.
Burnout is a growing conversation in the field of mental health. In 2021, researchers worked with the Royal Society of Public Health to identify predictors of academic burnout in medical students. Previous studies found that as many as 55% of medical students had suffered from academic burnout at some point in their careers.
Women were more likely to burn out due to mental exhaustion in med school, but all students were susceptible based on their perceived stress levels, social support systems, and degree of empathy for their peers.
Symptoms of academic burnout include:
- Absent from lectures and other responsibilities
- Decreased participation due to a lack of creativity and inspiration
- Feelings of anxiety or depression
- Increased maladaptive coping mechanisms, such as overeating, staying up too late, nail-biting, or substance abuse
- Increased physical symptoms, such as insomnia, headaches, muscle tension, and illness
- Loss of confidence and low self-esteem
- Loss of interest in hobbies or relationships
- Moodiness and irritability
- Persistent fatigue regardless of how much sleep you get
- Poor time management
- Procrastination and difficulty focusing
How to Combat and Prevent Academic Burnout
Whether you have burned out your first year, second year, third year, or fourth year of medical school, there’s hope once you’ve recognized the impacts of academic burnout.
You can recover from academic burnout by prioritizing your well-being in the following ways:
- Becoming aware of the symptoms
- Building supportive communities
- Establishing routines that remind you to take care of yourself
- Making time for activities you enjoy
- Managing stress
- Seeking help from qualified mental health professionals
- Spending time around loved ones
- Taking a leave of absence
3. Academic Arrogance and Unpreparedness
The inverse of imposter syndrome is academic arrogance. In some cases, students accepted into medical programs haven’t had to spend hours studying to retain their coursework.
Medical students who complete osteopathic and Caribbean medical programs can be less likely to graduate and match with a residency program due to the laxer admission requirements and less rigorous courses.
Without studying, these students fail to compete with their classmates. Many medical schools will ask a student to leave a program if they fail more than two classes.
If you are studying and still struggling to keep up, there is no shame in seeking out a tutor or study group.
MeetUp and Reddit regularly host resources for medical school students to commiserate and motivate each other with new study strategies. Your university or instructors may also have suggestions.
4. Low Test Scores and Wrong Specialty
Dr. Dougan McGrath, an emergency resident in Temple, TX explained that USMLE steps 1 and 2 tend to produce the most stress for medical students because residency programs use those scores to determine a match.
Some medical specialties require higher test scores than others. For example, aspiring neurosurgeons must score higher than pediatricians.
If you aren’t able to meet the scores required for your desired residency program, it may be time to reevaluate if you’re pursuing the right specialty. In general, medical students want to select their specialty by the end of their third year to prepare for residency.
5. Family Troubles, Illness, and External Pressures
Sometimes, life happens and the school doesn’t wait. If you’re responsible for caring for a sick loved one or you’ve become sick yourself, it can be incredibly challenging to balance medical school and family priorities.
Maybe you’ve recently gotten married or experienced the birth of a child. Many medical students have massive support systems helping their families and loved ones through the early stages of their careers. Students lacking family support often experience greater hardship during their education.
There are organizations for black, indigenous, people of color (BIPOC), and other marginalized individuals who are attending medical school and in need of support. These organizations include the Asian Pacific American Medical Student Association, Student National Association, and the National First-Generation and Low-Income Medical Student Association, among others.
Can You Repeat a Year of Medical School?
Yes, you can repeat a year of medical school, but it’s up to the discretion of the university. Each medical school will have its own policy and recommendations, so it’s important to consult your Advisory Dean and read materials closely.
For example, at the University of Southern California’s Keck School of Medicine, the Student Performance Committee reviews all students at the end of the year and provides necessary next steps to achieve promotion to the next year.
What to Do After Failing Out of Medical School
Students who fail to pass a required course in medical school may be dismissed. Some schools will pursue dismissal after two failing grades or two grades below a C. Dismissal is typically decided after an academic review meeting.
1. Challenging Dismissal
It is possible to challenge a dismissal if it is unjust or you haven’t been granted reasonable disability accommodations.
Lawyers specialized in student appeals will be able to review your case and determine if your dismissal was the result of unfair bias and inconsistencies. If your appeal is granted, you may be able to repeat the year.
Your student handbook will have an outline of the appeal requirements and rights. Of course, academic failures will be considered on different terms than misconduct, so it’s important to weigh the reason you were dismissed against the odds of winning your appeal.
2. Leveraging Your Medical Education for Other Career Paths
Medical school education is worth something even if you haven’t completed it. You already have an undergraduate degree, transcript, and educational background that got you into medical school; all those skills and resume items are transferable to other careers.
Before choosing your next career steps, you can reflect on a few questions:
- Do you want to stay in the medical profession?
- Would you be happy in academics or research?
- Are there other careers that interest you?
There are a number of healthcare careers you can transfer your skills to after failing medical school:
- Advanced practice nurse (midwife, nurse practitioner)
- Laboratory and research technician
- Occupational therapist
- Physician Assistant
- Registered nurse
- Respiratory Therapist
You can also use failing out of medical school as an opportunity to look inward. If a career in the medical profession isn’t right for you, you can look at other industries. If you don’t know where to start, networking events or working with a career coach can help.
3. Financial Planning for Med School Dropouts
Walking away from medical school without a degree can feel like a big slap in the face, especially if you have significant student loan debt, but it doesn’t have to be financially crippling.
You can contact your lender or refinance to negotiate a customized repayment plan. Income-driven repayment (IDR) plans to calculate your payment based on your income regardless of the amount of debt you have.
In many cases, IDR plans allow medical school dropouts to pursue fulfilling careers without having to stress about their monthly payments.