The USMLE Step 1 Is Pass-Fail: What It Means for Medical Students

Osmosis Team
Published on Oct 12, 2022. Updated on Feb 16, 2023.

As of January 2022, the USMLE Step 1 Exam shifted from being scored to a simple pass/fail grading structure. Learn more about the potential effects of the shift, including the benefits, challenges, and potential changes to the medical residency matching process. 

The road to becoming a physician is different for each medical student. You may hear the process portrayed as exciting, strenuous, inspiring, and challenging, but there's usually one mutually agreed upon word to describe the United States Medical Licensing Exam (USMLE) Step 1: stressful. The first of three USMLE exams taken by medical students on their academic journey, USMLE Step 1 has historically been used by residency programs as a metric for evaluating applicants and was often a factor in determining which specialty a student could confidently apply. 

On January 26, 2022, USMLE Step 1 score reporting shifted from a three-digit score to a simple pass-fail. The intent behind the change was to address concerns about student well-being and to promote the evaluations of students for residency programs in a more holistic way

With this change, prospective and current medical students need to consider:

  • How the lack of a numerical score may potentially affect them
  • How residency applications may now be evaluated
  • How to successfully prepare for the exam

Breaking the Glass Ceiling

In the 2021 National Residency Matching Program (NRMP) survey of residency program directors, 86.2% of program directors listed the USMLE Step 1 score as an important factor in deciding which applicants to interview. It was, in fact, the most endorsed academic factor listed. Many programs had a minimum USMLE Step 1 score requirement and would not review applications for students whose scores fell below that minimum.

Naturally, because of this critical importance, students experienced significant stress around achieving a competitive USMLE Step 1 score and undertook grueling studying schedules. During this period, their focus would shift from their medical school curriculum to third-party study materials. While this often resulted in an increased USMLE Step 1 score, it also led to devaluing core material covered in the medical curriculum. 

The good news is that the change to pass-fail reporting relieves much of the pressure. While supporting student well-being, it also offers an opportunity for students to remain engaged with their medical school curriculum rather than prioritizing a “parallel curriculum” for exam preparation. 

With the change, residency programs also have the opportunity to evaluate applicants more holistically. In considering both academic and personal characteristics, there is an opportunity to put more emphasis on areas ranging from leadership and research to volunteering and extracurriculars. This empowers students to focus on being competent and well-rounded individuals rather than just good test takers.

Next Test, New Stress

While residency programs may evaluate applicants more holistically in the future, in the short term, it's more likely that they will simply place more emphasis on the USMLE Step 2 CK score, which has not moved to pass/fail reporting. In the 2021 NRMP survey of residency program directors, 78.8% of program directors listed USMLE Step 2 CK as an academic factor considered in deciding which applicants to interview. As that emphasis increases, so will the pressure on students to prepare for the USMLE Step 2 CK during their clinical rotations.

With students unable to distinguish themselves based on USMLE Step 1 scores, the prestige of a medical school may also be weighed. International medical students have often used a high USMLE Step 1 score to stand out in residency programs. With the change to pass-fail reporting, these students are having to reconsider the best ways to effectively do this. Fortunately, there are a few different strategies international medical students can employ to stand out. 

In addition, in upcoming NRMP Match cycles, there will be a mix of students with a numerical score and those with a pass-fail result, depending on when they took the test. To date, schools have not outlined how this shift will be handled by residency program directors and whether it will affect which students are invited for interviews. Unfortunately, with so many unanswered questions comes a new set of stressors for medical students. 

Steps for Success

While there is uncertainty surrounding the effects of the new score reporting for the USMLE Step 1, there are things that remain unchanged. Students should study effectively to ensure that they are prepared for the eight-hour exam that awaits them. They should aim to pass the USMLE Step 1 on their first attempt. Though the passing score is 196, students should work on scoring higher than this on their practice exams, so they can confidently walk into test day to secure a pass. Learners should also remember the material for USMLE Step 1 is foundational knowledge needed to be successful in further coursework and the USMLE Step 2 CK. 

Here are three tips for preparing for the USMLE Step 1:

Remember, regardless of the score, your worth is not defined by a single exam. Keep going and best of luck to everyone preparing for the USMLE Step 1 Exam.

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