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What Does USMLE Step 1 Going Pass/Fail Mean for You?

  • by David Gallacher
  • Jan 03, 2022

I was quite shocked when I first heard the USMLE Step 1 exam was considering changing to a pass/fail scoring system. I knew what a big deal the exam was, and how much time and effort I had put into studying to obtain my goal score. After doing so, I began tutoring students for the exam, so that I could help them obtain their goals as well. Well, now the day is finally approaching. The USMLE Step 1 exam will officially become pass/fail, so what does this mean for you?

1. Why the change?

On January 26, 2022 the USMLE Step 1 exam will officially transition from a 3-digit score to pass/fail scoring. The eight-hour multiple-choice exam has been at the forefront of students’ minds for years, with most students learning about the importance of the exam early in their medical school education. The National Resident Matching Program (NRMP) consistently reports that Step 1 scores play a large role in applicants gaining interviews for many residency programs. Each year programs have a significantly greater number of applicants relative to residency spots available. This has led to several programs screening applicants based on Step 1 scores alone, particularly for highly competitive specialties. According to the 2021 NRMP Program Director Survey the average number of applications received was 1,013 with 506 of those applications being rejected by a standardized screening process.

Historically, Step 1 has been an opportunity for students (and residency programs) to objectively compare their performance to peers across the country. However, there are significant differences across medical schools with how students are prepared for the exam, the emphasis placed on the exam, and even when they take the exam (At my school, we took the exam after 18 months, while others take it after 3 years of medical education). For this, and other reasons, the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME) have decided the exam will officially become pass/fail in 2022. So, now what?

2. What does this mean for you?

No need to reinvent the wheel here!

While the scoring for Step 1 will change to pass/fail, the ultimate goal remains the same – learn as much as possible so that you can provide competent patient care in the future. The resources used before to prepare for Step 1, before the scoring change, are still useful: you can rely on the same qbanks, lectures, flashcards, and scheduling resources your peers used in years prior. Though this may sound counterintuitive, it may well become more important to have a study schedule now that the motivation to obtain “the highest score possible” is out of the equation. If you think the scoring change might cause you to procrastinate and spend less time on prep, then you will want to plan out your study schedule early. You don’t want to have to explain failing the pass/fail Step 1 exam to prospective residency programs!

Learn as much as possible so that you can provide competent patient care in the future!

While the USMLE Step 1 exam will become pass/fail, the scoring for the USMLE Step 2 CK exam will continue to be reported as a 3-digit score.

Doesn’t this just move the screening metric to a different exam? Maybe, but regardless, students who prepare well for the Step 1 exam are going to set themselves up for a better chance of obtaining a high score on the USMLE Step 2 CK exam. A big concern for those who opposed Step 1 becoming pass/fail was that students might become complacent in their preparation, and ultimately be less prepared for Step 2 CK. The best way to combat this is to get started with a study schedule early and stick with it to the best of your ability! (I greatly credit my detailed study schedule for keeping me on task!)

3. What if I want to take Step 1 for a score?

If you would like to have a USMLE Step 1 score reported when you go to apply for residency, you will need to take the exam prior to the January 26th, 2022 score change.

As with most things, there are pros and cons to this approach. One pro is that taking this exam before the scoring change gives you two opportunities to obtain a USMLE Step score that you are happy with. If students take Step 1 as a pass/fail exam they limit themselves to only one opportunity to obtain their goal score when they take Step 2. However, this must be balanced with the additional stress and time commitment that goes into taking the exam for a 3-digit score. This is not an easy decision to make, and one that takes significant insight into one’s abilities and goals.

Since every student I work with asks for my recommendation, I will provide it, but recognize this is not a one size fits all approach. If you are aiming for a “competitive specialty” such as dermatology, orthopedic surgery, or plastic surgery then I think it is beneficial to have two opportunities to obtain a high USMLE score, as opposed to just one. In other words, for students that are aiming for specialties that put a large emphasis on board scores, and feel well prepared for the exam (with strong practice test scores) then it is reasonable to take the USMLE Step 1 exam before the change to pass/fail scoring.

Regardless of your personal decision, the most important thing you can do to prepare for the exams is to have a study schedule and be consistent in your studying and preparation leading up to test day!

Whether you are taking Step 1 before the pass/fail change or after, you need a good study plan to ensure your success. Create your own detailed, personalized Step 1 study schedule in minutes with a FREE, no-strings-attached 7 day trial of Cram Fighter!