After years of debate, the Invitational Conference on USMLE Scoring (InCUS) announced their long-awaited decision to transition the USMLE Step 1 to only a pass/fail outcome.
In the weeks and months to follow as everyone awaits further information from InCUS, there will be much speculation. For now, here are the answers to the questions we've gotten so far from the update:
1. When will the USMLE Step 1 become pass/fail?
Per the announcement, the earliest the USMLE Step 1 will change to a pass/fail system is January 1st, 2022. The InCUS stated in their decision that further information — likely about how the change will be "rolled out" — will be available later this year. It's unclear how the USMLE will handle students who took the test before 2022 but delay applying (MSTP, gap/research years) until after the pass/fail change.
2. Will Step 2 CK, 2 CS and Step 3 become Pass/Fail also?
USMLE Steps 2 CK and 3 will still be reported based on numerical score outcomes. (Note: As of January 1, 2020, the passing score for Step 3 increased to 198 from a 196.) Step 2 CS will remain pass/fail as per its current iteration.
3. Why is USMLE Step 1 changing to a Pass/Fail scoring system?
The USMLE Step 1 (and usually Step 2 CK) are taken during medical school, prior to applying to medical residencies. The score students have received on the USMLE Step 1 has been treated with a great deal of emphasis and consideration by residency programs when screening and selecting applicants. As you would imagine, this has caused a tremendous amount of stress for students with regard to preparing for Step 1 — and for the Match.
When the USMLEs were created in 1992, the creators did not envision a world in which the numerical scores would be given such weight when selecting residents, largely due to the inherent limitations of summing up an applicant's skills and experiences with a number.
Additionally, medical schools have had to essentially balance educating and training future generations of doctors while increasingly teaching to these standardized exams over time. In general, student engagement has decreased as they neared taking Step 1, often opting to give their full focus and attention to preparing for Step 1 rather than their medical coursework, often resulting in falling attendance at medical school lectures and widening philosophical disputes between students and Deans about efficient uses of their times.
Moving toward a pass/fail system, per the coalition, is hopefully a sign of system-wide changes to come, which will ideally bring more emphasis to demonstrating competencies in other ways, increasing diversity within different specialty programs, defining and selecting applicants not just based on numerical scores, but from a more well-rounded perspective.
4. Will I be effected by the change to Pass/Fail for Step 1?
If you're currently in medical school and will be taking the USMLE Step 1 prior to January 2022 , you will still need to pass your Step 1 with a score of 194 or higher.
It's impossible to know for sure how a pass/fail USMLE Step 1 will affect the residency admissions process. Since many schools have to sift through hundreds, if not thousands, of applications many residency directors rely on certain key metrics to stratify applicants they should interview.
With the change in Step 1 scoring, added weight will certainly be given to a student's Step 2 CK score and their clinical grades. This will substantially increase the importance of end-of-rotation Shelf exams. We believe that letters of recommendation, research activities and CVs in general will likely become increasingly important as well.
In our opinion, we think that medical residency programs will likely start to place more emphasis on considering a medical school's reputation when selecting residents for their program. If you are not yet in medical school, we believe that this transition will likely make the MCAT an even more important factor in the long run, because it ties into where you will ultimately attend medical school. What will remain to be seen is what kind of impact this may have for residency applicants from lesser-known schools or DO applicants to ACGME programs.
5. Where can I find more information about the USMLE Pass/Fail decision?
As of right now, the information that has been released by the USMLE can be found here. We will provide updates as more is revealed, and are here if you have questions in the interim.
Looking for details regarding 2020 USMLE score reporting? We have you covered.