January 26, 2022-USMLE Step 1 Exam Goes to Pass/Fail

As announced earlier, the US Medical Licensing Examination -Step 1 test of basic medical knowledge will transition to reporting only Pass/Fail rather than the current three-digit numeric score. This change has been anticipated for about a year, but now that the deadline is approaching, many IMGs and others have questions about what will happen with the transition and what it means for the future of the residency application process.

Meanwhile, an additional announcement in December 2021 by the USMLE Management Committee changed the definition of what will be considered a Passing score from the current 194 to 196, an increase of two test points. This change will also go into effect on January 26. 

What exactly is changing with the USMLE and why is it occurring?

The primary purpose of the USMLE exam for basic medical knowledge (Step 1) is as a prerequisite for licensure in the US. Thus, the exam is to ensure applicants are ready to be licensed by their state to be able to practice medicine.  However, over time, a medical school graduate’s performance on the exam was often used for secondary reasons, most notably in the process of applying for medical residency. 

The test score has gradually become a way for residency program directors to filter out applicants, which is why they started requiring a certain level of performance on the exam in order to be considered for acceptance into their programs. This minimum score could vary, but was approximately 25 points higher (or more) than what the licensure exam itself required for a passing score. (The current passing score is 194, but some residency program directors only consider applicants who have scored 220 or higher). Over time, this has put tremendous pressure on medical students, and that is what eventually caught the attention of those who administer the exam. In converting the exam to Pass/Fail, their hope is to reduce the stress around the exam and allow it to be viewed for its primary purpose, which is licensure.  

According to both USMLE and the Educational Commission for Foreign Medical Graduates (ECFMG), Step 2 Clinical Knowledge and Step 3 examinations will continue to be reported as both a three-digit score and pass/fail.

So what will this USMLE Step 1 Pass/Fail score change look like on my test report?

Currently, after taking the Step 1 exam, examinees receive a three-digit numeric score as well as a Pass-Fail designation. Basically, if they scored higher than 194 on the test, then their transcript shows the numeric score as well as a “Pass” designation. Starting on January 26, 2022, the transcripts will only show a “Pass” or a “Fail”designation and no numeric scores will be shown. Also, with regard to feedback,  if the applicant passes (with a score of 196 or higher), then no content-based feedback will be provided, whereas if the examinee gets a failing score, then, according to the USMLE website, examinees “will receive information about how far they were from passing, as well as content-based feedback to guide the study plan for their next attempt.”

How will this affect the way in which program directors review residency applications?

Those who administer the USMLE Step 1 exam say their hope is that residency program directors will view the entire application package more holistically rather than relying primarily on one single score to consider whether to accept or reject an applicant. However, some insiders point out that the program directors are still under tremendous pressure to review a large volume of applications within a tight timeframe. According to one source, in 2019, a total of 47,012 applicants submitted an average of 92 applications each, for a total of over 4.3 million applications. This tremendous volume of applications can be overwhelming, and the new change regarding Pass/Fail reporting for Step 1 is unlikely to alleviate the burden on program directors.

That is why many observers point out that the USMLE Step 2-CK exam, which continues to report a three-digit numeric score, likely will become even more significant in the application process. Medical school rankings could also take on greater significance. While this might be helpful to USMGs who graduate from top medical schools in the US, it might make things more challenging for IMGs and those from lower-ranked US medical schools. 

What are the implications of this USMLE Step 1 Pass/Fail test score reporting change for IMGs?

After the change goes into effect, IMGs can put less emphasis on scoring high on the USMLE Step 1 exam. It is likely that more IMGs will now be able to pass the exam (with a score of 196 or higher) without having to worry about achieving an extra high score for consideration for residency. Thus, they can spend less of their time studying for Step 1 and more time gathering real clinical experience and enhancing other aspects of their applications and qualifications. Of course,  they may need to increase the amount of time they invest in preparing for the Step 2-CK exam. However, some say that this is a good thing, as giving more attention to higher clinical knowledge rather than basic knowledge will be more helpful overall in preparing applicants for their chosen fields of study. 

Until more time has passed, it remains to be seen how residency program directors will adjust their criteria for application consideration in light of this change.

If I have already taken the Step 1 exam, will this change affect my chances of getting accepted into a residency program? 

Maybe. Residency program directors are expected to take a more holistic approach to their review of applications, de-emphasizing their reliance on a particular test score to screen applicants. Thus, they may, for example, pay more attention to medical school rankings, transcripts, and other aspects of the application package, including the personal statement and the MSPE.

But it is still unknown exactly how residency program directors will adjust to the change. Some are speculating that the Step 2-CK exam scores will now take on more significance than before as this exam is still reported with a three-digit numeric score. In the short term, program directors are still overwhelmed by a large number of applications and thus are looking for ways to expedite the application review process. 

How will those with a Pass/Fail score on USMLE Step 1 compete with others who have the three-digit numeric score? 

This is one of the questions that is still being asked as the transition continues to evolve. In the short term, the three-digit score (especially a high one) is considered to be an advantage in the residency application process. Without that numerical score, program directors will need to look at other aspects of the application, and it remains to be seen whether norms will develop around the revised review process. For now, one can expect that each program director/review committee will respond differently to the change.

For more information about this change, see this article from the USMLE organization. Also, IMGPrep LLC has a useful step-by-step guide for IMGs on how to register for the USMLE Step 1 exam. 

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