The change was made to encourage a shift in focus from "high-stakes testing" to "learning and individual improvement," as well as to alleviate some of the stress associated with the exam.
[3][4] These changes were implemented starting in January 2022, with the first USMLE Step 1 scores reported in the pass/fail format in February 2022.
The changes to the USMLE Step 1 exam have elicited mixed reactions from the medical education community.
While some see the shift to pass/fail and the shorter exam format as positive steps toward reducing the pressure on medical students and promoting a more holistic approach to residency selection, others are concerned.
[5][6][7] Step 1 is designed to test the knowledge learned during the basic science years of medical school as applied in the form of clinical vignettes.
[9] It was announced on February 12, 2020, that beginning no earlier than January 2022, USMLE Step 1 would transition to a Pass/Fail scoring system.
[16] Residency program directors had historically utilized the scores as a means of filtering applications down to a more manageable number that allowed for a more thorough review of the remaining ones.
[21] Since 2001, there has been a strong plea to remove the Step 1 score barrier that disproportionately affects select racial and ethnic groups.
[33] Notably, medical students and program directors were among parties with only a minority in favor of this change, despite being the most directly affected.
A Pass/Fail score will help provide a more meaningful learning environment, improved emotional climate, and better student-student interactions, which can lead to better academic performance that includes USMLE tests (see Cause or effect?).
"[34] Further, they supported the move to Step 1 Pass/Fail citing unintentional negative impact of a single standardized exam on career exploration and selection.
[33] Notably, medical students and program directors were among parties with only a minority in favor of this change, despite being the most directly affected.
Step 2 CK is a three-digit-scored exam typically taken after the third year of medical school, which consists of clinical rotations in primary care fields.
[38] Without a numerical score on the USMLE Step 1, there is speculation that IMG's will be further be pushed out of the race for residency program spots.
This was supported to some extent by General Surgery program director respondents, which significantly agreed that the changes to Pass/Fail "Will put IMGs at a disadvantage" 56.0% [48.6–63.4%].
[17] The current use of Step 1 scoring as a major determinant for granting residency interviews has been met with tremendous criticism by the medical community.
The public outcry led to the formation of a committee and investigation in early 2019 called the Invitational Conference on USMLE Scoring (InCUS).
[39] In February 2020, InCUS concluded that residencies were overemphasizing Step 1 and not using it for its original purpose for which it was designed as a means of licensing.
[40] Upon reaching these conclusions, the USMLE program announced a plan to change Step 1 score reporting to a Pass/Fail system in an effort "to reduce overemphasis on Step 1 performance while allowing licensing authorities to use the exam for its primary purpose of medical licensure eligibility."
[52] In December 2018, NBME President Peter Katsufrakis and FSMB President Humayun Chaudhry wrote in opposition of USMLE Step 1 changes in from Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs: "If students reduce time and effort devoted to preparing for Step 1, they may indeed devote attention to other activities that will prepare them to be good physicians.
However, if students were to devote more time to activities that make them less prepared to provide quality care, such as binge-watching the most recent Netflix series or compulsively updating their Instagram account, this could negatively impact residency performance and ultimately patient safety.
We know that assessment drives learning, so another concern resulting from a shift to pass/fail scoring may be a less knowledgeable physician population.
[59] NBME and USMLE were met with criticism when they announced their raising cost for Step standardized tests.
Kevin MD wrote, "Safeguards are needed to ensure fees for mandatory testing such as the USMLE do not exceed reasonable operating costs, particularly for financially vulnerable medical students.