Thoughts On USMLE Step 1 Going Pass/Fail

The United States Medical Licensing Exam (USMLE) Step 1 is the first of several exams to become eligible for medical licensure. In many cases, a medical student’s performance on this exam either expands or limits their options regarding career choice and specific residency programs. Although many medical schools have gone pass/fail for the basic science portion of their respective curricula, clinical rotations largely remain stratified (honors, high pass, marginal pass, pass, fail, etc.) The USMLE is now slated to follow the pass/fail trend beginning in 2022.

I’ve always preferred written/oral examinations instead of multiple choice tests as medicine is an imperfect science with considerations that extend beyond a question stem. Furthermore, the performance on objective assessments often don’t correlate with the quality of the physician that will emerge from residency. Yes, academic ability is incredibly important, but so is bedside manner, trainability, and other “intangibles.” This news makes me concerned for several reasons:

  • How will admissions committees (adcoms) “screen” applicants… especially given the unified ACGME Match (“MD-DO merger”) and foreign medical graduates who often times rely on their Step 1 score to “stand out?” There aren’t enough hours in an application cycle for programs to interview every applicant.
  • Will USMLE Step 2 CK (still a graded exam) take on a larger role? Many medical students don’t take this exam until after they’ve already applied to residency. Maybe now they’ll take it earlier?
  • How will applicants distinguish themselves at the granular level? I’ve seen so many items of questionable significance listed on applications. I’m worried we’ll now applicants resort to an amplification of things that don’t make a meaningful difference.
  • It’s easy to “fake” a 30 minute interview and even easier to get generalized recommendation letters from “big name” faculty/researchers. It’s hard to do well on exams. How will adcoms holistically evaluate applicants?

Drop me a comment with your thoughts below!

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  1. I wonder if CV/resume may creep up on importance. If they are seeking more well rounded physicians, it seems likely that they will begin to consider the person as a whole with life experiences rather than the number on step scores. But, I dont know how they’ll manage to sort through the hundreds of applicants. Hm.


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