Medical School - Preclinical

NBME Just Made the USMLE Step 1 Pass/Fail! What Does this Mean for Medical Students?

USMLE Step 1 is now a Pass/Fail exam

USMLE Step 1 becoming Pass/Fail has implications for medical students, residencies and USMLE Step 2. Step 1 has always been very important in residency admissions, so now USMLE Step 2 becomes really important in how program directors evaluate candidates.

Changes to USMLE Exam Policies and What they Mean to You

The National Board of Medical Examiners (NBME) just introduced three recent policy changes to the USMLE:

  1. The attempts limit on each exam are reduced for 6 to 4
  2. USMLE Step 1 must be passed prior to taking Step 2 CS
  3. USMLE Step 1 score is changed from a three-digit numerical score to pass/fail

These policies will be implemented within the next two years. The big one is that USMLE Step 1 is going to be pass/fail. That is a huge change (which won’t be implemented before January 2022) that took years to come to fruition. According to NBME, the decision was made after the InCUS conference in March of 2019.

Traditionally, USMLE Step 1 has been the most important test utilized by residency program directors to evaluate residency applicants. The USMLE Step 1 score has been a great equalizer, equivalent to the MCAT or SAT for program directors in evaluating a student’s performance and knowledge. The goal of the USMLE score change to pass/fail was to spark systemic change and improve the overall transition to residency for medical students according to Michael Barone, VP of Licensure at NBME, and Dave Johnson, the Senior VP of the Federation of State of Medical Boards. Improving the transition from undergraduate to graduate (residency) programs was an important consideration of these policy changes.

While USMLE Step 1 certainly is not the only factor in residency admissions, it is a very important one. With the change, residency program directors will put even more emphasis on USMLE Step 2 CK scores. Now, Step 2 CK takes on an even greater role and importance as it will become the one data point that all applicant must have within their residency (ERAS) application. USMLE Step 2 CK is graded similar to USMLE Step 1, but the average scores tend to be higher. Step 2 CK is a more clinically oriented exam, and the literature suggest it’s more predictive of physician performance than Step 1.

What USMLE Score Do I Need on Step 2 To Be Competitive?

To help you determine where you stand now, Prospective Doctor, the content provider for MedSchoolCoach, created the USMLE Score Estimator. If you want to know what USMLE Step 2 score you need to match into the residency of your choice, use this USMLE calculator to find out.


Other Residency Selection Considerations

Other important factors in residency selection will remain research, letters of recommendation and clinical grades of medical students. Research in particular will play an even bigger role, as it’s another quantifiable measure (i.e., the number of publications a student has in a particular specialty). The dean’s letter from a school will also play a bigger impact, as it often ranks medical students amongst their classmates.

The other policy changes, specifically the limit on the number of times an exam can be taken, and that Step 1 must be passed prior to Step 2 CS, has very limited impact, especially for U.S. students. The majority of U.S. medical students already must pass USMLE Step 1 to take Step 2 CS. In terms of the limit on the number of exams tries, since most U.S. students (>94%) pass on the first try, the impact will not affect most students.

MedSchoolCoach is the leading USMLE Step 2 CK and residency admissions advising company in the world. We tutor the most USMLE Step 2 test takers a year and raise their score by up to 55 points. Our residency advisors are former program directors and understand how the change can impact students in the match process. Learn how we can help boost your USMLE score 23 to 55 points!

Read more about COMLEX level 1 tutoring

Sahil Mehta

Sahil Mehta M.D. is an attending physician in the Department of Radiology at Beth Israel Deaconess Medical Center and the Founder of MedSchoolCoach. Dr Mehta is one of the world’s experts on medical school admissions having founded MedSchoolCoach in 2007. MedSchoolCoach provides admissions consulting to premedical students in the form of interview preparation, essay editing and general advising. In the past 10 years, he has had a hand in over a thousand acceptances to medical school.

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