The USMLE Step 1 is Going Pass/Fail on January 26th, 2022: Here’s What You Need to Know

Dr. Charles Zhang and Dr. Alyssa Ehrlich

On February 12, 2020, it was first announced that the United States Medical Licensing Examination (USMLE) Step 1 would change the score reporting from a three-digit numeric score to a pass/fail result, with this change set to take effect no earlier than January 1, 2022. More recently, on September 15th, it was announced on the USMLE website that:

“USMLE Step 1 score reporting will transition from a numeric score and pass/fail outcome to pass/fail only for exams taken on or after January 26, 2022. The USMLE program views this change as an important first step toward facilitating broader, system-wide changes to improve the transition from undergraduate to graduate medical education.”

In this announcement, it was again confirmed that scores for all Step 1 exams taken before January 26th will continue to be reported as a numeric score on all USMLE transcripts (i.e., residency programs will still be able to see a numeric score, as long as you take your exam by January 25th, 2022). This major shift in score reporting will clearly have huge implications for the residency application process. Such a large change has resulted in uncertainty and confusion for many medical students. Here, we offer our answers to some of the most common questions our students ask about the score reporting transition.

Why did this happen?

The primary argument in favor of shifting to pass/fail was to relieve the psychological stress imposed on medical students due to the overemphasis of current residency programs on Step 1 test results. According to the program director survey conducted by the NRMP across many years, Step 1 has consistently been ranked as the number one factor in deciding if their program will extend interview offers to applicants. The more competitive the specialty, the more weight is typically placed on an applicant’s Step 1 score. Accordingly, medical students have embarked on a never-ending arms race to improve their scores in an effort to attain those limited, coveted interview spots.

This came at a price, with some students sacrificing important academic and non-academic endeavors unrelated to Step 1. Medical students were forced to devote an increasingly disproportionate time of their preclinical years in preparation for a single test that will likely dictate which fields of medicine they can ultimately pursue. This singular emphasis brought an increased sense of distress and mental anguish to many students, particularly for those who struggle with standardized testing. When arriving at this decision, the AMA acknowledged that the current residency application system is “causing significant distress for our students”. In our experience as tutors, we have certainly seen this to be the case, with many students experiencing significant psychological suffering throughout the Step 1 preparation period.

How did we get here?

Step 1 was never intended to be used as a screening tool for residency applications. It’s a multiple-choice question test of basic science knowledge; it was designed for medical licensure. At one point in time, residency directors noticed that those with higher scores had higher pass rates on their respective specialty board exams. While there are many publications that support this argument, most demonstrate diminishing returns after reaching a plateau of 210 (which, if you account for score inflation, would likely equate to a score of 215-220). With certain specialties such as Dermatology and Plastic Surgery having hard cutoffs of 240 or higher, there is little data to make the argument that these students are any more likely to pass their specialty board exams, relative to students scoring a 220 on Step 1.

Then why have program directors relied on Step 1 scores so heavily for screening applicants? Simply put, Step 1 scores seemed to be the most objective and convenient measure by which to reduce the number of applications requiring a thorough review. Residency