USMLE Step 1 Changes



1. When will the pass/fail grading on Step 1 go into effect? 

The USMLE announcement states that this change will go into effect “no earlier than January 1, 2022.” This is interpreted to mean that students taking the exam before January 1, 2022 should expect the exam to be numerically scored. However, we urge students to be cautious about making plans for future years, since the change to pass/fail scoring could be delayed beyond January 1, 2022. This might occur, for example, if the changes in processes needed for residency applications are not fully in place. There is an “alphabet soup” of national groups, including the AAMC, AMA, ACGME, ECFMG, NBME, FSMB and others, that are involved in implementing this new policy.


2. Will the change of Step 1 to pass/fail increase the emphasis on Step 2 CK, which will remain numerically graded?

Increased emphasis on Step 2 CK could be a consequence of this change, since it would become the only numerically graded USMLE exam available to residency program directors for screening applicants. One argument supporting this change is that, compared to Step 1, Step 2 CK is a more relevant assessment of the skills required for residency. One argument against this change is the concern that this would result in just shifting the stress on students from one exam to another.

Many residency programs are developing “holistic” screening procedures that take into account the whole of a student’s application, rather than over-relying on one metric, like Step 1 or 2 CK. Whether the change to pass/fail for Step 1 will aid and accelerate this holistic process is unknown. At present, it is too early to know.


3. What other metrics could residency program directors use for making interview decisions and/or final match ranking decisions?

Although there is support for movement towards a more holistic screening approach, program directors could use other metrics, ranging from Step 2 CK to shelf exams to even something like AOA membership. For our students, these other metrics might not be as important as being a Perelman School of Medicine graduate, given the reputation of our school and the outstanding performance of our graduates in residency. 


4. Would student scholarship (publications or presentations) become more valuable in the absence of Step 1 scores?

Some program directors, especially at academic residency programs, may place more emphasis on a student’s scholarly pursuits and productivity while in medical school. This could be an advantage for PSOM students.


5. Will anyone be harmed by this decision?

Students at “top” medical schools are in many ways in a privileged position regarding this change. The strength of a school’s reputation should be an asset for students during the residency application process. Some faculty are concerned that this change will increase the incentive for students to try to get into a “top” medical school and therefore increase the pressure on MCAT performance and college grades


6. What about students (MSTPs and other MD+ students), who apply for a residency position with a Step 1 numerical score in the same year that there will be students applying with Step 1 pass/fail. Will this help or hurt these students?

It is not known whether existing numerical scores will be converted to pass/fail scores once Step 1 becomes pass/fail. If there is a period of time where some applicants will have numerical scores and some pass/fail scores during the same Match year, we have no indication of how program directors will address this issue. Currently, our MSTP and MD+ students do quite well in the residency selection process. 


7. Will this change affect how pre-clerkship or clerkship courses are graded?

Several medical schools in the US have moved to pass/fail grades during clerkships, eliminating “pass with distinction” or “honors.” It is unclear whether any of these programs will reconsider this approach given the new Step 1 policy. Many medical schools are also exploring new and more holistic approaches to competency assessment during clerkships. However, developing a holistic assessment that is unbiased, streamlined and efficient takes thought, effort, and time.


8. Will away-rotations become a better way to “audition” for residency programs? 

Some expect to see an increase in students trying to do away-rotations as part of their application strategy.


9. Will there be any attempt to limit the number of residency programs that individual students can apply to in order to reduce the number of applicants individual programs need to screen?

This has part of the national conversation, even before the Step 1 announcement was made, as the monetary expense to students is enormous, the time spent is excessive (both for students and residency programs), and this process therefore disadvantages students who do not have the finances and/or time to apply to scores of programs and attend 20+ interviews.  There are conversations about new models for the match and we will keep our students posted as we learn more.


10. What is the education leadership at PSOM doing to address these issues?

There are discussions about forming a working group of education faculty with 12 of our peer institutions to develop a consensus statement about how to approach the items listed above. At PSOM, we will continue to keep you updated on changes made to the Step 1 process, and will work with residency program directors to ensure PSOM students remain highly competitive for residency positions.


Posted 2/28/2020