By Jennifer Larson, contributor Mar 24, 2020
Before physicians can practice medicine, they have to pass the boards. That
is, they have to successfully complete all three steps of the United States Medical
Licensing Examination, or USMLE.
USMLE’s co-sponsors, the Federation of State Medical Boards (FSMB) and
the National Board of Medical Examiners (NBME), recently announced that the
USMLE scores will look different in the future. The current three-digit score for
USMLE Step 1
performance will be replaced with a simple pass/fail designation.
The announcement has sparked a variety of responses from medical
students, educators and practitioners—ranging from relief to concern. Most
agree, however, that the change will have profound effects on medical
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What’s behind the change in Step
“The USMLE co-sponsors believe that changing Step 1 score reporting to
pass/fail can help reduce some of the current overemphasis on USMLE
performance, while also retaining the ability of medical licensing authorities
to use the exam for its primary purpose of medical licensure,” a statement
from the co-sponsors on the USMLE website explained.
“The decision by the NBME and FSMB to change USMLE Step 1 score
reporting to pass/fail was very carefully considered to balance student
learning and student well-being,” said Alison J. Whelan, MD, chief medical
education officer for the Association of American Medical Colleges (AAMC), in a
statement. “The medical education community must now work together to identify
and implement additional changes to improve the overall UME-GME transition
system for all stakeholders and the AAMC is committing to helping lead this
The challenges of USMLE Step 1
USMLE Step 1, which is the first of three parts, is known for being a
rigorous and challenging examination. It’s also been known to stoke anxiety
among the medical students who are taking it.
Medical students normally take the exam at the end of their second year
of medical school. Currently, they receive a three-digit numerical score that assesses
their performance; that score can range from 1 to 300, but students must score a minimum of 194 to pass the exam.
Residency program directors can see those scores when a student applies
to their program. That can have the effect of filtering out some future physicians
who may score lower on their first exam than others, yet possess intangible skills
that could help them be successful doctors.
That’s just one example of the pressure that the exam, as it’s
currently scored, puts on medical students, said Gary LeRoy, MD, president of
the American Academy of Family Physicians (AAFP).
“It’s become such a high-stakes examination that students are bowing to
commercial vendors to help them with preparing for the examination. So they’re investing money in that. Some
invest as much as $1,000 in prep materials for the thing, and then there’s the
cost of the test itself,” said LeRoy, the associate dean for student affairs
and admission at Wright State University Boonshoft School of Medicine. “That’s
just adding to the debt load and anxiety associated with it.”
Kristin Emodi, a fourth year MD/MBA student at New York University
School of Medicine, sees the value in the change, given the pressure its puts
on med students to perform well on a single test.
“Making Step 1 pass/fail is unequivocally a good thing, but it is just
the first step,” she said.
Changing the USMLE Step 1 score to a pass/fail designation could have
some other consequences, Emodi added. It could spur residency program directors
to place more emphasis on other factors, such as medical school prestige,
clerkship grades, research, and of course the scores on the USMLE Step 2 Clinical Knowledge (CK) exam. The Step 2 Clinical
Skills (CS) exam is already scored as pass/fail.
Step 2 exams are normally taken after the third
year of medical school, and some argue that the changes to Step 1 are shifting some
of the stress and anxiety further down the educational pathway, which can
impact medical students closer to when they will be applying for residencies.
Changes will take effect soon
The announcement about the change to USMLE Step 1 scores was released
in February 2020, but the actual change won’t take effect before January 1, 2022.
More details will be released later this year.
LeRoy noted that he and others in the administration at his medical
school were pleased by the announced change. He thinks the new way of scoring
the test will allow the test to remain challenging but be “a better way of
engaging and testing these students.”
“It’s still high stakes, but at least it’s not chasing a number,” he
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