Memorang Blog The USMLE Step 1 is changing to pass/fail. Here are the 7 things you need to know

After years of deliberation, the USMLE has announced that the USMLE Step 1 will be changed to a pass/fail score “no earlier than January 1, 2022” with further details to follow later this year. This is a change that will fundamentally alter the medical school and the residency application process. In this blog post we will be covering why this happened, the implications for your future residency applications, and what changes you can make as a student to navigate a world where your Step 1 score doesn’t matter.1. What is happening and when?“The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome. A numeric score will continue to be reported for Step 2 Clinical Knowledge (CK) and Step 3. Step 2 Clinical Skills (CS) will continue to be reported as Pass/Fail. This policy will take effect no earlier than January 1, 2022 with further details to follow later this year.”2. Why did this happen?The primary intended purpose of the United States Medical Licensing Exam is to “grant a provisional license to practice in a post-graduate training program and the decision to grant an initial license for the independent practice of medicine.” As residency training slots became increasingly competitive, program directors used USMLE scores as a means to screen and select applicants. While the directors “acknowledge the limitations of using USMLE scores for residency selection, but justify the practice given USMLE’s position as a nationally standardized measure of knowledge and skills and as the only common metric by which to evaluate all applicants.”3. What happens to my Step 1 score if I apply to the 2022 match (2021 ERAS submission) or earlier?Your USMLE Step 1 score will be reported as a 3 digit score, same as now.4. What happens to my Step 1 score if I apply to the 2023 match (2022 ERAS submission) or later?We don’t know the specific date that this transition will happen since it’s nearly two years away. However, if the change goes into effect before the ERAS applications in Fall 2022, then your USMLE Step 1 score will be reported as pass/fail.It’s important to note that the USMLE said that the change is not in how the USMLE Step 1 is scored, but in how it is reported. Although unconfirmed, it’s reasonable to assume that your prior Step 1 scores simply won’t be available to residency programs after the change goes into effect. This blog post will be updated when the details on this become clear.5. How will this change how residency programs rank applicants?The USMLE Step 1 is still important because you need to pass the exam, but how well you do beyond that will not matter. However, with the elimination of your Step 1 score as a factor in your ranking as an applicant, program directors will be paying more attention to the data that is still available. This means that your Step 2 CK score, performance on clinical rotations (of which your shelf exam scores are often an integral component), sub internships, leadership, and research will come into further focus. The increased focus on clinical knowledge and skills may seem like a cause for celebration, but this may not be the case across the board. The attention given to Step 1 and Step 2 CK scores actually leveled the playing field between students from top and bottom ranked medical schools because it allowed an applicant with poorer clinical exposure to shine in another area. In fact, these lower-ranked schools often tout their USMLE scores and their streamlined curriculum that “teaches to the test” as competitive advantages for their students to match into their chosen specialties. Now when pre-med students are considering which medical school to attend, schools that do not offer top-tier clinical exposure will be at a profound disadvantage, leading to a decline in the quality of applicants at lower-ranked schools and even more competition at schools with strong hospital systems and clinical affiliates. In other words, the playing field is going to become uneven.6. How will this change the 2022 match (2021 ERAS application) before the change goes into effect?For the 2022 match (2021 ERAS submissions), applicants will have their Step 1 scores factor into their ranking. For students with strong Step 1 scores, it will be business as usual. However, for students who are applying to competitive programs, they may elect to delay their graduation by doing a research year or masters program (e.g. MBA or MPH) for a double boost: their applications will be strengthened by the additional education and experience, and won’t be bogged down by a weaker Step 1 score. This means that you may see a dip in the number of students entering the 2022 match, leading to a less competitive field overall. Since medical students are typically risk averse, we can assume that more students will pursue the safer path of skipping the 2022 match to not have their Step 1 scores count against them. This will be especially true for students who are gunning for the most competitive programs. One insight is that it may be a good idea for a “less strong” applicant (e.g. lower scores or IMG) to match into a more competitive program since there will likely be less applicants overall.7. How will this change the 2023 match (2022 ERAS application) after the change goes into effect?For the 2023 match (2022 ERAS submissions), applicants will not have their Step 1 scores factor into their ranking. This means that Step 2 CK scores, clinical grades, research, and other education and experience will matter more. Expect to see a greater focus on Step 2 CK scores. While that may seem like good news at first, the students who delayed their graduation in order to purposefully avoid having their Step 1 scores count against them will be piling into the 2023 match. This could potentially result in a significant spike in applications, leading to poorer match outcomes since the number of residency spots will be the same as the previous year but the number of applicants will be higher.What’s next?Unfortunately, there is going to be a seismic shift in residency application cycles immediately preceding and following the change of Step 1 becoming pass/fail. The downstream implications and strategies for students are huge and will be the subject of another in-depth blog post.