USMLE Step 1, a multiple choice question test of basic science knowledge, was never intended to be used as it is today. These criticisms are not entirely without merit, but ignore the realities of how we got here. Others have strongly criticized the decision, arguing that it will remove an essential “ objective” metric for selecting medical students for residencies and harm individuals from international medical schools and less prominent American medical schools. Many medical students, residents, and faculty are overjoyed, viewing the change as a long overdue course correction for medical education. Since the news broke, many have reacted with strong feelings. Ultimately, the harms of maintaining the “ Step 1 Climate” became too great to ignore, even for the test’s corporate sponsors. As we noted in a piece for in-House prior to the Invitational Conference on USMLE Scoring last year, there were plenty of reasons, including glaring financial conflicts of interest and worrisome written comments from the leaders of the NBME and FSMB, to suspect that the USMLE and its sponsors would maintain the status quo. It is only fair that we give the USMLE and its corporate sponsors credit for making the right decision.
In explaining its decision to change the Step 1 scoring system, the USMLE noted that its co-sponsors, the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB), “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 eligibility.” We have also made similar arguments advocating for a shift to a pass/fail scoring system in the past, due to concerns regarding the three-digit score’s pernicious effect on medical curricula, medical student well-being, and its misuse in selecting candidates for specialty training. The three-digit scoring systems for Step 2 Clinical Knowledge (CK) and Step 3, and the pass/fail system for Step 2 Clinical Skills, will remain unchanged. Last week, the United States Medical Licensing Examination (USMLE) announced that Step 1, the first of three required licensing examinations for medical trainees, will stop reporting three-digit scores and instead report only a pass/fail designation as early as January 2022.
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