Medical Licensing Exam (USMLE Step 1) to change from grades to pass/fail, to prevent over-reliance by residency programs

Among the concerns surrounding residency applications, interviews and matching is that the USMLE step 1 exam scores play an exaggerated role in determining who gets which residencies.  The Board of Medical Examiners is about to change that, with a new policy that will only report pass/fail rather than exam grades.

USMLE Program Announces Upcoming Policy Changes

"PHILADELPHIA, PA (February 12, 2020) – Today, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®), co-sponsors of the United States Medical Licensing Examination® (USMLE®), announced upcoming policy changes to the USMLE program.

• Changing Step 1 score reporting from a three-digit numeric score to reporting only pass/fail;

• Reducing the allowable number of exam attempts on each Step or Step Component from six to four; and

• Requiring all examinees to successfully pass Step 1 as a prerequisite for taking Step 2 Clinical Skills. 

"These new policies will continue to enable the USMLE program to provide high-quality assessments for the primary user of exam results (state medical boards) while also addressing other considerations, such as exam security and unintended consequences of secondary score uses. The secondary uses of Step 1 scores for residency screening, in particular, have been the focus of extensive discussion over the past year at the FSMB and NBME, within the USMLE program, and with multiple stakeholders within the broader medical education and regulatory communities.

“These new policies strengthen the integrity of the USMLE and address concerns about Step 1 scores impacting student well-being and medical education,” said Humayun Chaudhry, DO, MACP, President and CEO of the FSMB. “Although the primary purpose of the exam is to assess the knowledge and skills essential to safe patient care, it is important that we improve the transition from undergraduate to graduate medical education.”

“The USMLE program governance carefully considered input from multiple sources in coming to these decisions. Recognizing the complexity of the environment and the desire for improvement, continuation of the status quo was not the best way forward,” reported Peter Katsufrakis, MD, MBA, President and CEO of NBME. “Both program governance and staff believe these changes represent improvements to the USMLE program and create the environment for improved student experiences in their education and their transition to residency." 

These policy changes are currently planned to be phased in over the next 11-24 months. For specific information on each policy, consult the link to the detailed statements accompanying each policy change. A podcast supplementing the information contained in this announcement is also available here."

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Here's some more detail:

Change to pass/fail score reporting for Step 1

"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.

...

"The FSMB and NBME 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. The USMLE co-sponsors also believe that moving to pass/fail reporting of Step 1 while retaining a scored Step 2 CK represents a positive step toward system-wide change, while limiting large-scale disruption to the overall educational and licensing environment.

"The FSMB and NBME view this change as an important first step toward facilitating broader, system-wide changes to improve the transition from undergraduate to graduate medical education. The two organizations remain actively involved in the additional work sparked by InCUS, that of a broader system-wide review of the UME-GME transition that is being undertaken by the organizations in the Coalition for Physician Accountability **. As this future work develops, and as additional system-wide changes may unfold, including advances in reliable and holistic assessment of the training of physicians, the USMLE program will offer its resources and partnership."