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Letters to the Editor

The New Era of Pass/Fail USMLE Step 1: Medical Students’ Call to Action

Conway, Nicholas B.; Khan, Irfan A.; Geraghty, Joseph R.

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doi: 10.1097/ACM.0000000000003529
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To the Editor:

With the announcement that United States Medical Licensing Examination (USMLE) Step 1 will be going from the traditional 3-digit score to pass/fail scoring, there was a shock wave felt throughout medical education. Several parties have described the unique opportunity this transition provides and its impact on medical students worldwide.1 As medical student leaders representing our peers, we describe 2 implications to consider as we approach the era of pass/fail Step 1.

First, consideration must be given to students in unique curricula, such as dual-degree programs, or medical schools with Step 1 scheduled after core clerkships. We are qualified to speak on behalf of both perspectives since we represent both of these curricula. Dual-degree students with a scored Step 1 exam may return to medical school with peers having pass/fail results. Additionally, students who take Step 1 after core clerkships may be applying for residency having taken a pass/fail exam as third-year students, while students from other institutions will have taken a scored exam as second-year students. We are concerned the timing of this scoring change may profoundly impact students, especially in the class of 2023, as residency program directors will receive both scored and pass/fail Step 1 results in a single application year. Rather than as early as January 2022, we propose the transition to pass/fail Step 1 should occur at a time that is dependent on the residency application cycle, beginning with the class of 2024. Special considerations, such as score conversions, may need to be discussed for dual-degree students.

Second, medical students have historically used their numerical Step 1 score as one factor to influence specialty decisions. Now, the Step 2 Clinical Knowledge (CK) examination may become more influential in this decision. With this exam traditionally being taken either just before or after residency applications are submitted, we worry medical students will have little time to make career-altering decisions. Medical schools should provide students adequate time to take their Step 2 CK before submitting applications, consider how to improve career advising, and increase opportunities for students to explore specialties in the preclinical years.

Although change can make anyone feel uneasy, this is an exciting time in medical education, ripe with opportunity. We hope these considerations will spark new ideas and collaborations in the field of medical education.

Nicholas B. Conway
Second-year medical student, Florida International University Herbert Wertheim College of Medicine, Miami, Florida;; ORCID:
Irfan A. Khan
Third-year medical student, Florida International University Herbert Wertheim College of Medicine, Miami, Florida; ORCID:
Joseph R. Geraghty
Sixth-year MD/PhD candidate, University of Illinois College of Medicine, Chicago, Illinois; ORCID:


1. Chaudhry HJ, Katsufrakis PJ, Tallia AF. The USMLE Step 1 decision: An opportunity for medical education and training [published online ahead of print March 6, 2020]. JAMA. doi:10.1001/jama.2020.3198.
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