As part of its wide-ranging commitment to help medical students succeed in medical school, thrive when they become residents and flourish in practice, the AMA is taking action to address the pressures linked to standardized licensure exams and help unmatched residency applicants.
The move to pass-fail scoring on the first exam in the United States Medical Licensing Examination (USMLE Step 1) and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA Level 1) series was intended to encourage a more holistic review of residency applicants.
Still, unintended consequences have emerged. Most notably, pass rates on Step 1 have declined since the shift to pass-fail scoring—an outcome that coincided with a modest increase in the exam’s minimum passing score. As a result, medical students now face increased pressure to pass on their first attempt, concerned that failure may negatively influence their residency prospects.
Preparation for these demanding and expensive exams may be disrupted by personal crises or family tragedies, so flexibility in scheduling the exam is necessary to accurately reflect the student’s true performance.
In an effort to create an environment in which medical students can improve their Step 1 or Level 1 performance and advance the shift toward a holistic residency-application process, the AMA House of Delegates (HOD) adopted new policy to encourage:
- The National Board of Mdical Examiners and National Board of Osteopathic Medical Examiners to continue evaluating barriers for students related to testing centers (e.g., rescheduling, cost, etc.).
- Medical schools to assist examinees in scheduling of USMLE and COMLEX-USA exams and consider opportunities for flexibility.
“Medical trainees are required to pass demanding and expensive licensure exams during their training, where failure could end their medical career,” said AMA Trustee Melissa J. Garretson, MD. “Unforeseen events, such as a family tragedy or personal crisis, can significantly disrupt a trainee’s exam preparation. It’s essential that all stakeholders in graduate medical education work to remove barriers and offer support to trainees during this demanding process, so we can continue building a strong physician workforce.”
The exam is intended to serve as a steppingstone toward physician licensure, and performance on the USMLE exam series is correlated with later performance on board-certification exams. But these exams alone provide an incomplete picture of professional competence.
“Step 1 is an inadequate indicator of future professional competence as a physician,” says an AMA Council on Medical Education report whose recommendations were adopted. The report also highlights the exam’s contribution to medical student stress and well-being challenges, and points to documented performance inequities related to gender and age.
The AMA offers essential tools and resources to support medical students in their preparation for the USMLE series of exams. To help you with your studies, AMA members receive a discount on test prep materials for the USMLE and the Comprehensive Osteopathic Medical Licensing Exams (COMLEX-USA).
The AMA Succeeding in Medical School series offers tips and other guidance on a wide range of critical topics, including preparing for the USMLE and COMLEX exams, navigating clinical rotations, publishing scientific research, and maintaining optimal health and wellness.
Dive deeper:
- How the switch to pass-fail scoring for USMLE Step 1 is going
- USMLE Step 1 FAQ: How, what to study to pass the exam
- 4 keys to maintaining personal wellness during USMLE prep
- As Step 1 pass rates dip, take these study tips to heart
- Why failing Step 1 shouldn’t end your dream of being a doctor
In a separate action, delegates also moved to address concerns about unmatched medical school graduates. They adopted new policy encouraging relevant parties involved in the residency-selection process to:
- Examine the root causes for physicians who do not secure entry into an accredited residency program by graduation and evaluate each of their efforts to address them, including informing medical students and their advisers how to obtain graduate medical education training opportunities. Such parties include—but are not limited to—medical schools, residency programs, Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, National Resident Matching Program, Intealth and the Accreditation Council for Graduate Medical Education.
- Evaluate opportunities that have successfully matched previously unmatched physicians into residency positions, so students can be better counseled on opportunities that improve their chances of matching into a residency program.
Delegates also reaffirmed existing AMA policy on the physician shortage and reforming the National Resident Matching Program.
For medical students, the Match process can be filled with twists and turns, and it’s natural to feel a little daunted, even overwhelmed. That’s why the AMA offers resources to successfully navigate the process of researching, selecting and applying to residency programs. With the AMA Road to Residency Guide, medical students can successfully plan their path to residency, from researching programs and excelling at interviews to navigating Match Day and more.
Dive deeper:
- “Meet Your Match”: A guide to reapplying
- What if you don’t match? 4 things you should do
- What to know about SOAP’s last-minute Match options
- “Meet Your Match”: How a physician found a residency slot outside the Match
Follow the road to residency
Get tips and insider advice from the AMA on how to successfully Match to a residency program—delivered to your inbox.
Opposing harmful student-loan changes
With four years of medical school, three to seven years of residency, and between 10,000 and 16,000 hours of clinical experience, physicians are the most highly trained—and essential—members of the patient care team.
That depth of preparation, however, comes at a significant cost. More than 70% of medical students graduate with an average education debt of $212,341, according to the Association of American Medical Colleges. The cost to graduate from a public, in-state medical school topped $286,000 in 2024; and for private institutions, that figure exceeded $390,000.
Changes now under consideration by Congress—such as placing a cap of $150,000 on the amount a student could borrow for professional school under the Direct Unsubsidized Loan program—could make the path more expensive and introduce cumbersome barriers toward a career in medicine.
AMA President Bruce A. Scott, MD, addressed the issue during his speech at the Annual Meeting’s opening session.
“We must also continue to educate Congress on why our nation should be working to bring down the cost of a medical education, not erecting barriers that deter brilliant young minds from pursuing this noble profession,” Dr. Scott said. “The proposed changes in student lending practices in the reconciliation bill would make medical school unaffordable for many students. This is simply unconscionable when our country has a shrinking physician workforce to confront its growing health care needs.”
Dr. Scott also addressed how the proposed federal student-loan changes would worsen the physician shortage in a recent AMA Leadership Viewpoints column.
In addition to Dr. Scott’s remarks, the AMA recently provided comments (PDF) to House leadership on how the budget-reconciliation bill—now in the hands of the Senate—would affect patients and the nation’s health system. In this letter, the AMA specifically addresses proposed changes to Federal Direct Unsubsidized Loans and Federal Direct Graduate (GRAD) PLUS loan programs.
Read about the other highlights from the 2025 AMA Annual Meeting.
