Since Step 1 of the United States Medical Licensing Examination (USMLE) transitioned to pass-fail scoring, the vast majority of medical students are passing the exam—about nine out of 10—on their first attempt. That represents, however, a slight dip from the pass rates in the years in which examinees were given a numerical score.
Is the dip cause for concern?
As long as medical students take the right steps to prepare, experts on Step 1 prep say no.
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).
“Students should approach Step 1 with a sense of confidence,” said AMA member Mark Meyer, MD. “The supermajority will pass the exam. If you are well prepared and have a good sense of where you stand going into the exam, there’s no reason to think you won’t be successful.”
So, what separates the medical students who pass from those who don’t? Test-prep experts outlined key strategies students can use to stay on track and build the right foundation for success.
Understanding the dip
In 2021—the year prior to Step 1’s moving to pass-fail scoring—95% of first-time test takers from MD-granting medical schools and 94% from DO-granting schools passed Step 1. In the years since, that number has ranged from 91–93% for MD students and 86–89% for DO students.
What’s behind the decline? One simple answer is that the threshold for passing increased. When the exam went pass-fail in January 2022, the score required to pass moved from 194 to 196.
As senior associate dean for student affairs at the University of Kansas Medical Center, Dr. Meyer works directly with students on the Step 1 process. In the test cycle after the exam went pass-fail he noticed that at least some medical students took their foot off the gas when it came to test prep.
“I was very supportive of Step 1 going pass-fail because the emphasis on the exam was detrimental to student wellness,” Dr. Meyer said. “But I do think in the cycles immediately after the exam changed, student preparation changed, and there might have been a different sense of urgency in preparation.”
“Students are very goal-oriented and when Step 1 was a three-digit score, they were competing for every point because it enhanced potentially their competitiveness for residency. In those days, it was said that a Step 1 score was the first filter for many residency programs.”
In this AMA news article, medical students will get valuable information regarding:
- How preclinical performance correlates with Step 1 success.
- The importance of studying early for the USMLE Step 1.
- How to approach your Step 1 studying in the weeks leading up to the exam.
- The data points that indicate whether you are on track to pass the USMLE Step 1.
- When to delay taking the exam.
- What failing Step 1 means for a medical student—and what it doesn’t mean.
