The Upcoming Pass/Fail USMLE Step 1 Score Reporting: An Impact Assessment From Medical School Deans

Abstract

Background: The US Medical Licensing Examination (USMLE) Step 1 change to pass/fail has been met with mixed reviews, and the impact on medical student education and residency match is unknown. We surveyed medical school student affairs deans regarding their thoughts on the upcoming transition of Step 1 to pass/fail. Methods: A questionnaire was emailed to medical school deans. Deans were asked to rank the importance of the following after the Step 1 reporting change: Step 2 Clinical Knowledge (Step 2 CK), clerkship grades, letters of recommendation, personal statement, medical school reputation, class rank, Medical Student Performance Evaluation, and research. They were asked how the score change will affect curriculum, learning, diversity, and student mental health. Deans were asked to select 5 specialties they thought would be most affected. Results: Regarding perceived importance of residency applications following the scoring change, the most frequent number 1 choice was Step 2 CK. The majority of deans (93.5%, n = 43) felt that the change to pass/fail would benefit medical student education/learning environment; however, most (68.2%, n = 30) did not believe their school curriculum would change. Students applying to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery were felt to be most affected by the scoring change; 58.7% (n = 27) felt it would not adequately address future diversity. Conclusion: The majority of deans feel the USMLE Step 1 change to pass/fail would benefit medical student education. Deans feel that students applying to traditionally more competitive specialties (ie, programs with fewer overall residency positions available) will be most affected.

The Impact of United States Medical Licensing Examination Step 1 Transitioning To Pass/Fail on Medical Student Perception of Research Needed to Match Into One's Preferred Specialty

“…However, most of these impacts will not be immediately apparent, and there is currently little research on this topic from the students’ perspectives. Medical school deans have already stated that this transition will lessen the negative experience of studying for Step 1 on medical students' mental health and well-being as well as foster a more comprehensive method of looking at each medical student’s residency application [ 7 ]. An additional positive outcome is the speculation that this change to the scoring system could decrease disparities in cost and availability of Step 1 preparation materials among medical students [ 7 , 8 ].…”

Securing Interviews as an Underrepresented Applicant Post-USMLE Pass/Fail: A National Survey of Competitive Residency Directors

“…Step-2CK score. Collectively, medical school deans reported feeling that students who apply to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery would be most impacted 25 . Many stakeholders have expressed concerns about removing the standardized Step-1 score and posit additional issues that may arise from this scoring change 2,27,28,29 .…”

Program Signaling in the New Era of Residency Applications: An Asset or Liability?

“…1 and 2 Additionally, with the transition of the United States Medical Licensing Exam (USMLE) Step 1 from a scored to pass/fail system, it is more difficult than ever for programs to distinguish between applicants and for applicants to stand out to their programs of interest. 3 In response, the Association of American Medical Colleges (AAMC) piloted the Electronic Residency Application Service (ERAS) supplemental application during the 2021-2022 residency match cycle with a new section for program preference signaling where applicants were provided with a limited number of virtual “tokens” per specialty that they could send to individual programs to signal their interest in at the time of application. 4 For the AAMC, the purpose of this addition was to provide a fair way for applicants to share their information with programs and promote a holistic review of a large volume of applicants, thereby allowing applicants to express their interest in individual programs in a formal capacity and serving as a tool for residency programs to decide whom to interview and to promote the inclusion of diverse applicants.…”