Pass/Fail Score Reporting for USMLE Step 1: An Opportunity to Redefine the Transition to Residency Together

Abstract

The upcoming transition of the United States Medical Licensing Examination Step 1 to pass/fail score reporting has wide-ranging implications for the medical education community. The decision to discontinue 3-digit numeric score reporting comes following advocacy to change the exam because of its disproportionate importance in the residency match process, the negative impact the exam has on student well-being, and the prominent influence the exam has on medical school curricula. Shifting to pass/fail score reporting for Step 1 creates significant uncertainties to be addressed by the stakeholders in the transition from undergraduate medical education to graduate medical education. In this Invited Commentary, the authors reflect on the positive implications of this scoring change, potential negative ramifications that need to be proactively addressed, and future ways that the transition to residency can be optimized. The transition to pass/fail score reporting for Step 1 creates an opportunity to redefine the residency match process, to support applicant decision making, and to encourage a holistic review of applicants. These changes to the review process will require grace and trust among stakeholders, including students, as well as active support for students who might be negatively impacted during a complex implementation phase. By removing the dominance of Step 1 numeric scores from the residency selection process, the change to pass/fail scoring provides a unique opportunity for all stakeholders to work together and redefine the transition to residency while protecting students from unintended negative consequences.

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process

“…Other tests such as the USMLE Step 2 Clinical Knowledge (CK) may gain more importance, 7 and many programs may seek other standardized/objective metrics or prefer firsthand experience with candidates 8 . It is also argued that this transition may negatively affect certain student populations such as doctor of osteopathic medicine (DO) or international medical graduates, underrepresented or minority applicants, and those from less prestigious institutions 9 . Given the previously significant importance of USMLE Step 1 scores in evaluating otolaryngology residency candidates, 1,10 investigating the potential implications of this transition to pass/fail scoring from the perspective of residency program faculties is warranted.…”

Comprehensive Reform and Greater Equity in Applying to Residency—Trainees' Mixed Responses to a Pass/Fail USMLE Step 1

“…21 This potential consequence contradicts one of the initial reasons for the score reporting change, which was to decrease the negative impact of Step 1 numeric scores on student well-being. 7,22 These perspectives may explain why the majority (59%) of IMGs in our study disagreed with the score reporting change.…”

“…Osteopathic students face similar challenges to IMG students. Lin et al 22 describe how, for students of osteopathic and international backgrounds, the loss of Step 1 numeric scores represents the loss of a key metric to ensure applications from these nonallopathic students are reviewed. Similarly, in a single institution cross-sectional survey of 215 medical students, osteopathic students were more likely to report that the pass/fail transition will negatively impact their residency match compared to allopathic students (adjust OR 1.454, 95% CI 0.515-4.106).…”

Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow

“…36 Trainees were closely involved in conversations leading up to this decision, including participation as key stakeholders in the Invitational Conference on USMLE Scoring held in March 2019. 37 We believe this decision is a step in the right direction toward improving the medical education landscape. Trainees are helping lead this conversation, as well as highlighting potential unintended consequences.…”