Is step 1 still logical now that it has gone pass/fail?
Yesterday some long rumored changes were finally confirmed and took the whole online USMLE community by storm. It is in the title of this post, and you have probably seen memes about it, yes, step 1 is going to be pass/fail starting 2022.
Why the change?
It is no secret that program directors use step 1 scores as a screen to filter out the applications they receive, whether this is good or bad is a matter for another discussion. This single filter screen has put extreme emphasis on step 1 score, making it the single most important exam in any medical student’s life intending on practicing in the US.
The unrivaled importance of step 1 score is a major stressor in the already stressful life of a medical student, so taking the pass/fail route is meant to address the ever inflating scores and rising bar when it comes to matching. With less stress over an exam designed to tell if a student has met the “minimum requirements” to practice medicine under the supervision of a licensed physical, students will have more time and freedom to pursue their interests. It should be noted that many other countries already use pass/fail licensing exams, e.g., PLAB (soon to be replaced by UKMLA) in the UK, or AMC CAT in Australi.
so what now?
Good intentions do not always yield good results and by making Step 1 less of a beast, Step 2 CK will most likely take over and become the new step 1. This is not necessarily a bad thing because step 2, the more clinical of the two exams, is more suitable as a tool for predicting how good of a clinician a student is likely to become.
If the current situation was a Uworld arrows question, here is how we imagine it would look like:
Step 1 comes to your clinic for a follow up after being diagnosed with an impending degeneration of scores that is replaced by a necrotic fibrinous granulomatous pass/fail lesion. Step is now asking about the possible prognosis. How will the following parameters change in terms of relative importance over the coming years?
A. ↑MCAT score, ↑medical school ranking, ↓step 1, and ↑ step 2 CK score.
B. Sorry for only including the correct answer and no other choices.
No one is sure yet if step 2 will follow suit and go pass/fail but there’s good chance it will.
Will this affect me?
Short answer is, it depends on who is asking.
Did you take the exam? Or will be taking it before 2022?
If your answer to either question is yes, then the change will not affect you. Students taking the exam starting 2022 will probably start matching around 2024, and if anything, competing with them with an actual score on your report might give you an edge.
I will be taking step 1 after 2022, am i safe?
If you are a US MD student you are going to be fine as long as you have a dazzling CV. The same can’t be said for IMGs however, coming from less prestigious medical school will now be worse than it has ever been. DOs are another group of students who will get the short end of the stick.
Conclusions
If you are an IMG capable of taking step 1 before 2022, you should definitely do it.
If you are an undergrad you will now need to work harder to get into more prestigious medical schools.
Research, publications, and LORs, be prepared to secure these.
The stress is not going anywhere it is just shifting.
Step 2 will gain more attention unless it also goes pass/fail later.
You are awesome for reading this.
The memes are hands down the best thing to come from pass/fail change.