USMLE Step 1 Is Now Pass-Fail – The Good, Bad, & Ugly Of The Decision

The most incredible news regarding Step 1 just came out today, February 12, 2020! Before the announcement, it was most likely thought to be the most crucial exam you took throughout your time in medical school; however, from today, the Step 1 examination will be graded on a pass-fail basis.

What exactly does that entail? Is it a good thing? Is it bad? In this essay, I will share my opinions with you and also provide some recommendations for the future that you should think about.

Let's get into it!

Wait a minute! If you prefer to watch this post in video format, you may do so by clicking on the link to my YouTube video that is provided below. If you found this article to be enjoyable, don't forget to sign up for the weekly updates!

Listing of Contents (Table Of)
The first step is now a pass-fail evaluation of the good, the bad, and the ugly.

Today, a significant topic of conversation is the transition of Step 1 to a pass-fail grading system. I'm going to share some of my ideas with you, and I want all of you to feel like you're a part of the discussion.

Leave your thoughts in the comments section below! Please share your opinions with me so that I can have an understanding of the various viewpoints and perspectives that exist.

I discovered that the Step 1 pass-fail mechanism is now operational after receiving a number of notifications on Twitter, Instagram, and direct messages (DMs), respectively. And when you look over all of the responses, you'll see that they aren't actually cohesive.

There are some people who are genuinely happy but there are other people who are not. So, let's discuss the good, the bad, and the ugly about this post, shall we?
The Reasons Behind the Changes Made to the USMLE Step 1

To begin, let's talk about the motivation behind making this adjustment in the first place.

The United States Medical Licensing Examination (USMLE) is really co-sponsored by two separate regulating boards. The NBME is the one you are most accustomed to, but the FSMB is the one you have less experience with.

These two governing boards have discussed, based on the feedback they've received from students as well as institutions, the best way to modify each of the separate Step tests in order to meet the needs of candidates.

So, there's Step 1, Step 2, and Step 3, and you take each one at a different time along your journey through medical school and residency. However, on February 12, 2020, both of these regulatory boards stated that the first step would henceforth be graded as either pass or fail.

Because of this, it is quite likely that this will have an effect on any student who is planning to begin their studies in a medical school in the fall of 2020. If you are already enrolled in medical school or are planning to take Step 1 either this year or the following year, you will not be impacted by this score adjustment.
What Are Some of the Passing Benefits of the First Step in the Pass-Fail System?

What Are the Advantages of Using a Pass-Fail System for the First Step?

Is this something to be celebrated or lamented? I've heard quite a few of y'opinions all's on Instagram, and while some of you absolutely adore it, others believe that it's completely biased, and I really want to tell you my perspective on the matter.

Let's talk about the very wonderful things that have happened.

First things first, let's address the elephant in the room, which is that the Step 1 score used to be the single most critical piece of information that residency programs used to consider when deciding whether or not to accept an applicant.

It is for this reason that the Step 1 examination is considered to be the most difficult and stressful for pupils.

It was not unheard of for this to have an effect on a person's wellness, and it was also not unheard of for students to cut themselves off from all of their various hobbies, friends, and family members, as well as their wellness in general, for weeks or months in order to prepare for and perform well on this exam.

A successful performance on Step 1 was a major source of pressure. You can probably imagine how much less stressful things are going to be now that the old pass-fail system for Step 1 is finally being replaced with the new one.

When I started medical school, my institution switched from a grading scheme to a pass-fail scheme for the first year and a half of pre-clinicals. This made my wellness so much better despite the fact that medical school is already a stressful environment. I can speak from experience because of this change.

If I had a score to study for, I can only picture myself becoming more stressed out than I already am.

You can see how the first- and second-year medical students will unquestionably experience a sense of calm and less worry as they go closer and closer to taking Step 1.

However, you really can't afford to let yourself become too comfortable because Step 1 is still going to be a test for which you will need to prepare. Check out our previous article, "How to Study for Step 1," to get yourself prepared for the examination.

Check out the video that we've embedded below from YouTube if you'd prefer to watch these Step 1 hints and recommendations presented in video style.

The second thing that I believe is really excellent about the shift is that now we can focus on what matters more. This is a preference of mine, but it is something that I think is really nice about the change.

To tell you the truth, having a high score on Step 1 does not automatically indicate that a person would be a good doctor. It's possible that you have a lot of medical knowledge, but your interactions with patients leave a lot to be desired.

These are persons who I encountered during my rotations, my residency, and even among those who have now gone on to become attendings.

Even though you did well on the test, it's possible that you're not the finest physician. On the other hand, that score can occasionally determine the course of your future professional life.

Now that the first step is a pass-fail test. We are able to put our attention where it needs to be, which is on the things that truly count, such as clinical expertise, but also on how you engage with your patients, how you communicate with members of your team, and how you can focus on critical thinking rather than just an ABC exam.

On social media, the most of the feedback I've seen regarding this issue has been from students who are currently enrolled in medical school, not from students who are going to be directly impacted by the upcoming shift.
What Are the Repercussions of Using a Pass-Fail System for the First Step?

What Are The Implications Of Using A Pass-Fail System For The First Step?

The most of the comments that I've gotten have been along the lines of "Well, this is sort of terrible." There is a great deal of hostility as well as discomfort directed against this transition.

Quite frequently, this occurs from individuals who pose queries like...

How can I differentiate myself now if I graduated from a medical school that is not particularly prestigious, if I come from a family with a modest income, or if I graduated from a medical school in the Caribbean?

How can I differentiate myself from other applicants to residency programs if I am an international medical student and come from a less prestigious school than those who have graduated from more prestigious schools?

And each and every one of these questions has a perfectly reasonable basis. The honest response is that we just do not know at this time.

During my rotation in cardiology, I worked with a fellow who shared with me...

You guys went to a fantastic medical school, but there's going to be someone there who graduated from an Ivy League university. Even if they are less qualified than you are, there is a possibility that they will have a better opportunity to get into a more prestigious residency program than you will.

Also, there is some validity to that statement.

We just don't know how things are going to change over the next two years with regard to residency programs as well as how things are going to change with regard to medical students and medical schools in order to provide them with access to additional information.

This is due to the fact that Step 1 used to be the most essential piece of information that our residency programs concentrated on. They are going to have to shift their focus to other things at this point.

Since we now use a pass-fail grading system for Step 1, it is highly possible that Step 2 CK will be given a greater amount of importance; nonetheless, I believe that this kind of shift also contains both positive and negative aspects.

First of all, in comparison to Step 1, which requires you to identify a variety of enzymes, I believe that Step 2 CK is probably a better indicator of the kind of physician you are going to become in terms of your ability to think critically and your clinical expertise.

To tell you the truth, I just don't need to recall them at this point because I can look them up. Therefore, there is going to be a greater emphasis placed on that exam, which will likely include questions that are more typical of the type of physician you have the potential to become.

On the other hand, as you shift the emphasis to Step 2 CK, you highlight its growing significance. However, it is really challenging to prepare for that exam.

You are participating in clinical rotations that already incorporate assessments within their structure. It's possible that your school won't grant you any time off in particular to prepare for Step 2 CK, in which case you'll have to find a way to fit your studies into the busy fourth-year timetable in order to pass the exam.

Burnout during rotations in your third year is known to be extremely common, and adding an additional exam that is now more more crucial only makes the situation more stressful.



The following thing that is going to be changed as a result of this adjustment is the weight that will be placed on your rotation grades in addition to the weight that will be placed on your shelf examinations.

When it comes to the rotation grades, one of the most difficult aspects is that it is not always simple to get those standardized from one educational establishment to the next as well as from instructor to instructor.

It is possible to have a truly wonderful attending who provides you with a high grade while you are on a rotation. However, if I were to go through that same rotation with a different attending, I could be able to pass with a high grade simply because their grading methodologies were different.

And I can see how that could be an issue for educational institutions that are regarded as being on the lower or middle tier because those institutions are more likely to give their students higher grades in the hope that their students would still stand out when they apply for residency programs.

Even though that shouldn't be the case, I can see why the decision was made to make that adjustment.
Where Do We Go From Here Given That Step 1 Has Already Been Completed and Failed?

Where Are We Supposed to Go From Here? (Step 1 Pass Fail)

As a way to wrap up this piece, I would like to discuss what I believe to be the single most significant topic, which is: "Where do we go from here?"

Although many people are upset by this shift in policy, I'd like to make it clear that it's not something brand new. Things concerning the path to medical school have been subject to continual revision.

When I was in the process of going to medical school, for instance, the MCAT used to include a writing section, but they later eliminated it. During that time, I was able to hear all of my upperclassmen grumbling that the situation was unfair.

I am aware that you have previously witnessed this behavior shown by the institutions. You are going to see them more frequently now since they have made the first two years of their program graded on a pass/fail basis. Additionally, they have accelerated the transition of their students into rotations, which will help them do better on the Step 2 CK.

Certain things have a modicum of mystery surrounding them.

After the implementation of the pass-fail remarks for Step 1, what kinds of information will residency programs start to need from applicants? Will they require video interviews just like they do for those applying to their residency programs for emergency medicine?

Will they now request more precise evaluations, or will they seek for additional letters of recommendation? Is it going to be the case that during your clinical rotations you will be subjected to a variety of tests and examinations so that they can better evaluate you?

This path, particularly over the next two to three years, is likely to be fraught with challenges.

There are going to be educational establishments that are going to be pressured to become more innovative in order to help their pupils get better results. There are going to be residency programs out there that are going to look for innovative approaches to assessing potential applicants and extrapolating further information from the data they provide.

It also indicates that you, as a student, will likely be required to exercise a greater degree of originality.

This could mean increasing the amount of time you spend conducting research, increasing the amount of time you spend shadowing other physicians, or simply putting yourself in the same room as the doctors whose careers you admire and hope to one day emulate.

In the end, though, I do believe that this is going to be a positive move for early medical students who are still figuring out how to study, how to comprehend and retain all of this material without the pressure of Step 1.

However, the road ahead for students will be challenging, as it will be difficult for them to learn how to differentiate themselves throughout their rotations and to pass Step two CK in order to get into residency programs.

In general, there is a lot of information to process. Although it will take some innovation over the course of many years to get to the point where doctors are better clinicians than they are test-takers, I have hope that we will be able to make a lot of progress that will move medicine in the right direction so that we can move medicine in the right direction.

I really hope you found the information in this page on the new pass-fail method for Step 1 to be helpful.