What is changing about the USMLE?
Starting no earlier than January 1, 2022, the USMLE Step 1 scoring system will change from a three-digit numerical score to pass/fail.
Why is the USMLE Step 1 scoring changing?
The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), co-sponsors of the USMLE, are committed to making the transition from medical school to residency as smooth as possible for applicants. The current residency selection system is extremely stressful, in large part because of the overemphasis placed on USMLE scores. In changing the scoring from a numerical to a pass/fail system, candidates for residency will be considered holistically, with the USMLE Step 1 result considered as one of many application factors.
Since the other USMLE steps will continue to be scored as they have been in the past (Step 2 CK and Step 3 are scored numerically), the FSMB and NBME believe that the USMLE as a whole will remain a good determinant of whether or not a student is qualified to practice medicine, without placing undue stress on residency applicants.
The USMLE co-sponsors are clear that this change is the beginning of systemic changes in the transition from undergraduate to graduate medical education. The well-being of medical students is taking center stage in the transition from undergraduate to graduate medical education.
What does the Pass/Fail USMLE mean for students?
For most medical students, this change won’t affect residency applications at all. Students should still study for the USMLE Step 1, since they’re still required to pass in order to practice medicine, and the knowledge they gain will help them in medical school and in their remaining board exams.
Not only does this test change not require students to change their study strategy, but there are also many medical students, present and future, who will still take the numerically-scored test. Students planning on being in the 2023 Match, for example, will likely be taking the USMLE in May of 2021– before the USMLE scoring changes. And because the timeline information from the USMLE co-sponsors indicates that this scoring change will take place no earlier than January 1, 2022, there’s the possibility that it may take place later than January 1, 2022. That means that even the incoming medical school classes of 2020, who will be taking the USMLE Step 1 after the proposed deadline, may still be required to take the numerically-scored Step 1.
Because of the uncertainty of the date on which this change will be implemented, all students should continue to prepare for the USMLE Step 1 as if it were going to be scored numerically. If it so happens that the change is implemented before they test, they’ll be prepared. But if students lighten up on their studying in hopes of taking the pass/fail version of the USMLE and are then required to take the numerically-scored version, their score may suffer.
Dr. Cimino, Vice President and Chief Medical Officer of Kaplan Medical, discusses the changes to the USMLE and the impact it may have on medical students here:
What to consider: International Medical Graduates (IMGs)
IMGs don’t follow the same USMLE timeline as US medical graduates, but they are advised to spend 12-18 months preparing for Step 1 and 6-10 months for Step 2. Instead of altering their study schedules to complete Step 1 before or after the scoring change, depending on what they think would help their residency application the most, IMGs should take the full amount of time they need to study — but not significantly longer — and take Step 1 when they feel prepared. That will help their score more than prolonging their studying and potentially burning out, or rushing their studying and potentially not being fully prepared.
What does the Pass/Fail USMLE mean for educators?
The USMLE Step 1 will supply less information in the residency match process than it has in the past. That means that medical schools will need to come up with alternative methods of assessing the qualifications of residency applicants.
It’s anticipated that the FSMB and NBME will continue to roll out changes to the USMLE and residency match process. Though we don’t know yet what these changes will be, the co-sponsors of the USMLE have said that “additional system-wide changes may unfold, including advances in reliable and holistic assessment of the training of physicians.”
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