Perspectives on Transitioning Step 1 of the United States Medical Licensing Examination to a Pass/Fail Scoring Model: Defining New Frameworks for Medical Students Applying for Residency

Adv Med Educ Pract. 2021 Feb 11;12:149-154. doi: 10.2147/AMEP.S296286. eCollection 2021.


For years, the USMLE Step 1 has acted as an unofficial "concours" for medical students applying to residency positions in the United States. The three-digit numeric score has been used to rank thousands of applicants without any evidence of validity. The USMLE will soon change score reporting to a pass/fail outcome. The main reason given was to address the concerns about its effects on the well-being of the students and medical education. It is argued that time for change has come. The authors discuss the various viewpoints of the stakeholders and the effects of this change on applicants and potential changes on the undergraduate medical curriculum. Furthermore, this article discusses several metrics that can be utilized in the application process in lieu of the USMLE Step 1. Additionally, some novel key metrics in the application process are identified, and their unique dynamic and adaptive characteristics are deliberated. Finally, the benefits of a transparent and holistic process are strongly advocated.

Keywords: USMLE step 1 residency; holistic graduate medical education admissions; multiple mini interviews.

Grant support

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.