Why Is It All About USMLE® Step 2?

Why Is It All About USMLE® Step 2?

Bill Gossman, MD; Professor of Emergency Medicine, Department of Emergency Medicine, Creighton University

For most physicians currently practicing, USMLE® Step 1 was the most important examination in making the cut-off for the best residency training slots. However, that all came to an end when the USMLE® announced beginning in 2022, the USMLE® Step 1 will drop the three-digit numerical score to pass/fail.

The theory is that the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), co-sponsors of the USMLE, believe there is an overemphasis placed on USMLE® Step 1 scores leading to undue medical student stress. In changing the scoring to a pass/fail system, the USMLE® Step 1 result will no longer be a major consideration in resident selection. 

Since USMLE® steps 2 and 3 will continue to be numerically scored, my opinion is there will be a rapid shift of program directors to place most of the emphasis on USMLE® Step 2 CK to determine who they will select.

To be successful in the match, this will require students to change their study strategy. However, those still in the transition planning to match in 2023 will still have to take the numerically scored USMLE® Step 1 prior to May-June of 2021 before the exam changes.

What does pass-fail on USMLE® Step 1 mean for U.S. medical students?

  • Incoming medical school classes of 2020 will most likely still take the numerically scored USMLE® Step 1
  • Incoming medical school classes of 2021 will most likely take the pass-fail exam and, as a result, should focus more of their attention on scoring well on USMLE® Step 2

Until you are certain which version of the exam you will take, students should continue to prepare to do well on USMLE® Step 1. If you are fortunate enough to take the pass-fail exam, at least you will be prepared.

What does pass-fail on USMLE® Step 1 mean for international medical students?

International medical students and graduates are typically on a different timeline for taking the USMLE® Step 1, USMLE® Step 2 CK, and USMLE® Step 3. Most take the exams after medical school, which means they have to spend a lot more time preparing for USMLE® Step 1. If possible, students should time their exams to avoid the numerically scored USMLE® Step 1. If they are going to take this exam, a minimum of 6-8 months of preparation is probably necessary for a high score, and students should do as many questions as possible, especially if the basic sciences are in their distant past. If they are fortunate enough to take the pass-fail version of USMLE® Step 1, they should consider shortening their study time to 3-4 months and then devote most of their energy to USMLE® Step 2 and USMLE® Step  2 CK.

What does pass-fail on USMLE® Step 1 mean for program directors?

While the answer to this question remains in limbo, my opinion is program directors will deemphasize USMLE® Step 1 pass-fail and emphasize the importance of the USMLE® Step  2 CK. They may come up with a scoring system that increases the value of medical school grades, letters of recommendation, publications, and activities but as these are very subjective, and program directors have limited time, my suspicion is it will quickly be all about the USMLE® Step 2 CK or COMLEX® Step 2.

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