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September 2, 2020

USMLE Step 1 Scoring System Change to Pass/Fail—An Opportunity for Change

Author Affiliations
  • 1Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
  • 2University of California, Irvine, Irvine
JAMA Surg. Published online September 2, 2020. doi:10.1001/jamasurg.2020.2836

On February 12, 2020, the National Board of Medical Examiners announced that the US Medical Licensing Examination (USMLE) Step 1 will become a pass/fail test beginning January 1, 2022. Although the test was created in 1992 as a pass/fail state licensing examination, the academic community has developed secondary uses of the score, including using it for student promotion and residency selection.1 Consequently, medical students spend an inordinate amount of time focusing on Step 1 rather than on becoming a physician. They skip important classes to study, and their well-being suffers. Step 1 does not measure markers for success in medicine such as emotional intelligence, resilience, or charisma. It does not predict who will become a compassionate clinician, and it disadvantages members of underrepresented minorities. As eloquently stated by Emmanuel and Gudbranson,2 medicine as a profession overemphasizes general intelligence to the detriment of emotional intelligence. By making Step 1 pass/fail, the hope is that students will focus on learning medicine instead of obscure facts and that, without a score, residencies will take a more holistic approach to recruitment.

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