[Skip to Navigation]
Views 1,060
Citations 0
September 2, 2020

USLME Step 1 Scoring System Change to Pass/Fail—Perspective of a Clerkship Director

Author Affiliations
  • 1Department of Surgery, University of North Carolina, Chapel Hill
JAMA Surg. 2020;155(12):1096-1098. doi:10.1001/jamasurg.2020.2839

In February 2020, a landmark policy change in the reporting of the United States Medical Licensing Examination (USMLE) Step 1 was announced by the National Board of Examiners and the Federation of State Medical Boards. Starting January 2022, the USMLE will be transitioning Step 1 from the current 3-digit score to a pass/fail outcome. The USMLE will retain the 3-digit scoring for Step 2 and 3 and a pass/fail outcome for the Step 2 Clinical Skills.

The USMLE Step 1 was implemented in 1992, and its initial purpose was a standardized assessment of preclinical knowledge, with a pass/fail outcome report only for state licensure. Its initial 2-digit percentile-based score was phased out in 1999 with the introduction of a combined scaled 2- and 3-digit score.1 In 2003, the 2-digit score was abandoned, and the 3-digit scale system was fully adopted. Even though guidelines for examination results interpretation have been published, the USMLE has not yet released how the 3-digit score is actually calculated. The current minimum USMLE Step 1 passing score is 194, with a mean (SD) score of 230 (19) in the 2018-2019 academic year. Over the last 2 decades, idiosyncrasies in the interpretation of Step 1 scores beyond its initial purpose of assessment of a minimum proficiency in the knowledge of preclinical sciences has led to a paradigm change in the US graduate and postgraduate medical education.2

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words