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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. Published online September 2, 2020. 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

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