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September 2, 2020

USMLE Step 1 Scoring System Change to Pass/Fail—Perspective of a Program Director

Author Affiliations
  • 1Department of Surgery, East Carolina University, Greenville, North Carolina
JAMA Surg. Published online September 2, 2020. doi:10.1001/jamasurg.2020.2847

Educational systems use combinations of grades and standardized examinations to assess knowledge for advancement, remediation, and application to higher tiers of education and employment. The US Medical Licensing Examination (USMLE) Step 1 examination, which is designed to assess medical applications of scientific foundations, is widely used in conjunction with other metrics to screen hundreds of applicants to residency programs. Despite this, the National Board of Medical Examiners1 has recently declared that Step 1 numerical performance will be replaced by a simple pass/fail status. The announcement, which was supported by the Association of American Medical Colleges, stated that pass/fail reporting will reduce “overemphasis on USMLE performance”1 and improve the “overall experience of medical students.”1 The USMLE Step 2 Clinical Knowledge and Step 3 examinations will continue to be reported with numerical scores, as will the parallel Comprehensive Osteopathic Medical Licensing Examinations.

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    1 Comment for this article
    Couldn't agree more
    Syed Ahmed, MD | Clinical Associate Professor of Surgery, Texas Tech Health Science Center
    Exactly my thoughts. Step 1 score may not be reliable, but it's replacement by subjective criteria will empower nepotism in selection of surgical residents. This will affect international medical graduates a lot. Many of us escaped from our country because of use of subjective criteria in advancement and promotion in careers. Letters of recommendation will be given not to the best, but to those who are well connected. Happens all the time in third world countries.
    CONFLICT OF INTEREST: None Reported
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