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September 2, 2020

USMLE Step 1 Scoring System Change to Pass/Fail—Implications for International Medical Graduates

Author Affiliations
  • 1Division of Vascular Surgery, Penn State Heart and Vascular Institute, Penn State Hershey College of Medicine, Hershey, Pennsylvania
  • 2Division of Vascular Surgery, Loyola University School of Medicine, Chicago, Illinois
JAMA Surg. Published online September 2, 2020. doi:10.1001/jamasurg.2020.2850

The recent decision by the National Board of Medical Examiners to change the United States Medical Licensing Examination (USMLE) Step 1 examination from score-based results to pass/fail has mostly been hailed by medical experts and many prominent experts in the field of medical education. The points that have been raised in favor of these changes include creating a less stressful examination, cost savings by avoiding the need to attend costly private examination preparation courses, and the fact that multiple choice questions can only determine the depth of medical knowledge and is not able to evaluate the broader areas of medical education. It is vital to consider the long-term implications of this decision. Both of us are international medical graduates (IMGs) and program directors who feel that it is essential to hear a different perspective. We each have firsthand experience of coming from foreign countries with different education and examination systems and then taking examinations based on multiple choice questions to qualify for certification by the Educational Commission for Foreign Medical Graduates.

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    1 Comment for this article
    Another Unintended Consequence of the Step 1 change to Pass/Fail
    Marcel BRUSRAMER, MD PhD | Elite Medical Prep LLC
    The authors highlight potentially important effects of chaning the Step 1 exam to Pass/Fail. The challenges that foreign medical graduates (FMG) face, particularly those that are not US citizens or greencard holders, to match into a residency in the US are significant. Objective, though imperfect, scoring systems such as the USMLE Step 1 have likely helped FMGs to attain their training positions in the US.
    Although the increasing emphasis on the USMLE Step 1 among US medical graduates (and FMGs) over the past 20 years has affected medical education, it is unclear that switching to
    a Pass/Fail grading system will really benefit even the US medical graduates. Earlier this year, I outlined a series of likely downstream effects from this change: https://elitemedicalprep.com/how-usmle-step-1-going-pass-fail-will-affect-medical-school-curricula/
    I believe that the change in scoring may have dramatic effects on medical school class and clinical schedules and potentially negative effects on medical student participation and engagement in clinical rotations. The underlying assumption is that the Step 2 CK exam and the associated clinical Shelf exams will rise in importance, so much so that they may overwhelm any expected benefits in reducing excessive emphasis on USMLE Step 1 material and reducing student stress.
    CONFLICT OF INTEREST: President of Elite Medical Prep LLC