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Change to pass/fail score reporting for Step 1

April 24, 2020
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Starting as early as 2022, there will be some changes to the scoring method for one of the major exams for medical students.

The United States Medical Licensing Exam Step 1, commonly shortened to “USMLE Step 1” or even just “Step 1”, is the first of 3 US medical licensing exams that all students planning to practice in the US must take. This makes the Step 1 exam an important landmark for Saint James School of Medicine students.

Several months ago, the USMLE announced this important change, which consisted of changing the scoring system for the Step 1 exam from a 3 digit score to a pass/fail outcome. This has raised a lot of questions from medical students regarding how this will affect their education and plans for residency after graduation.

Current medical students shouldn’t fret however. Dr. Violeta Nikolova, the Assistant Dean of Clinical Sciences, assures most students enrolled in SJSM currently will not have to worry about the upcoming changes. If students pass Step 1 as scheduled, it will not affect them. However, those who extend or delay their certification may have to account for the new scoring method.

And how will this affect students? Simply put, the USMLE Step 1 has traditionally been considered the most important exam of the 3 Steps. The three digit score a student receives is almost universally the first thing a residency director checks when considering candidates for their open residency spots each year.

The USMLE Step 1 score range is believed to be from 1 to 300, with most examinees scoring in between 140 to 260. The current passing score for the USMLE is 194. A score of about 220 is considered very competitive for residency, however other factors are also taken into account.

So if this exam is so important for determining who is chosen for residency, why would they change the scoring method?

The USMLE website describes their reason for the change to be that they “ believe that changing Step 1 score reporting to pass/fail can help reduce some of the current overemphasis on USMLE performance”. What does that mean exactly?

The USMLE Step 1 is taken fairly early in medical school, approximately 2 years into a typical 4 year program. It is the first major standardized test taken, and considering that students have not yet had any clinical experience at the time of the exam, the heavy emphasis on the exam may not be the best way to judge a student 2-3 years later when they apply for residency. Especially because the USMLE Step 2 exam exists.

Taken during the 4th year of most medical programs, the USMLE Step 2 is a 2 part exam, testing Clinical Knowledge (Step 2 CK) and Clinical Skills (Step 2 CS). These exams are a much better approximation of what a practicing doctor needs to know, and allows students to showcase skills learned after the Basic Sciences, much closer in time to when students would be applying for and starting residency. The Step 2 CS is also pass/fail, but the Step 2 CK still receives a 3 digit score and is expected to remain in this same scoring format going forward.

So essentially we will be seeing the emphasis moving from the USMLE Step 1, to the USMLE Step 2 CK. Now how will this affect students?

SJSM’s Head of Research, Dr. Branka Filipovic, said some exam anxiety will be relieved from students. SJSM students traditionally perform very well on the Step 2 CK exam. Dr. Stavros Vouyiouklis, an SJSM alum, said one of the pros are that “students will be less stressed. A poor Step 1 score will not be a disqualifying factor during The Match as long as other parts of the application, including extracurriculars and rotations are fantastic”.

Overall, the response from students and faculty is optimistic. Incoming students should plan to make some changes to their overall plan, shifting from focusing almost solely on maximizing their Step 1 score, to having a varied resume and strong Step 2 CK store.

Dr. Erblin Qosaj, SJSM alum and USMLE Counselor, said the change will cause students to focus more on perfecting their residency applications as a whole, rather than relying on their Step 1 scores to help them land an interview. He said things like the personal statement, letters of recommendation, extracurricular activities, volunteer work, and research will be considered more important, as opposed to trying to score a 250 on Step 1.

Overall, SJSM will be monitoring the new changes and will keep students educated and informed, as well as provide resources to make sure every Saint James student is putting their best foot forward on their residency applications.

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