USMLE Step 1 updates on score reporting and standard setting

Two United States Medical Licensing Examination® (USMLE®) Step 1 changes may coincide in early 2022. First, Step 1 score reporting will transition to pass/fail only for administrations on or after January 26, 2022. Second, as part of best practices for licensing and certification examinations, the USMLE program reviews the minimum passing score of each Step exam every three to four years. The standard review process for the Step 1 minimum passing score is currently underway, which includes substantial input from licensing authorities, medical educators, and subject matter experts. If any change to the minimum passing score is determined appropriate by the USMLE Management Committee, it will become effective for examinees who take Step 1 on or after January 26, 2022. While the timing may overlap, the standard review process is unrelated to the upcoming transition to pass/fail score reporting.

Pass/Fail Score Reporting

The pass/fail reporting change is in alignment with the Invitational Conference on USMLE Scoring (InCUS) recommendations, which were based on a broad range of input from state medical board members, physicians, medical educators and examinees. To support this transition, USMLE Step 1 score reports for administrations on or after January 26, 2022 will be updated in the following ways:

  • Passing outcome reports will only display the notification of “Pass.” This change is intended to reduce the overemphasis of USMLE Step 1 scores on secondary uses while retaining the ability to use the exam for its primary purpose of medical licensure eligibility.
  • Failing outcome reports will display “Fail” and have 1) a visual illustration showing the distance between the examinee’s overall score and the minimum passing standard and 2) content area feedback that shows whether the examinee scored lower, about the same, or higher than examinees with a low pass (ie, above but near the passing standard) for each content category. This additional information is intended to guide study plans for future exam attempts.

Sample score reports for USMLE Step 1 examinations taken on or after January 26, 2022 are available here. USMLE transcripts will be similarly revised to display only a “Pass” or “Fail” for Step 1 exams taken on or after January 26, 2022. USMLE transcripts for Step 1 exams taken January 25, 2022 or earlier will continue to report a numeric score along with a “Pass” or “Fail” outcome.

Minimum Passing Score Review

The USMLE program reviews the minimum passing score for each Step examination every three to four years with extensive input from faculty and subject matter experts. This ensures that the standard is aligned with the potentially changing expectations within medicine.

Based on its routine schedule, the review of the Step 1 minimum passing score was originally scheduled to occur in December 2020 but was postponed as a result of the COVID-19 pandemic. Instead, the review will occur in December 2021, and any change to the minimum passing score will be made effective with Step 1 administrations beginning on or after January 26, 2022. This review is consistent with USMLE’s standard operating procedures and is not connected to the upcoming transition to pass/fail score reporting. For reference, the last reviews of the minimum passing scores for Steps 1, 2 CK and 3 resulted in changes that ranged between 0 and 2 points.

Four types of data are considered:

  • Results of content-based standard-setting exercises conducted with three independent groups of physicians;
  • Results of surveys of various stakeholders (e.g., samples of examinees, state licensing representatives, medical school faculty) concerning the appropriateness of current pass/fail standards for Step examinations;
  • Trends in examinee performance;
  • Score precision and its effect on the pass/fail outcome.

Changes to the minimum passing score, if any, are determined by the USMLE Management Committee. This committee is comprised of a diverse national group of medical professionals from undergraduate and graduate medical education as well as state medical boards. Two public members and a resident member also serve on the committee.

An additional announcement that reports the outcome of the minimum passing standard review, whether there is a change or not, will be made on December 9, 2021.