The USMLE’s co-sponsors—the Federation of State Medical Boards (FSMB) and NBME―have recently received requests from examinees and student organizations to accelerate or delay the change to pass/fail score reporting for USMLE Step 1 in light of the uncertainties caused by the COVID-19 pandemic and social movements across the country. Our announcement of the Step 1 score reporting policy change, posted in February 2020, said the change in score reporting would be implemented no earlier than January 2022. After careful consideration of all the recent concerns that have been brought to our attention, we remain committed to the January 2022 timeline and would like to share our rationale below.
Our decision to move to pass/fail score reporting for Step 1 was made after more than a year of thoughtful evaluation, discussion and feedback with numerous stakeholder groups, among them medical students. One of our guiding principles of the policy change was to help reduce the overemphasis on USMLE Step 1 numeric scores (among both examinees and secondary users of exam scores, such as residency program directors), while also retaining the ability of state medical licensing boards to use the exam results for the primary purpose of determining medical licensure eligibility. We intentionally selected an implementation date of January 2022 to provide medical schools with adequate time to adjust their curricula, allow examinees sufficient time to adjust their planning for their USMLE administration, and enable leaders in medical education to develop substantive improvements to the critical transition period from medical school to residency training. The USMLE decision for pass/fail Step 1 score reporting acknowledged the need for more holistic consideration of residency applicants. Yet many agreed that an overly rapid transition to pass/fail could lead to a residency transition system that was more reliant on attributes such as medical school reputation and other subjective factors.
Inequities and bias exist across the continuum of medical education and training, and we are committed to helping improve the way in which medical students and graduates are assessed for the competencies necessary for patient care. We are very pleased that the Coalition for Physician Accountability – which includes the senior leadership of the AACOM, AAMC, ACCME, ACGME, AMA, AOA, CMSS, ECFMG, FSMB, LCME, NBME, NBOME, the Joint Commission, and representatives of the public – has set up a framework for a comprehensive review of the transition from medical school to residency, and is poised to move forward in the months ahead with an effort to provide recommendations to its member organizations and many additional stakeholders.
During the recent months, medical schools and state medical boards have been demonstrating flexibility in their requirements for taking the USMLE. USMLE has expanded testing opportunities and permitted rescheduling of tests when desired or needed and waived rescheduling fees. While this flexibility is welcomed and necessary, we realize that it does not completely eliminate the stress that can be associated with taking standardized exams such as USMLE. However, accelerating the change to pass/fail scoring for Step 1 at this time, before the Coalition advances its work, risks introducing undesirable complexity, uncertainty and potential disruption into the transition from undergraduate medical education (UME) to graduate medical education (GME) in the coming years. We therefore remain committed to our initial implementation timeframe for USMLE Step 1 pass/fail as no earlier than January 2022. As the organizations that co-sponsor USMLE, we also remain committed to doing our part to constructively influence the development of broad, systematic changes in the UME to GME transition so that the end result is one that is fair for everyone.