The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome


The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome. A numeric score will continue to be reported for Step 2 Clinical Knowledge (CK) and Step 3. Step 2 Clinical Skills (CS) will continue to be reported as Pass/Fail. This policy will take effect no earlier than January 1, 2022 with further details to follow later this year.

In taking this action, the USMLE’s co-sponsors—the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®)—considered the broad range of input received from the Invitational Conference on USMLE Scoring (InCUS), the subsequent InCUS report and its preliminary recommendations, and the extensive feedback and national conversation that preceded and followed the conference.*

In reaching this decision, various score reporting options were considered, including maintaining the status quo (i.e., no change to score reporting). The views of all stakeholders were considered throughout the score reporting discussions. Specific consideration was placed on supporting the educational engagement and overall experience of medical students – and on increasing the dialogue about how multiple assessments of competency could best be utilized by stakeholders in medical regulation and medical education.

The FSMB and NBME believe that changing Step 1 score reporting to pass/fail can help reduce some of the current overemphasis on USMLE performance, while also retaining the ability of medical licensing authorities to use the exam for its primary purpose of medical licensure eligibility. The USMLE co-sponsors also believe that moving to pass/fail reporting of Step 1 while retaining a scored Step 2 CK represents a positive step toward system-wide change, while limiting large-scale disruption to the overall educational and licensing environment.

The FSMB and NBME view this change as an important first step toward facilitating broader, system-wide changes to improve the transition from undergraduate to graduate medical education. The two organizations remain actively involved in the additional work sparked by InCUS, that of a broader system-wide review of the UME-GME transition that is being undertaken by the organizations in the Coalition for Physician Accountability **. As this future work develops, and as additional system-wide changes may unfold, including advances in reliable and holistic assessment of the training of physicians, the USMLE program will offer its resources and partnership.

“The ECFMG supports the informed decision making of the NBME and FSMB Boards on these policy changes. We are looking forward to continually advocating for international graduates as well as participating in the important future conversations on residency selection and transition.” – Dr. William W. Pinsky, President and CEO of ECFMG/FAIMER

“The American Medical Association supports the decision to move to a pass/fail reporting structure for the USMLE Step 1 as a first element in improving the UME to GME transition. Our student, resident and physician members voted to endorse a pass/fail policy, in part, because we know our current residency selection system is causing significant distress for our students. The AMA is currently supporting new ideas in the transition from medical school to residency through our funding of the Reimagining Residency Initiative and our Accelerating Change in Medical Education Consortium. We look forward to working with our colleagues across the continuum of medical education in developing improvements in physician education transitions.” – Susan Skochelak, MD MPH, Chief Academic Officer for the AMA

“The transition from medical school to residency training is a matter of great concern throughout academic medicine. The decision by the NBME and FSMB to change USMLE Step 1 score reporting to pass/fail was very carefully considered to balance student learning and student well being. The medical education community must now work together to identify and implement additional changes to improve the overall UME-GME transition system for all stakeholders and the AAMC is committed to helping lead this work.” – Alison Whelan MD, Chief Medical Education Officer AAMC