It is well documented that Residency Program Directors put significant emphasis on USMLE scores. 77% either prefer or require a target score (i.e. passing on the first try) while 23% only require that you pass at some point. This makes USMLE exams a critical component to your residency application. Program Directors used to weigh Step 1 very heavily and higher scores often led to more interview invitations. As we'll discuss, USMLE Step 1 transitioning to Pass/Fail in 2021 has dramatically altered how USMLE exams contribute to your residency application.
What You Need to Know About Step 1 Failure Rates
US/Canadian MD Schools=100% Increase in Step 1 Failure Rate
- Fail Rate in 2021=5%
- Fail Rate in 2023=10%
DO Medical Schools=133% Increase in Step 1 Failure Rate
- Fail Rate in 2021=6%
- Fail Rate in 2023=14%
USMLE Step 1 Pass Rates Since 2014
As you can see, pass rates for both US/Canadian MD (blue line) and DO (orange line) students have dropped significantly since 2021 (red arrow). This timing lines up precisely with Step 1 transitioning to Pass/Fail. While the pass rate is still relatively high for US/Candian MD and DO students, you are twice as likely to fail the exam now compared to just three years ago!
International Medical Graduates=39% Increase in Step 1 Failure Rate
- Fail Rate in 2021=23%
- Fail Rate in 2023=32%
Similar to US/Canadian MD and DO students, IMG's (orange line) have seen a drop in scores since the test transitioned to Pass/Fail in 2021. The chart also includes the trend for repeat test takers from US/Canadian MD and DO Schools (blue line) who have actually increased scores slightly since the Pass/Fail transition (More on this in a minute).
Why Have Step 1 Failure Rates Gone Up So Much?
- The minimum passing score did increase from 194 to 196. This would explain a small percentage of the increased failure rate.
- Reduced in-person learning as a result of the COVID-19 pandemic has also been blamed for some of the decline in scores.
- The single biggest reason is most likely the change in attitudes around the exam. Data shows students are completing 25% fewer practice questions in preparation for Step 1. Students are taking these exams less seriously and preparing less because they feel like the exam is somehow easier. Don’t fall into this trap!
- Repeat Test Takers know how difficult the exam is because they have already failed once. As a result of this, repeat test takers have not experienced a drop in scores after the transition to Pass/Fail. They are the only group that hasn't been impacted negatively!
How Switching to Pass/Fail Impacts You
- Failing Step 1 will still be a red flag for residency applications, but for most who pass Step 1 the score will no longer be a useful way to differentiate applicants. This makes Step 2 more important as a way to differentiate yourself from your fellow applicants
- Most people score about the same percentile on Step 2 as they do on Step 1 because its similar questions over similar material and students use similar study methods. Take Step 1 seriously to ensure you pass and also help you prepare for Step 2
- Most students don’t take Step 2 until much later in their medical school curriculum. This means you don’t know what specialties you might be competitive for until very late in the process. If you take Step 1 seriously you will have an idea of how you perform relative to your peers and what scores you might be able to expect on Step 2.
Sources
- National Resident Matching Program DRaRC. Results of the 2022 NRMP Program Director Survey. Washington, DC: National Resident Matching Program; 2022.
- https://www.usmle.org/performance-data
- https://blog.blueprintprep.com/medical/step-1-pass-rates-are-decreasing-how-to-make-sure-youll-pass/
