Medical students, physicians, deans, and representatives from both the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB), the organizations that oversee the USMLE, have contributed thoughtful commentaries on the current use of Step 1 scores in resident selection. 3 However, the use of Step 1 scores in this manner may lead to a less holistic and equitable residency application process for key stakeholders. 2 PDs argue that this emphasis on Step 1 scores is necessary due to the increase in the number of residency applications submitted per student over the past 15 years and the lack of other quantitative metrics available now, as many medical schools have pass/fail curricula. Due to the subjective and heterogeneous nature of many aspects of undergraduate medical education (UME) and the residency application process, including how clerkship grades are assigned, how the Medical Student Performance Evaluation (MSPE) and letters of recommendation are written, and the content and structure of medical school curricula, Step 1 scores are used by residency program directors (PDs) to screen out, in a standardized fashion, those applicants they deem to be less qualified. However, in addition to that pass/fail grade, a numerical score is given for Step 1, Step 2 CK, and Step 3. To be licensed to practice medicine in the United States, students must pass all parts of the USMLE. Step 3 focuses on new medical school graduates’ ability to practice unsupervised in different clinical settings. Step 2 Clinical Knowledge (Step 2 CK) and Step 2 Clinical Skills (Step 2 CS) focus on the application of medical knowledge in a clinical context, with the former being a multiple-choice exam and the latter standardized patient encounters. 1 Step 1 tests foundational basic science knowledge related to the practice of medicine. In recent years, there has been a growing discussion regarding the status of the 3-step United States Medical Licensing Examination (USMLE).
They also call attention to outstanding issues with the USMLE that must be addressed to improve undergraduate medical education for all stakeholders, and they offer advice for further improvements to the residency application process. Here, the authors discuss the impact that the change to Step 1 scoring will have on these key stakeholder groups, from their perspective as students at MD-granting medical schools in the United States. This decision will undoubtedly impact medical students, medical schools, and residency program directors. It was announced in February 2020 that the score-reporting protocol for Step 1 would be changed from a 3-digit numerical score to pass/fail only, beginning no earlier than January 1, 2022.
As a result, a deleterious environment in undergraduate medical education has been created, given the importance of Step 1 to medical students matching to their preferred residency program. Residency program directors have come to use the Step 1 score to efficiently screen a growing number of residency applicants. However, in addition to that pass/fail grade, students are currently given a numerical score for Step 1, Step 2 Clinical Knowledge, and Step 3. To be licensed to practice medicine in the United States, medical students must pass all parts of the USMLE. The United States Medical Licensing Examination (USMLE) consists of Step 1, Step 2 Clinical Knowledge, Step 2 Clinical Skills, and Step 3.