JMIR Publications

ABSTRACT

Background:

The United States Medical Licensing Examination (USMLE) Step 1, arguably the most significant assessment in the USMLE examination series, changed from a 3-digit score to a pass/fail outcome in January 2022.

Objective:

Given the rapidly evolving body of literature on the subject, this article aims to provide a comprehensive review of the historical context of the change and the impact on various stakeholders involved in residency selection.

Methods:

Appropriate keyword-based searches were carried out in PubMed, Google Scholar, and Scopus to identify relevant literature.

Results:

Given the unique history of USMLE Step 1 in the US residency selection process and the score’s correlation with future performance in board-certifying examinations of different specialties, this scoring change is predicted to significantly impact US Doctor of Medicine (US-MDs), US Doctor of Osteopathic Medicine (US-DOs), International Medical Graduates (IMGs), residency program directors (PDs), amongst others. The significance and the necessity of the pass/fail change, along with the implications for both residency applicants and educators are also summarized.

Conclusions:

While medical programs, academic institutions, and residency organizing bodies around the world have swiftly stepped up to ensure a seamless transition and attempted to ensure equity for all, the conversion process carries considerable uncertainty for residency applicants. For educators, the rising number of applications conflicts with holistic application screening, leading to expected greater use of objective measures, with USMLE Step 2 Clinical Knowledge (CK) likely becoming the preferred screening tool in lieu of Step 1.