How Will the USMLE Step 1 Pass Fail System Affect Your Step 2 Score?
It used to be that USMLE Step 1 was “the big one”, but with it becoming pass/fail, attention has shifted to Step 2. The first thing my brain went to was: “Step 2 scores will be lower in the coming years”. I say this because Step 1 and Step 2 scores correlate very closely across a wide variety of specialties. How you do on Step 1 is the best predictor of how you will do on Step 2.
The USMLE scoring percentile guidelines are shown below. Percentiles tell you “what percentage of students did I score better than?”. So, if you are in the 50th percentile, you score better than half of all medical students. With the potential changes in Step 2 scores in the coming years, there’s anticipation that residency programs will look more at your percentile than the raw score.
My best advice, then, would be for students who recently USMLE Step 1 as a Pass/Fail exam to critically evaluate their study methods at the beginning of their clinical years by talking to successful peers who recently took USMLE Step 2. Ask them “What worked? What didn’t work?”. Now is the time – when you’re not in academic trouble – to get a USMLE Step 2CK tutor to set you on the right path and set you up for future success.
Since USMLE Step 1 is now pass/fail, you might not have the shock of “my study method is not working to get me to my goal, and I need to change something”. You may not come to realize how important it is to start small and early with your studying.
It is good for mental health that Step 1 is Pass/Fail. Just make sure that complacency doesn’t come back to bite you when you are preparing for Step 2: Now is the time to build effective and efficient study skills that are necessary for balancing clinical rotations, studying for shelf exams, and studying for USMLE Step 2.
I collated my most useful advice for standardized tests on this page. Here’s the summary: Everybody is slightly different, but I have found these core principles to be helpful to all students:
- Studying for standardized tests is NOT like studying for class exams. The best way to study for a standardized test is by taking lots of standardized tests (practice questions!).
- Doing as many practice questions as possible by starting small and starting early is the absolute best thing you can do for yourself. Again, I think USMLE Step 2 scores are higher than USMLE Step 1, because people are doing practice questions throughout their clinical year. Most people are not doing practice questions all year for Step 1.
- Reviewing practice questions deeply, making sure you walk away understanding exactly what you didn’t know.
- You need some form of spaced repetition (preferably flashcards) to consolidate and memorize the material that you just figured out you don’t know, so that you don’t forget it again before the exam. Without a form of spaced repetition, you are not taking full advantage of practice questions and wasting time.
- Use practice questions as a branching point to look at other high-yield material you may not know (i.e., to drop you into a particular section of First Aid, and look at the neighboring pages to see what else you don’t know). Just reading through a section in a review book, cold, is very tough. Doing practice questions as a way to take you to different topic areas is much more approachable, and gradually covers material with the same relative weighting of topics as the exam has.
That’s it. It’s not complicated, but learning how to do it efficiently is not easy. It takes time to build your confidence in your study method and gain a grounded sense of self-efficacy. It takes time, iteration, and problem-solving, to build effective study habits that will help you reach your score goals.
Here are some common pitfalls:
- Start with practice questions, NOT content review. There’s so much content that it’s overwhelming to just say to yourself “I’m going to read a chapter of First Aid” and expect yourself to memorize it. Moreover, re-reading is one of the least effective study methods. Practice questions help you understand why things are the way they are, and starting early gives you the liberty to spend time in textbooks and Google to make sense of things. These two approaches together – poking holes in knowledge and asking “Why are things this way?” – will give you a conceptual understanding. Then, with a solid grasp of the concept, it’s easier to memorize small details. So, start with practice questions, and once you’ve done a lot of questions, then you can look at content review, and because you understand the overarching concepts, it’s easier to make sense of the little details and fit them into your disease frameworks.
- Beware of pre-made decks. There are so many cards, and often, you’ve already seen most of the material. Instead, use practice questions to drill down to what you know, rather than relying on enormous crowd-sourced resources to tell you your gaps in knowledge. It’s just not efficient, and there are so many cards that when you fall behind, it gets to be overwhelming and frustrating. Making your own flashcards is an evolving document tailored to everything you don’t know.
- “I wish I had started earlier”. Oof, that sentence hurts! Do NOT have any regrets when it comes to these exams. They are not insurmountable, and how to do well on them is not a secret. The key ingredients are practice questions, spaced repetition, and time. There’s only so much information you can take in within a single day. Buy yourself the insurance of starting very early. When you have an efficient study method that involves spaced repetition, you can be confident that the work you do when starting early will not be wasted.
Don’t let the move of Step 1 to Pass/Fail hamper your chances of performing very well on Step 2. With the uncertainty of USMLE Step 2 scores in the future, residency programs will likely focus directly on percentiles. So, the best thing you can do for yourself is to find the most efficient and effective study method that fits into your clinical years. Talk to successful peers and expert tutors who can help set you on the path to success.
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