Aim High or Just Pass USMLE Step 1

With USMLE Step 1 now being scored as pass/fail, many medical students are wondering – how much time and effort should I put into this exam if I am no longer aiming to get the highest 3-digit score possible? While it may be tempting to put in less effort for USMLE Step 1 now that it is no longer scored, it is worth your time and effort to do your best on this exam. 

Why the Switch to Pass/Fail?

In the years before Step 1 was pass/fail, many medical students used their score on this exam to determine their “competitiveness” for a given medical specialty or residency program. According to the American Medical Association (AMA), one of the primary goals in changing how this exam is scored was to lessen the stress on medical students and make residency selection a more holistic process. 

The impact of Step 1 changing to pass/fail scoring is still being studied. Here is what we currently know about how the change has affected medical students. 

• Step 1 Pass Rates – Before 2022, Step 1 was scored with a passing score of 194. However, most students were working to earn a high Step 1 score and average scores in 2021 and 2020 were 231 and 235 respectively according to USMLE*. After 2022, the passing score has been increased to 196. In 2019- 2021, the pass rate for students taking the exam for the first time ranged between 96%-98%*. After implementing pass/fail scoring and increasing the pass rate, students taking the exam for the first time saw a 93%* pass rate in 2022 and 92% in 2023 (USMLE). It would be reasonable to attribute some of this decrease in passing rate to the exam becoming pass/fail. *All these numbers are for US MD candidates. See here for additional information on DO candidates and international medical graduates. 

• Step 2 Pass Rates and Scores – Traditionally, medical school curriculums allow for medical students to take Step 2 about 1 year after Step 1. Average Step 2 scores and passing rates have not changed much since Step 1 became pass-fail. The average Step 2 score has ranged from 246-248 over 2020-23 and pass rates have remained high at 98%-99% during the same time period. 
• Residency Selection and Match – According to research at University of Nevada, Las Vegas, many students make a residency selection during the second half of their clinical year. In the past, a Step 1 score would typically be available for students at this time to provide information on their “competitiveness” for various medical specialties. Without this score, some students may struggle to identify how they will be viewed academically by residency programs. The 2024 match is the first match cycle where a large portion of the applicants did not have a Step 1 score, so more information about how this impacted residency selection and match rates will become clearer once the NRMP releases match data.

Reasons Why You Should Aim High for Step 1, Even if You Don’t Need a High Score

• Maximize your chances of passing – Step 1 is a difficult exam, and even if you feel confident, it is in your best interest to safely pass the exam. Even students with strong pre-clinical course scores struggle with this exam. It is a risk to take the exam with minimal preparation and failure could cost you a significant amount of money in testing fees, logistical trouble with medical school rotations, and added stress when making a specialty choice and applying to residency. 
• Invest in a high Step 2 score – While Step 1 is no longer scored, you will receive a 3-digit score for Step 2. While the exams each have a different focus (see “Navigating the Transition from Step 1 to Step 2 CK” blog), the content on Step 2 builds from Step 1, and understanding the foundations of basic science and medicine is critical to performing well on this exam. Additionally, there will be questions that overlap between the two exams. From personal experience, I recall getting questions correct in Step 2 that I learned while studying for Step 1. 
• Master concepts for your career – Learning the basics of medical physiology and pathology will serve you well on your future medical school assessments, clinical clerkships, Step 2, and beyond. Use this time to clarify concepts you otherwise struggle with (ex: learning why cardiac diseases cause specific murmurs or reviewing which organisms are targeted by antibiotics) or master relevant subjects for the field you see yourself entering (ex: nervous system if you’re interested in neurology, musculoskeletal if you’re interested in orthopaedics or PM&R, and GI for general surgery). 

What Score Should You Be Aiming for on Your Step 1 Practice Exams?

While we know the passing score for Step 1 is 196, there is no official percent correct released to pass Step 1. A generally agreed upon estimated percent correct for a passing score is 60% correct. We at Elite Medical Prep recommend receiving a score of >70% correct on a practice test before sitting for the actual exam to ensure a high chance of passing.

In conclusion – it is worth your time to do your best and study well for this exam! 

If you find yourself struggling to safely pass a practice exam, or have failed your first attempt at Step 1, you are not alone! Reach out for help and contact EMP to set up a tutoring consultation.