How many people fail Step 1 and Step 2 CK every year? How has this changed over time? These are the questions I looked at, as I considered whether Step 1 being pass-fail would help/hurt IMGs and/or DOs.
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How Many People Fail Step 1 Every Year?
First, the data on the number of people who fail Step 1 (source: USMLE):
| Step 1 | # Tested (2019) | % Passing (2019) | # Failed* (2019) | # Tested (2020) | % Passing (2020) | # Failed* (2020) | # Tested (2021) | % Passing (2021) | # Failed* (2021) | # Tested (2022) | % Passing (2022) | # Failed* (2022) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MD Degree | 22,146 | 96% | 886 | 20,343 | 97% | 610 | 23,078 | 95% | 1,154 | 24,317 | 91% | 2,189 |
| 1st Takers | 21,308 | 97% | 639 | 19,772 | 98% | 395 | 22,280 | 96% | 891 | 22,828 | 93% | 1,598 |
| Repeaters | 838 | 66% | 285 | 571 | 67% | 188 | 798 | 66% | 271 | 1,489 | 71% | 432 |
| DO Degree | 4,837 | 96% | 193 | 5,274 | 95% | 264 | 5,365 | 94% | 322 | 4,722 | 89% | 519 |
| 1st Takers | 4,794 | 96% | 192 | 5,235 | 96% | 209 | 5,309 | 94% | 319 | 4,659 | 89% | 512 |
| Repeaters | 43 | 67% | 14 | 39 | 74% | 10 | 56 | 75% | 14 | 63 | 67% | 21 |
| IMGs | 16,065 | 78% | 3534 | 13,117 | 83% | 2,230 | 19,210 | 77% | 4,418 | 24,956 | 71% | 7,237 |
| 1st Takers | 14,046 | 82% | 2528 | 11,742 | 87% | 1,526 | 16,952 | 82% | 3,051 | 22,030 | 74% | 5,728 |
| Repeaters | 2,019 | 45% | 1110 | 1,375 | 50% | 688 | 2,258 | 45% | 1,242 | 2,926 | 45% | 1,609 |
| Total Step 1 Exams | 43,048 | 38,734 | 47,653 | 53,995 | ||||||||
| Total Step 1 Repeaters | 2,900 | 1,985 | 3,112 | 4,478 | ||||||||
| Total Step 1 Fails | 4,614 | 3,104 | 3,104 | 9,945 |
For perspective, 2022 was an odd year (to say the least) with Step 1 pass/fail being introduced, and the raising of the Step 1 passing score. For some perspective, here is a similar look at Step 1 fails from 2017-2022:
| Step 1 Passing Rates | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|---|---|
| MD Degree Examinations | 21,382 | 21,611 | 22,146 | 20,343 | 23,078 | 24,251 |
| MD Degree Passing % | 94% | 95% | 96% | 97% | 95% | 91% |
| MD Fails* | 1,283 | 1,081 | 886 | 610 | 1,154 | 2,183 |
| DO Degree Examinations | 3,835 | 4,136 | 4,837 | 5,274 | 5,365 | 4,722 |
| DO Degree Passing % | 95% | 96% | 96% | 95% | 94% | 89% |
| DO Fails* | 192 | 165 | 193 | 264 | 322 | 519 |
| IMGs Examinations | 17,203 | 16,443 | 16,065 | 13,117 | 19,210 | 24,956 |
| IMGs Passing % | 73% | 75% | 78% | 83% | 77% | 71% |
| IMG Fails* | 4,645 | 4,111 | 3,534 | 2,230 | 4,418 | 7,237 |
| Total Step 1 Exams | 42,420 | 42,190 | 43,048 | 38,734 | 47,653 | 53,929 |
| Overall Step 1 Pass Rate | 86% | 87% | 89% | 92% | 88% | 82% |
| Total Step 1 Fails | 6,119 | 5,357 | 4,614 | 3,104 | 5,894 | 9,939 |
How Many People Fail Step 2 CK Every Year?
Next, the same for the number of people who fail Step 2 CK:
| Step 2 CK | # Tested (2018-2019) | % Passing (2018-2019) | # Failed (2018-2019) | # Tested (2019-2020) | % Passing (2019-2020) | # Failed (2019-2020) | # Tested (2020-2021) | % Passing (2020-2021) | # Failed (2020-2021) | # Tested (2021-2022) | % Passing (2021-2022) | # Failed (2021-2022) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MD Degree | 21,721 | 97% | 652 | 18,574 | 98% | 371 | 24,019 | 98% | 480 | 24,632 | 98% | 493 |
| 1st Takers | 21,093 | 98% | 422 | 18,138 | 98% | 363 | 23,607 | 99% | 236 | 24,205 | 99% | 242 |
| Repeaters** | 628 | 72% | 176 | 436 | 76% | 105 | 412 | 75% | 103 | 427 | 71% | 124 |
| DO Degree | 3,476 | 97% | 104 | 3,362 | 97% | 101 | 4,499 | 98% | 90 | 5,199 | 97% | 156 |
| 1st Takers | 3,445 | 97% | 103 | 3,341 | 97% | 100 | 4,475 | 98% | 90 | 5,177 | 97% | 155 |
| Repeaters** | 31 | 74% | 8 | 21 | 71% | 6 | 28,518 | 98% | 570 | 29,831 | 98% | 597 |
| IMGs | 12,941 | 82% | 2329 | 10,295 | 87% | 1,338 | 13,799 | 88% | 1,656 | 14,077 | 86% | 1,971 |
| 1st Takers | 11,082 | 87% | 1441 | 9,123 | 90% | 912 | 12,431 | 91% | 1,119 | 12,708 | 89% | 1,398 |
| Repeaters** | 1,859 | 57% | 799 | 1,172 | 59% | 481 | 1,368 | 62% | 520 | 1,369 | 57% | 589 |
| Total Step 2 CK Exams | 38,138 | 32,231 | 42,317 | 43,908 | ||||||||
| Total Step 2 CK Repeaters | 2,518 | 1,629 | 1,804 | 1,818 | ||||||||
| Total Step 2 CK Fails | 3,085 | 1,811 | 2,226 | 2,619 |
And the same data for Step 2 CK fails from 2017-2022:
| Step 2 CK Passing Rates: | 2016-2017 | 2017-2018 | 2018-2019 | 2019-2020 | 2020-2021 | 2021-2022 |
|---|---|---|---|---|---|---|
| MD Degree Examinations | 21,071 | 22,367 | 21,721 | 18,574 | 24,019 | 24,632 |
| MD Degree Passing % | 95% | 96% | 97% | 98% | 98% | 98% |
| MD Fails* | 931 | 836 | 628 | 436 | 480 | 493 |
| DO Degree Examinations | 2,581 | 3,076 | 3,476 | 3,362 | 4,499 | 5,199 |
| DO Degree Passing % | 94% | 94% | 97% | 97% | 98% | 97% |
| DO Fails* | 34 | 38 | 31 | 21 | 90 | 156 |
| IMGs Examinations | 14,291 | 13,613 | 12,941 | 10,295 | 13,799 | 14,077 |
| IMGs Passing % | 76% | 78% | 82% | 87% | 88% | 86% |
| IMG Fails* | 2,342 | 2,144 | 1,859 | 1,172 | 1,656 | 1,971 |
| Total Step 2 CK Exams | 37,943 | 39,056 | 38,138 | 32,231 | 42,317 | 43,908 |
| Overall Step 2 CK Pass Rate | 88% | 90% | 92% | 94% | 95% | 94% |
| Total Step 2 CK Fails | 4,638 | 4,074 | 3,085 | 1,811 | 2,226 | 2,619 |
A Few Observations of the USMLE Failure Rate Data
Pass Rates for DOs and MDs are Virtually Identical
One thing you’ll notice is that DOs and MDs pass Step 1 and Step 2 CK at very similar rates.
IMGs Pass Step 1 and Step 2 CK at a Much Lower Rate
Conversely, we can see clearly that IMGs pass Step 1 and Step 2 CK at a much lower rate. In working with IMGs, and hearing about the additional barriers they face when preparing for the USMLEs, this makes sense. Not only is the content emphasis different, oftentimes it has been years since they learned it. (Or they may not have learned some of those topics at all, like a lot of basic science topics).
Whatever the reason, IMGs pass both Step 1 and Step 2 CK at a lower rate.
Pass Rates for Step 1 Have Dropped Significantly While Step 2 CK Scores Are Increasing, Especially for IMGs
The drop in the pass rate for Step 1 is alarming and even has prompted the USMLE governing body to state that there may be several reasons for the drop. Possibly, this is to avoid blame on Step 1 pass/fail as a reason for score drops.
The Step 1 pass/fail transition coincided with an increase in the minimum passing score from 194 to 196 in January 2022. It’s also claimed that examinees shifted their test dates (either to fall in or out of the start of pass/fail), so the examinees who tested in this period are not an equal comparison to those in the past.
Regardless, it is a worrisome trend that has disproportionately affected IMGs with pass rates dropping 12 points over the last two years (83% to 71%) after years of passing rate improvement.
For Step 2 CK, the pass rates have been improving overall, driven largely by the increasing pass rates from IMGs. This is encouraging and would be a welcome trend to see continue.
Have You Failed Step 1 or Step 2 CK?
Maybe you failed Step 1 or Step 2 CK. Or perhaps you are struggling to improve your score and are worried you might not pass your USMLE. If so, you may be feeling like there is no hope. We invest so much into these exams, and for many of us, this is the first time we’ve struggled this much with anything. It can be one of the most emotionally draining and isolating experiences of our lives.
There is, however, hope. As you can see, every year thousands of examinees don’t pass their USMLE Step 1 or Step 2 CK. If you are not passing your exams, read this article to see what you can do to turn your USMLE fail into a new trajectory.
