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Step 1 is Pass-Fail: What is the New Passing Score in 2023?

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by Alec Palmerton, MD in Step 1 Pass-Fail

You’re now well aware that Step 1 became pass-fail on January 26, 2022. But now that it’s pass-fail, what is the new passing score? What is the passing rate for Step 1? And will the USMLE make passing that much more difficult?

In this article, we will discuss:

  • The new passing score for Step 1,
  • What the Step 1 passing rate is,
  • Whether the increased passing score explains why so many more people are struggling to pass Step 1,
  • What may happen to the Step 1 passing score in the future, and
  • Much more

Table of Contents

What Is the New Passing Score for Step 1 Now That It’s Pass-Fail?

The new passing score for Step 1 was raised to 196 from 194 on January 26, 2022. If that date is familiar, it is the same date that Step 1 became pass-fail.

Why did the USMLE Raise the Passing Score?

Per the announcement from the USMLE Management Committee:

As part of the USMLE program’s operational procedures and in alignment with best practices for licensing and certification exams, a comprehensive review and analysis of the passing standard for each Step exam typically occur every three to four years. This ensures that the passing score is consistent with expectations of the level of content mastery of the knowledge and skills needed to support effective medical practice and licensure.

This minor adjustment to the passing standard was determined through the thorough and careful consideration of information from multiple sources, including:

    1. Recommendations from independent groups of physicians unaffiliated with the USMLE who participated in content-based standard-setting panels in October 2021;
    2. Results of surveys of various groups (e.g., residency program directors, medical school faculty, state licensing representatives, examinees) concerning the appropriateness of the current passing standard for the Step 1 examination;
    3. Data on trends in examinee performance; and
    4. Score precision and its effect on the pass/fail outcome.

What Were the Effects of Pass-Fail on Pass Rates?

As we’ve discussed, passing Step 1 is more challenging than most people realize. The overall passing rate for Step 1 ranged from 86% to 92% from 2017 to 2021 with 3,000-6,000+ people failing Step 1 each year.

In 2022’s change to pass-fail, overall passing rates were at a historic low of 82% with nearly 10,000 people failing Step 1. This is the lowest pass rate since at least 2013.

Step 1 Passing Rates2019202020212022
MD Degree Examinations22,14620,34323,07824,251
MD Degree Passing %96%97%95%91%
MD Fails*8866101,1542,183
DO Degree Examinations4,8375,2745,3654,722
DO Degree Passing %96%95%94%89%
DO Fails*193264322519
IMGs Examinations16,06513,11719,21024,956
IMGs Passing %78%83%77%71%
IMG Fails*3,5342,2304,4187,237
Total Step 1 Exams43,04838,73447,65353,929
Overall Step 1 Pass Rate89%92%88%82%
Total Step 1 Fails4,6143,1045,8949,939

Note that these are people who take their test. Therefore, the passing rate does NOT reflect how often people had to take longer to study to pass than they originally anticipated.

Now That Step 1 is Pass-Fail, Will the Passing Score Rise Even More?

Many med students feared that with Step 1 going pass-fail, the passing score could go substantially higher. Implicit in this fear is the idea that scoring high was the challenge before but that passing wouldn’t be very hard. The reasoning is that since passing Step 1 would be easier than scoring high, the USMLE would ultimately raise the passing score even more.

But 2022’s data isn’t supporting that reasoning. As discussed before, passing Step 1 is more challenging than many people think. Why? The thesis here is that the system of medical education is broken. In what world is it reasonable to expect optimal outcomes from a system where:

  • Most professors are not paid for teaching,
  • Most lecturers provide only a single lecture,
  • It is hard to coordinate between professors,
  • Many professors don’t know how much students know – or what year they’re in?

Step 1 mania – for all of its flaws – gave students a strong enough incentive to study independently. So despite all of the massive problems with the medical education system, students worked hard enough on their own to pass and even excel.

Step 1 Pass-Fail is Uncovering Many of Medical Education’s Flaws

But now that Step 1 is pass-fail, more and more students from American medical schools are struggling even to pass. Why would this be the case? The intense studying to achieve a high score caused students to cross the passing threshold at a much higher rate. In the process, this independent, parallel Step 1 studying masked many of the problems with our current medical education system.

It seems as if this has caught medical schools unaware. In the time leading up to pass-fail Step 1, it wasn’t uncommon to hear schools tell students:

  • All they needed to do was to focus on the school curriculum, and they would pass, or
  • Using outside resources was unnecessary,

Some schools have reportedly also told their students that they might need no more than a few days of dedicated study to pass Step 1.

The data from the first year of pass-fail is not promising. More stories trickle in on how many students struggle to pass Step 1. Large percentages of students are delaying their tests – even taking a year off – to study even longer to pass Step 1.

Will the Passing Score of Step 1 Be Raised in the Future?

So, with Step 1 going to pass-fail, will the passing score be raised further? More importantly, if/when the Step 1 passing score increases, how much will it go up?

I speculate that the passing score will continue to creep up slowly, as it has over the years. For example, before January 1, 2018, the passing score was 192. From January 2018 to January 2022, the Step 1 passing score was 194. And from January 2022, it will be 196.

Making Step 1 pass-fail is a massive change to the USMLE and the residency process. Therefore, I assume they will wait to see the longer-term effects before re-visiting the Step 1 passing score.

As discussed above, Step 1 mania, with all its warts, likely covered many of the problems with medical education. I hope that with the issues with the medical education system harder to ignore, the reformers within the system will have more sway to make it better.

Concluding Thoughts

The Step 1 passing score has inched higher every few years. From 192 before 2018 to 196 now, it has changed in small increments over the years.

While it is natural to wonder if it will shoot higher now that Step 1 is pass-fail, the data doesn’t support it. Passing Step 1 seems to be a lot harder than many anticipated – including many within med school administrations. While the consequences of this will take years to sort out, one thing that is unlikely to change soon is the Step 1 passing score.

What do you think of the Step 1 passing score? Should it be raised? Lowered? Kept the same? Let us know in the comments!

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.