What Do Medical Students Think About a Pass/Fail USMLE Step 1? A Survey of 18 Allopathic Schools

The United States Medical Licensing Examination (USMLE) Step 1 exam changed from a 3-digit score format to pass/fail in 2022. The current study aimed to examine how medical students perceive this change, factors associated with those perceptions, and determine their preferred exam scoring format.

A cross-sectional survey of US medical students was distributed from March through June 2024. The survey gathered data including demographic and school information, desired specialty, research involvement, and Step 1 scoring preference.

The survey was completed by 192 students from 18 different US allopathic schools. Of students surveyed, 65.5% preferred pass/fail scoring, while 34.5% preferred a 3-digit-score format. Older age increased likelihood of preferring a 3-digit score (β = 0.345, P = .047, odds ratio [OR] 1.41). A later graduation year decreased the likelihood of preferring a 3-digit score (β = -0.576, P = .020, OR 0.56). Gender (β = 0.293, P = .320, OR 1.34), specialty competitiveness (β = -0.095, P = .776, OR 1.10), and research productivity (β = 0.0047, P = .990, OR 1.00) had no significant effect on Step 1 scoring preference.

Medical students seem to prefer a pass/fail Step 1 regardless of gender, desired specialty and research productivity. However, pass/fail preference differed by graduating class year and age, with younger class years and students preferring pass/fail. While prior literature largely surveyed preference among medical educators, student sentiment on Step 1 scoring supports recent changes to the USMLE Step score format.