Student-specific Factors Associated with Passing the USMLE Step 1 Examination Within an Institution-allotted...

In 2022, USMLE Step 1 scoring was changed from numeric to pass/fail. The pass rate dropped from 95% in 2021 to 90% in 2023 among US allopathic MD students. Predictors for student success and how study habits have changed since the scoring change to pass/fail have not been well-studied. This study aims to evaluate potential factors associated with achieving an on-time pass for Step 1 (OTP, passing by the end of a six-week period) among students at a single US medical school.

A survey evaluating study methods prior to and during the dedicated Step 1 period was sent to second-year medical students who took Step 1. Responses were linked to individual metrics, and logistic regression was used to evaluate each factor in relation to the probability of an OTP.

The survey response rate was 50.3% (N = 93). OTP was significantly associated with reviewing completed courses before the dedicated period (OR = 4.69, 95% CI 1.80-13.43), beginning a question bank before the dedicated period (OR = 4.11, 95% CI 1.62-10.86), all-preclerkship course average (OR = 1.32, 95% CI 1.17-1.54), highest MCAT score (OR = 1.18, 95% CI 1.03-1.39), first year CBSE score (OR = 1.15, 95% CI 1.12-1.34), second year CBSE score (OR = 1.21, 95% CI 1.12-1.34), and final practice exam score (OR = 1.39, 95% CI 1.18-1.77).

These data highlight objective metrics and study habits associated with passing Step 1 on time and thereby may help identify at-risk students and inform institutional study recommendations.

The online version contains supplementary material available at 10.1007/s40670-025-02636-w.