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Clerkship Grading, USMLE Step 1, and Student Distinction: A CERA Study.

Kathryn Rampon1, Daniel J Parente1, Miles Crowley1

  • 1Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS.

Family Medicine
|June 12, 2026
PubMed
Summary
This summary is machine-generated.

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Family medicine clerkship directors perceive increased student stress after the USMLE Step 1 pass/fail change. They believe students can still distinguish themselves, but neither tiered nor pass/fail grading is ideal.

Area of Science:

  • Medical Education
  • Residency Admissions
  • Student Assessment

Background:

  • The 2022 transition of USMLE Step 1 scoring to pass/fail impacted residency selection criteria.
  • Family medicine clerkship directors (FMCDs) are key stakeholders in evaluating medical students.
  • Understanding FMCDs' perceptions is crucial for adapting to new student evaluation metrics.

Purpose of the Study:

  • To explore FMCDs' views on how medical students differentiate themselves post-USMLE Step 1 pass/fail transition.
  • To investigate FMCDs' perspectives on clerkship grading methodologies in light of the scoring change.
  • To assess perceived student stress related to distinguishing themselves for residency.

Main Methods:

  • A survey was distributed to 173 FMCDs in 2024, with 83 responses (48% response rate).

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  • The survey included 10 questions on student distinction, stress, and grading practices.
  • Statistical analyses involved descriptive statistics, Kruskal-Wallis, and Wilcox signed-rank tests.

    • Main Results:

    • 59% of respondents used pass/fail grading pre-clerkship; 22% used it for clerkships.
    • A majority (58%) reported no changes to clerkship grading, but 20% had changed and 22% considered changes.
    • 37% perceived harm from Step 1 changes on student distinction, 48% perceived neutrality, and 14% perceived benefit.
    • 78% perceived increased student stress regarding distinction; no significant association was found between grading and distinction/stress perceptions.

    Conclusions:

    • FMCDs acknowledge increased student stress post-USMLE Step 1 pass/fail transition.
    • Despite stress, FMCDs largely believe students can still distinguish themselves.
    • Standardized, competency-based assessments and clear communication of distinguishing factors are needed for residency applications.