Preparing for the USMLE® Step 1 as a Pass/Fail Exam

Dr. Ryan Colaço - Jun 11, 2021

As everyone knows by now, the USMLE®  Step 1 exam is becoming pass/fail for exams taken on or after January 26, 2022. Finally, the 3-digit numerical score will be a thing of the past (for Step 1 at least)! While we know there are pros, cons, and many varied opinions about this change, let’s just pause and breathe a collective sigh of relief一the intense pressure on Step 1 aspirants to score high is gone. Our AMBOSS physicians are very jealous! 

However! (Yes, there is a “however”). It’s vital that students don’t use the pass/fail development to become complacent in their Step 1 prep. Depth of understanding and mastery of Step 1 topics are still absolutely essential. Let’s take a look at why. 

The possible effects on the USMLE Step 2 CK exam 

One of the most frequent predictions is that the moving of Step 1 to pass/fail will pass the buck to the Step 2 CK exam. Step 2 CK will continue to be graded with the 3-digit score and it is believed that Step 2 CK scores will now have a greater impact on residency applications as residency programs try to differentiate applicants. And one of the best ways to set yourself up for a solid Step 2 CK score is by building strong foundations of knowledge during your pre-clinical years. 


Kick-start your Step 1 prep with a study plan tailor-made just for you. Check out the AMBOSS Study Planner today. 



Another point to consider is that when the time for Step 2 CK rolls around, you’ll be busy with clinical rotations and residency applications so you won’t have the same kind of dedicated study time that you did for Step 1. But if you have a solid knowledge base from Step 1, it will make you more efficient at studying and recalling information when you prepare for Step 2 CK. 

The impact on your development as a doctor 

The ultimate goal of medical school is for you to become a well-rounded, empathetic, and effective physician. If our sights are set only on achieving a particular score, core elements of being a great doctor get lost along the way. The switch to pass/fail should give you some breathing room so you can focus on the curriculum, learn your stuff back to front, and be confident in your abilities as a caregiver. 

The Step 1 exam is constantly evolving

Not only has the scoring system changed, but there have also been significant content changes within both Step 1 and Step 2 CK. Questions that deal with the so-called soft skills are now appearing more frequently and with more importance. There is now an “increased number of questions assessing communication skills, systems-based practice and patient safety, and legal/ethical skills and professionalism.” 

However, it's important to note that purely ethics-related questions and patient safety-related questions will not be tested on Step 1. You can learn more about this in our blog post here

Side note: the team of AMBOSS physicians has been working hard to bring you new questions that will prepare you for these changes. You can try out a sample of these questions here and here

It’s not only the content that has been evolving within the Step 1 exam: the difficulty of the exam has been changing from year to year, too. With this in mind, it’s crucial that you don’t take any chances and are prepared and confident come exam day. 

The emphasis on resources will shift

Up until now, the widely accepted route to Step 1 success was using many different resources and doing many passes of Qbanks. But, with the need to achieve a high score no longer a factor, it will be wise to make your studying as efficient as possible. That said, it’s important you have a solid grasp of the content as your studying in pre-clinical years is going to form your base of knowledge for the clinical years. 

Your pre-clinical study should have two main goals: 

  1. To gain a deep understanding of the topics
  2. To be able to answer the exam-style questions in trusted, high-quality Qbanks (and, of course, ultimately, in the exam!)

It is crucial to find a way to achieve both these goals in the most efficient manner: by focusing on a few key resources. 

Up until now, students would typically try to study a topic with a combination of all (or most) of the following: lecture notes from class, a video that explains the topic (like those from Sketchy/OME/B&B), a subject-specific resource (e.g. Pathoma), and also a review book (e.g. First Aid), and a Qbank. With the focus now changing to “efficient studying”, students can instead focus on developing an understanding of the topic enough to be able to reason their way through most practice questions. This means no longer having to get all the esoteric details down!

Here is an example of an efficient study method using only two resources

  1. Review your knowledge of a topic that was recently taught at school with the relevant AMBOSS article.
  2. Deepen your understanding of the topic with the related Boards & Beyond video.
  3. Test yourself on the topic by answering the relevant AMBOSS question block.

Another popular resource that promotes efficient study is the AMBOSS Anki add-on. This student-favorite tool unifies your resources and connects instantly to high-yield info by putting AMBOSS definitions right there in your flashcards. 


It follows that students will now be tempted to leave some topics out of their Step 1 study plan. Just be sure to choose wisely and focus your attention on the high-yield topics. AMBOSS users can be at an advantage here, considering that they get a handy roadmap of what to focus on, with the High-Yield and Highlight features in AMBOSS articles.

Your health and well-being are the most important considerations

While we can’t know for certain the exact impact that Step 1 moving to pass/fail will have down the line, we can certainly revel in its immediate effects! There is nothing more important than keeping our doctors-to-be healthy, relaxed, and in the best frame of mind that you can possibly be. So don’t forget to sleep, eat well, and stay positive. Your health is priority number one一no exam comes even close.