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

Dr. Ryan Colaço - Nov 29, 2022
A medical student studies at her laptop as she prepares to take Step 1 pass/fail.

Since the USMLE® Step 1 exam became pass/fail in January 2022, the notorious 3-digit score has become 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 become complacent in their Step 1 prep simply because the exam is pass/fail. We're not just saying this because we like to see the world suffer. Depth of understanding and mastery of Step 1 topics are still absolutely essential. Let’s take a look at why. 

How will Step 1 pass/fail affect residency & the Step 2 exam? 

One of the most frequent predictions is that moving Step 1 to pass/fail will pass the buck onto the Step 2 exam which will continue to be graded with the 3-digit score. It is widely believed that Step 2 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 score is by building a strong foundation of knowledge for Step 1. (If you’re curious about the average Step 2 match scores by medical specialty, you can find them here.) 

Another point to consider is that by the time Step 2 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, it will make you more efficient, and recalling information will become easier. Not to mention the fact that there is a huge content crossover between Step 1 and Step 2. 

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, the 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 caregiver abilities. 

The exam is constantly evolving (including the Step 1 pass/fail rate, passing score, and content)

Not only has the scoring system changed but there have also been significant content changes within both Step 1 and Step 2 over the last few years. Questions that deal with 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.” 

Side note: the team of AMBOSS physicians worked hard to bring you new questions that will prepare you for these topics. 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. 

When the Step 1 exam became pass/fail in January 2022, the passing score changed along with it. Since then, the passing score has been 196. This was an increase from the previous score of 194. 

In terms of the Step 1 pass/fail rate, there has been a little fluctuation over the last few years. What happens to the pass rate as a result of the exam changes remains to be seen. For the time being, here are the passing rates for first-time examinees from US or Canadian schools from 2019-2021 (performance data is from the USMLE). 

Year MD pass rate DO pass rate
2021 95% 94%
2020 97% 95%
2019 96% 96%

The emphasis on resources is shifting

Before Step 1 became pass/fail, the standard 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, you can make studying as efficient as possible. Just make sure that your efficient studying leaves you with a solid grasp of pre-clinical content as it will be your knowledge base 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 which means focusing on a few key resources. 

In the past, students typically studied a topic with a combination of all (or most) of the following resources: 

  • Lecture notes from class
  • A video that explains the topic (e.g., Sketchy, OME, Boards & Beyond) 
  • A subject-specific resource (e.g., Pathoma)
  • A review book (e.g., First Aid)
  • A Qbank (e.g., AMBOSS)

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. New to Anki? Learn the basics with this Anki Crash Course.

Get the AMBOSS Anki add-on

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.

If you want to learn more about the USMLE Step 1 pass/fail experience, check out this article by Paulino Gárate, a USMLE Step 1 test-taker who shares his advice in the era of pass/fail.

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. 

Whether you’re looking for a top-tier Qbank or a medical knowledge library filled with high-yield info, we’ve got you covered. Start your AMBOSS free trial today.

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