USMLE Step 1 Pass Rates Decline Since Pass/Fail Change: What It Means for Med Students

The USMLE Step 1 pass rate has declined since the exam went pass/fail in 2022 but here's what you can do as a med student to improve your chance of passing

When was USMLE Step 1 changed to pass/fail?

In February of 2020, the High Overlords of the Boards NBME/FSMB announced that Step 1 would be changing to Pass/Fail grading, and beginning in January of 2022, score reporting did, in fact, change for the USMLE Step 1 exam. Now, instead of receiving a numeric score, medical students—i.e., you—only receive a pass-fail result. 


Taking Step 1 is a major medical school milestone (understatement #1). At eight hours long and with up to 280 multiple choice questions covering a vast amount of basic science content related to medicine, it’s no surprise that changing the scoring system was a very big deal (understatement #2).


Are more students seriously failing USMLE Step 1?

In the past, your score on Step 1 could impact whether you matched with your residency specialty and program of choice. This made getting a high score on Step 1 a source of significant stress (understatement #3). So let’s talk a little bit about the question everybody and their mother (just mine?) is asking: how has the change to pass-fail affected pass rates, the match, and life itself? 

Let’s start with every researcher’s favorite sentence: more data is needed. In all honesty, we really do need more time and data to better understand the impact on medical students and their residency application and match process. But! Some interesting findings have emerged. Most notably, between 2021 (old busted graded version) and 2022 (hot new p/f version), Step 1 pass rates declined

For allopathic students, the Step 1 pass rate dropped from 95% to 91%. For osteopathic students, the passing rate decreased from 94% to 89%.


So, what can you do about the lower USMLE Step 1 Pass Rate?

The exact causes and all of the contributing factors of this decline are… unclear. But that sorta doesn’t matter—the more important take-home point here is that passing Step 1 requires serious preparation. If you’re taking Step 1 soon, or if you are looking ahead at what’s to come, here are some key things to consider. 


1. Identify Step 1 Study Resources Early

First, identify Step 1 study resources early in medical school, then integrate these resources as you learn different topics. Gonna say that once more, with feeling: early. For example, when you’re on your immunology block or anatomy or pharmacology, you can use Sketchy’s corresponding lessons and quiz questions to create a strong, memorable foundation. Our symbols are designed to stick with you, so when it comes time to review for Step 1, you’ll already be on solid footing. And yes, obviously we’re gonna say Sketchy. But seriously, this stuff works.


2. Create a Detailed Step 1 Study Plan

Also: create a detailed plan. How are you going to cover all the topics on Step 1? Check out our Step 1 Content Review Guide. We break down what you need to review on a weekly and daily basis. And if you’re using Sketchy, we’ve included how to pair our lessons with your study plan.


3. Friends who study for Step 1 together, stay together <3

Get with your friends! Consider forming a study group for support, motivation, and to share tools, resources, and study strategies—not just before an exam, but throughout the year. Sketchy’s interactive symbol explorer card is a great way to quiz each other on key, high-yield concepts.


4. Get Help

Get help early and as often as needed. Many institutions offer tutoring and other academic support services for free. If you’re struggling with a topic, don’t wait to get help. Med school moves really fast and there usually isn’t time before Step 1 to learn a topic for the first time. 


While you won’t receive a numeric score after taking it anymore, the recent decline in Step 1 pass rates is a reminder of just how challenging this major exam is. At Sketchy, we have over a thousand lessons and thousands of quiz questions to make learning for Step 1 unforgettable.

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