# Medical students' perspective on the United States Medical Licensing Examination (USMLE) Step 1 transition to Pass/Fail

## TL;DR

Medical students preparing for a pass/fail Step 1 exam studied less intensively and may be less prepared compared to those preparing for a scored exam.

## Contribution

This study compares study behaviors and outcomes before and after the Step 1 exam transition to pass/fail, highlighting changes in student preparedness.

## Key findings

- Students preparing for the pass/fail Step 1 started studying less rigorously and spent fewer hours per day studying.
- The pass/fail group used fewer traditional board preparation resources compared to the scored exam group.
- The transition to pass/fail may require institutions to adjust support and resources for students.

## Abstract

The transition of the United States Medical Licensing Exam: Step 1 to Pass/Fail (P/F), from scored, caused uncertainty about students’ preparedness and wellbeing related to the exam. Comparison of study behavior and results, before and after the P/F transition can provide insights for the medical curriculum and student support.

Data from four cohorts of second-year medical students (Class of 2022–25, N = 204) were collected from their dedicated Step 1 self-study block. Student study regiments, aggregate practice test results, Step 1 pass rates and post-block self-reported surveys were analyzed.

Analysis of practice exam averages across the four student cohorts demonstrates a potentially slower and less rigorous start to Step 1 self-studying during the dedicated preparation block for the cohorts that took the P/F Step 1 exam format as compared to the previous cohorts that prepared for a scored Step 1 exam. Similarly, self-reported study regiments decreased in the median number of hours/day and number of weeks of study for the cohorts with P/F Step 1 exam. There was also a slight shift in the type of study resources used, between the two groups, with the scored group using more traditional board preparation resources.

The P/F transition of the Step 1 exam may lead to reduced student preparedness and may require adjustments in the resources and support provided by institutions.