# Strategies for Success: Assessing Student Perspectives on the Impact of Step 1 Pass/Fail

## TL;DR

This study explores how the pass/fail format of the Step 1 medical exam affects students' experiences, mental health, and academic support needs.

## Contribution

The paper provides insights into student perspectives on the Step 1 pass/fail transition and suggests strategies for improving medical education.

## Key findings

- Students face mental health challenges that could be reduced with more academic advising and mental health support.
- Supplemental student-led Step 1 preparation and peer mentoring are seen as beneficial for the pre-clerkship curriculum.
- Students desire more National Board of Medical Examiners test preparation resources.

## Abstract

The United States Medical Licensing Examination Step 1 Exam became pass/fail in January 2022 with an objective of reducing the test-taking pressure for medical students. The impact of Step 1 pass/fail on student experiences and outcomes is unknown. We responded by surveying the classes of 2024 and 2025 with five Likert-scale questions to assess the impact of curriculum, mental health, and academic advising/preparation on the Step 1 pass/fail experience. We surveyed students’ experiences with counseling services, advising about mental health, weekly quizzes, completing pre-clerkship curriculum in 1.5 years, the order in which our pre-clerkship courses were completed, and time dedicated to study for Step 1. Students were surveyed on their experience with peer guidance/advice, student panels, and advising for exam readiness. Open-response questions assessed individualized preparation. Results demonstrate that students are facing adversity in mental health that may be mitigated with frequent academic advisor meetings, increased access to mental health counselors, and reduced isolation. Students desire more National Board of Medical Examiners test preparation. Results also indicate that the pre-clerkship curriculum may benefit from supplemental student-led Step 1 preparation and structured peer mentoring for Step 1. Our results may benefit other schools looking to implement change and improve their medical education with emphasis on those anticipating moving to a 1.5-year curriculum. If needed, medical schools may consider soliciting a similar survey to assess their own medical education’s impact on students with Step 1 now being pass/fail.

The online version contains supplementary material available at 10.1007/s40670-025-02434-4.