Featured, Journeys in Education

How the Transition to Pass/Fail Step 1 Could Impact Medical Education


With the transition of the United States Medical Licensing Examination (USMLE) Step 1 to a pass/fail grading system, many wonder if this will lead medical students to shift their priorities during their first two years of medical school. I personally have seen more and more students exploring research opportunities for ways to stand out and fulfill their natural curiosity rather than their Step-related textbooks. Students that I mentor on my own campus are reaching out to get involved sooner, whether that be in research, leadership within student-led organizations or grand rounds to get familiar with different competitive specialties. This shift in priorities thus begs the question of how this transition to a non-graded Step 1 exam will impact medical education for students across the nation.

This issue is multifaceted. Could this increased emphasis on scientific research, extracurriculars, community volunteerism and deviation from concrete, step-by-step standard learning prove to be too unstructured for proper training of pre-clerkship students? Will this more fluid approach create an environment not conducive to adequate preparation for the demands of clerkships, including “regurgitation” of disease presentations at the flip of a dime? In addition to this, a growing concern is how residency admission committees will compare students if there is a push towards pass/fail exams; although Step 2 Clinical Knowledge remains graded, who knows how long it will be before it possibly follows suit? With an ever-increasing number of applicants to residency programs, residency admissions committees often look to hard metrics to funnel down the pool of applicants. However, these hard metrics appear to be shrinking with no apparent end in sight as many institutions have had or have recently moved to pass/fail curriculums.

These are all valid concerns; however, what does the opposing argument look like? This change could mean that we have stepped into a new era in medical education that demands students spread their wings into a more customized educational experience. Without the need to fit the same mold that has been in use for the past few decades, students might just find themselves taking a more holistic approach to their educational journey. This, in turn, could lead to third-year medical students entering the wards with a more refreshed viewpoint on the task ahead, approaching their patients with the aim to connect to the human sitting in front of them rather than looking to fit them into one of the thousands of multiple-choice questions they have studied over the past couple of months.

It can be difficult to grasp how much of an impact this will have on the trajectories of young doctors in training. Consequently, I have examined my own experience with pre-clerkship courses as my class was the first at my institution to experience the shift. Some key aspects I have noticed are students putting a heavier emphasis on research and leadership endeavors, advocacy opportunities and focusing on other interests and hobbies. This is not to say that students did not pursue these interests before the change to the Step 1 grading system; however, post-transition, there is this new sense of freedom surrounding Step studying that has opened the door for many students to pursue their passions both tangential to their current goals and outside of medicine entirely. This change has forced students to use their innovative and abstract-thinking skills to lead the way rather than sticking to a predetermined path driven towards obtaining as high of a Step 1 score as possible.

From my own experience I have learned to enjoy and respect the field of scientific research and welcome it with open arms. I have had the opportunity to engage in biomechanical studies within the field of orthopaedics in addition to bench work projects. These can often be very time-consuming, as any project that requires a hands-on approach necessitating materials, engineer input and the space to perform the said tests often means the timeline is greatly dependent on extraneous factors. Nevertheless, having more time to focus on endeavors like these has allowed myself and many of my colleagues to put our extra energy into projects that may have otherwise been neglected due to time constraints. Likewise, we now find ourselves with more time to reflect on what we are being taught during the first two years of medical school, able to take a step back and appreciate our progress and where we still have room to grow. This luxury perhaps was not so easily attainable when Step 1 consumed our line of sight.

Thus far, my newfound time during my pre-clerkship years has allowed me to travel across the country to give talks on my research, network and learn from experts within the field; I also have been able to get involved in leadership opportunities both on and off campus and tend to my own mental and physical well-being. Likewise, first- and second-year medical students around the country are now finding themselves with seemingly more time to dedicate to women’s health advocacy, mentorship of pre-medical students, their newfound desire to learn the piano or whatever is calling out to them.

As I watch the classes below me kick-off their medical journeys, it has led me to reflect on whether this change is indeed for the betterment of our future physicians. With a retraction from the obsessive emphasis of Step 1 studying to a more relaxed view on what once was the biggest test in one’s medical journey, the consequences are still unknown. However, I believe this increase in freedom to shape individual educational experiences in ways students see fit during their first two years will undoubtedly bring about its own positive changes. For instance, the need for more physicians within the realm of patient advocacy has been an increasingly hot topic as of late, and with this new transition, medical students might just find themselves in a unique position to start setting themselves up to make a difference within their own communities. It is at times like these that early involvement can prove to be pivotal to building a strong foundation of principles that young future physicians can aim to expand upon as their status within their communities evolve. 

So, whether we look at the research being done, the leadership positions being filled, the advocacy work or the attention put on the mental health of the next generation of physicians, I think we can all agree that this transition is one to take note of. Only time will tell how this change will truly impact the growth of our future doctors. So, we look forward to seeing what this new era brings and the changes this new generation of physicians can make in medical education and healthcare at large. Perhaps, this was long due, but I see it applicable to the classic proverb of when to plant a tree: “The best time was 20 years ago; the second-best time is today.”

Image credit: some more first aid by coleman and caroline is licensed under CC BY-NC-ND 2.0 

Analisa Narro Analisa Narro (1 Posts)

Medical Student Contributing Writer

McGovern Medical School at UT Health

Ms. Analisa Narro is a medical student within the class of 2024 at McGovern Medical School at the University of Texas Health Houston. Ms. Narro completed a Bachelor of Science in Biochemistry with a minor in Mathematics from the University of Texas at San Antonio. Ms. Narro enjoys playing basketball and powerlifting in her free time.