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InCUS – USMLE Step 1 Score Changes to Pass/Fail
  • 13 Feb 2020

The USMLE Step 1 exam is changing from a 3-digit numerical score, to a pass/fail result.

On February 12th 2020, co-sponsors of the USMLE Program, the FSBM and NBME®, announced several important policy changes regarding USMLE eligibility and score reporting.

Tweet from @TheUSMLE

The most notable amongst these changes is that the USMLE Step 1 exam will no longer be scored as a 3-digit numerical score. This change will be implemented no sooner than January 2022.

This decision follows extensive discussions from within the USMLE Composite Committee, FSMB & NBME® governing boards, and informed by extensive input from outside of the USMLE Program including feedback and commentary before, during and after InCUS in March 2019. (InCUS: the Invitational Conference on USMLE Scoring, co-sponsored by FSMB, NBME®, AMA AAMC & ECFMG).


The FSMB and NBME® believe that changing Step 1 score reporting to pass/fail can help reduce some of the current overemphasis on USMLE performance, while also retaining the ability of medical licensing authorities to use the exam for its primary purpose of medical licensure eligibility.

The USMLE Step 2 CK and Step 3 scores will be maintained, there are currently no plans to review these. Speculation from the USMLE Connection Podcast suggests that residency programmes may turn to Step 2 CK for an objective metric to compare candidates, in lieu of the Step 1 score.

There is more information available on the InCUS page, as well as a set of USMLE scoring FAQs and a timeline leading up to this decision.

Other USMLE Policy Changes:

The attempt limit for each USMLE Step component will reduce from six to four.

This will be implemented no earlier than January 2021.

The USMLE cite that change will contribute to test security and the validity of outcome.

One key reason for the change is that it limits exposure to exam content. By bringing the attempt limit down to four, it also brings the USMLE in line with the practice of other Medical Boards in the United States.

USMLE candidates will need to pass Step 1 as an eligibility requirement for taking Step 2 CS.

This will be implemented no earlier than March 2021.

This updated policy will ensure a demonstration of success within the USMLE Program before providing access to the more in-depth, case-based content included in Step 2 CS. The change mirrors other exam formats around the world where examinees have to pass a knowledge-based exam as a prerequisite for access to a performance-based exam. Currently the vast majority of examinees both in the US and internationally, take and pass the Step 1 exam before attempting Step 2 CS. As such, this policy change will impact relatively few examinees.

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  • 13 Feb 2020