The Current Use of United States Medical Licensing Examination Step 1 Scores: Holistic Admissions and Student Well-Being Are in the Balance

Abstract

United States Medical Licensing Examination Step 1 scores increasingly are being used by graduate medical education programs to "screen out" applicants to invite for an interview; medical students with scores below a certain (usually unpublished) point are not considered for an interview. Conversely, many students are extended an interview invitation based solely on their Step 1 scores, prior to the release of their Medical Student Performance Evaluation. In this Invited Commentary, the author discusses why this practice has gained popularity as well as the unintended effects it has had in multiple domains-holistic undergraduate medical education admissions practices, student well-being, and medical school curricula. Possible solutions are considered, including a pass/fail reporting structure, a national basic science curriculum, and better alignment between undergraduate and graduate medical education admissions processes and values. Through collaborative work between the Association of American Medical Colleges, the National Board of Medical Examiners, the Accreditation Council for Graduate Medical Education, and medical educators, an alternative, more holistic standardized metric by which to compare students' applications should be developed.