Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 1;6(4):311-318.
doi: 10.36518/2689-0216.1895. eCollection 2025.

Converting USMLE Step 1 to Pass or Fail: The Potential Impact on Applicants Who Are Female or From Underrepresented Groups

Haris Ahmed  1 , Peter Yu  2 , Brendan Rosamond  3 , Jonathan Lall  3 , Scott Zimmerle  3 , Said Maldonado  3 , Nicole Lyons  4 , Ashlynn N Mills  3 , Yoolim Alex Seo  3 , Angelica C Rodriquez  3 , Jacqueline E Levesque  3 , Oluwatunmininu A Anwoju  2   5 , Zuhair Ali  2   5 , Rajeev Raghavan  2   5 , Mike Liang  2   5
Affiliations

Converting USMLE Step 1 to Pass or Fail: The Potential Impact on Applicants Who Are Female or From Underrepresented Groups

Haris Ahmed et al. HCA Healthc J Med. .

Abstract

Background: In January 2022, the United States Medical Licensing Examination (USMLE) Step 1 exam became pass/fail and the transition to using USMLE Step 2 scores for residency interview screening appeared imminent. While this change was intended to result in holistic reviews of residency applicants, the impact remains unclear. In this study, we aimed to determine how USMLE scoring changes might affect female candidates and applicants from underrepresented groups (URM).

Methods: We performed a retrospective cross-sectional study of all applicants to a single institution. Data for applicants were extracted from their 2021-2022 residency applications and included age, race, sex, medical school, region, USMLE Step 1 score, and USMLE Step 2 scores. All applicants who graduated from a US medical school with both USMLE Step 1 and Step 2 scores were eligible for inclusion. Our primary outcome was the difference between USMLE Step 1 versus Step 2 scores. Two comparisons were made; female candidates were compared to male candidates and URM compared to non-URM.

Results: On regression analysis, we noted that female candidates (coefficient = 4.007; 95% CI, 2.64-5.37, P < .001) had greater improvements between USMLE Step I and Step II scores compared to male applicants, while URM (coefficient = -5.056; 95% CI, -7.6 to -2.5, P < .005) demonstrated smaller differences between USMLE scores compared to the reference group (non-URM).

Conclusion: Making USMLE Step 1 pass/fail may benefit female candidates during the interview process, while adversely impacting URM. As the application process evolves, the impacts on female and URM need to be carefully evaluated to achieve equitable representation in residency programs.

Keywords: USMLE scores; diversity; gender equity; medical education; underrepresented minorities.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: Dr Levesque reports honoraria and financial support from the Association of American Medical Colleges, Louisiana State University, New Orleans.

Figures

Figure 1
Figure 1
The United States (US) medical school applicant selection flowsheet reporting the study inclusion and exclusion criteria with the final “n” value for those applicants analyzed.
See this image and copyright information in PMC

References

    1. A Joint Program of the Federation of State Medical Boards of the United States Inc, and the National Board of Medical Examiners. 2021 USMLE bulletin of information. FSMB and NBME; 2022. [Accessed January 9, 2023]. https://www.fsmb.org/siteassets/usmle-step3/pdfs/2021-usmle-bulletin.pdf .
    1. USMLE Step 1 Transition to pass/fail only score reporting. USMLE; Sep 15, 2021. [Accessed January 9, 2023]. https://www.usmle.org/usmle-step-1-transition-passfail-only-score-reporting .
    1. National Resident Matching Program, Data Release and Research Committee. Results of the 2021 NRMP Program Director Survey. [Accessed January 9, 2023]; National Resident Matching Program. 2021 https://www.nrmp.org/wp-content/uploads/2021/11/2021-PD-Survey-Report-fo... .
    1. InCUS Planning Committee. Summary Report and Preliminary Recommendations from the Invitational Conference on USMLE Scoring (InCUS) Mar 11–12, 2019. [Accessed January 8, 2023]. https://www.usmle.org/sites/default/files/2021-08/incus_summary_report.pdf .
    1. Underrepresented in medicine definition. AAMC; [Accessed January 8, 2023]. https://www.aamc.org/what-we-do/equity-diversity-inclusion/underrepresen... .

LinkOut - more resources