USMLE Step 1 Goes Pass/Fail: What Will ACTUALLY Change? | Ask Dr. Gray

Today on Ask Dr. Gray, our student asks how USMLE Step 1 going pass/fail will actually change things. Specifically, his question focuses on how this may affect DO schools using COMLEX, as COMLEX Level 1 has not gone pass/fail (yet). He also wonders what residency directors might look at more closely now instead.

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When talking about Step 1 going P/F, the first thing to note is that the USMLE system was born in the 1990s, so it's really not that old. Exams used for medical education in the past have changed many times. So this is just more change. Things will be okay and keep moving forward in the end.

The way everyone is reacting to Step 1 going P/F right now is just based on assumptions. We don't have data on how this change will actually affect things long term.

One of the big assumptions is that Step 1 being pass/fail will negatively affect international students and DO students the most. The assumption is that, now, attending a prestigious med school will be required in order to get into a good residency program afterward.

But residency program directors, when surveyed, don't report putting much weight on the name of the medical school applicants are coming from. In fact, as of 2018, around half say they don't consider it at all.

Yes, there are subjective judgments that go into the residency MATCH process—just like there are with job hirings and everything else in life. But there are still things within your control that you can do to stand out.

Letters of recommendation are rated very high in importance by residency program directors. So those are important and will stay important.

On my Specialty Stories podcast (http://specialtystories.com), I've been talking to residency program directors about this upcoming change for a while. Most of them say that nothing much will change. ALL of them say your scores in your clerkships are very important, along with your letters of rec and your Dean's letter. It's possible that Step 2 will become more important, too, as those exams are still scored.

Personally, I'm confused about why only Step 1 was made pass/fail. I think all the Step exams—and COMLEX—should be pass/fail. They are exams to test whether you're prepared to practice medicine, which should be a pass/fail measure, not a score. Up to this point, board scores have been being used in a way that they were not even intended to be used—to determine which specialties you can be competitive in.

Bottom line: We don't know how everything will play out at this point, but in the end, everything will be fine. I do NOT think this is a reason to avoid osteopathic medical schools. It's just change. We will adapt. And what YOU do is still the biggest thing, and that is still within your control.

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