By BRYAN CARMODY, MD

Well, it happened.

Beginning as soon as 2022, USMLE Step 1 scores will be reported pass/fail.

I’m shocked. Starting around two weeks ago, I began hearing rumors from some well-connected people that this might happen… but I still didn’t believe it.

I was wrong.

The response thus far has been enormous – I haven’t been able to clear my Twitter mentions since the news broke. And unsurprisingly, the reaction has been mixed.

In the future, I’ll post more detailed responses on where we go from here – but for now, I’d like to emphasize these five things.

1. By itself, making USMLE Step 1 pass/fail doesn’t fix much.

Simply getting rid of three digit scores doesn’t improve medical education. And it doesn’t make residency selection any better, either.

It does give us the opportunity to make changes. And the importance of that should not be understated.

Put simply, this is the greatest opportunity for medical education reform since Flexner, and the greatest opportunity to re-design residency selection since… ever.

“WHAT WILL REPLACE STEP 1?” IS A HARD QUESTION. AND MAKE NO MISTAKE, THE FACT THAT IT’S A HARD QUESTION IS ONE OF THE VERY REASONS MANY CLUNG TO STEP 1 SCORES SO DOGGEDLY.

2. The path of least resistance does not take us where we want to go.

Most of the commentary on social media thus far has taken the following form:

Now only Ivy League medical students will get into competitive specialties.Don’t worry! USMLE Step 2 CK will just be the new Step 1.I guess DOs and IMGs can forget about getting into top residency programs.

And you know what? Most of these concerns are justified.

If we do nothing, Step 2 Mania is the natural result of a pass/fail Step 1. And unless we give program directors more useful information – and the time to thoughtfully review all the applications they receive – they’ll gravitate to another convenience

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