Results indicate a higher fail rate on the Step 1 exam for the 2022 examinees relative to recent years. It is important to note that factors not present in previous years introduce complexities when comparing the 2022 examinee group to previous years. These differences should be considered when interpreting report data. The factors include:

Increased Passing Standard for Step 1

The Step 1 pass/fail transition beginning on January 26, 2022, coincided with an increase in the exam’s minimum passing standard from 194 to 196. The increase in passing standard accounts for some increases observed in the fail rates.

Shift in Examinee Scheduling Patterns

We have observed shifts in the timing of when examinees tested, particularly around the pass/fail transition date. These changes in test timing patterns suggest that those who tested during this period may not be representative of the typical group that tested during these times in the past. These potential differences complicate comparisons to past performance data.

Within each Step examination, USMLE creates various forms that are similar in difficulty and content. Each USMLE Step examination includes multiple forms that are similar in difficulty and content for the respective Step. Scores on individual examination forms are made comparable through equating, a psychometric process that adjusts scores based on the difficulty of the questions. This process ensures examinees who take different forms are held to the same passing standard.

No Change to Exam Specifications for Step 1 in 2022

All USMLE examinations are constructed from an integrated content outline, which organizes content according to general principles and individual organ systems. While not all topics listed in the content outline are included in each Step exam, overall content coverage is comparable among the various examination forms that different examinees of each Step will take. The test specifications used to construct USMLE Step 1 examinations did not change when the exam transitioned to pass/fail reporting.

Consistent Style and Difficulty for Step 1 Exam Questions

No changes were made to the style and targeted difficulty of the Step 1 2022 exam. USMLE collaborates with a network of medical school faculty and clinicians that come from a variety of educational backgrounds and specialties and throughout the United States to create test items, or questions and cases, that make up the USMLE Step exams.

Each year, this network draws on their own experience and expertise to develop high-quality test items with NBME staff that address the topics and challenges that they encounter in their own classrooms and practice based on years of lessons and learned best practices. Participating physicians maintained the standard USMLE item writing approach for the Step 1 2022 exam.

Step 1 2022 Summary Performance Data