Since January 2022, Step 1 no longer reports a three-digit score — it reports Pass or Fail. The exam didn't get easier. The bar got slightly higher, the failure rate roughly doubled, and a failing result now stands out more than ever in residency applications. This guide explains what changed, what the national data show, and how to prepare with a clear head.
Unofficial guide. This site is an independent educational reference. Policies, eligibility rules, and the passing standard can change — confirm current details at the authoritative sources: usmle.org and nbme.org. We are not affiliated with the NBME, USMLE program, NRMP, LCME, or AAMC.
What changed in January 2022
In January 2022, the USMLE program switched Step 1 score reporting from a three-digit numeric score to a simple Pass/Fail result. The change was intended to reduce the overemphasis on a single number in residency selection and to refocus the exam on its original purpose: a licensure-level check that a student has mastered the basic-science foundations needed to care for patients.
But the exam itself did not become easier. At the same time reporting changed, the minimum passing standard rose from 194 to 196, and the observed result was that the national failure rate roughly doubled. For US MD first-time test takers, the pass rate fell from 95% in 2021 (the last numeric-score year) to 91% in 2022, then continued drifting to 90% in 2023 and 89% in 2024. For US DO first-time takers, the drop was sharper: from 94% in 2021 to 91% in 2022, then 86% in both 2023 and 2024. (Source: USMLE Performance Data via NBME, as summarized in AMA reporting; authoritative tables at usmle.org → Performance Data.)
| Year | US MD first-time | US DO first-time |
|---|---|---|
| 2021 (last numeric-score year) | 95% | 94% |
| 2022 (pass/fail begins, Jan 2022) | 91% | 91% |
| 2023 | 90% | 86% |
| 2024 | 89% | 86% |
First-time pass rates only (not eventual/overall rates). Source: USMLE Performance Data via NBME, as summarized in AMA reporting. The definitive tables are published at usmle.org under Performance Data. National rates continue to be updated yearly; treat these figures as snapshots through 2024.
Why "just passing" still demands respect
It is tempting to read "pass/fail" as "lower stakes." The national data say the opposite. Failure rates roughly doubled after the change, and a failing result now carries outsized weight precisely because almost everyone is expected to pass on the first attempt. In the 2024 NRMP program-director survey, 77% of respondents said they consider failed Step attempts when deciding whom to interview for residency. A single fail becomes one of the most visible lines on an application.
Pass/fail also shifted the competitive weight toward other parts of the application: clerkship performance, Step 2 CK scores, letters, research, and demonstrated fit. None of that changes the fundamental task for Step 1 itself. The goal is a confident pass — not a high score, and not a bare-minimum scrape. Students who aim for "just barely passing" leave no margin for a bad testing day, and the data show that margin matters.
The bottom line for your planning. About 1 in 10 US MD first-time takers and about 1 in 7 US DO first-time takers did not pass in 2024. That is a real, non-trivial risk — and it is manageable with the right preparation, the right readiness checks, and the discipline to delay if you are not ready. This site is built around that mindset: prepare like the pass is not guaranteed, test when you are ready, and pass once.
Start here
The goal is a confident pass, not a maximum score. How to anchor preparation in preclinical coursework, use one question bank deeply, build spaced repetition into every day, and use NBME self-assessments as readiness gauges.
Read the strategy →The categories of study resources — review books, video series, visual mnemonics, flashcard platforms, question banks, and official NBME self-assessments — described plainly, with official sources linked. Fewer, deeper resources beats a shelf of half-finished ones.
Survey the resources →From preclinical foundations through a typical 4–8 week dedicated period to test day and score reporting. Schools differ on scheduling — this is the general shape, with the caveats spelled out.
See the timeline →What happens if you fail, how many attempts are allowed, when to take Step 1 relative to Step 2, how many study hours is typical, how to know you're ready, and more — answered in plain language.
Read the FAQs →SI MedEd family
SI Step 1 is one of five new SI MedEd sites, alongside the flagship portal and the USMLE overview hub.