USMLE Pass/Fail Implications for IMGs | MedSchoolCoach

What Are the USMLE Pass/Fail Implications for IMGs


Posted in: USMLE & COMLEX

2022, the United States Medical Licensing Exam (USMLE) changed Step 1 from a numerical score to a pass/fail designation. What are the implications for international Medical Graduates (IMGs)?

This is a pretty major change in the world of medical education, and one that has a lot of people scratching their heads if not down-right panicking. A lot of information is getting put out about how this will affect students, and we’ll discuss some of the possible implications for IMGs.

What is USMLE Step 1?

As a quick background for those that don’t know, there are 3 medical licensing exams, called steps, that must be passed before obtaining a medical license. Step 1 is not only well known to be the most difficult exam, but also has historically carried the most weight. 

Just as the MCAT carries enormous weight for determining if you can get into medical school and which particular medical school, the USMLE step 1 determines if you can match into a residency, and which specialty. 

Now that test will switch over to pass/fail for those taking the test after January 2022.

What Does the USMLE Pass/Fail Change Mean for IMG students?

There are 2 major implications that come to mind right off the bat for International Medical Graduates. One good, and one not so good.


The first consideration is that many IMGs typically struggle to score well on the USMLE step 1. This can be for a number of reasons, from poor support and preparation in medical school to a language barrier, and everything in between. With a strong focus on a numerical score for residencies, this puts extra pressure on IMGs. 

Now that the test is going pass/fail, this could be considered a boon for IMGs. Take Caribbean schools for example – 3 of the top 4 schools have a first time pass rate >96%, and only one has a 94% rate. Caribbean students may feel more confident knowing all they need to do is pass.


What I’m about to share may be a more significant problem. When you look at the USMLE step 1 scores for any American medical graduate (AMG) that successfully matches and compare them to their international medical graduate counterpart in any specialty, you’ll find that the IMG always has the higher score.

Why? Because residency programs are already somewhat hesitant about IMGs, but are comforted if they know they can score exceedingly well on USMLE step 1. Without that ability to showcase your talents on Step 1, many people are worried the IMGs will have an even harder time matching. Thus, all things being equal, AMGs get the “benefit of the doubt.” While I hear that concern, you also have to remember that Step 2 CK still exists. If IMGs are worried that without a numerical score to compete against AMGs, they can still do it in Step 2 CK.

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What’s the Impact of the USMLE Change to Pass/Fail?

As someone who works closely with IMGs applying to residency, I’m not worried for you guys out there!

The fact remains that IMGs are and will always be at a disadvantage when competing against AMGs. The same efforts are needed in order to be successful before and after this new decision, and that is in optimizing every other part of your application: MORE research, MORE volunteering, MORE leadership, a strong personal statement, and pristine writing for the work/activities section. Instead of pouring your energy into USMLE step 1, you can focus on those other things to build your resume.

Once you get to 3rd year, keep your head in the game while on rotations paying extra close attention to every clinical detail, and then put that practice into play by rocking Step 2 CK. These good practices will never go out of style.

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