Predictors of Performance on USMLE Step 1

Abstract

Background

94% of program directors cited the USMLE Step 1 score as the most important factor in determining an applicant’s competitiveness for residency. Thus, medical students are motivated to attain the highest possible score. With the recent announcement of Step 1 switching to a pass/fail standard, it is important to analyze factors which predict meeting this goal.

Objective

To investigate the factors which can influence or predict performance on USMLE Step 1.

Methods

We conducted a systematic literature search on PubMed, Web of Science, Scopus and ERIC in 2019. The key words were “USMLE”, “Step-1”, “score”, “success” and “predictors.” The search included articles published between 2005 and 2019.  Studies that did not focus on Step 1 outcome or allopathic medical students in the United States were excluded.

Results

275 articles were found, 29 of which met our inclusion criteria. Analysis from these articles demonstrated that predictors of USMLE Step 1 score can be divided into unmodifiable and modifiable factors. Unmodifiable factors include gender, MCAT score, pre-clinical grades and NBME/CBSE scores. Modifiable factors include taking USMLE Step 1 within two months of completing pre-clinical courses, motivation from anxiety, multiple-choice questions completed, unique Anki cards seen and complete passes of First Aid for the USMLE Step 1.

Conclusion

Our review suggests that although students can focus on modifiable factors to increase their score, the energy expenditure required to increase Step 1 score by one point is unrealistic. This may have impacted the NBME’s decision to change Step 1 to a pass/fail exam.