The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity

Purpose: Given the significance of the US Medical Licensing Exam (USMLE) Step 1 score moving from a 3-digit value to pass/fail, the authors investigated the impact of the change on students' anxiety, approach to learning, and curiosity.

Method: Two cohorts of pre-clerkship medical students at three medical schools completed a composite of four instruments: the State-Trait Anxiety Inventory, the revised two-factor Study Process Questionnaire, the Interest/Deprivation Type Epistemic Curiosity Scale, and the Short Grit Scale prior to taking the last 3-digit scored Step 1 in 2021 or taking the first pass/fail scored Step 1 in 2022. Responses of 3-digit and pass/fail exam takers were compared (Mann-Whitney ) and multiple regression path analysis was performed to determine the factors that significantly impacted learning strategies.

Results: There was no difference between 3-digit ( = 86) and pass/fail exam takers ( = 154) in anxiety (STA-I scores, 50 vs. 49,  = 0.85), shallow learning strategies (22 vs. 23,  = 0.84), or interest curiosity scores (median scores 15 vs. 15,  = 0.07). However, pass/fail exam takers had lower deprivation curiosity scores (median 12 vs. 11,  = 0.03) and showed a decline in deep learning strategies (30 vs. 27,  = 0.0012). Path analysis indicated the decline in deep learning strategies was due to the change in exam scoring ( = - 2.0428,  < 0.05).

Conclusions: Counter to the stated hypothesis and intentions, the initial impact of the change to pass/fail grading for USMLE Step 1 failed to reduce learner anxiety, and reduced curiosity and deep learning strategies.

Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01878-w.