Impact of USMLE Step 1 Transition to Pass/Fail Scoring System on Medical Students' Anxiety, Sleep Quality, and Burnout


  • Lana AlDoori B.S., Second-year Medical Student. Drexel University College of Medicine, Reading, PA, United Sates.
  • Peter G. Zaki B.S., Third-year Medical Student. Drexel University College of Medicine, Reading, PA, United States.
  • Vivek Joshi MD, MBBS, FAGE. Drexel University College of Medicine, Reading, PA, United States.



Medical Education, Medical Student, Medicine


BACKGROUND: Originally designed to evaluate the application of foundational scientific knowledge in clinical contexts, the United States Medical License Exam Step 1 evolved into a comparative tool for assessing candidates' educational foundations. This transition heightened the pressure on medical students to excel in the exam. In response, collaborative efforts involving the National Board of Medical Examiners prompted a significant change from reporting scores to a pass/fail system. However, the true impact of this shift remains insufficiently explored. This study aims to assess the emotional toll - encompassing burnout, anxiety, depression, and sleep quality - experienced prior to taking the Step 1 exam. Additionally, it aims to uncover potential gender-based disparities in perceived stress, anxiety, and depression.

METHODS: The study encompasses the entirety of third-year medical students at Drexel University College of Medicine, who were invited to participate in a comprehensive survey. Drawing from retrospection, the survey relies on self-reported data regarding anxiety, depression, sleep quality index, and burnout levels. Data compilation was anonymized and executed through the Qualtrics platform.

RESULTS: A total of 102 medical students completed the survey, with a 97% pass rate for the USMLE Step 1. Despite their excellent performance, 75% of students reported inadequate sleep quality, and 68% exhibited mild to moderate anxiety levels. Among them, a higher percentage of females (83%) experienced mild to moderate anxiety compared to their male counterparts (50%). Furthermore, 66% of students felt that their commitment to education exceeded what was reasonable for their well-being.

CONCLUSION: The transition from traditional scoring to a pass/fail system was ostensibly intended to enhance the mental well-being of medical students. Nevertheless, our findings underscore that students continue to grapple with heightened levels of stress, anxiety, and burnout during the pivotal month leading up to the Step 1 examination.


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How to Cite

AlDoori, L., Zaki, P. G., & Joshi, V. (2023). Impact of USMLE Step 1 Transition to Pass/Fail Scoring System on Medical Students’ Anxiety, Sleep Quality, and Burnout. International Journal of Medical Students, 11, S116.



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