Sparking Change: How a Shift to Step 1 Pass/Fail Scoring Could Promote the Educational and Catalytic Effects of Assessment in Medical Education

This Invited Commentary explores the implications of the upcoming shift to pass/fail scoring for the United States Medical Licensing Examination Step 1 that was announced in February 2020. Using the frameworks of validity and growth/mastery mindset, the authors describe how this change in Step 1 score reporting presents an opportunity to advance the meaningful assessment of medical students and improve the transition from undergraduate medical education (UME) to graduate medical education (GME). The authors explore the potential risks and consequences associated with a narrow implementation of pass/fail scoring. Alternatively, with a shift in scoring, educators can leverage consequential validity, particularly the educational and catalytic effects of assessment. The authors emphasize the importance of assessment that motivates learners to prepare in a fashion that benefits their learning and that provides results and feedback that motivate all stakeholders to create, enhance, and support education. The authors suggest that this use of assessment will require a culture change from fixed mindset to growth mindset among both students and educators, a shift from static to dynamic testing, and a transition to assessment that focuses on a learner's trajectory. The authors conclude by emphasizing the importance of work-based assessment and the need for improved transparency across the UME-GME continuum.