The Step 1 Pass Rate is Dropping – Let’s Talk About It

If you’ve been keeping up, you might have noticed a troubling trend: the pass rate keeps dropping. And now, as of January 24, 2025, we’re officially below 90% for first-time MD test-takers.

Let me break it down:

2019: 96%
2020: 97%
2021: 95%
2022: 91%
2023: 90%
2024 (so far, up to Jan 24, 2025): 89%

That’s a consistent downward trend. And if first-time MD students—the group that traditionally performs the best—are now below 90%, what does that mean for everyone else?

If you’re a DO student, IMG, repeat test-taker, or from an underrepresented background, this trend matters. Fewer students passing Step 1 means fewer people moving on to clinical years, fewer students graduating, and ultimately, fewer physicians.

Why Is This Happening?

If you’ve taken Step 1 recently, you probably noticed a disconnect between how we prepare for the exam and what actually shows up on test day.

The exam is shifting toward more clinical reasoning, but most prep resources were built around an older, knowledge-based version of the test.
By the time new study materials catch up, the exam will have changed again—widening the gap between preparation and reality.
We’re essentially watching, in real time, how the system is leaving students behind.

I talk about this a lot in Step 1000, my study guide based on my own struggles with Step 1. I failed this test once. Then I failed it again. And I had to completely rethink my approach just to get through it. I don’t want anyone else to go through that same experience if it can be avoided.

Is This a Step in the Right Direction?

This shift to a pass/fail system was supposed to relieve stress and make Step 1 less of a high-stakes ordeal. But if fewer people are passing, we have to ask:

Is the exam getting harder?
Are resources outdated?
Are test-takers not adapting fast enough?

And most importantly: What can we do as a community to bridge this gap?

Where Do We Go from Here?

I started Step 1000 to help fill in these gaps—not just as someone who’s researching medical education for my PhD, but as someone who’s lived through this process and knows how brutal it can be.

I’ve built an adaptive study system that focuses on efficiency and sustainability, not just endless memorization.
I’ve analyzed real data from practice exams, UWorld, and NBME forms to make sense of what’s actually tested.
And I’ve developed Crib Sheets and Clinical Clues, tools designed to help students recognize high-yield patterns without wasting time on low-yield fluff.

If we don’t start thinking critically about these changes, more people will fail. And when that happens, it disproportionately affects people who are already struggling in medical education—students of color, IMGs, and those from under-resourced backgrounds.

Let’s Talk About It

I want to open this up for discussion. If you’ve taken Step 1 recently, did you feel the shift?

Were your study materials aligned with what was on the test?
Did the exam feel different than what you expected?
What worked for you, and what didn’t?

If we want to fix this, we need to share what’s actually happening—not just rely on outdated study methods that clearly aren’t keeping up.

Let me know what you think. And if you’re struggling with Step 1 prep, check out Step 1000—it’s a quirky but relevant survival guide designed to help you navigate this evolving mess of an exam.

Until next time, Protect ya neck!

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