| Year | Overall | US/CAN MD | US/CAN DO | Non-US IMG | US IMG |
|---|---|---|---|---|---|
| 2024 | 88% | 93% | 86% | 71% | 78% |
| 2023 | 89% | 94% | 87% | 71% | 78% |
| 2022 | 89% | 94% | 87% | 72% | 79% |
| 2021 | 91% | 96% | 91% | 75% | 82% |
| 2020 | 88% | 93% | 87% | 71% | 78% |
| 2019 | 88% | 94% | 88% | 73% | 79% |
| 2018 | 87% | 93% | 87% | 72% | 79% |
| 2017 | 88% | 94% | 88% | 73% | 79% |
| 2016 | 88% | 94% | 87% | 73% | 78% |
| 2015 | 87% | 93% | 87% | 72% | 78% |
Data sourced from NBME annual performance data summaries. Percentages represent first-time taker pass rates for each academic year cohort.
Why Step 1 Pass Rates Matter (Especially for IMGs)
Since USMLE Step 1 became Pass/Fail for US allopathic students in 2022, its role has changed dramatically. US MD students no longer receive a numeric score — only Pass or Fail — making the pass rate the primary metric tracked. For DO students taking the exam (who still need scores for some programs), and especially for International Medical Graduates (IMGs), Step 1 score and pass rate remain competitive differentiators in residency matching. NRMP data consistently shows that program directors still weigh Step 1 pass rates as a screening criterion, particularly at competitive specialties.
What the IMG Pass Rate Gap Means
The roughly 22-percentage-point gap between US MD (93%) and non-US IMG (71%) first-attempt pass rates reflects preparation differences, not intelligence. The top factors: English language proficiency for non-native speakers, access to high-quality question banks and tutoring resources, and the gap between the US-focused biomedical exam content and curricula in other countries. The good news: IMGs who pass on first attempt and achieve scores above 240 (when scores were reported) match at rates comparable to US DO graduates in many specialties.
Step 1 Trends Since the Pass/Fail Transition
The 2022 shift to Pass/Fail had an immediate effect: US MD students now treat Step 1 as a hurdle rather than a differentiator, and Step 2 CK scores have become the primary numeric marker for residency applications. This has NOT reduced the pressure on IMGs to perform well — if anything, a high Step 2 CK score is now more important for distinguishing IMG applicants. For DO students, Step 1 pass rates remained stable post-transition.
How to Use This Data for Your Prep Strategy
If you are a US MD student: aim to pass on the first attempt, ideally with buffer. Failed attempts are now disclosed to programs even without a numeric score. If you are a DO or IMG student: treat Step 1 as a scored exam even though US MD results are P/F — your score matters for residency competitiveness. Use UWorld completion rate and percent-correct benchmarks: aim for 60%+ correct on first pass, 70%+ on second pass before your actual exam date.
Frequently Asked Questions
What is the average USMLE Step 1 pass rate?
The overall first-time USMLE Step 1 pass rate is approximately 88–89% across all examinees. US MD students pass at ~93%, US DO students at ~86%, and non-US IMGs at ~71%. These rates have been relatively stable over the past decade, with a slight uptick during 2021 (COVID cohort) that has since normalized.
Is it harder to pass Step 1 as an IMG?
Yes — non-US IMG students have a first-attempt pass rate approximately 22 percentage points lower than US MD students (71% vs 93%). The primary contributors are: (1) exposure to US-specific biomedical exam format, (2) access to expensive but highly effective resources like UWorld, and (3) English academic writing proficiency for non-native speakers. With the right resources and preparation, IMGs can absolutely achieve competitive scores.
Does failing Step 1 end your residency chances?
Not necessarily, but it creates a significant headwind. Failed attempts are disclosed to residency programs in the pass/fail era. However, a failed attempt followed by a strong pass — especially paired with strong Step 2 CK scores, research, and letters of recommendation — can still lead to competitive matches, particularly in less competitive specialties. The key is demonstrating the failure as an isolated event, not a pattern.
What Step 1 score is competitive for residency?
Since Step 1 became Pass/Fail for US MD students in 2022, 'competitive' now primarily refers to DO and IMG applicants who still receive numeric scores. Historically, 240+ was considered strong for competitive specialties; 230+ was adequate for most programs. Given the pass/fail transition, Step 2 CK has become the primary numeric discriminator, and scores above 250 are now considered very competitive across most specialties.
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