How is the USMLE Step 1 Scored?

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I mentioned earlier this month that my second year med school student is studying intensely for his board exams to be taken before he starts rotations at the end of June. Test day has already arrived for fellow students, and we have heard some dejected reports. I know these students - they are incredibly smart, have studied for many long hours, and proven on practice exams that their study plans were helpful. These are students that are getting honors in classes at Western University - COMP NW. I was more than surprised to hear them say that the board exam was so hard they were sure they had failed. Besides making us nervous, it made me think that the scoring of the exam must not be simple (example of complicated: GMAT scoring algorithm).

Its not simple! The USMLE Step 1 is a test sponsored by the National Board of Medical Examiners (NBME). The board exam consists of 322 multiple choice questions taken over an 8 hour time frame. The final score is shown as a three digit number with the maximum score on the Step1 being 300. According to the sources I referenced, it is impossible to get above a 295. A passing score is around 188 (passing score changes periodically), but students typically aim high for 245. The NBME isn't clear on how the exams are scored, but from my research it is clear it is not based solely on the number of questions answered correctly. From what I read, the exams may be scored based on how you compare with other test takers' performance in the three months prior to your exam. Since each test is comprised of different questions, NBME uses "equating" in the final scoring in order to make sure score results are comparable for students across the country.

Are you confused yet? Yeah, me too! The main fact I discovered is that the exam is so difficult it is NOT uncommon for students to leave the exam feeling like they have completely bombed it. I've heard mention of double negatives and purposeful trickery in question wording. One former medical student wrote that of the seven exam sections, the anatomy section was so advanced that many currently practicing surgeons would be surprised with the content.

These facts were only a slight relief, if that, to my med student husband. It was however, immensely relieving for me! Test scores take three to four weeks to be announced, so I would rather spend that whole time temporarily relieved. Regardless, I remain positive that my med student will perform to the best of his abilities, and we will have an adventure no matter his scores. Not to mention a Man of Steel movie celebration when he's done!


Reference:
USMLE Outline of Step 1 Exam
USMLE forum discussion from 2008
National Board of Medical Examiners
USMLE Frequently Asked Questions
More recent forum discussion