Name: 史詩級的「過關/未過關」決定，讓一切都變得更糟了！(證據在此) (Step 1 Pass/Fail Made Everything Worse (Here's Proof))
Uploaded: 2026-03-07T17:45:05.000Z
Duration: 13 min 30 s

For decades, step one was the single most dreaded exam in all of medical education.

幾十年來，Step one 都是醫學教育中最令人聞風喪膽的考試。

For many students, preparation started nearly a year in advance.

對很多學生來說，準備幾乎要提前一年開始。

Months of steady buildup that eventually culminate in two to three months of intense full time studying 12 hours a day, six days a week.

持續數月的扎實累積，最終濃縮成每週六天、每天 12 小時的密集全職準備，長達兩到三個月。

Your future compressed into a three digit number.

你的未來被壓縮成一個三位數的分數。

Burnout was rampant, and the calls for change grew louder and Louder.

過勞情況普遍，要求改變的呼聲也越來越大。

The announcement sparked an immediate and heated debate.

這個消息立刻引發了一場熱烈的辯論。

Online medical forums erupted, Twitter threads multiplied.

網路上的醫學論壇炸開了，Twitter 討論串也越來越多。

Students, residents and physicians argued that making step one pass fail would finally address burnout, improve mental health, and

學生、住院醫師和執業醫師都認為，將 Step one 改為通過/不通過制，最終能解決倦怠問題、改善心理健康，並

Deans and institutions echoed similar hopes.

系主任和各個機構也表達了類似的期望。

Students exhaled for the first time in years.

學生們終於鬆了一口氣，這是他們多年來第一次。

Except there were a few voices, ours included, saying, hold on, you're confusing the symptom with the cause.

除了我們幾個，也有一些聲音說，等等，你們把症狀和病因搞混了。

It was a thermometer measuring a much deeper problem.

它只是個溫度計，測量出一個更深層次的問題。

And removing the thermometer doesn't cure the fever.

And it tells a very different story than the one everyone expected.

這講述了一個與大家預期截然不同的故事。

So Was turning step one pass fail a mistake?

所以，把 Step one 改成通過/不通過制是個錯誤嗎？

Jubbal Medschoolinsiders.com to understand how this went wrong, you need to understand what step one actually did before it went past fail in 2022, step one was a single high stakes exam taken between second and third year.

Medschoolinsiders.com 想要了解事情為何會出錯，你得先了解 Step one 在 2022 年改成通過/不通過制之前，到底做了什麼。Step one 是一場在高風險的單一考試，在二年級和三年級之間進行。

It tested foundational medical knowledge, but more importantly, it functioned as a sorting tool.

它測試了醫學的基礎知識，但更重要的是，它扮演了篩選工具的角色。

A higher step one score shaped which specialties you could realistically pursue, which programs would consider your application, and

更高的 Step one 成績決定了你實際能追求哪些專科、哪些計畫會考慮你的申請，以及

how early you could gauge your own competitiveness.

你能在多早評估自己的競爭力。

For better or worse, you knew where you stood.

無論好壞，你都知道自己的位置。

Residency programs face overwhelming application volume.

醫學院的住院醫師計畫面臨著龐大的申請量。

They need fast, standardized filters just to function.

他們需要快速、標準化的篩選機制才能運作。

Step one filled that role for decades when critics argued that too much weight was being placed on a single test.

幾十年來，Step one 一直扮演這個角色，當時有人批評說，太過重視單一考試了。

The logic behind pass fail seemed straightforward.

採用通過/不通過制的邏輯似乎很簡單。

Remove numeric scores and reduce pressure.

But as we argued, when the pass fail change was announced, the pressure wouldn't disappear.

但正如我們所說，當通過/不通過制的變革宣佈時，壓力並不會消失。

The intention behind pass fail was to reduce stress.

採用通過/不通過制的初衷是為了減輕壓力。

但這場辯論卻忽略了一個更大的問題。

What happens to the rest of the system when you remove one of its primary filters?

當你移除一個主要的篩選機制時，整個系統會發生什麼事？

You can actually check out those videos and articles from back in 2020, linked in the description.

你可以看看 2020 年的那些影片和文章，連結在說明欄。

Making step one pass fail didn't change the stakes or how competitive programs are.

讓 Step one 採用通過/不通過制，並沒有改變競爭的利害關係或各項目的競爭激烈程度。

它們把你的備用分數給丟掉了。

Mess up step one in the past, you could make real improvement on step two.

以前 Step one 搞砸了，你還可以在 Step two 上取得實質的進步。

CK Mess up Step two ck, now that's your only shot.

Step two CK 搞砸了，現在就只剩下這一次機會了。

Pass rates dropped by about 5 to 7 percentage points, with a larger decline among D.O. students.

通過率大約下降了 5 到 7 個百分點，其中 D.O. 學生下降的幅度更大。

Before pass fail, U.S. mD students had pass rates around 95 to 97%.

在採用通過/不通過制之前，美國 MD 學生通過率大約是 95% 到 97%。

By 2023 and 2024, that dropped to roughly 89 to 91%.

到 2023 年和 2024 年，這個數字下降到大約 89% 到 91%。

That means about 1 in 10 MD students now fail step one, compared to roughly 1 in 20 before.

這表示現在大約有十分之一的 MD 學生 Step one 不通過，而以前大約是二十分之一。

For D.O. students, the decline was steeper.

Pass rates fell from the low 90s into the mid to high 80s, a drop of about 6 to 8 percentage points.

通過率從 90% 初掉到 80% 中高，大約下降了 6 到 8 個百分點。

When an exam feels less impactful, preparation becomes more variable.

當考試感覺沒那麼重要時，準備的程度就會變得比較不一致。

So some students still over prepare, others pull back, and

所以有些學生還是會過度準備，有些則會放鬆，

that variability increases the risk of failure at the margins.

而這種不確定性增加了邊緣學生的失敗風險。

Removing the incentive to excel also removed the buffer against failing.

拿掉追求卓越的誘因，也拿掉了不通過的緩衝。

And there's another factor most students don't consider.

還有一個大多數學生沒考慮到的因素。

On the exact Same day step one went pass fail, the USMLE raised the minimum passing score from 194 to 196.

在 Step one 實施通過/不通過制的那天，USMLE 就把最低通過分數從 194 提高到 196。

So students were preparing less intensely for an exam that had actually become harder to pass.

所以學生們準備考試反而沒那麼認真，但其實考試變難了。

準備變少，門檻卻提高了，而且是同一天。

But what's worse is that the stress didn't disappear.

但更糟的是，壓力並沒有消失。

Recent studies of students approaching Step one in the pass fail era still show high levels of anxiety and poor sleep.

最近針對進入通過/不通過制時代 Step one 的學生研究顯示，他們仍然有高度焦慮和睡眠品質差的問題。

Even without a numeric score, step 1 remains a major psychological stressor.

即使沒有數字成績，Step 1 仍然是主要的心理壓力來源。

So the experience didn't become calm or low pressure.

所以考試經驗並沒有變得平靜或低壓力。

Step 2 CK has become the primary numeric test score differentiator in residency selection.

Step 2 CK 已經成為住院醫師選拔中，主要的數字成績差異化指標。

Scores didn't suddenly rise faster after 2022.

2022 年之後，分數並沒有突然上升得更快。

What changed is how heavily programs depended on them.

改變的是各科系對成績的依賴程度。

The timing of Step two didn't change either.

Step two CK is still taken after your third year clinical rotations, usually with a short, dedicated study period.

Step two CK 通常是在你第三年臨床輪訓結束後考，通常會有一個短暫的專心準備期。

But that means much of your studying is overlapping with long work hours, evaluations, and residency applications.

但這意味著你的大部分準備時間，會跟長時間工作、評估和住院醫師申請重疊。

That concentrates more pressure into a single exam.

這將更多的壓力集中在一次考試上。

During one of the busiest periods of medical school, when Step one became pass fail, many students reallocated their time.

在醫學院最忙碌的時期之一，當 Step one 改成通過/不通過制時，許多學生重新分配了時間。

Some pulled back on Step one prep and spent more time on research and extracurriculars.

有些學生減少了 Step one 的準備，花更多時間在研究和課外活動上。

For some students, that shift meant less consistent Step one preparation, increasing the risk of failing.

對某些學生來說，這個轉變意味著 Step one 的準備不那麼穩定，增加了不及格的風險。

Meanwhile, residency programs didn't stop needing filters.

同時，住院醫師申請項目並沒有停止篩選的需求。

They still have to sift through thousands of applications.

他們還是得從成千上萬的申請中篩選。

Removing one numeric metric didn't eliminate the need for sorting.

移除一個數字指標，並沒有消除篩選的需求。

It meant programs leaned more heavily on the remaining ones.

這意味著項目更傾向於依賴剩下的指標。

Now there's more pressure on a single exam with no backup test to offset a weak Step two performance.

現在，單一考試的壓力更大了，沒有額外的考試來彌補 Step two 表現不佳。

This translates into fewer opportunities to recover and more downstream consequences from a single bad outcome.

這意味著補救的機會更少，單一糟糕結果的後續影響更大。

Knowing what matters isn't the same as knowing how to prepare for it.

知道什麼重要，不等於知道如何為它做準備。

Many students hit a plateau, let's say 2 32, 35, 245 grinding through more and more practice questions and content review, hoping their score will eventually climb.

許多學生遇到了瓶頸，假設是 232、35、245，不斷地刷更多練習題和複習內容，希望能讓分數最終爬升。

When Step one was still numerically scored, most students didn't spend months studying for Step two.

以前 Step one 還有分數的時候，大部分學生不會花好幾個月準備 Step two。

CK dedicated periods were often only a few weeks long.

I studied for three and a half weeks and scored a 269.

我準備了三個半星期，考了 269 分。

Students today are spending multiple months and not hitting that number.

但現在的學生花了好幾個月，分數卻沒有提升。

The difference isn't intelligence or effort.

It comes down to three pillars that most people don't fully understand content knowledge, study strategies, and

關鍵在於三個大多數人不太懂的支柱：內容知識、學習策略，以及

I'm breaking these down in detail over on the Med School Insiders Blueprint Channel where we dig into the strategies that actually move the needle based on our experience helping over 10,000 students succeed.

我會在 Med School Insiders Blueprint Channel 頻道裡詳細解析這些，我們結合了幫助超過 10,000 名學生成功的經驗，深入探討那些真正能帶來改變的策略。

Link in the description but here's the short version.

連結在說明裡，但這是簡短版本。