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force of its own weight? And perhaps most importantly, what are we gonna do once three-digit scores go away? This is a virtual Grand Rounds presentation that I did for another institution in August 2020. I changed the initial slide, but the rest of it is exactly what they got. NOTES PROLOGUE (0:16) Announcement of the USMLE Step 1 Pass/Fail decision CHAPTER 1: In the beginning... (1:38) The formation (and original goal) of the National Board of Medical Examiners CHAPTER 2: Evolution of the NBME Exam (3:47) Traces the history of the NBME’s licensure exams, from 1916 to 1991, and the decisions and forces that shaped the exam’s format CHAPTER 3: 1992 (13:21) Three critical events occurred in 1992 that set in motion the events of the coming decades: the first administration of the USMLE Step 1 exam; the plans for an Electronic Residency Application System (ERAS); and a decrease in the relative number of residency positions available for applicants CHAPTER 4: Application Fever (16:53) The drivers - and consequences - of residency application inflation CHAPTER 5: Step 1 Mania (22:03) The costs and consequences of our over-reliance on Step 1 scores in residency selection, leading up to the pass/fail decision CHAPTER 6: The future (46:26) How do we turn pass/fail into a net positive for residency selection? It’s not by using Step 2 CK. To move forward, we have to have a shared vision of reality; acknowledge that numbers alone will mislead us; embrace holistic review; advocate for application reform; and demand meaningful evaluation