The New Era of Pass/Fail USMLE Step 1: Medical Students’ Call to Action

AbstractImportanceThe factors influencing medical student clinical specialty choice have important implications for the future composition of the US physician workforce. The objective of this study was to determine the career net present values of US medical students’ clinical specialty choices and identify any relationships between a specialty’s net present value and competitiveness of admissions as measured by US Medical Licensing Examination (USMLE) Step 1 scores.MethodsNet present values were calculated by using results of the 2019 Doximity Physician Compensation report, a survey of 90,000 physicians. Mean USMLE Step 1 scores for matched US allopathic seniors in the 2018 National Resident Matching Program were used as a measure of clinical specialties’ competitiveness of admissions. We calculated a composite measure of net present value and annual work-hours by dividing each specialty’s net present value by the reported average number of hours worked per year.ResultsIn our analysis, orthopedic surgery had the highest net present value ($10,308,868), whereas family medicine had the lowest net present value ($5,274,546). Dermatology and plastic surgery had the highest mean USMLE Step 1 scores (249 for both), whereas family medicine had the lowest (220). Clinical specialties’ net present values were positively associated with mean USMLE Step 1 scores (Pearson’s r=0.82; p<.001).Conclusion and RelevanceIn this study, we describe associations suggesting that medical students choose clinical specialties as rational economic agents and that these decisions are mediated by USMLE Step 1 scores. This underscores the importance of titrating and aligning economic incentives to improve the allocation of medical students into clinical specialties

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Using Markov chain model to evaluate medical students’ trajectory on progress tests and predict USMLE step 1 scores---a retrospective cohort study in one medical school

BMC Medical Education ◽

10.1186/s12909-021-02633-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ling Wang ◽

Heather S. Laird-Fick ◽

Carol J. Parker ◽

David Solomon

Keyword(s):

Markov Chain ◽

Medical Students ◽

Medical School ◽

Markov Chain Model ◽

First Year ◽

Chain Model ◽

Progress Test ◽

Usmle Step 1 ◽

Licensing Examination ◽

Usmle Step

Abstract Background Medical students must meet curricular expectations and pass national licensing examinations to become physicians. However, no previous studies explicitly modeled stages of medical students acquiring basic science knowledge. In this study, we employed an innovative statistical model to characterize students’ growth using progress testing results over time and predict licensing examination performance. Methods All students matriculated from 2016 to 2017 in our medical school with USMLE Step 1 test scores were included in this retrospective cohort study (N = 358). Markov chain method was employed to: 1) identify latent states of acquiring scientific knowledge based on progress tests and 2) estimate students’ transition probabilities between states. The primary outcome of this study, United States Medical Licensing Examination (USMLE) Step 1 performance, were predicted based on students’ estimated probabilities in each latent state identified by Markov chain model. Results Four latent states were identified based on students’ progress test results: Novice, Advanced Beginner I, Advanced Beginner II and Competent States. At the end of the first year, students predicted to remain in the Novice state had lower mean Step 1 scores compared to those in the Competent state (209, SD = 14.8 versus 255, SD = 10.8 respectively) and had more first attempt failures (11.5% versus 0%). On regression analysis, it is found that at the end of the first year, if there was 10% higher chance staying in Novice State, Step 1 scores will be predicted 2.0 points lower (95% CI: 0.85–2.81 with P < .01); while 10% higher chance in Competent State, Step 1scores will be predicted 4.3 points higher (95% CI: 2.92–5.19 with P < .01). Similar findings were also found at the end of second year medical school. Conclusions Using the Markov chain model to analyze longitudinal progress test performance offers a flexible and effective estimation method to identify students’ transitions across latent stages for acquiring scientific knowledge. The results can help identify students who are at-risk for licensing examination failure and may benefit from targeted academic support.

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Making Much of the Mundane: A Retrospective Examination of Undergraduate Medical Students’ Completion of Routine Tasks and USMLE Step 1 Performance

Medical Science Educator ◽

10.1007/s40670-018-0552-3 ◽

2018 ◽

Vol 28 (2) ◽

pp. 351-357 ◽

Cited By ~ 1

Author(s):

Cecile M. Foshee ◽

Amy S. Nowacki ◽

Jeffrey T. Shivak ◽

S. Beth Bierer

Keyword(s):

Medical Students ◽

Undergraduate Medical Students ◽

Routine Tasks ◽

Usmle Step 1 ◽

Usmle Step ◽

Retrospective Examination ◽

Usmle Step 1 Performance

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Objective predictors of intern performance

BMC Medical Education ◽

10.1186/s12909-021-02487-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amanda C. Filiberto ◽

Lou Ann Cooper ◽

Tyler J. Loftus ◽

Sonja S. Samant ◽

George A. Sarosi ◽

...

Keyword(s):

Medical Students ◽

Medical School ◽

Core Competencies ◽

Cohort Analysis ◽

The United States ◽

Grade Point ◽

Class Rank ◽

Residency Programs ◽

Usmle Step 1 ◽

Usmle Step

Abstract Background Residency programs select medical students for interviews and employment using metrics such as the United States Medical Licensing Examination (USMLE) scores, grade-point average (GPA), and class rank/quartile. It is unclear whether these metrics predict performance as an intern. This study tested the hypothesis that performance on these metrics would predict intern performance. Methods This single institution, retrospective cohort analysis included 244 graduates from four classes (2015–2018) who completed an Accreditation Council for Graduate Medical Education (ACGME) certified internship and were evaluated by program directors (PDs) at the end of the year. PDs provided a global assessment rating and ratings addressing ACGME competencies (response rate = 47%) with five response options: excellent = 5, very good = 4, acceptable = 3, marginal = 2, unacceptable = 1. PDs also classified interns as outstanding = 4, above average = 3, average = 2, and below average = 1 relative to other interns from the same residency program. Mean USMLE scores (Step 1 and Step 2CK), third-year GPA, class rank, and core competency ratings were compared using Welch’s ANOVA and follow-up pairwise t-tests. Results Better performance on PD evaluations at the end of intern year was associated with higher USMLE Step 1 (p = 0.006), Step 2CK (p = 0.030), medical school GPA (p = 0.020) and class rank (p = 0.016). Interns rated as average had lower USMLE scores, GPA, and class rank than those rated as above average or outstanding; there were no significant differences between above average and outstanding interns. Higher rating in each of the ACGME core competencies was associated with better intern performance (p < 0.01). Conclusions Better performance as an intern was associated with higher USMLE scores, medical school GPA and class rank. When USMLE Step 1 reporting changes from numeric scores to pass/fail, residency programs can use other metrics to select medical students for interviews and employment.

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The relationship between second-year medical students' OSCE scores and USMLE Step 1 scores

Medical Teacher ◽

10.1080/0142159021000012586 ◽

2002 ◽

Vol 24 (5) ◽

pp. 535-539 ◽

Cited By ~ 27

Author(s):

Steven R. Simon ◽

Kevin Volkan ◽

Claus Hamann ◽

Carol Duffey ◽

Suzanne W. Fletcher

Keyword(s):

Medical Students ◽

Usmle Step 1 ◽

Usmle Step ◽

Second Year ◽

The Relationship

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Retention of Biomedical Knowledge in Medical Students Predicts USMLE Step 1 Scores

MedEdPublish ◽

10.15694/mep.2021.000070.1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Anna Blenda ◽

Renee Chosed ◽

Carrie Bailes ◽

Mary Caldwell ◽

Matthew Tucker

Keyword(s):

Medical Students ◽

Biomedical Knowledge ◽

Usmle Step 1 ◽

Usmle Step

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The WRITE Stuff: A Rural Longitudinal Integrated Clerkship Addresses Workforce Needs

Journal of Regional Medical Campuses ◽

10.24926/jrmc.v2i5.2103 ◽

2019 ◽

Vol 2 (5) ◽

Author(s):

Misbah Keen ◽

Danielle Bienz ◽

Toby Keys ◽

Douglas Schaad ◽

David Evans

Keyword(s):

Primary Care ◽

Medical Students ◽

Family Medicine ◽

Medical School ◽

First Year ◽

Key Word ◽

Usmle Step 1 ◽

Longitudinal Integrated Clerkship ◽

Usmle Step ◽

Workforce Needs

Introduction: The University of Washington School of Medicine has six campuses in the five state WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. The WRITE (WWAMI Rural Integrated Training Experience) program is a 22 to 24 week long rural longitudinal integrated clerkship experience offered to medical students in their clinical phase (third year) of training. This program seeks to meet the rural workforce needs of the WWAMI region by increasing the number of medical students going into primary care. Critics of LIC’s have expressed concern about overall quality control of the more remote educational experience and the lack of specialty specific teaching. The aim of this study was to compare medical school and PGY-1 performance of WRITE and Non-WRITE students while determining how well each cohort is meeting the regional workforce needs. Methods: The study group was all UWSOM students who matriculated from 2009 to 2013, advanced to graduation, and subsequently matched to a residency through the National Residency Match Program. WRITE and non-WRITE cohorts were compared for USMLE step 1 and 2 scores, MSPE (Medical Student Performance Evaluation) key word, and self and program director assessments in the first year of residency. The match results of the two cohorts were also compared to determine the proportions entering primary care residencies. Finally, for both cohorts the specialty choice at matriculation was compared with the match results. Descriptive statistics were used to test the comparisons. Results: The medical school performance of the WRITE and Non-WRITE cohorts was equivalent in all metrics (USMLE Step 1 and 2, MSPE key word, self and program director assessment of performance in the first year of residency). WRITE students were significantly more likely to match into primary care (67.6% vs 48.3%, p<0.001) overall and, in particular, Family Medicine as their specialty (40% vs 14.3%, p<0.001). WRITE students were also more likely to match into the same specialty that they indicated on the UWSOM matriculation survey. For Family Medicine the loss of fidelity between matriculation and match among WRITE students was 3% (43.4 - 40.4) and among Non-WRITE students, it was 6.3% (20.6 - 14.3). Conclusions: Performance outcomes of the WRITE program are equivalent to a traditional block curriculum. However, the WRITE cohort is significantly more likely to go into primary care fields, especially family medicine and is more likely to stay with the declared specialty at matriculation. Medical schools that seek to increase the number of students going into primary care may benefit from adopting a similar model.

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Relationship between students’ perceptions of the adequacy of M1 and M2 curricula and their performance on USMLE step 1 examination

BMC Medical Education ◽

10.1186/s12909-019-1796-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Mohammed K. Khalil ◽

William S. Wright ◽

Kelsey A. Spearman ◽

Amber C. Gaspard

Keyword(s):

Medical Students ◽

Continuous Evaluation ◽

Organ Systems ◽

Medical Licensing ◽

Apparent Relationship ◽

Usmle Step 1 ◽

Usmle Step ◽

Preclinical Curriculum ◽

Insight Into ◽

Important Milestone

Abstract Background Performance on United States Medical Licensing Exam® (USMLE®) Step 1 examination (Step 1) is an important milestone for medical students. It is necessary for their graduation, and selection to interview for the National Resident Match Program®. Success on Step 1 examination requires content alignment, and continuous evaluation and improvement of preclinical curriculum. The purpose of this research was to observe the association between students’ perceptions of deficits in the curriculum based on core disciplines and organ systems in relation to students’ performance in those disciplines and systems on USMLE® Step 1 examination. Methods An anonymous survey with closed-ended and open-ended questions was sent to 174 medical students, the class of 2018 (77), and 2019 (97) within 2–3 weeks of taking Step 1 examination. Students’ feedback as well as students’ performance on Step 1 examination were organized into disciplines and organ systems to allow for more specific curriculum analyses. The closed-ended questions provide three selections (yes, no and not sure) regarding students’ agreement to the adequacy of M1 and M2 curricula to prepare students for Step 1 examination. Students’ responses on the closed-ended questions were reviewed in conjunction with their Step 1 performance. The open-ended feedback was qualitatively analyzed for emergent themes or similarity with closed-ended questions in identifying any shortcoming of the curriculum. Results The data show an apparent relationship between students’ evaluations and students’ performance on Step 1 examinations. A high percentage of students’ disagreement of the curriculum adequacy was also reflected in a lower performance on Step 1 examination. Additionally, the themes that emerged from the qualitative analysis have confirmed the areas of curricular deficiency. Conclusion The data collected from this research provides insight into the degree of usefulness of students’ evaluations as a way of assessing curriculum deficits in preparing students for their Step 1 examination.

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Study of Selected Outcomes of Medical Students Who Fail USMLE Step 1

Medical Education Online ◽

10.3402/meo.v11i.4589 ◽

2006 ◽

Vol 11 (1) ◽

pp. 4589 ◽

Cited By ~ 3

Author(s):

Diane M. Biskobing ◽

Sonya R. Lawson ◽

James M. Messmer ◽

J. Dennis Hoban

Keyword(s):

Medical Students ◽

Usmle Step 1 ◽

Usmle Step

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