Reply to the Letter to the Editor: CORR® Curriculum-Orthopaedic Education: Changing USMLE Step 1 Scores to Pass/Fail Removes an Objective Measure of Medical Knowledge

Abstract Background Nearly all U.S. medical students engage in a 4–8 week period of intense preparation for their first-level licensure exams, termed a “dedicated preparation period” (DPP). It is widely assumed that student well-being is harmed during DPPs, but evidence is limited. This study characterized students’ physical, intellectual, emotional, and social well-being during DPPs. Methods This was a cross-sectional survey sent electronically to all second-year students at four U.S. medical schools after each school’s respective DPP for USMLE Step 1 or COMLEX Level 1 in 2019. Survey items assessed DPP characteristics, cost of resources, and perceived financial strain as predictors for 18 outcomes measured by items with Likert-type response options. Open-ended responses on DPPs’ influence underwent thematic analysis. Results A total of 314/750 (42%) students completed surveys. DPPs lasted a median of 7 weeks (IQR 6–8 weeks), and students spent 70 h/week (IQR 56–80 h/week) studying. A total of 62 (20%) reported experiencing a significant life event that impacted their ability to study during their DPPs. Most reported 2 outcomes improved: medical knowledge base (95%) and confidence in ability to care for patients (56%). Most reported 9 outcomes worsened, including overall quality of life (72%), feeling burned out (77%), and personal anxiety (81%). A total of 25% reported paying for preparation materials strained their finances. Greater perceived financial strain was associated with worsening 11 outcomes, with reported amount spent associated with worsening 2 outcomes. Themes from student descriptions of how DPPs for first-level exams influenced them included (1) opportunity for synthesis of medical knowledge, (2) exercise of endurance and self-discipline required for professional practice, (3) dissonance among exam preparation resource content, formal curriculum, and professional values, (4) isolation, deprivation, and anguish from competing for the highest possible score, and (5) effects on well-being after DPPs. Conclusions DPPs are currently experienced by many students as a period of personal and social deprivation, which may be worsened by perceived financial stress more than the amount of money they spend on preparation materials. DPPs should be considered as a target for reform as medical educators attempt to prevent student suffering and enhance their well-being.

Download Full-text

Objective Strategies and Recommendations in the Era of the Binary USMLE Step 1 Score

Journal of Surgical Research ◽

10.1016/j.jss.2021.03.029 ◽

2021 ◽

Vol 265 ◽

pp. 11-12

Author(s):

Zain Aryanpour ◽

Shivani Ananthasekar ◽

Carter J. Boyd

Keyword(s):

Usmle Step 1 ◽

Usmle Step

Download Full-text

Fourth-Year Medical School Course Load and Success as a Medical Intern

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00043.1 ◽

2017 ◽

Vol 9 (1) ◽

pp. 58-63 ◽

Cited By ~ 6

Author(s):

Christopher J. Richards ◽

Kenneth J. Mukamal ◽

Nikki DeMelo ◽

C. Christopher Smith

Keyword(s):

Medical School ◽

Medical Knowledge ◽

Intensive Courses ◽

Course Work ◽

Increased Risk ◽

Medical Licensing ◽

Course Load ◽

Usmle Step 1 ◽

Intensive Course

ABSTRACT Background The fourth year of medical school has come under recent scrutiny for its lack of structure, cost- and time-effectiveness, and quality of education it provides. Some have advocated for increasing clinical burden in the fourth year, while others have suggested it be abolished. Objective To assess the relationship between fourth-year course load and success during internship. Methods We reviewed transcripts of 78 internal medicine interns from 2011–2013 and compared the number of intensive courses (defined as subinternships, intensive care, surgical clerkships, and emergency medicine rotations) with multi-source performance evaluations from the internship. We assessed relative risk (RR) and 95% confidence interval (CI) of achieving excellent scores according to the number of intensive courses taken, using generalized estimating equations, adjusting for demographics, US Medical Licensing Examination (USMLE) Step 1 board scores, and other measures of medical school performance. Results For each additional intensive course taken, the RR of obtaining an excellent score per intensive course was 1.05 (95% CI 1.03–1.07, P < .001), whereas the RR per nonintensive course taken was 0.99 (95% CI 0.98–1.00, P = .03). An association of intensive course work with increased risk of excellent performance was seen across multiple clinical competencies, including medical knowledge (RR 1.08, 95% CI 1.04–1.11); patient care (RR 1.07, 95% CI 1.04–1.10); and practice-based learning (RR 1.05, 95% CI 1.03–1.09). Conclusions For this single institution's cohort of medical interns, increased exposure to intensive course work during the fourth year of medical school was associated with better clinical evaluations during internship.

Download Full-text

Racial Bias in Using USMLE Step 1 Scores to Grant Internal Medicine Residency Interviews

Academic Medicine ◽

10.1097/00001888-200112000-00021 ◽

2001 ◽

Vol 76 (12) ◽

pp. 1253-1256 ◽

Cited By ~ 54

Author(s):

Michael B. Edmond ◽

Jennifer L. Deschenes ◽

Maia Eckler ◽

Richard P. Wenzel

Keyword(s):

Internal Medicine ◽

Racial Bias ◽

Internal Medicine Residency ◽

Usmle Step 1 ◽

Usmle Step

Download Full-text

The Fellowship Competitiveness Index: A Novel Way to Estimate Admission Competition into Internal Medicine Subspecialties

10.21203/rs.2.10863/v1 ◽

2019 ◽

Author(s):

Huynh Wynn Tran ◽

Russell W. De Jong ◽

Quinto Gesiotto

Keyword(s):

Internal Medicine ◽

Infectious Disease ◽

Critical Care ◽

Valid Measure ◽

Medical Graduates ◽

Multiple Factors ◽

Physician Compensation ◽

Salary Increase ◽

Usmle Step 1 ◽

Usmle Step

Abstract Background The competitiveness of internal medicine (IM) fellowships have not been well studied. Our novel competitiveness metric aims to estimate IM subspecialty fellowships entry competitiveness in a single, concise number that is easily accessible and understandable. Through this we hope to offer assistance to prospective fellowship applicants in making an educated and realistic fellowship choice. Methods Fellowship filled percentages, the percentage of applications from US medical graduates (USMGs), average matriculating USMLE Step 1 scores, and average post-fellowship salary were used to construct our metric. Procedural specialties included cardiology, pulmonary/critical care, and gastroenterology. Non-procedural specialties included hematology/oncology, rheumatology, endocrinology, infectious disease, and nephrology. Data were gathered from the National Resident Matching Program (NRMP) 2009 - 2018 reports, Medscape’s Physician Compensation Reports, and other sources used to corroborate salaries. Results 2018 procedural FCI (25.92) was higher than non-procedural (15.61). Cardiology (FCI 28.72, salary $423,000, Step 1 237.67) was the most competitive field. Hematology/oncology leads non-procedural fields in FCI (28.02), USMG percentage (60%), and salary ($363,000). Nephrology fill rates have declined from 94.8% to 60.1% despite 32% salary increase, giving it the lowest FCI (7.04). Conclusions Calculations show procedural specialties are most competitive, with cardiology at the top. Hematology/oncology leads non-procedural fields and is approaching procedural competitiveness, as evidenced by multiple factors that rival or surpass gastroenterology and pulmonary/critical care. We believe that this metric is a simple, accessible, and valid measure of competitiveness of fellowship entry and with further manipulation can be generalized to residency competitiveness.

Download Full-text