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March 6, 2020

Medical Education Takes a Step in the Right Direction: Where Does That Leave Students?

Author Affiliations
  • 1Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA. Published online March 6, 2020. doi:10.1001/jama.2020.2950

With guidance from the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) announced on February 12, 2020, that beginning at the earliest on January 1, 2022, the Step 1 licensure examination would change from reporting the results as a 3-digit score to reporting the results as pass/fail. The potential consequences of this decision are wide ranging, and the implementation of this policy will have substantial implications for training a new generation of physicians. This modification in score reporting requires careful consideration of the options moving forward, including potential benefits and challenges this change may create. While this change is part of a concerted effort to improve student wellness and clinically focused education, this announcement, perhaps paradoxically, also will generate uncertainty and anxiety for a cohort of students caught in the transition period, and for future medical students.

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    2 Comments for this article
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    USMLE Scoring
    James Campbell, MD | Prior academic and VA
    Scores were helpful but only a limited portion in evaluation for dermatology residency. This looks like a way to blind selection to get more diversity instead of quality.
    CONFLICT OF INTEREST: None Reported
    One Less Objective Data Point
    Matthew Snyder, BS | UVA
    "Despite its shortcomings, Step 1 provides an opportunity for comparison of students across medical institutions, allowing performance rather than pedigree to be an important determinant of a student’s competitiveness for the match. By removing one of the few universal and objective preclinical measures without an immediate replacement, more opportunities are inevitably being introduced for disparities and biases to manifest."

    I couldn't have stated this better. To be frank, applying to medical school is a wild card, with a lot of factors outside an applicant's control determining which specific schools they might receive an acceptance at. Removal of another objective
    data point from the residency application will make which school you end up at much more important.

    I do think that it's unfortunate that so much weight ended up on one test... but it's also unfortunate that clerkships are graded in the way that they are (i.e. subjectively), which contributed to the weight placed on this exam in the first place. It seems that reporting shelf scores might be the best next option, as they are standardized, but also greater in number. This distributes the risk across multiple data points, such that "one bad test day" wouldn't hurt a student the same way a similar bad day would on Step 1.
    CONFLICT OF INTEREST: None Reported
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