In the absence of USMLE Step 1 scores, challenges and opportunities arise


With Step 1 Upon passing or failing the United States Medical Licensing Examination (USMLE), major changes may be underway in the assessment of medical education. The Stage 1 score was a stressor and anxiety factor for students and raised concerns about the negative effects on diversity in medicine. Changing this exam to pass / fail was intended to increase well-being and encourage a more holistic view of performance.

“With so many people applying for residency positions, one of the things we heard from residency program directors was that they needed ways to screen all of those hundreds, if not thousands of applications,” Humayun J. Chaudhry, DO, chairman of the Federation of State Medical Boards (FSMB), said in a JAMA Podcast. “While USMLE stage 1 might not be the screen, a measurement might not be the screen either. And so the objective is not to substitute a single measure as a surrogate, but to examine an assortment of measures. “

What are the challenges that residency programs and medical schools will face in making up for the lack of digital Level 1 scores? Two WADA experts shared their thoughts.

The numerical score of stage 1 had played an unexpected role. All three levels of the exam are required – and intended – for a physician’s license to practice. While the communication of Stage 1 scores became a key measure for residency selection, this was never the goal of the review.

The owners of USMLE, the National Board of Medical Examiners and the Federation of State Medical Boards, in partnership with the AMA and other medical education stakeholders, met in 2019 to examine the issue under several angles, which ultimately led to the decision to take action. fail. There was consensus that the residency selection system is flawed and does not serve applicants or programs well.

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The Coalition for Physician Accountability, a group of which WADA is a member, is tasked with fully examining systemic issues in the resident selection process. This work will include consideration of one or more potential replacements for Stage 1 scores in the residency selection measures.

“My wish would be for the review of any candidate’s application to be complete,” said John Andrews, AMA vice president for GME innovations. “It wouldn’t just be an easily accessible number. I can’t say that there is an objective metric that should replace it.

Get the answers to Seven more key questions as USMLE step 1 moves on to pass-fail.

The goal has always been to see a candidate as more than a numerical score. Reducing the importance of Stage 1 will reduce the pressure of the “parallel curriculum” in which students prioritize counseling preparation over other learning experiences. This could give medical school faculty members more meaningful experiences with students which, in turn, could help them offer additional insight into a student’s development.

“Schools already invested in competency-based medical education would like to be able to safely share a given student’s strengths in areas beyond medical knowledge, as well as share areas of continuing development that should be supported by the beneficiary [residency] program, ”said Kim Lomis, MD, AMA vice president for undergraduate medical education. “Ideally, the learner is engaged in this process to encourage self-directed growth. “

Learn how schools develop flexible and competency-based pathways for students.

Medical schools and residency programs have tried for years to facilitate the transition to residency. Residency programs seek an understanding of the areas of a learner’s preparation and development. Medical schools attempt to provide this in the performance appraisal of medical students, commonly referred to as the Dean’s Letter.
“One barrier to the holistic competency review has been the lack of confidence on both sides of this transition,” said Dr Lomis. “[Medical schools] fear jeopardizing a student’s potential selection by flagging areas for improvement, so residency programs doubt the credibility of the information they receive. If both sides focused more on shared responsibility to support a development continuum, greater transparency would allow students to grow throughout the transition.

Residency programs need to know what they are getting on day one. For this reason, there is a movement to create some sort of standardized competency framework that all medical schools use in the same way.

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“The altruistic point of view is that schools would provide a standardized assessment of how a student’s trajectory toward competence is progressing,” said Dr Andrews. “If there was such a measure comparable from one institution to another, it would be really appreciated. Then it’s not you have a good score, you have a bad score, it’s about what you can and can’t do. This would be helpful in planning, not only in selecting residency, but in planning the program of study for someone once they have reached residency.

Creating a smooth transition from medical school to residency is one of WADA’s top priorities Reinventing the residency initiative. The $ 15 million grant program aims to promote systemic change in higher medical education.

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