At the end of January, the influential step 1 of the US Medical Licensing Examination (USMLE) changed from numerical to unsatisfactory scoring. Program sponsors wanted to shift the emphasis from numerical scores but kept the exam to determine whether a physician qualifies for a license.
According to the AMA, the previously used three-digit numerical score was detrimental to student well-being because it created a parallel curriculum to prepare for the exam and distracted medical students from developing teamwork and communication skills.
Although the exam content has not changed, medical students have questions about the switch. It is already creating a number of challenges for directors of residency programs. For the next few residency application cycles, some applicants will have numerical scores while others will have pass and pass in Step 1.
“The current MS2 — which is now becoming MS3 class, as they took it — if they wanted to do it particularly early, they could still get a numerical score. But on the timeline where most students across the country are taking it, they would failing that class,” Daniel Dent, MD, a professor of surgery and medical education at the University of Texas Health San Antonio explained to Joe R. & Teresa. Lozano Long School of Medicine.
He discussed what stands for the USMLE Step 1 exam and what it means for program directors, medical students, and residency applicants on a recent episode of “AMA Moving Medicine.”
Several factors have caused this change, said Dr. dent. The numerical format created stress in achieving a certain score. Medical students felt that they were judged by a single test result rather than what they achieved in their courses over two years.
Medical students who haven’t done the previous iteration may not appreciate “that there may be significantly less stress in your life now because you’re not pressured to get a 250 on step 1,” he noted.
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Concerns have been raised about the impact of the change on candidates from lesser-known schools who counted on an excellent numerical score to get noticed.
“Ultimately, I think you can distinguish yourself through step 2. Many schools have class rank. Many don’t. And schools that aren’t just a fail, but have an honorable mention, a high pass, a pass or an A, B, C rating — you can set yourself apart with those grades,” said Dr. Dent.
Get study tips and insight into the future of USMLE Step 2.
Program directors will look at aspects other than the Step 1 score in a medical student’s application, such as clinical rotation grades and shelf exam scores, said Dr. dent.
Doing exams on clinical medicine well will be just as important as a step 1 score “because you’ll be doing tests on clinical medicine for the rest of your life,” like the board exam, he said. A letter of recommendation that speaks of a person’s medical knowledge and work ethic is crucial.
“Ultimately, you’re looking for someone you want on your team at 2 a.m., taking care of a sick person,” said Dr. dent.
Residency programs also value leadership roles, team sports, and volunteerism. That includes participation in organized medicine and health policy advocacy, noted Dr. Get up.
“All of this is viewed positively. I want to make that clear. But a significant commitment to it is seen much more positively,” he said. “And so, if you’re the AMA representative for your school, or you’ve done other things within the AMA and worked with — to do some local volunteer work for the AMA and your community and things like that, whether it’s to AMA or your state medical association – that is certainly viewed favorably as well.
“But then again, there are people who show up so they can tick a box and put it on their resume,” said Dr. dent. “And then there are the people who show up, pay attention and commit. And that is really who we are looking for.”
Learn more about the possibilities of medical student leadership with the AMA.
“AMA Moving Medicine” highlights innovation and the emerging issues affecting physicians and public health today. You can watch each episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version, which also includes educational presentations and in-depth discussions.