On February 12, 2020, the Nationwide Board of Medical Examiners (NBME) introduced that the USMLE Step 1 will transition to a pass/fail exam in January 2022 on the earliest. This transfer comes amidst growing strain on the NBME concerning its monetary conflicts of curiosity, in addition to the tangible sense amongst medical faculty deans that college students had been neglecting coursework in favor of cramming for this vastly essential examination. This coverage has already led to dramatic reactions from all corners of the medical neighborhood. Program administrators overwhelmingly reported Step 1 as an important consider deciding candidates to interview, and will now have to seek for different metrics to be able to consider residency purposes. Though specifics concerning the transition have but to be introduced, listed here are among the seemingly winners and losers from this coverage.
Winner: Step 2 CK (and its test-preparation trade)
Loser: Pupil anxiousness ranges
And not using a numerical Step 1 rating, program administrators will naturally lean to the one remaining standardized metric: Step 2 CK. Somewhat than easing pupil anxiousness, this variation places an incredible quantity of strain on college students to excel on Step 2 CK. Beforehand, college students who did poorly on Step 1 had a second probability to indicate their test-taking capacity by enhancing on Step 2 CK. Now, they solely have one shot to show themselves to residency applications. A brand new arms-race of Step 2 CK preparation sources will start.
Winner: College students from top-ranked medical colleges
Loser: Worldwide medical graduates and DO college students
Program administrators additionally positioned excessive emphasis on letters of advice, Medical Faculty Efficiency Analysis (primarily a abstract of scientific grades), and analysis. College students at top-ranked colleges have extra entry to well-known school and analysis alternatives in comparison with college students from different colleges. Since scientific grading techniques differ amongst all medical colleges, USMLE scores had been theoretically used as goal metrics that would support in evaluating candidates from totally different medical colleges around the globe. The absence of Step 1 scores will exacerbate the benefits that college students from top-tier colleges get pleasure from.
Winner: Proponents of holistic software evaluation
Loser: Workers chargeable for screening residency purposes
A typical criticism of Step 1 was that program administrators used it as a crutch to filter purposes primarily based on a seemingly goal cutoff. Applications will now want to search out different, hopefully holistic strategies of screening residency candidates. Whereas this sounds nice in idea, it’s tremendously troublesome to implement in apply. It’s not unusual for applications to obtain >100 purposes for a single residency place. To display screen all of those purposes with no rating cutoff, applications will seemingly have to put money into extra workers, or improve the workloads of already-drowning school members and residents.
Winner: Scientific training in medical faculty
Loser: Fundamental science training in medical faculty
With out the strain of a Step 1 rating, many college students is not going to really feel that it’s essential to be taught fundamental science info which have seemingly little relevance to scientific medication. The elevated concentrate on Step 2 CK could incentivize college students to deepen their scientific data. Proponents of the essential sciences could lament this variation on condition that the latest discoveries in scientific medication typically originate in fundamental science, and one could by no means know when a pearl of fundamental science data may impression scientific care in a novel method. It stays to be seen how medical colleges will regulate their curricula to this new actuality. Many colleges have transitioned to a systems-based curriculum already, in order that fundamental and scientific sciences are built-in. Maybe extra colleges will comply with go well with.
Altering Step 1 to a pass/fail examination could also be one of many greatest shifts in medical training prior to now three many years. Residency applications will seemingly lean on Step 2 CK as a filtering mechanism, triggering a cascade of adjustments in different areas of the residency software course of. Solely time will inform whether or not these adjustments will enhance or worsen the state of medical training.
Aamir Hussain is an inside medication resident.
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