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  • As of January 26, 2022, the USMLE Step 1 exam has officially become pass/fail.

  • The goal of this change was to improve wellbeing and decrease burnout among medical students,

  • but has it succeeded in achieving this goal?

  • How has it actually changed the medical school experience?

  • Let’s talk about it.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • The United States Medical Licensing Examination, or USMLE, is a 3-part test designed to assess

  • one’s medical knowledge and application of said knowledge to patient care.

  • Step 1 is typically taken at the end of the second year of medical school and is followed

  • by Step 2 CK at the end of the third year or sometime during the fourth year.

  • If you want to learn more about the USMLE step exams and their timelines, check out

  • my 4 years of medical school explained video.

  • Up until now, Step 1 has been arguably the most important test a future physician will

  • ever take.

  • It was initially designed to assist state authorities in granting medical licenses;

  • however, it evolved far beyond the intended pass/fail indication of competence.

  • These scores became heavily weighted during residency applications to assess a candidate’s

  • strength.

  • So much so in fact, that low scores became prohibitive for students wishing to pursue

  • highly competitive specialties.

  • If you wanted to become a dermatologist or a plastic surgeon, for instance, but you didn’t

  • score high enough on Step 1, you could pretty much kiss your dream specialty goodbye.

  • Many medical students have had to completely change their career trajectory due to a low

  • Step 1 score and pursue entirely different specialties than they had initially intended.

  • As of January 2022, however, this will no longer be the case.

  • USMLE Step 1 will be graded as pass/fail and will no longer be the primary determinant

  • of one’s competitiveness as a residency applicant.

  • The main reason for this change was to improve the well-being of first and second-year medical

  • students by decreasing stress around the Step 1 Exam.

  • Burnout and depression are a big problem amongst medical students and having one exam pretty

  • much determine your entire career trajectory was, unsurprisingly, incredibly stressful

  • for most students.

  • Historically, the first two years of medical school have been spent stressing and grinding

  • for this exam.

  • The thought process is that by making it pass/fail, much of that stress will go away.

  • This is a reasonable assumption, as pass/fail medical school curriculums, which have been

  • around for quite some time, have been shown to improve mood and group cohesion.

  • When you aren’t feeling like you have to compete against your classmates for the top

  • grades, there’s much less pressure to perform and youre more likely to collaborate and

  • help each other out.

  • Although that may be the intention, in reality, I don’t believe it’s necessarily the case.

  • Instead, making step 1 pass/fail just kicks the can down the road and puts additional

  • stress on Step 2 CK, which is still graded on a numerical scale.

  • The stress surrounding Step 1 was never a function of the exam itself, but rather a

  • function of the fear that you wouldn’t be able to get into your desired residency program

  • - and that fear is still there.

  • The most competitive specialties will continue to be competitive as there are more medical

  • students interested in those specialties than there are spots available.

  • Step 1 becoming pass/fail doesn’t change that.

  • In addition, this change may make Step 2 CK even more stressful than Step 1 was.

  • Before, if you didn’t do well on Step 1 then you at least had Step 2 CK to help bolster

  • your application.

  • Now, if you mess up on Step 2 CK you don’t have another exam to help offset your lackluster

  • performance.

  • To further complicate things, your schedule for away rotations is determined at the end

  • of your third year, usually before taking Step 2 CK.

  • If you intended on derm or plastics but don’t perform well on the test, you might no longer

  • be aiming for those specialties.

  • With Step 1 being graded, there was more lead time to know where you stood.

  • With competitiveness now relying heavily on Step 2 CK, that lead time is no longer there.

  • Step 2 is also taken after clinicals - when your schedule is incredibly busy.

  • As such, many students will likely have an even more difficult time balancing Step 2

  • preparation with their clinical responsibilities.

  • That being said, many schools will likely allocate more time to Step 2 preparation now

  • that Step 1 is pass/fail; however, programs that don’t adapt their curriculum in time

  • will make it very tough for their students.

  • Step 2 isn’t the only metric that’s being given more weight either.

  • Subjective measures like letters of recommendation and clerkship grades will also be more important

  • for residency applications moving forward.

  • These measures may introduce another unintended level of stress as medical students have less

  • control over them.

  • For instance, clerkship grades are highly variable between programs with some programs

  • grading more heavily based on your shelf scores and others emphasizing subjective evaluations

  • from preceptors.

  • In addition, some clerkships give out high honors like candy, whereas others make it

  • near impossible.

  • This can further increase stress for students when these metrics are more subjective and

  • less standardized.

  • The transition of USMLE Step 1 to pass/fail has also changed how students are allocating

  • their time during medical school.

  • Since Step 1 will no longer be weighted as heavily on residency applications, students

  • are spending less time studying for Step 1 and more time on the components of their applications

  • that will make them more competitive.

  • This includes Step 2 CK prep, research, extracurricular activities, and medical school performance.

  • Step 2 CK is essentially becoming the new Step 1 in terms of residency application importance,

  • so it stands to reason that many students are allocating less time to Step 1 prep and

  • more time to Step 2 CK prep.

  • This can be seen as a big win for medical students as the material tested on Step 2

  • CK is much more clinically relevant than Step 1.

  • So instead of spending hours studying the Kreb’s cycle, they can now spend that time

  • reinforcing material that will be more relevant during residency.

  • Another way for students to stand out on their residency applications now is to maximize

  • their research experience.

  • Having more publications and research projects is typically seen as more impressive.

  • It is also an easy metric for residency programs to use to sort applicants since the number

  • of publications and research projects is numerical.

  • Extracurricular activities such as volunteering in underserved medical clinics, taking on

  • leadership positions in clubs or interest groups, and getting involved in unique opportunities

  • will be other ways that students allocate their time now that they don’t have to spend

  • as much time studying for Step 1.

  • Dean’s lists and class rankings will also become more important as they are an objective

  • way of comparing students amongst their peers.

  • As such, students will likely allocate more time and effort to doing well in graded pre-clerkship

  • classes and clerkship rotations.

  • One hope with the pass/fail transition is that it will force residency programs to take

  • on a more holistic application review process instead of using score cutoffs.

  • But this is just wishful thinking.

  • What you have to remember is that residency programs receive far more applications than

  • they have residency spots.

  • As such, they don’t have time to go through every single application in detail.

  • They need ways to objectively compare applicants to each other and numbers are often the easiest

  • way.

  • For this reason, primarily Step 2CK, but also research and clerkship grades as it relates

  • to class ranking, will all become more heavily weighted in residency applications.

  • Much of what weve talked about up until this point is mainly relevant for students

  • in U.S. MD programs; however, USMLE Step 1 becoming pass/fail also has implications for

  • DO students and international medical graduates as well.

  • The main concern for DOs and IMGs is that they will have a harder time standing out

  • to residency programs now that USMLE Step 1 is pass/fail.

  • In the past, a strong Step 1 score has allowed DOs and IMGs to compete more readily against

  • MD students for residency positions.

  • That being said, I don’t believe this should be too much of a concern as Step 2 CK is still

  • graded on a numerical scale and will essentially replace Step 1 as an application metric.

  • As such, DOs and IMGs will still be able to stand out by having a stellar Step 2 score.

  • And just like their U.S. MD counterparts, theyll still be able to stand out through

  • their research experience, extracurricular activities, and letters of recommendation.

  • Strong letters of recommendation, in particular, have been and will continue to be important

  • for IMGs and DOs to stand out.

  • These solid connections are often made by impressing research or clinical mentors who

  • go to bat for them during the residency application cycle, or by having family or other connections.

  • It is unfortunate, but nepotism continues to play some role in residency match outcomes.

  • As you can see, USMLE Step 1 becoming pass/fail changes the details a bit but it doesn’t

  • change the overall picture.

  • Just as before, medical students will need to take steps to make themselves stand out

  • above their peers if they wish to pursue a competitive specialty.

  • Specialties are not becoming more or less competitive from this change, and the stress

  • that accompanies that competition and uncertainty is not going away, despite what passionate

  • medical students and residents may tweet.

  • When changes like this occur, it’s important to remember that it is better to focus on

  • the things you can control than the things that you can’t.

  • You don’t want to fall into the trap of having a victim mentality and blaming your

  • inability to get into your desired residency on external factors.

  • It is only by adopting an internal locus of control that you can make yourself the best

  • applicant, and more importantly, the best version of yourself.

  • This mentality is what will allow you to get through the gauntlet that is medical school

  • and residency.

  • Some residency programs will always be more competitive than others and there will always

  • be metrics that they use to pare down the pile of applicants.

  • What separates those who are successful from those who are not is a willingness to adapt

  • and push forward.

  • Life is 10% what happens to you and 90% how you react to it”.

  • So instead of worrying about the 10% you can’t control, figure out how you can make the other

  • 90% that you can work in your favor.

  • If you find yourself getting discouraged because your dream specialty is highly competitive,

  • stop right there.

  • Your ability to crush Step 2 CK and have dozens of research articles is less a function of

  • your intelligence and more a function of proper preparation, constantly improving, and putting

  • in the work.

  • Having a stellar residency application and crushing the interviews is no different.

  • At Med School Insiders, our mission is to empower a generation of happier, healthier,

  • and more effective future doctors.

  • From medical school or residency application help to crushing your MCAT or USMLE, weve

  • got your back.

  • We know what youre going through and can help you excel on your exams and help put

  • you in the best light possible with your medical school and residency applications.

  • And our results speak for themselves.

  • Weve become the fastest-growing company in the space with the highest satisfaction

  • ratings.

  • See for yourself and learn more at MedSchoolInsiders.com.

  • Thank you all so much for watching!

  • If you enjoyed this video, check out the Top 5 Most Competitive Specialties or How to Crush

  • Step 2 CK.

  • Much love and I’ll see you guys there.

As of January 26, 2022, the USMLE Step 1 exam has officially become pass/fail.

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How USMLE Step 1 Pass/Fail is Changing Medical School

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    Summer に公開 2021 年 11 月 13 日
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