US Medical Student Perspectives on the Impact of a Pass/Fail USMLE Step 1

Alisa O Girard; Cecil Qiu; Isabel V Lake; Jonlin Chen; Christopher D Lopez; Robin Yang

doi:10.1016/j.jsurg.2021.09.010

US Medical Student Perspectives on the Impact of a Pass/Fail USMLE Step 1

J Surg Educ. 2022 Mar-Apr;79(2):397-408. doi: 10.1016/j.jsurg.2021.09.010. Epub 2021 Sep 30.

Authors

Alisa O Girard¹, Cecil Qiu², Isabel V Lake², Jonlin Chen², Christopher D Lopez², Robin Yang³

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Plastic Surgery, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey.
² Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: ryang14@jhmi.edu.

PMID: 34602379
DOI: 10.1016/j.jsurg.2021.09.010

Abstract

Objective: The purpose of this study is to (1) gather US medical student attitudes regarding pass or fail score reporting of the USMLE Step 1 exam and (2) investigate the impact of this new policy on specialty interest and redistribution of efforts to enhance individual competitiveness.

Design: This is a cross-sectional analysis of US medical students surveyed from July to October 2020. Surveys were administered on social media and via medical school email list serv. Data were analyzed using Student t test and Chi-squared statistic, alpha = 0.01.

Setting: Data analysis was conducted at Johns Hopkins University in Baltimore, Maryland.

Participants: This study included a sample of 852 students enrolled in US medical schools.

Results: The plurality of students (39.0%) was in favor of the new policy; 30.9% of students were opposed. Students interested in highly competitive specialties (HCS) and students who scored 240 or higher on Step 1 ("high scorers") were more likely to oppose the policy compared with HCS-disinterested students and students who scored below 240 ("sub-240 scorers"). If students were to hypothetically take Step 1 with pass or fail scoring, most students report that they would dedicate less time studying than they had for the numerical exam (72.7%) and more time preparing for Step 2 CK (70.5%) and conducting research in HCS (59.6%). Sub-240 scorers would be more likely to apply to a more competitive specialty (44.4%). Nearly half of HCS-interested post-Step 1 students would be more likely to dual apply (48.7%), the majority of which were also high scorers (89.5%).

Conclusions: Students expressed polarized opinions regarding pass or fail Step 1 score reporting. Time spent studying for Step 1 may be displaced toward Step 2 CK and research. Residency programs in both HCS and non-HCS can expect an increase in applicant pool size and diversity.

Keywords: Education; Match; Medical student; Pass/fail; Residency application; USMLE Step 1.

MeSH terms

Cross-Sectional Studies
Educational Measurement
Humans
Internship and Residency*
Licensure, Medical
Schools, Medical
Students, Medical*
United States