The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity

Renée J LeClair; Andrew P Binks; Cecilia T Gambala; Judith M Brenner; Joanne M Willey

doi:10.1007/s40670-023-01878-w

The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity

Med Sci Educ. 2023 Sep 18;33(5):1197-1204. doi: 10.1007/s40670-023-01878-w. eCollection 2023 Oct.

Authors

Renée J LeClair¹, Andrew P Binks¹, Cecilia T Gambala², Judith M Brenner^{3

4}, Joanne M Willey³

Affiliations

¹ Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA USA.
² Office of Academic Affairs, Tulane University School of Medicine, New Orleans, LA USA.
³ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA.
⁴ New York University Grossman Long Island School of Medicine, Mineola, USA.

PMID: 37886271
PMCID: PMC10597890 (available on 2024-10-01)
DOI: 10.1007/s40670-023-01878-w

Abstract

Purpose: Given the significance of the US Medical Licensing Exam (USMLE) Step 1 score moving from a 3-digit value to pass/fail, the authors investigated the impact of the change on students' anxiety, approach to learning, and curiosity.

Method: Two cohorts of pre-clerkship medical students at three medical schools completed a composite of four instruments: the State-Trait Anxiety Inventory, the revised two-factor Study Process Questionnaire, the Interest/Deprivation Type Epistemic Curiosity Scale, and the Short Grit Scale prior to taking the last 3-digit scored Step 1 in 2021 or taking the first pass/fail scored Step 1 in 2022. Responses of 3-digit and pass/fail exam takers were compared (Mann-Whitney U) and multiple regression path analysis was performed to determine the factors that significantly impacted learning strategies.

Results: There was no difference between 3-digit (n = 86) and pass/fail exam takers (n = 154) in anxiety (STA-I scores, 50 vs. 49, p = 0.85), shallow learning strategies (22 vs. 23, p = 0.84), or interest curiosity scores (median scores 15 vs. 15, p = 0.07). However, pass/fail exam takers had lower deprivation curiosity scores (median 12 vs. 11, p = 0.03) and showed a decline in deep learning strategies (30 vs. 27, p = 0.0012). Path analysis indicated the decline in deep learning strategies was due to the change in exam scoring (β = - 2.0428, p < 0.05).

Conclusions: Counter to the stated hypothesis and intentions, the initial impact of the change to pass/fail grading for USMLE Step 1 failed to reduce learner anxiety, and reduced curiosity and deep learning strategies.

Supplementary information: The online version contains supplementary material available at 10.1007/s40670-023-01878-w.

Keywords: Curiosity; Learner anxiety; Learning behaviors; USMLE Step 1 examination.

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