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Changes in medical licensing exam create new problems


At-risk students and diversity both suffer from changing the first part of the exam to pass/fail

The United States Medical Licensing Examination three-step test was recently changed so that step 1 is pass/fail instead of assigning a score to students. Prior to the change, the higher the score, the more likely the student would match into their desired residency program and specialty. The score provided residency directors a way to assess student applications in an equal manner.

Changes in USMLE create new problems: ©Arrowsmith2 -

Changes in USMLE create new problems: ©Arrowsmith2 -

In January 2022, step 1 of the exam was changed to pass/fail largely to reduce the stress and anxiety prevalent among medical school students and improve their overall mental health. Step 2 still awards a three-digit score.

TrueLearn surveyed 250 medical educators to see what effect the change to pass/fail was having and if it had unintended consequences.

Less than half (41%) of survey respondents indicated that while students will be less stressed and have better quality of life, 58% believe students will spend less time preparing for step 1, and 31% said students will be at-risk for underperforming on step 2.

Diversity also is seen to have taken a big hit thanks to the change to pass/fail. The survey revealed that 40% believe students – especially less privileged ones – will have a tougher time matching to their top choices for residency. The challenge for residency directors is that without a score, they tend to rely on the prestige of the school attended because they have little else to go on. Students from less prestigious schools therefore will have a more difficult time.

The top three challenges indicated by the survey were identifying at-risk students (39%), ensuring students retain basic science and preclinical content to ensure optimal step 2 performance (38%), and measuring board exam readiness and performance within the curriculum (36%). Only 26% said they had the data necessary to identify at-risk students.

The biggest change at medical schools is 31% said they have communicated to students that the difficulty of the test has not changed, just the grading method.

Read the full report here.

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