Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey

J Bryan Carmody; Lauren M Green; Patti G Kiger; Jared D Baxter; Todd Cassese; Tonya L Fancher; Paul George; Erin J Griffin; Yolanda C Haywood; David Henderson; Nancy A Hueppchen; David J Karras; Andrea N Leep Hunderfund; Janet E Lindsley; Paul G McGuire; Mimoza Meholli; Chad S Miller; Seetha U Monrad; Kari L Nelson; Kristin A Olson; Amit K Pahwa; Stephanie R Starr; Allan R Tunkel; Richard N Van Eck; Julie H Youm; Deborah J Ziring; Senthil K Rajasekaran

doi:10.1080/10401334.2020.1825962

Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey

Teach Learn Med. 2021 Apr-May;33(2):139-153. doi: 10.1080/10401334.2020.1825962. Epub 2020 Dec 8.

Authors

J Bryan Carmody¹, Lauren M Green², Patti G Kiger¹, Jared D Baxter³, Todd Cassese⁴, Tonya L Fancher⁵, Paul George⁶, Erin J Griffin⁷, Yolanda C Haywood⁸, David Henderson⁹, Nancy A Hueppchen¹⁰, David J Karras¹¹, Andrea N Leep Hunderfund¹², Janet E Lindsley¹³, Paul G McGuire¹⁴, Mimoza Meholli⁴, Chad S Miller¹⁵, Seetha U Monrad¹⁶, Kari L Nelson³, Kristin A Olson¹⁷, Amit K Pahwa¹⁸, Stephanie R Starr¹⁹, Allan R Tunkel²⁰, Richard N Van Eck²¹, Julie H Youm²², Deborah J Ziring²³, Senthil K Rajasekaran²⁴

Affiliations

¹ Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA.
² EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia, USA.
³ Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁴ Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA.
⁵ Department of Internal Medicine, University of California Davis, Sacramento, California, USA.
⁶ Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁷ Office of Medical Education, University of California Davis, Sacramento, California, USA.
⁸ Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
⁹ Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
¹⁰ Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
¹¹ Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
¹² Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA.
¹³ Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, Utah, USA.
¹⁴ Department of Cell Biology and Physiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
¹⁵ School of Medicine, Saint Louis University, Saint Louis, Missouri, USA.
¹⁶ Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁷ Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA.
¹⁸ Department of Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
¹⁹ Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.
²⁰ Section of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
²¹ Department of Medical Education, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
²² Office of Medical Education, University of California, Irvine, Irvine, California, USA.
²³ Academic Affairs, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA.
²⁴ Medical Academic and School Programs, Wayne State University School of Medicine, Detroit, Michigan, USA.

PMID: 33289589
DOI: 10.1080/10401334.2020.1825962

Abstract

Phenomenon: Because of its importance in residency selection, the United States Medical Licensing Examination Step 1 occupies a critical position in medical education, stimulating national debate about appropriate score use, equitable selection criteria, and the goals of undergraduate medical education. Yet, student perspectives on these issues and their implications for engagement with health systems science-related curricular content are relatively underexplored. Approach: We conducted an online survey of medical students at 19 American allopathic medical schools from March-July, 2019. Survey items were designed to elicit student opinions on the Step 1 examination and the impact of the examination on their engagement with new, non-test curricular content related to health systems science. Findings: A total of 2856 students participated in the survey, representing 23.5% of those invited. While 87% of students agreed that doing well on the Step 1 exam was their top priority, 56% disagreed that studying for Step 1 had a positive impact on engagement in the medical school curriculum. Eighty-two percent of students disagreed that Step 1 scores should be the top item residency programs use to offer interviews. When asked whether Step 1 results should be reported pass/fail with no numeric score, 55% of students agreed, while 33% disagreed. The majority of medical students agreed that health systems science topics were important but disagreed that studying for Step 1 helped learn this content. Students reported being more motivated to study a topic if it was on the exam, part of a course grade, prioritized by residency program directors, or if it would make them a better physician in the future. Insights: These results confirm the primacy of the United States Medical Licensing Examination Step 1 exam in preclinical medical education and demonstrate the need to balance the objectives of medical licensure and residency selection with the goals of the broader medical profession. The survey responses suggest several potential solutions to increase student engagement in health systems science curricula which may be especially important after Step 1 examination results are reported as pass/fail.

Keywords: HSS; Medical education; USMLE; survey.

Publication types

Multicenter Study

MeSH terms

Attitude
Education, Medical, Undergraduate*
Educational Measurement
Humans
Internship and Residency*
Licensure, Medical
Students, Medical*
United States