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

J. Bryan Carmodya Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA

Lauren M. Greenb EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia, USA

Patti G. Kigera Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA

Jared D. Baxterc Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA

Todd Cassesed Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA

Tonya L. Fanchere Department of Internal Medicine, University of California Davis, Sacramento, California, USA

https://orcid.org/0000-0001-5486-6123

Paul Georgef Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

Erin J. Griffing Office of Medical Education, University of California Davis, Sacramento, California, USA

Yolanda C. Haywoodh Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA

David Hendersoni Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA

Nancy A. Hueppchenj Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

David J. Karrask Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA

https://orcid.org/0000-0003-2303-4986

Andrea N. Leep Hunderfundl Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA

Janet E. Lindsleym Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, Utah, USA

Paul G. McGuiren Department of Cell Biology and Physiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA

https://orcid.org/0000-0002-7284-4339

Mimoza Mehollid Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA

Chad S. Millero School of Medicine, Saint Louis University, Saint Louis, Missouri, USA

Seetha U. Monradp Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

https://orcid.org/0000-0002-3374-2989

Kari L. Nelsonc Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA

https://orcid.org/0000-0003-0763-8077

Kristin A. Olsonq Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA

Amit K. Pahwar Department of Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Stephanie R. Starrs Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA

Allan R. Tunkelt Section of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

Richard N. Van Ecku Department of Medical Education, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, USA

https://orcid.org/0000-0002-9826-9774

Julie H. Youmv Office of Medical Education, University of California, Irvine, Irvine, California, USA

Deborah J. Ziringw Academic Affairs, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA

https://orcid.org/0000-0001-5909-3457

Senthil K. Rajasekaranx Medical Academic and School Programs, Wayne State University School of Medicine, Detroit, Michigan, USACorrespondence[email protected]

https://orcid.org/0000-0002-6445-5931

show all

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.

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

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

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