When the Nationwide Board of Medical Examiners and the Federation of State Medical Boards modified the method for grading a bit of the U.S. Medical Licensing Examination, they hoped it will lower scholar stress and cut back the emphasis on scores within the determination course of for residency placement.

However a yr and a half after the transition, some medical faculty college students and school are uncertain if the change was efficient and are involved that it could have amplified inequities amongst college students.

The reform, which went into impact in January 2022, shifted the primary of three exams required for a medical license from a standard numerical scoring to a pass-fail mannequin.

The examination, USMLE Step 1, is a grueling eight-hour evaluation of scholars’ data of primary medical sciences, together with anatomy, biochemistry, immunology and pharmacology. It’s usually taken on the finish of the second yr of medical faculty. The high-stakes examination was recognized for inducing excessive ranges of stress in college students as a result of it was used as a major analysis metric for medical residency placements.

The NBME and the FSMB, co-sponsors of the examination, mentioned the swap to pass-fail aimed to “tackle considerations about Step 1 scores impacting scholar well-being,” “cut back the overemphasis” on examination outcomes and promote a extra holistic residency choice course of.

Nevertheless, many college students and medical faculty school now say that eradicating scores has merely shifted stress to the second examination and put further strain on college students to distinguish themselves by way of analysis and extracurricular alternatives, which can take time away from their research and amplify pre-existing inequalities in medical schooling.

“I feel most individuals agree with the idea and assume that it’s a step in the best path, which I additionally agree with,” mentioned Natasha Topolski, a sixth-year scholar pursuing an M.D. and Ph.D. at McGovern Medical College in Houston. “However nonetheless being burdened in that interval is a really actual factor … Step 1 isn’t the foundation of the issue. It’s a symptom.”

Pupil Stress Stays

Topolski, who can be chair of the American Medical Affiliation’s Medical Pupil Part, mentioned her stress ranges have been nonetheless excessive when she took the examination final yr beneath the pass-fail mannequin.

“Should you fail, residency applications know. You’re allowed to retake it, however they know and that’s this black mark,” Topolski mentioned, noting that numerical scores supplied college students an opportunity to indicate enchancment on the second examination. “They simply see that I failed after which I handed finally … I feel that’s the place quite a lot of the anxiousness nonetheless comes from.”

Topolski mentioned she’s heard many friends say the stress “simply will get pushed to Step 2,” which remains to be scored and is now anticipated for use as an analysis metric for residency placements.

Abbigayle Willgruber-Rawls, a fourth-year medical scholar on the College of Kentucky School of Drugs–Bowling Inexperienced, intends to use for an ear, nostril and throat residency this fall. However she pushed her Step 2 check date again from June to August to have extra time to review as a result of she’s nervous her rating received’t be excessive sufficient to get accepted into the extremely aggressive specialty.

“It actually places quite a lot of strain on completely different elements of medical schooling that perhaps we wouldn’t have burdened a lot about initially if we had that numeric Step 1 rating,” she mentioned.

A research printed in Medical Science Educator in February indicated many college students are nonetheless feeling burdened regardless of the change to pass-fail.

The research was carried out by medical residents on the Georgetown College College of Drugs and in contrast the stress ranges of scholars there who took the primary portion of the examination each earlier than and after the transition to pass-fail. Outcomes confirmed that though exam-specific stress charges for pass-fail college students have been considerably decrease than their scored friends through the first two years of medical faculty, the distinction “disappeared” when college students reached the “devoted research interval” within the months instantly earlier than the examination.

College Expresses New Considerations

Medical faculty school members and directors are additionally involved. In a current survey of about 250 medical faculty officers carried out by TrueLearn, a third-party USMLE test-preparation firm, solely about 39 % mentioned they believed the swap would reduce check takers’ stress ranges. Nevertheless, about 56 % of respondents expressed considerations that college students would spend much less time getting ready for the examination on account of the shift to a pass-fail mannequin.

Dr. Rance McClain, who was dean on the Arkansas Faculties of Osteopathic Drugs till June, agreed that the change to pass-fail shifted college students’ stress to the second a part of the examination. Not like Step 1, for which college students are usually granted a number of months of “unhindered” time to review, he famous that Step 2 is commonly taken throughout college students’ fourth-year medical rotations.

“Now they put much more strain on themselves for Step 2, after they don’t have that point and talent to review the best way they now assume they need to,” he mentioned. “We’re very involved about our college students taking away helpful medical studying experiences attempting to return and research.”

Medical faculty officers are additionally involved that as college students search for new methods to distinguish themselves from friends in residency functions, extra emphasis will likely be positioned on elements corresponding to analysis expertise and extracurricular involvement. They fear it will amplify pre-existing inequities within the residency placement course of, making it tougher for college students who aren’t attending elite establishments to be accepted into their top-choice applications.

“College students from these deprived backgrounds, who could not have entry to others who’re physicians or scientists, they could not have these alternatives to volunteer and shadow or have analysis alternatives to essentially assist embellish their résumés as they’re making use of for these residency applications,” mentioned Dr. Yolanda Lawson, president of the Nationwide Medical Affiliation, a company that represents African American physicians.

Dr. Jonathan Waters, a professor of anesthesiology and biomedical engineering on the College of Pittsburgh College of Drugs, has been “closely concerned” in choosing residents and fellows prior to now. He believes analysis is extra about who you already know than what you already know and that it isn’t the identical caliber “screening software” as a USMLE rating.

“Varied professors have completely different expectations for medical college students and the roles that they play in analysis … you could be a good man and have a professor take excellent care of you,” Dr. Waters mentioned. “I don’t see it as making up for the rigor of getting to review for an examination with the strain that goes together with it.”

Mark Speicher, a senior vp on the American Affiliation of Faculties of Osteopathic Drugs, voiced comparable considerations. He mentioned analysis and extracurricular alternatives could be tougher to entry at rural, regional establishments and osteopathic medical colleges, that are generally seen as much less rigorous. College students of shade and first-generation college students might also face boundaries.

“There’s some foundation to assume that the USMLE was not equitable throughout all demographic teams, however no less than it was a recognized goal,” Speicher mentioned. “If I’m a first-generation faculty scholar, I knew the best way to put together for the USMLE. However how am I speculated to get a analysis alternative that ends with a publication?”

Associations Wait to Choose

The USMLE, and the boards that oversee it, acknowledged a number of the considerations in an announcement greater than a yr earlier than the change went into impact, however they moved ahead with it anyway.

Joe Knickrehm, a USMLE spokesperson, mentioned in an e-mail that the choice was made “after almost two years of cautious analysis” and it “is just one motion that may assist enhance this course of.”

He implied that it was as much as medical colleges to handle scholar stress.

“We encourage different organizations in undergraduate and graduate medical schooling to establish options to optimize the transition from medical faculty to residency,” he wrote.

The American Affiliation of Medical Faculties declined to touch upon the affect of the change. Different medical associations, together with the Nationwide Resident Matching Program and the American Medical Affiliation, acknowledged considerations however mentioned it was too early to totally assess the situation.

The American Medical Affiliation described the numerical rating as “detrimental” and mentioned it “created a parallel curriculum to arrange for the examination,” which “distracted medical college students from growing teamwork and communication abilities.” The affiliation additionally famous that the primary cohort by which a majority of scholars took the examination beneath the pass-fail mannequin will likely be making use of for residencies this fall, after which the total affect of the examination on college students’ acceptance to residency applications could possibly be higher gauged.

“There’s concern voiced by the group about how these adjustments the willpower of who applications need to invite for interviews and choose for residency applications” Donna Lamb, president and CEO of the Nationwide Resident Matching Program, mentioned in an e-mail. Nevertheless, “Anecdotal enter is considerably limiting, and so I take into account it cautiously.”

“This can be a new course of that the Nationwide Board of Medical Examiners and others are working to higher perceive,” she mentioned.