For years, the USMLE Step 1 has acted as an unofficial "concours" for medical students applying to residency positions in the United States. The three-digit numeric score has been used to rank thousands of applicants without any evidence of validity. The USMLE will soon change score reporting to a pass/fail outcome. The main reason given was to address the concerns about its effects on the well-being of the students and medical education. It is argued that time for change has come. The authors discuss the various viewpoints of the stakeholders and the effects of this change on applicants and potential changes on the undergraduate medical curriculum. Furthermore, this article discusses several metrics that can be utilized in the application process in lieu of the USMLE Step 1. Additionally, some novel key metrics in the application process are identified, and their unique dynamic and adaptive characteristics are deliberated. Finally, the benefits of a transparent and holistic process are strongly advocated.
The most important core competencies for medical learners to master are reviewing history, performing physical examination, communication skills and clinical reasoning. The Objective Structured Clinical Examination (OSCE) provides a consistent, reliable, and valid assessment of these integrated skills and is considered to be the gold standard. OSCEs are advantageous because they provide opportunities in evaluating skills that written tests cannot do (stage 3 of Miller’s Pyramid of Learning). In this article, we have provided tips and helpful pointers to medical students and residents, based on available literature and authors’ expertise in managing formative, summative, and virtual OSCE experiences. In virtual OSCEs, in-person learning objectives need to be modified to the virtual milieu and new competencies such as “webside manner” need to be introduced. Harmonizing the process and content of the OSCEs create operational challenges, thus learning the various moving parts of the OSCEs such as psychometrics, tasks of the standardized patients and checklists will ease optimal performance.
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