Binary Reporting of USMLE Step 1 Scores: Resident Perspectives

The Impact on Medical Student Stress in Relation to a Change in USMLE Step 1 Examination Score Reporting to Pass/Fail

“…It is possible that changes in Step 1 stress were not large enough to impact the overall stress that typically accompanies medical school and/or the PSS-4 was not sensitive enough to pick up the relatively smaller changes in stress levels. Another possibility is the one suggested by Kogan, Hauer, and others, where students’ stress may be shifted to other elements without a change in overall stress [ 12 , 13 ]. For instance, we found stress related to Step 2 and clerkship coursework appeared higher in the pass/fail group at certain time points which could support their concerns.…”

“…In focus groups, students have voiced concerns about how residency programs will react to the change to pass/fail and “almost panic” about how they themselves will be impacted [ 11 ]. Some of these stresses relate to increased emphasis on the USMLE Step 2 score, which is a similar exam more focused on clinical applications, as well as clerkship grades in an opaque grading environment [ 12 ] and pressure to engage in extracurricular activities [ 11 ]. Kogan and Hauer have suggested that a singular change in Step 1 scoring without other adjustments to the residency selection process will result in increased emphasis on and stress over the aforementioned items [ 13 ].…”

How to Reassure Program Directors of International Medical Graduates’ Preparedness for Residency With the Fall of the USMLE Step 2 CS Exam

“…The demise of the Step 2 Clinical Skills (CS) exam of the United States Medical Licensing Examination (USMLE), together with the USMLE Step 1’s transition to a binary reporting format, means that applicants for medical licensure have a single objective opportunity (Step 2 Clinical Knowledge) in proving their candidacy. 1 Programs may be reluctant to hire international medical graduates (IMGs) whom they have not previously observed in a clinical setting. As a potential substitute for the Step 2 CS exam, we propose that direct clinical observation of several new patient interactions during clerkships, or online assessment of communication and interpersonal skills while interacting with standardized patients, be included in respective clerkship evaluations.…”

Reply: Changing United States Medical Licensing Examination Step 1 to Pass/Fail: Anticipated Ramifications for Plastic Surgery Residency Applicants and Programs

“…Indeed, despite the current use of video conferencing, we would offer that the current crisis calls for a more articulated learning approach most commonly referred to as blended learning. 3 The current strategies adopted by Kania et al propose asynchronous offline activities (assignments and a surgical laboratory) with the addition of synchronous online activities (daily briefings, online teaching, and lectures in the form of virtual grand rounds), which in our opinion could be even further enhanced to the benefit of the residents.…”

“…Importantly, the clinical shelf examinations that are taken before the Step 2 examination have shown strong correlations with Step 2 Clinical Knowledge scores. 3 This means that students will have had numerous standardized examinations to gauge their scoring potential and to compare themselves to their peers before taking Step 2.…”