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Physician Licensing Exams: Failure Or Success?

All physicians practicing medicine in the United States must pass a series of standardized exams known as the United States Medical Licensing Exams (USMLE), which consists of the Step 1, Step 2 Clinical Knowledge (CK), and Step 3 exams Before January 26 of this year, all three exam grades were reported as a numerical score in addition to the pass or fail designation. Since January 26ethe USMLE and its sponsorsthe National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB), have decided to dispense with a numeric grade for the Step 1 exam, denoting the score as pass or fail only.

The reason for the change? According to dr. Kevin Jubbal, a plastic surgeon and founder of Medical school insiders, the change was made to improve the well-being of medical students and reduce students’ stress and anxiety around the exam. According to the 2018 National Resident Matching Program Program Director Survey, the USMLE Step 1 score was the most important factor used in deciding which candidate to interview for residency training (postgraduate training that takes place for any medical specialty immediately after completing medical school). Often taken between the second and third years of medical school, this test aims to confirm minimum competency for licensure by testing the fundamentals of the basic clinical sciences taught in the preclinical years of medical school. It is no surprise that many medical students are often obsessed with getting the highest score possible in order to enter the career of their choice after graduating from medical school.

Did the USMLE Pass/Fail Step 1 amendment do what it was intended to do, which was to reduce stress and anxiety among medical students? According to the National Resident Matching Program Program Director Survey 2021, 94% of residency programs require a numerical score on the USMLE Step 2 CK exam before offering interviews to candidates. According to another study, many residency programs now consider the USMLE Step 2 CK the most important factor when considering which medical students should offer interviews for residency training. The stress and anxiety many medical students feel has simply shifted from the Step 1 exam to the Step 2 CK exam. In other words, the USMLE Step 2 CK Exam is the new Step 1 when it comes to the well-being and mental health of medical students.

According to a study in JAMA network opened, 50% of medical students suffer from burnout. While much attention has been paid to the crisis surrounding the dramatic rise of doctor burnout since the Covid-19 pandemic, much less attention has been paid to burnout among medical students, the future caregivers and first responders who will care for you and your loved ones. How can we expect future doctors to master clinical medicine and care for the sick if they can’t even care for themselves?

Equally troubling for the ill-effects of welfare are the racial and ethnic disparities the USMLE creates for underrepresented medical student candidates for residency. According to data from an article in Academic Medicine, black and Latino medical students are more likely to score lower and/or fail all three USMLE exams compared to white students. The reason- downstream effect of decades of systemic racism, depriving them of resources and opportunities to succeed and excel in academics. Consequently, it is much more difficult for underrepresented minorities to receive job interview offers in the specialty of their choice when they graduate from medical school compared to white students.

The USMLE, NBME and FSMB have a real opportunity to promote the well-being of medical students and physicians as well as racial equality by addressing physician licensing exam scores. Just as they passed/failed the Step 1, they must pass/fail all USMLE exams. This would undoubtedly reduce the immense stress and anxiety that medical students face during their tough years in school. In addition, underrepresented students may have a better chance of pursuing their dream specialties after graduation. Standardized tests are just one measure and measure of success. Eliminating numerical scores on the USMLE will force residency programs to make a more holistic assessment of potential candidates.

Some medical schools already do this for admission to medical schools. At the University of Maryland School of Medicine, the admissions committee conducts holistic research emphasizing standardized test scores, provides unconscious bias training for interviewers, and blinds interviewers to standardized scores; to name a few initiatives. Residency programs across the country should follow suit when considering prospective interns in their programs. The USMLE, NBME, and FSMB, as well as the hundreds of medical training programs across the country, need to start taking care of medical students, who we will all rely on to take care of us.

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