[The following notes were generated by Andrea Belovich, PhD.]
The second installment of the Winter 2021 IAMSE Web Seminar Series, “USMLE Step-1 is Going to Pass/Fail, Now what do we do?”, was presented on January 14th, 2021 by Dr. Douglas Gould, Professor and Chair of the Department of Foundational Medical Studies at the Oakland University William Beaumont (OUWB) School of Medicine. In his webinar, entitled “Pass/Fail Step 1: Implications for a Foundational Sciences Department” Dr. Gould provided an overview of how the transition of the USMLE Step 1 scoring to pass/fail (P/F) may impact biomedical/foundational sciences departments across medical schools. Throughout his presentation, he incorporated audience polling questions, enabling participants to interact in real-time.
Dr. Gould began by introducing the changes in USMLE Step 1 scoring and a poll question gauging the audience’s familiarity with the topic. Based on the response, Dr. Gould provided an abridged review of the USMLE Step exam sequence and the recommendations made by the AAMC, AMA, ECFMG, FSMB, and NBME’s Invitational Conference on USMLE Scoring (InCUS) conference in March, 2019. As recommended by the InCUS, the transition of USMLE Step 1 to P/F scoring will be implemented beginning in January, 2022, with no numeric score reported. The content of USMLE Step 1 will remain unchanged, as it will continue to focus on foundational sciences including Anatomy, Biochemistry, Microbiology, Pharmacology, and Physiology. USMLE Step 2 CS will remain P/F, although it may continue to be suspended due to COVID-19, as it involves in-person interaction with Standardized Patients, and USMLE Step 2 CK and 3 will remain numerically scored.
Dr. Gould provided an overview of the anticipated impacts of the transition of the USMLE Step 1 to P/F scoring. He addressed how the loss of the numeric score eliminates a valuable tool for residency program directors to screen and filter applicants and suggested the possibility that the transition may disadvantage students from newer or less-well known medical schools. This could possibly amplify disparities for underrepresented minorities, women, and international students if they lack equitable access to the subjective components of residency applications. Later in the webinar, he would mention the likelihood for increased pressure on students to attend more prestigious medical schools and apply to greater number of residencies, both of which would contribute to increased student debt.
Next, he focused on what residency program directors may use to replace the Step 1 numeric scores in screening applications and how preclinical curricula may be generally impacted. Citing the 2018 Program Director survey results from the National Resident Matching Program, Dr. Gould identified the following top-seven criteria used to rank residency applications (in order of decreasing importance): Step 1 score, Letters of Reference, MSPE, Step 2 (CK) score, Personal Statement, Grades in required clerkships, and Failed USMLE attempts. Other factors emphasized included AOA membership (#14), ‘other’ life experience (#16), Step 2 (CS) score (#17), and finally, Involvement in Research (#26) . Dr. Gould then mapped the results from a poll question administered during the previous week’s webinar asking webinar participants which factors they themselves would consider most likely to be relied upon to screen residency applications in the absence of a Step 1 numeric score. The audience results indicated the top three factors to be 1) Step 2 (CK) score, 2) Grades in required clerkships, and 3) Letters of Reference. Dr. Gould suggested that these IAMSE webinar audience response results underscore the variation and unpredictability of which factors may become most important going forward, emphasizing the need for the flexibility of medical schools as they adjust to the Step 1 P/F change. With these results in mind, Dr. Gould discussed the potential for preclinical, foundational sciences curricula to transition to P/F as well, and may experience reorientation towards preparing students for Step 2 CK, as this exam will still be assessed with a numeric score. In short, Dr. Gould anticipates further de-emphasis on basic science education going forward.
Importantly, an expose of the process of holistic review of the residency application dossier revealed opportunities for biomedical/foundational sciences to promote strong applications by providing students with research activities. Dr. Gould then presented the mission statement of his home institution, OUWB, and showcased their Department of Foundational Medical Studies (FMS), which encompasses approximately 40 faculty members, including those in basic science and medical education, medical humanities, community/public health, traditional (bench) researchers and medical librarians. As part of the department’s approach to research activities, he discussed their longitudinal, 4-year required research program (Embark). Students are paired with mentors and receive training across multiple domains of the research design and implementation process, including navigating IRB requirements, presentation skills, abstract writing, and paper publication. Dr. Gould noted the possibility of using the outcomes of student research activities as quantifiable metrics for residency application, which will favor the development of research programs.
Finally, Dr. Gould described the COVID-19 pandemic as a significant catalyst for the changes medical education has already been experiencing recently. This includes an increase in medical school and residency applications, which have not been accompanied by an increase in federally-funded residency programs. While not necessarily a novel trend, this does contribute to application inflation and makes holistic review more challenging. Other significant changes include the transition of USMLE Step 2 CS to a virtual format, along with a vast majority of medical education. COVID-19 has also forced a more rapid acceleration in the digitization of teaching materials across the literature. He highlighted factors that contributed to his FMS department’s adaptation to the COVID-19 pandemic, crediting the department’s collaborative nature as well as the presence of faculty already devoted to medical education in mounting a rapid and effective response to the unforeseen changes. A robust faculty development program also enabled a quick transition to online learning and asynchronous education, while promoting evaluation of effectiveness.
While the number of traditionally-structured foundational sciences departments has been decreasing over the last two decades, Dr. Gould suggested this may be due to department name changes and combination of disciplines into single departments. In fact, according to the AAMC, overall numbers of basic/foundational science departments have increased 33% over the last five years, and the number of foundational science faculty has increased from 14,047 in 1998 to 18601 in 2018, with 21% of medical school faculty holding a PhD as of 2018 . As continued changes to medical education are inevitable, Dr. Gould strongly promoted the increase and development of dedicated foundational science medical education faculty, who are invested in maintaining and innovating effective education in the face of unforeseen events, such as the COVID-19 pandemic and the transition of the USMLE Step 1 to P/F.
1. National Resident Matching Program. Program Director Survey Results. 2018.
2. Association of American Medical Colleges. 2018 US Medical School Faculty Report. https://www.aamc.org/data-reports/faculty-institutions/interactive-data/2018-us-medical-school-faculty