2021 Winter: USMLE STEP-1 is going to Pass/Fail: Now what do we do?

The debate about the pros and cons of the United States Medical Licensing Examination (USMLE) Step 1 score reporting has been ongoing for over a decade. The issues are complicated and both positive and negative aspects of score reporting can be cited, depending on where you are positioned in the UME-GME continuum. In March of 2019, the Association of American Medical Colleges (AAMC), American Medical Association (AMA), the Educational Commission for Foreign Medical Graduates (ECFMG), the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) convened a multi-stakeholder Invitational Conference on USMLE Scoring (InCUS) to explore issues and concerns regarding the USMLE Step 1 exam and to consider recommendations specific to USMLE score reporting and the broader system of transition from UME to GME. A general consensus emerged: the current UME-GME transition system is flawed and not meeting the needs of stakeholders. As a result of further stakeholder discussions, the USMLE decided that beginning with the administration of Step 1 in 2022, the exam will be scored as pass/fail and no numeric score will be reported. This decision will undoubtedly impact faculty, students, and programs across the UME-GME continuum. In this five part series, recognized experts from the various stakeholder groups will present and discuss the impact of this decision, identify challenges to their respective programs and explore creative ways to address the consequences of this important medical education milestone. These thought–provoking sessions will include the perspectives of allopathic and osteopathic residency program directors, basic science faculty, undergraduate medical education curriculum designers, clinical educators, and programs that involve international medical students matriculating to the United States.

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January 7, 2021 at 12:00 pm

The Challenges of Resident Candidate Assessment and Selection

Presenter: Mark Jordan, MD, FACS and Justin La, MD

Dr. Mark Jordan is an alumnus of the University of Toronto Medical School (1977) and the Gallie training program in Surgery and Urology (1983). He was elected Junior AOA in 1976. Following his residency in Toronto, he did fellowships at the Cleveland Clinic (1983-1984) and University of Minnesota (1984-1986) before returning to the University of Toronto as a Faculty member in 1987. In 1989 he was recruited by his former fellowship director Dr. Richard L. Simmons to join the faculty at the University of Pittsburgh Medical School where he served for 14 years (1989-2003), advancing to the position of Professor of Surgery with Tenure, and Director of the Urologic Renal Transplant Division at the University of Pittsburgh Medical Center and the Veterans Administration Medical Center in Pittsburgh. After 14 years at the University of Pittsburgh, Dr. Jordan was recruited to assume the position of Harris L. Willits Chair and Program Director of the Urology Division in the Department of Surgery at Rutgers-New Jersey Medical School in July 2003. At that time he was also appointed Professor of Surgery (Tenured) at New Jersey Medical School and Chief of Urology at University Hospital in Newark, NJ.

Dr. Jordan has published more than 200 journal articles and written 12 chapters in medical textbooks. Dr. Jordan’s clinical expertise includes complex renal and reno-vascular surgery, renal transplantation, urologic oncology, and robotic surgery. Dr. Jordan served as President of the Society of Urologic Chairs and Program Directors (SUCPD, currently SAU), having previously served as SUCPD Secretary-Treasurer from 2011-2012 and on the Board of Directors from 2007-2011. He also served as a Councilor for the New Jersey Chapter of the American College of Surgeons. He has previously served on the Examination Committee for the American Board of Urology, as Councilor for the Association of Academic Surgery, on the Audit Committee for the American Urologic Association, and on the Executive Committee of the Northeast Section of the American Urologic Association, and is Past President of the Urologic Society for Transplantation and Renal Surgery. In 2011 and 2012, Dr. Jordan was nominated for the Golden Apple Teaching Award by the Rutgers-New Jersey Medical School Student Council. He has given many International and National Lectures. Dr. Jordan has been named a Top Doctor by New York Magazine in 2012, Top New York Doctor for Cancer in 2013, by Castle Connolly as Top Doctor in New York in 2012 and 2013, Top Doctor in New York/Jersey in 2013, Best Doctors in U.S. News and World Report in 2012 and 2013, Best Doctors in Orange County (2017) and “Best Doctors in America” in consecutive years from 1994-present.

In December 2013, Dr. Jordan joined the Department of Urology at University of California, Irvine as Professor and Residency Program Director and Chief of Urology at the Long Beach VA Medical System. He currently serves as the SAU representative to the AAMC, on the AUA Education Council, on the VA National Surgery Board, and on the Program Committee for the Council for Faculty and Academic Societies (CFAS).

Justin La

The original intention of the USMLE was to serve as the primary assessment tool for state medical board physician licensing. Gradually, USMLE (in particular reliance on Step 1 scores) has been adopted as the primary screening and selection tool for the transition of candidates from UME to GME by residency directors and selection committees. Consensus has been developing that the current UME-GME transition reliance on USMLE Step 1 is inherently flawed since the results of a high stakes exam designed to qualify physicians for state licensing is not relevant in either holistically evaluating residency candidates or in providing an equitable means fairly distributing residency positions.  This culminated in the Invitational Conference on USMLE Scoring (InCUS) conference in March 2019, where it became clear that USMLE Step 1 was no longer serving the stakeholders in what has become a flawed UME-GME transition system. Although the was general consensus of InCUS was that changes were needed, USMLE alone would not be the only component requiring a “fix”. However, several suggestions included implementing a “pass/fail” , composite, or categorical USMLE scoring system, as well as minimizing racial demographic difference affecting USMLE performance, among others.

From the program director’s perspective, it is unclear that  changes in USMLE scoring alone would provide significant additional guidance in residency selection.  Equitable selection of  residency applicants has become major challenge, in view of the absence of hard data to reliably predict residency performance. In addition to USMLE part 1, our traditional tools have included letters of reference, medical school grades, election to AOA,  Deans letter, and clinical course evaluations. Unfortunately, notwithstanding the MSPE and Dean’s letter,  critical factors such as professionalism, accountability, social responsibility, team performance, peer interactions, and clinical skills cannot adequately be assessed.   For many candidates, the most important determinants of future resident performance are observed during clinical rotations in the chosen subspecialty, either at the home school or as away rotations. Unfortunately, most students are faced with the challenge of a limited number of clinical elective rotations, and hence exposure to potential residency programs. As a consequence, most residency directors overly rely on the USMLE part 1 as a surrogate of clinical performance for students that have not rotated with them. During the COVID pandemic, the absence of in person away rotations has made clinical assessment of resident candidates even more challenging for programs.

Potential solutions could include incorporating a standardized residency assessment tool (RAT) utilized by all medical schools, that may include milestone – type assessments that correlate to the six core competencies, as well as evaluation of skills relevant  to the type of residency applied to ( e.g. spatial coordination, technical ability for surgical specialties). Other tools such as the Jefferson Scale of Empathy and Crowd sourcing of clinical skills to assess potential candidates are being piloted in some programs.

This webinar will review the current challenges of resident candidate assessment and selection. The pandemic coming on the heels of the planned conversion of USMLE conversion to Pass/Fail has magnified the importance of developing alternative and viable candidate assessment tools and will be a major factor informing our discussion.

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January 14, 2021 at 12:00 pm

Pass/Fail Step 1: Implications for a foundational science department

Presenter: Doug Gould, PhD, FAAA

Douglas GouldDoug is currently a Professor and Chair of the Department of Foundational Medical Studies at the Oakland University William School of Medicine (OUWB). He leads a Department of 40 faculty members from all basic science and medical humanity disciplines. He joined IAMSE in 1998 and served on the Development Committee from 2001-2003. From 2002-2007 he served as the Editor-in-Chief of Medical Science Educator and Chaired the Editorial Board, served as a member of the Publications Committee and as an ex officio member of the Board of Directors; Doug also moderated a host of plenary and discussion sessions during his time as an IAMSE member. For over 20 years, IAMSE has been his ‘go to’ home for collaboration and interaction with colleagues for all things medical education!

This session will explore the impact of the USMLE Step 1 exam moving to pass/fail on a foundational science department. Focus will be on the potential and expected impacts on our faculty, curriculum and students.

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January 21, 2021 at 12:00 pm

USMLE Step 1 P/F: A UME Curriculum Dean’s Perspective

Presenter: Jonathan Amiel, MD

Jonathan Amiel, MD, is an Associate Professor of Psychiatry, Interim Co-Vice Dean for Education, and Senior Associate Dean for Curricular Affairs at the Vagelos College of Physicians and Surgeons (VP&S). His scholarly work focuses on competency-based medical education (CBME). He is the faculty leader for the AAMC national study on the implementation of Core EPAs to Enter Residency, a member of the International CBME collaborators and past-chair of the AAMC Northeast Group on Educational Affairs. He chairs the membership committee of the Gold Humanism Honor Society.

This session will review the anticipated impact of the shift of USMLE Step 1 on the undergraduate medical education curriculum and on medical students’ experience of the residency application process.

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January 28, 2021 at 12:00 pm

Step 1 Going Pass-Fail: Are We Just Kicking the Can Down the Road?

Presenter: Brenda Roman, MD and Bruce Z. Morgenstern, MD

Brenda RomanBrenda Roman, MD is Associate Dean of Medical Education and Professor in Psychiatry at Wright State University Boonshoft School of Medicine in Dayton, OH. Previously she was the Director of Medical Student Education in Psychiatry for 18 years. Dr. Roman received her medical degree from the University of Nebraska Medical Center in 1988, and completed her residency in psychiatry at the University of Cincinnati Hospital system in 1992, then joined the faculty at Wright State University Boonshoft School of Medicine. She is certified by the American Board of Psychiatry and Neurology. She is a member of Alpha Omega Alpha Medical Honor Society and the Gold Humanism Honor Society. Her clinical work has focused on the college population and the homeless population. Her scholarly work focuses on medical education, curriculum development, and women’s mental health issues.

Dr. Roman has extensive experience with the medical school curriculum, being on the forefront of introducing Team-Based Learning into the psychiatry curriculum, and working to introduce Peer Instruction and a unique brand of problem-based learning (WrightQ) to the overall curriculum. When she was Assistant Dean for Curriculum, she led the transformation to a lecture free curriculum that debuted in 2017.

In addition to numerous school and university committees, Dr. Roman served on the Executive Council of the Association of Directors of Medical Student Educators for 10 years, including President. She served as chair of the USMLE Step 2 Psychiatry Test Material Development Committee, and continues to serve on Interdisciplinary Review Committees. In 2013, she completed the prestigious Executive Leadership in Academic Medicine (ELAM) program for women. Recent awards at the Boonshoft School of Medicine include the Leonard Tow Humanism in Medicine Award in 2014, and the Faculty Mentor Award and Lifetime Achievement Award in 2012. She is currently faculty and mentor for the Leadership Education and Development Program (LEAD) Certificate Program of the American Association of Medical Colleges, and is chair elect of the Undergraduate Medical Education Section of the GEA. Most recently she received the Laureate Award in the CGEA for her contributions as a mentor in medical education and to the CGEA. She has over 50 publications, most in the area of medical education.

Bruce Morgenstern is Vice Dean for Academic & Clinical Affairs at the Roseman University College of Medicine. He received his MD degree from Jefferson Medical College. He trained in General Pediatrics at the Long Island Jewish – Hillside Medical Center and in Pediatric Nephrology at the St. Christopher’s Hospital for Children. After serving in the US Air Force at Keesler Medical Center, he practiced for 15 years at the Mayo Clinic and for another decade at Phoenix Children’s Hospital.

Bruce has also been involved in medical student education for more than 25 years. He has served as president of COMSEP and is the immediate past president of the Alliance for Clinical Education, the organization of medical school clerkship director organizations from Pediatrics, Internal Medicine, Family Medicine, Ob/Gyn, Neurology, Psychiatry, Surgery and Emergency Medicine. He was the editor-in-chief of the 4th and 5th editions of the Guidebook for Clerkship Directors.

In recent years there has been growing concern about the potential negative impact of USMLE Step 1 scores being used as determinants as to who is invited to interview for residency positions, a step taken as the number of applications for each residency program became unmanageable. Concerns included the medical students focusing more on Step 1 study versus the curriculum of the medical school, and the general learning environment of Step 1 “frenzy” amongst the students. The announcement by the National Board of Medical Examiners in February 2020 that USMLE Step 1 is going to a pass/fail scoring system in 2021 was both applauded and condemned by medical educators and students. The president and immediate past-president of the Alliance of Clinical Education, the organization of medical school clerkship director organizations from Pediatrics, Internal Medicine, Family Medicine, Ob/Gyn, Neurology, Psychiatry, Surgery and Emergency Medicine will discuss the impact of USMLE Step 1 not having a numerical score, including the concern that with USMLE Step 2 CK remaining scored, are we just shifting the concerns to a different time in the life of a medical student.

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February 4, 2021 at 12:00 pm

USMLE Step 1: Osteopathic and International Perspectives

Presenter: Jack Boulet, PhD and Robert Cain, DO

Dr. Boulet is Vice President, Research and Data Resources, for both the Educational Commission for Foreign Medical Graduates (ECFMGÂŽ) and the Foundation for Advancement of International Medical Education and Research (FAIMERÂŽ). Dr. Boulet holds a B.Sc. in Mathematics from the University of Western Ontario and both a M.A. and Ph.D. in Education, specializing in measurement and evaluation, from the University of Ottawa. He is a Senior Scholar at the University of Illinois at Chicago, College of Medicine, an Adjunct Professor of Medicine at the F. Edward Hebert School of Medicine, Uniformed Services University, and a Fellow of the Society for Simulation in Healthcare. Dr. Boulet currently serves on the editorial boards for Advances in Health Sciences Education: Theory and Practice, Education for Health, and Simulation in Healthcare. He is a Deputy Editor for Medical Education.

Robert A. Cain, DO, FACOI, FAODME, currently serves as the President and CEO of the American Association of Colleges of Osteopathic Medicine. In this role he represents osteopathic medical education in a variety of settings while overseeing the operations of the association that supports the nation’s colleges of osteopathic medicine and graduate medical education leaders.

Prior to assuming this role with AACOM, he was the Associate Dean for Clinical Education at the Ohio University Heritage College of Osteopathic Medicine, where he was responsible for business development and relationship management for clinical experiences associated with undergraduate and graduate medical education (GME). As part of his GME related duties, he served as the Chief Academic Officer for the Ohio Centers for Osteopathic Research and Education (CORE). Past roles include Director of Medical Education (DME) at Grandview Hospital in Dayton, Ohio (2006-2014) and director of the internal medicine residency program at the same facility (1999-2007).

Dr. Cain operated a private practice (pulmonary medicine) from 1994-2008. He is a 1988 graduate of the Ohio University Heritage College of Osteopathic Medicine, a 1989 graduate of the traditional rotating internship program at Firelands Community Hospital in Sandusky, Ohio, a 1992 graduate of the internal medicine training program at Brentwood Hospital in Cleveland, Ohio, and a 1994 graduate of the pulmonary medicine fellowship program at Grandview Hospital in Dayton, Ohio. He completed Midwestern University’s Costin Institute for academic leadership in 2009. The American Osteopathic Board of Internal Medicine (AOBIM) recently recertified him in pulmonary medicine (2018).

Reporting a Pass/Fail Outcome for USMLE Step 1: The Challenges Faced by International Medical Graduates

On February 12, 2020, after extensive stakeholder discussion, the National Board of Medical Examiners (NBME) announced that the United States Medical Licensing Examination (USMLE) Step 1 will transition to pass/fail. For program directors, the scores from this examination have been one of the most important factors in deciding which residency candidates to interview. The lack of scores will force changes to the residency selection process, some of which could have both positive and negative consequences for International Medical Graduates (IMGs). In this session, I will discuss some of the relevant issues associated with the transition to Step 1 pass/fail and how they are likely to impact IMGs. I will also provide insights on how this change could help motivate the medical community to develop a more efficient and effective pathway for medical school graduates to transition to postgraduate training.

USLME Transitions, An Osteopathic Perspective

Dr. Cain will review the Osteopathic medical community reactions to USLME moving to Pass/Fail and the challenges of a dual licensing system.

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February 25, 2021 at 12:00 pm

The Coalition for Physician Accountability: UME-GME Review Committee

Presenter: Elise Lovell, MD

Dr. Lovell graduated from the University of Wisconsin School of Medicine and Public Health, and completed her emergency medicine residency at the University of Cincinnati. She is the Program Director at the Advocate Christ Medical Center (ACMC) emergency medicine residency and a Clinical Professor at the University of Illinois, Chicago. Dr. Lovell currently serves as the Co-Chair of the Coalition for Physician Accountability UME-GME Review Committee, and as Chair of the Organization of Program Director Societies (OPDA). From 2011 through 2015, she served as a member of the Board of Directors for the Council of Residency Directors in Emergency Medicine (CORD). She has received teaching awards from the Emergency Medicine and Internal Medicine residency programs at ACMC, the CORD Impact Award for contributions to the national CORD Academic Assembly, the Associate Program Director of the Year award from the national Emergency Medicine Residents’ Association, and the Ally Award from the Society of Academic Emergency Medicine Academy for Diversity and Inclusion in Emergency Medicine.

Over the past few years, increasing attention has been devoted to identifying trends negatively impacting the UME-GME transition. InCUS (Invitational Conference on USMLE Scoring) laid important ground work for the efforts ahead. The decision to change the scoring of the USMLE Step I examination to pass/fail has accelerated the timeline for solutions, and the UME-GME community is energized to more comprehensively improve the UME-GME transition for all stakeholders. In follow-up to InCUS, the Coalition for Physician Accountability convened a UME-GME Review Committee (UGRC) in September 2020 with a one year charge to develop recommended solutions to identified challenges in the UME-GME transition. The UGRC is to act with transparency, consider stakeholder engagement, and utilize data when available. Assuring learner competence and readiness for residency, wellbeing, and equity are primary goals.

Learner Objectives:
At the end of this session, attendees will be able to:
–describe the history and background leading to the creation of the UME-GME Review Committee (UGRC)
–identify the goals, work process, and timeline of the UGRC

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