Evaluation and treatment of students with difficulties passing the Step examinations

The author designed this retrospective case series study both to systematically examine characteristics of individuals referred for treatment after multiple failures on the United States Medical Licensing Examinations (USMLE) Step 1 or 2 administered by the National Board of Medical Examiners and to evaluate treatment effectiveness in a uniform sample.

Six medical students referred to rehabilitation psychology met selection criteria. All students completed the requisite neuropsychological, academic, and psychological testing to identify cognitive and emotional strengths and weaknesses. All six underwent individualized cognitive rehabilitation (CR) with a primary focus on reading fluency and accuracy.

All participants improved on a quantitative measure of reading speed and accuracy, and five of the six passed their next USLME Step examination in spite of past failures.

Medical students with identified difficulties on reading fluency, but no history of a learning disability, may benefit from systematic CR that addresses cognitive weaknesses related to test-taking abilities. The strong relationships between language and reading skills and the USMLE Step examinations suggest that some students may fail these examinations because of a relative weakness in language processing and reading fluency that may prohibit their successful completion of the Step examinations.