Identifying and Supporting Students to Prevent USMLE Step 1 Failures When Testing Follows Clerkships: Insights From 9...

Area of Science:

• Medical Education
• Standardized Testing
• Student Support Services

Background:

• Many medical schools are postponing the United States Medical Licensing Examination (USMLE) Step 1 exam until after core clerkships.
• Concerns exist regarding late identification of struggling students and potential negative impacts of delayed exam failures on remediation and debt.

Purpose of the Study:

• To share experiences from nine medical schools that have moved the USMLE Step 1 exam to a postclerkship timing.
• To outline strategies for preventing USMLE Step 1 failures and mitigating adverse outcomes for students who do not pass.

Main Methods:

• Review of curricular policies and early warning systems at nine medical schools with postclerkship USMLE Step 1 exams.
• Identification of at-risk students through performance outcome tracking and understanding of challenges.
• Description of interventions and support mechanisms for all students and those identified as struggling.

Main Results:

• Institutions can implement proactive strategies including coaching, timely feedback, commercial study tools, learning specialists, and wellness programs.
• Specific interventions for at-risk students may include intensive tutoring, accommodations, board prep courses, deceleration, or postponement of the exam.
• In rare cases, compassionate withdrawal from medical school may be necessary.

Conclusions:

• Shifting the USMLE Step 1 exam timing requires careful planning and robust support systems.
• Proactive identification and intervention are crucial for student success, particularly with the upcoming pass/fail scoring change.
• Guidance from institutions that have already made this transition can help others prevent failures and minimize negative consequences.