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Improving USMLE Step 1 outcomes in academically vulnerable students through a targeted, competency-based curriculum.
Meghan M Kiefer1, Edith Wang2, Kellie Engle2
1University of Washington School of Medicine, 325 9th Ave, Box 359780, Seattle, WA, 98104, USA. meghanm@uw.edu.
BMC Medical Education
|December 13, 2025
Summary
A new review course significantly boosted United States Medical Licensing Exam (USMLE) Step 1 scores for at-risk students. This intervention supported academic success without delaying graduation.
Area of Science:
- Medical Education
- Licensing Examinations
- Student Support
Background:
- Failing the USMLE Step 1 has severe consequences for medical students' well-being and academic progression.
- Identifying at-risk students is possible, but effective support strategies for first-attempt success and timely graduation are limited.
- Standard interventions like extending study periods do not guarantee improved USMLE Step 1 outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a 10-week Comprehensive Basic Sciences Review (CBSR) course for medical students at high risk of failing USMLE Step 1.
- To assess the impact of the CBSR course on both USMLE Step 1 scores and on-time graduation rates.
- To determine if a proactive curricular intervention can improve outcomes for at-risk medical students.
Main Methods:
- A cohort of 50 at-risk medical students participated in the optional 10-week CBSR course between 2019-2021.
- Effectiveness was measured by comparing USMLE Step 1 scores and on-time graduation rates.
- A propensity-matched control group of 50 students who did not take the course was used for comparison.
Main Results:
- Students who completed the CBSR course achieved significantly higher USMLE Step 1 scores (mean 212.7) compared to the control group (mean 202.1).
- On-time graduation rates were comparable between the CBSR group (65.3%) and the control group (60.0%).
- The intervention demonstrated a positive impact on exam performance without hindering timely graduation.
Conclusions:
- The optional Comprehensive Basic Sciences Review (CBSR) course is an effective intervention for improving USMLE Step 1 scores in at-risk medical students.
- This proactive approach enhances academic performance without negatively impacting on-time graduation rates.
- The CBSR course offers a valuable support system for medical students facing challenges with the USMLE Step 1 examination.
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