Improving USMLE Step 1 outcomes in academically vulnerable students through a targeted, competency-based curriculum

Failing the United States Medical Licensing Exam (USMLE) Step 1 can have significant and lasting negative consequences on medical student well-being, academic performance and time to graduation. Although academic predictors can identify students at higher risk for Step 1 failure, there is limited evidence on how to best support these students in achieving first-attempt success and maintaining on-time graduation. Time-variable progression is one feature of competency-based medical education, but simply extending the dedicated study period is not associated with improved Step 1 outcomes.

Beginning in 2019, the University of Washington School of Medicine offered a 10-week Comprehensive Basic Sciences Review (CBSR) course to students identified as having an elevated risk for Step 1 failure. This optional curricular intervention precedes the dedicated study period for these students. Program effectiveness was evaluated by comparing Step 1 scores and on-time graduation rates of 50 students who took CBSR in 2019-2021 with 50 academically propensity-matched controls.

CBSR students scored significantly higher on Step 1 (mean of 212.7 vs. 202.1, P < 0.001) than their academically-matched controls. Rates of on-time graduation were similar between the two groups (65.3% [32/49]) for CBSR students, compared to (60.0% [30/50] for the control group).

This proactive, optional curriculum is associated with significantly higher Step 1 scores for at-risk students than their propensity-matched controls, without negatively affecting on-time graduation.