Can pre-clinical examination performance identify student challenges in competency-based medical education?

By design, frequent assessments occur in competency-based medical education to identify struggling learners, so early intervention can occur. We conducted a longitudinal evaluation of pre-clinical student remediations to explore whether patterns exist that can identify future testing performance.

Five cohorts of medical students who matriculated between 2014 and 2018 were included. A trend analysis was conducted to explore test performance patterns that would identify students at risk of future remediation, and the odds of subsequent remediations were calculated. Associations between remediations, delaying USMLE Step 1, USMLE Step 1 scores, and pass rates were also assessed.

Over 600 students (n = 612 of 758 or 80.7%) did not require remediation, and 146 of 758 students (19.3%) required one or more block remediations. Of these, 65 (44.5%) had a single remediation, and 81 (54%) remediated two to five blocks. The trend analysis did not identify any specific pattern over the course of the pre-clinical curriculum, although prior remediation did increase the odds of future struggles at the block level. Remediating any block was associated with needing extra study time to prepare for step 1, as well as an increased likelihood of failing step 1 on the first attempt. The number of remediations for a single student was not associated with higher rates of step 1 failure.

In a competency-based curriculum, past remediation was associated with increased risk of future difficulties. However, broader approaches for remediation support beyond academic strategies may be needed, including social support and wellbeing. As most students who experienced remediation went on to successful careers, unexpected struggles can occur and foster students' growth.