Are We Teaching to the Test? Medical Student Perceptions of the USMLE Step 1 Exam

Abstract

With many medical schools having undergone significant curricular reform, including those who have transitioned to a pass/fail curriculum model, residency programs have little quantitative data with which to compare individual medical students who apply to their programs. For these programs, the primary source of quantitative data is a student’s USMLE Step 1 exam score, because it provides a common measurement across medical schools with different curricula. This circumstance puts an immense amount of pressure on this one exam, sparking discussions at medical schools across the nation about the “Step 1 Climate” ( Chen et. al., 2019). In 2016, Indiana University School of Medicine – Bloomington (IUSM‐BL) underwent curricular reform. The new curriculum uses a pass/fail system for all courses. Given the emphasis placed on the Step 1 exam, I am interested in learning more about student perceptions of the Step 1 exam, specifically how it impacts their relationship with the IUSM‐BL curriculum.First‐ and second‐year medical students at IUSM‐BL were interviewed using a 30–60‐minute semi‐structured interview format. The questions were designed to obtain student perceptions of the USMLE Step 1 exam and its relationship to the current medical school curriculum at IUSM‐BL. Interview questions included the following: 1) Having students explain the Step 1 exam and its importance in their future education, 2) Explanations of how students are studying for the Step 1 exam, 3) Perceptions of how well the IUSM‐BL curriculum is preparing students for the Step 1 exam. A thematic analysis of the interview transcripts was performed to determine commonalities in responses. Resultant themes indicate that the USMLE Step 1 exam is ever‐present in the minds of our medical students. They stress the overemphasis on this exam for their future residency applications, and suggest some ideas for ways to alleviate the emphasis placed on the Step 1 exam. This study will contribute to answering the larger questions surrounding the effect of the Step 1 exam on students and medical education.