Abstract
BackgroundNearly all U.S. medical students engage in a 4–8 week period of intense preparation for their first-level licensure exams, termed a “dedicated preparation period” (DPP). It is widely assumed that student well-being is harmed during DPPs, but evidence is limited. This study characterized students’ physical, intellectual, emotional, and social well-being during DPPs.MethodsThis was a cross-sectional survey sent electronically to all second-year students at four U.S. medical schools after each school’s respective DPP for USMLE Step 1 or COMLEX Level 1 in 2019. Survey items assessed DPP characteristics, cost of resources, and perceived financial strain as predictors for 18 outcomes measured by items with Likert-type response options. Open-ended responses on DPPs’ influence underwent thematic analysis.ResultsA total of 314/750 (42%) students completed surveys. DPPs lasted a median of 7 weeks (IQR 6–8 weeks), and students spent 70 h/week (IQR 56–80 h/week) studying. A total of 62 (20%) reported experiencing a significant life event that impacted their ability to study during their DPPs. Most reported 2 outcomes improved: medical knowledge base (95%) and confidence in ability to care for patients (56%). Most reported 9 outcomes worsened, including overall quality of life (72%), feeling burned out (77%), and personal anxiety (81%). A total of 25% reported paying for preparation materials strained their finances. Greater perceived financial strain was associated with worsening 11 outcomes, with reported amount spent associated with worsening 2 outcomes. Themes from student descriptions of how DPPs for first-level exams influenced them included (1) opportunity for synthesis of medical knowledge, (2) exercise of endurance and self-discipline required for professional practice, (3) dissonance among exam preparation resource content, formal curriculum, and professional values, (4) isolation, deprivation, and anguish from competing for the highest possible score, and (5) effects on well-being after DPPs.ConclusionsDPPs are currently experienced by many students as a period of personal and social deprivation, which may be worsened by perceived financial stress more than the amount of money they spend on preparation materials. DPPs should be considered as a target for reform as medical educators attempt to prevent student suffering and enhance their well-being.
Highlights
Most U.S medical students engage in a 4–8 week period of intense preparation for their firstlevel licensure exams, termed a “dedicated preparation period” (DPP)
National Board of Medical Examiners (NBME) Part I and II exams were not high on the list of factors used in residency selection [2], but by 2008, when the first survey of residency program directors was conducted by the National Resident Matching Program (NRMP), USMLE Step 1 and the equivalent exam for osteopathic schools, Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, were collectively the top-ranked factor used by programs when selecting which applicants to interview [3]
The sponsors of the USMLE became sufficiently concerned about the potential impact of Step 1 on student well-being to organize the Invitational Conference on USMLE Scoring (INCUS) in March 2019, which resulted in the announcement that USMLE Step 1 will change to pass/fail reporting after January 1, 2022 [6]
Summary
Most U.S medical students engage in a 4–8 week period of intense preparation for their firstlevel licensure exams, termed a “dedicated preparation period” (DPP). Tackett et al BMC Medical Education (2022) 22:16 requiring students to pass the National Board of Medical Examiners (NBME) comprehensive Part I exam (the predecessor to United States Medical Licensing Exam (USMLE) Step 1) before moving on to their clerkships [1]. NBME Part I and II exams were not high on the list of factors used in residency selection [2], but by 2008, when the first survey of residency program directors was conducted by the National Resident Matching Program (NRMP), USMLE Step 1 and the equivalent exam for osteopathic schools, Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, were collectively the top-ranked factor used by programs when selecting which applicants to interview [3]. The National Board of Osteopathic Medical Examiners announced in December 2020 that it would change COMLEX Level 1 to pass/fail reporting beginning in May 2022 [7]
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