Impact of USMLE Step 1 Transition to Pass/Fail Scoring System on Medical Students' Anxiety, Sleep Quality, and Burnout
DOI:
https://doi.org/10.5195/ijms.2023.2337Keywords:
Medical Education, Medical Student, MedicineAbstract
BACKGROUND: Originally designed to evaluate the application of foundational scientific knowledge in clinical contexts, the United States Medical License Exam Step 1 evolved into a comparative tool for assessing candidates' educational foundations. This transition heightened the pressure on medical students to excel in the exam. In response, collaborative efforts involving the National Board of Medical Examiners prompted a significant change from reporting scores to a pass/fail system. However, the true impact of this shift remains insufficiently explored. This study aims to assess the emotional toll - encompassing burnout, anxiety, depression, and sleep quality - experienced prior to taking the Step 1 exam. Additionally, it aims to uncover potential gender-based disparities in perceived stress, anxiety, and depression.
METHODS: The study encompasses the entirety of third-year medical students at Drexel University College of Medicine, who were invited to participate in a comprehensive survey. Drawing from retrospection, the survey relies on self-reported data regarding anxiety, depression, sleep quality index, and burnout levels. Data compilation was anonymized and executed through the Qualtrics platform.
RESULTS: A total of 102 medical students completed the survey, with a 97% pass rate for the USMLE Step 1. Despite their excellent performance, 75% of students reported inadequate sleep quality, and 68% exhibited mild to moderate anxiety levels. Among them, a higher percentage of females (83%) experienced mild to moderate anxiety compared to their male counterparts (50%). Furthermore, 66% of students felt that their commitment to education exceeded what was reasonable for their well-being.
CONCLUSION: The transition from traditional scoring to a pass/fail system was ostensibly intended to enhance the mental well-being of medical students. Nevertheless, our findings underscore that students continue to grapple with heightened levels of stress, anxiety, and burnout during the pivotal month leading up to the Step 1 examination.
Metrics
References
Anderson, Kirstie N, and Andrew J Bradley. “Sleep Disturbance in Mental Health Problems and Neurodegenerative ...” National Institutes of Health , Dove Medical Press Ltd, May 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3674021/.
Baniadam, K., Elkadi, S., Towfighi, P. et al. The Impact on Medical Student Stress in Relation to a Change in USMLE Step 1 Examination Score Reporting to Pass/Fail. Med.Sci.Educ. 33, 401–407 (2023). https://doi.org/10.1007/s40670-023-01749-4
Bartsch T;Döhring J;Rohr A;Jansen O;Deuschl G; “CA1 Neurons in the Human Hippocampus Are Critical for Autobiographical Memory, Mental Time Travel, and Autonoetic Consciousness.” Proceedings of the National Academy of Sciences of the United States of America, U.S. National Library of Medicine, 10 Oct. 2011, pubmed.ncbi.nlm.nih.gov/21987814/.
Carmody, J. Bryan MD, MPH; Rajasekaran, Senthil K. MD. On Step 1 Mania, USMLE Score Reporting, and Financial Conflict of Interest at the National Board of Medical Examiners. Academic Medicine 95(9):p 1332-1337, September 2020. | DOI: 10.1097/ACM.0000000000003126
Chen, David R.; Priest, Kelsey C. MPH; Batten, Jason N. MA; Fragoso, Ligia E. MA; Reinfeld, Bradley I.; Laitman, Benjamin M. MD, PhD. Student Perspectives on the “Step 1 Climate” in Preclinical Medical Education. Academic Medicine 94(3):p 302-304, March 2019. | DOI: 10.1097/ACM.0000000000002565
Durmer, Jeffrey S., and David F. Dinges. “Neurocognitive Consequences of Sleep Deprivation.” Seminars in Neurology, U.S. National Library of Medicine, 25 Jan. 2005, pubmed.ncbi.nlm.nih.gov/15798944/.
Han, Audrey Sol. Medical Students’ Test Anxiety As They Face the USMLE Step 1 Exam, May 2020, repositories.lib.utexas.edu/bitstream/handle/2152/84270/HAN-MASTERSREPORT-2020.pdf?sequence=1.
Havekes R, Park AJ, Tudor JC, Luczak VG, Hansen RT, Ferri SL, Bruinenberg VM, Poplawski SG, Day JP, Aton SJ, Radwańska K, Meerlo P, Houslay MD, Baillie GS, Abel T. Sleep deprivation causes memory deficits by negatively impacting neuronal connectivity in hippocampal area CA1. Elife. 2016 Aug 23;5:e13424. doi: 10.7554/eLife.13424. PMID: 27549340; PMCID: PMC4996653.
Havekes, Robbert, and Ted Abel. “The Tired Hippocampus: The Molecular Impact of Sleep Deprivation on Hippocampal Function.” Current Opinion in Neurobiology, U.S. National Library of Medicine, June 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5511071/.
Huq, S., Khalafallah, A. M., Botros, D., Jimenez, A. E., Lam, S., Huang, J., & Mukherjee, D. (2020). Perceived impact of USMLE Step 1 pass/fail scoring change on neurosurgery: program director survey. Journal of Neurosurgery JNS, 133(3), 928-935. https://doi-org.ezproxy2.library.drexel.edu/10.3171/2020.4.JNS20748
Ishak W;Nikravesh R;Lederer S;Perry R;Ogunyemi D;Bernstein C; “Burnout in Medical Students: A Systematic Review.” The Clinical Teacher, U.S. National Library of Medicine, 8 July 2013, pubmed.ncbi.nlm.nih.gov/23834570/.
Makhoul, Alan T, et al. Objective Measures Needed - The New England Journal of Medicine, 18 June 2020, www.nejm.org/doi/10.1056/NEJMp2006148
Perotta, B., Arantes-Costa, F.M., Enns, S.C. et al. Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students. BMC Med Educ 21, 111 (2021). https://doi.org/10.1186/s12909-021-02544-8
Robbert Havekes, Alan J Park, Jennifer C Tudor, Vincent G Luczak, Rolf T Hansen, Sarah L Ferri, Vibeke M Bruinenberg, Shane G Poplawski, Jonathan P Day, Sara J Aton, Kasia Radwańska, Peter Meerlo, Miles D Houslay, George S Baillie, Ted Abel (2016) Sleep deprivation causes memory deficits by negatively impacting neuronal connectivity in hippocampal area CA1 eLife 5:e13424. https://doi.org/10.7554/eLife.13424
Tackett S, Jeyaraju M, Moore J, Hudder A, Yingling S, Park YS, Grichanik M. Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams. BMC Med Educ. 2022 Jan 4;22(1):16. doi: 10.1186/s12909-021-03055-2. PMID: 34983481; PMCID: PMC8728922. https://www-ncbi-nlm-nih-gov.ezproxy2.library.drexel.edu/pmc/articles/PMC8728922/
Downloads
Published
How to Cite
License
Copyright (c) 2023 Lana AlDoori, Peter G. Zaki, Vivek Joshi
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org
