In the midst of a global health crisis, USMLE Step 1 needs to be made pass/fail now

Every aspect of life has been affected by COVID-19, including medical education.

Since March 17, medical schools across the nation have suspended clinical rotations, per guidelines from the Association of American Medical Colleges (AAMC). The target end date for this temporary pause was set originally to March 31.

The National Board of Medical Examiners (NBME) followed suit, declaring that Prometric testing centers were closing for at least 30 days starting March 18, with an anticipated re-opening from April 16 onwards.

Then on Sunday, March 29, President Trump declared an extension on social distancing guidelines to the end of April.

At this writing, AAMC and NBME have not issued updated guidelines in response to these new social distancing measures. But as medical students await for further instruction, we anticipate that Prometric centers will continue to be closed down beyond the original target date of April 16.

We know that the COVID crisis continues to escalate. Entire countries have been put on lockdown. Both patients and healthcare workers have died. These are unnerving times, and medical students are feeling the effects of the pandemic in more ways than one. They are worried not only about their education, but their health, finances, and their own families. On top of all this, the postponement of Step 1 has caused emotional distress for many medical students. Exam dates are in limbo, prone to change each week. This affects the start of third-year clinical rotations as well. Some schools mandate a passing grade of Step before entering rotations. It is not only second-year students who are studying for the exam, but third-years and those who took a gap year before fourth year. Students are not only thinking about this exam; they are worried about their families and loved ones, their communities, and cities.

Amidst these chaotic times, we advocate for making Step 1 pass/fail now amid COVID-19. On February 12, the United States Medical Licensing Examination (USMLE) program had already issued new policies that changed the reporting of Step 1 from a three-digit number to pass/fail, but only two years from now starting in January 2022. Even if decisions are not released soon on whether further Prometric testing sites will close down, it would be reassuring for students if Step 1 was changed to pass/fail. Making it pass/fail would alleviate some stress during an already stressful time. Given the unprecedented effects of the pandemic, we plead to apply these changes now.

Administration and others may see the delay as extra time for studying, but studies have shown that the number of days dedicated for Step study do not have a correlation with scores. If anything, the delay has compounded additional dread on top of the already-stressful nature of the board exam. It is well-documented that the 3-digit score has played a significant part in students’ applications to residencies, often determining who may interview at a specific program or not.

We recognize that NBME has tried to assuage the negative ramifications of test cancellations by offering free practice exams beginning April 3. They have also waived fees for permit extensions. But as a classmate put it, why did it take a pandemic for NBME to offer free study materials? This organization already makes millions of dollars each year, profiting from medical students who are already mired in thousands of dollars of debt.

Many students who were in the midst of intense periods of Step study are now actually taking this time to fight COVID-19 outside the hospitals. Whether it’s providing childcare for physicians or virtual visits the elderly at assisted living facilities, whether it’s making phone calls for PPE donation campaigns or helping the local department of health gather epidemiological data, medical students from all class years have stepped up – including those who are still studying for Step.

Exam dates have been re-scheduled ever since the testing suspension from March 18-April 16; however, now that social distancing guidelines have extended, we know that exam dates are still truly up in the air. This kind of uncertainty and confusion compounds the stress that many of my peers are already facing from an exam as challenging as Step 1. I hear their worry and concerns; people I know have been studying for several weeks, some months, now, and they’re understandably frustrated. Burnout looms ahead. I write this advocating for the thousands of medical students who are in the throes of studying for this exam.

USMLE has already declared Step 1 to be pass/fail – and future medical students are grateful. But we hope these changes will apply to our current medical students now, many of whom are taking the time and stepping up to fight against the global health crisis.

Anna Delamerced is a medical student.

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