Internal medicine residency program director perceptions of USMLE Step 1 pass/fail scoring: A cross-sectional survey.
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SUBMITTER: Mun F
PROVIDER: S-EPMC8052063 | biostudies-literature | 2021 Apr
REPOSITORIES: biostudies-literature
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Internal medicine residency program director perceptions of USMLE Step 1 pass/fail scoring: A cross-sectional survey.
Mun Frederick F Scott Alyssa R AR Cui David D Chisty Alia A Hennrikus William L WL Hennrikus Eileen F EF
Medicine 20210401 15
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Project description:Rationale and objectivesIn February 2020, administrators for the US medical licensing examination (USMLE) announced that Step 1 reporting would change to pass/fail in hopes of reducing the overemphasis of USMLE performance on the residency selection system and improving medical student well-being. Our objective was to determine the perspectives of diagnostic radiology (DR), interventional radiology (IR), and nuclear medicine (NM) program directors (PDs) regarding pass/fail USMLE Step 1 scoring.Materials and methodsA survey composed of thirteen questions on a three-point Likert scale, five demographic questions, and a free-text question was distributed to 179 DR, 84 IR, and 34 NM PDs from ACGME-accredited residency programs.ResultsIn total, 140 unique responses were obtained (response rate = 47.1%). The PD respondents had a male predominance of 79.1%, average age of 46 ± 7.2 years, and average tenure of 5.9 ± 5.2 years. A majority of PDs (69.6%) disagreed that the change is a good idea, and a minority (21.6%) believe the change will improve medical student well-being. Further, 90.7% of PDs believe a pass/fail format will make it more difficult to objectively compare applicants and most will place more emphasis on USMLE Step 2 scores and medical school reputation (89.3% and 72.7%, respectively).ConclusionThe lasting impact of pass/fail Step 1 scoring are uncertain and many radiology PDs do not support this change. While the central motivations to reduce the overemphasis on USMLE Step 1 performance and improve medical student well-being are admirable, it remains to be seen if pass/fail scoring will accomplish these goals.
| S-EPMC7485567 | biostudies-literature
Project description:BackgroundUnited States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process.MethodsA 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association's Fellowship and Residency Electronic Interactive Database.ResultsWe received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit.ConclusionOrthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.
| S-EPMC8091716 | biostudies-literature
Project description:ObjectiveThis study sought to evaluate the perspectives of surgical program directors regarding the change of USMLE Step 1 to pass/fail grading.DesignValidated electronic survey.SettingVanderbilt University Medical Center Department of Plastic Surgery.ParticipantsProgram directors of all ACMGE-accredited General Surgery, Integrated Vascular Surgery, Integrated Thoracic Surgery, and Integrated Plastic Surgery residency programs.ResultsThe overall response rate was 55.5%. Most PDs (78.1%) disagreed with the scoring change. Only 19.6% believe this change will improve medical student well-being. For 63.5% of PDs, medical school pedigree will become more important, and 52.7% believe it will place international medical graduates at a disadvantage. Only 6.2% believe Step 2 CK should also be pass/fail, while 88.7% will increase the weight of Step 2 CK and 88.4% will now require Step 2 CK score submission with the electronic residency application service.ConclusionsWhile well-intentioned, changing USMLE Step 1 to pass/fail may have unintended consequences and may disadvantage certain groups of applicants. The emphasis on Step 1, and resulting test-taking apprehension, will likely shift to Step 2 CK. Proponents of equitable evaluation should direct their efforts toward increasing, not decreasing, the number of objective measures available for student assessment.
| S-EPMC7347473 | biostudies-literature
Project description:BACKGROUND: To assess the impact of a change in preclerkship grading system from Honors/Pass/Fail (H/P/F) to Pass/Fail (P/F) on University of California, San Diego (UCSD) medical students' academic performance. METHODS: Academic performance of students in the classes of 2011 and 2012 (constant-grading classes) were collected and compared with performance of students in the class of 2013 (grading-change class) because the grading policy at UCSD SOM was changed for the class of 2013, from H/P/F during the first year (MS1) to P/F during the second year (MS2). For all students, data consisted of test scores from required preclinical courses from MS1 and MS2 years, and USMLE Step 1 scores. Linear regression analysis controlled for other factors that could be predictive of student performance (i.e., MCAT scores, undergraduate GPA, age, gender, etc.) in order to isolate the effect of the changed grading policy on academic performance. The change in grading policy in the MS2 year only, without any corresponding changes to the medical curriculum, presents a unique natural experiment with which to cleanly evaluate the effect of P/F grading on performance outcomes. RESULTS: After controlling for other factors, the grading policy change to P/F grading in the MS2 year had a negative impact on second-year grades relative to first-year grades (the constant-grading classes performed 1.65% points lower during their MS2 year compared to the MS1 year versus 3.25% points lower for the grading-change class, p?<?0.0001), but had no observable impact on USMLE Step 1 scores. CONCLUSIONS: A change in grading from H/P/F grading to P/F grading was associated with decreased performance on preclinical examinations but no decrease in performance on the USMLE Step 1 examination. These results are discussed in the broader context of the multitude of factors that should be considered in assessing the merits of various grading systems, and ultimately the authors recommend the continuation of pass-fail grading at UCSD School of Medicine.
| S-EPMC4083104 | biostudies-literature
Project description:BACKGROUND: The development of autonomy is a key component of residency training. Although studies have examined levels of graduated autonomy within specialties, they have not, to our knowledge, examined how residents' perceptions of autonomy differ among specialties. OBJECTIVE: We surveyed residents in internal medicine-pediatrics programs to determine their perceptions of the autonomy they experienced when they were serving on internal medicine (IM) and pediatrics inpatient rotations. METHODS: In 2012, we administered a 24-item online survey to residents in 36 internal medicine-pediatrics programs. RESULTS: Of 698 eligible residents, 143 (20.5%) participated. Participants were distributed equally among all 4 postgraduate years and between IM and pediatrics rotations. Participants were more likely to agree they experienced an appropriate level of autonomy when they were on IM rotations than when they were on pediatrics rotations (97.9% versus 34.3%, P < .001), were more likely to report experiencing frustration with too little oversight while on IM rotations (32.9% versus 2.2%, P < .001), and were more likely to report experiencing frustration with too much oversight while on pediatrics rotations (48.2% versus 0.7%, P < .001). Responses to items that described frequently encountered circumstances and hypothetical medical cases indicated participants were more likely to feel anxiety and discomfort with autonomous decision making while on pediatrics rotations. CONCLUSIONS: Residents in internal medicine-pediatrics programs perceive significant differences in the autonomy they experience during IM and pediatrics rotations. This may influence their confidence in medical decision making.
| S-EPMC4054737 | biostudies-other
Project description:BackgroundThe increase in applications to residency programs, known as "application inflation," creates challenges for program directors (PDs). Prior studies have shown that internal medicine (IM) PDs utilize criteria, such as United States Medical Licensing Examination (USMLE) Step examination performance, when reviewing applications. However, little is known about how early these filters are utilized in the application review cycle.ObjectiveThis study sought to assess the frequency and types of filters utilized by IM PDs during initial residency application screening and prior to more in-depth application review.MethodsA web-based request for the 2016 Internal Medicine In-Training Examination (IM-ITE) PD Survey was sent to IM PDs. Responses from this survey were analyzed, excluding non-US programs.ResultsWith a 50% response rate (214 of 424), IM PDs responded that the most commonly used data points to filter applicants prior to in-depth application review were the USMLE Step 2 Clinical Knowledge score (32%, 67 of 208), USMLE Step 1 score (24%, 50 of 208), and medical school attended (12%, 25 of 208). Over half of US IM PD respondents (55%, 114 of 208) indicated that they list qualifying interview criteria on their program website, and 31% of respondents (50 of 160) indicated that more than half of their applicant pool does not meet the program's specified interview criteria.ConclusionsResults from the 2016 IM-ITE PD Survey indicate many IM PDs use filters for initial application screening, and that these filters, when available to applicants, do not affect many applicants' decisions to apply.
| S-EPMC6919169 | biostudies-literature
Project description:BackgroundResidency programs have experienced a trend toward decreased work hours and case volumes, negatively affecting the perception of graduating residents' competence. Subspecialty tracks have been proposed to help address these issues.ObjectiveWe evaluated the perceptions of obstetrics and gynecology (ob-gyn) residency program directors (PDs) on subspecialty tracking during training.MethodsIn 2017, a web-based, anonymous survey with Likert scale and open-ended items was e-mailed to US ob-gyn PDs.ResultsOf 250 PDs surveyed, 169 (68%) responded. More than half (54%) reported tracking would positively affect training of future ob-gyn physicians; 80% agreed it would increase resident preparedness for fellowship. Nearly half (49%) indicated it should be available for interested residents. However, some respondents expressed concerns this would negatively affect resident training (38%) and could decrease the number of ob-gyn generalists (50%). Most (88%) believed that tracking, if implemented, should not be mandatory, and 84% agreed that a tracking curriculum should be accompanied by Accreditation Council for Graduate Medical Education (ACGME) and American Board of Obstetrics and Gynecology changes. Only 31% of PDs felt tracking could be successfully implemented in their programs. Barriers to implementation included too few residents to divide into tracks, challenging administrative logistics, and concerns about meeting ACGME case volume requirements.ConclusionsPDs have defined but diverse opinions on the implementation of tracking in ob-gyn. Slightly more than half of responding PDs reported tracking would positively affect the training of future ob-gyn physicians, and less than one-third indicated that their program could successfully implement tracking.
| S-EPMC6314374 | biostudies-literature
Project description:BackgroundResidency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance.DesignThe authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees' first Step 2 CK scores for analysis.ResultsOn multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = -3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78).ConclusionDespite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.
| S-EPMC9296728 | biostudies-literature
Project description:Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc. (ACP), and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative of the Cleveland Clinic's internal medicine residents to improve diabetes care and outcomes within an underserved patient population at an East Cleveland, OH, health center.
| S-EPMC7164989 | biostudies-literature
Project description:BackgroundNorth American and European accreditation bodies have legislated progressively more strict work hour restrictions for residents in light of evidence that sleep deprivation leads to increased medical errors and decreased wellbeing. The purpose of the study is to determine the physiologic demands of internal medicine training during residency as well as document average sleep (on- and off-call) and physical activity performed using accelerometers.MethodsA total of 40 internal medicine residents working on the clinical teaching unit at a single center were enrolled in the study from November 2011 to March 2016. There were 22 subjects that completed the study and were included in the analysis. SenseWear PRO 2 armband monitors were worn for 5 consecutive days including one call day. The primary outcomes of the study were to quantify and compare the calories per day, steps per day, METs per hour, hours of activity, hours of sleep, and sleep efficiency for on call versus post-call and non-call days.ResultsThe average activity per day, calories per day, steps per day and METs per hour for the call day were 7.6 ± 7.6 h, 2647.0 ± 541.1, 11,261.1 ± 2355.9, and 1.7 ± 0.2 respectively. Each of these parameters had a statistically significant F statistic compared to post-call and non-call days. The subjects had a mean of 1.8 ± 2.0 h of sleep per day with a sleep efficiency of 77.3 ± 23.8% for the call day. The F statistic for sleep per day was significant with a p value < 0.001.ConclusionThis study shows that overnight call has a substantial impact on multiple metabolic parameters. These findings have potentially important implications on future resident working hour restrictions.
| S-EPMC6501377 | biostudies-literature