• USMLE Step 1 Scoring Change Removes a Harmful Barrier to Holistic Specialty Selectio

    Thursday, February 20, 2020

    USMLE Step 1 Scoring Change Removes a Harmful 
    Barrier to Holistic Specialty Selection

    Statement attributable to:
    Gary LeRoy, MD
    American Academy of Family Physicians

    “On behalf of the 37,400 medical student members our organization represents, as well as our members of the graduate and undergraduate medical education communities, we applaud this Step 1 scoring change as the start of a better way forward for medical student wellness, career exploration and specialty selection.

    “In response to input from our medical student and resident members, medical student and resident educators, and residency program directors, the American Academy of Family Physicians advocated for pass/fail scoring on the Step 1 exam as part of our organization’s guidance to the United States Medical Licensing Examination parent organizations on the issue. We suggested this change to create a more meaningful learning environment and improve the emotional climate for medical students, as both factors have been proven to lead to better academic performance as well as performance on USMLE tests.

    “While this change is only a first step, it will reduce the unintentional negative impact of a single standardized exam on career exploration and selection, which is increasingly important as we face a looming shortage of primary care physicians. Undergraduate medical education should support and encourage student opportunities to gain experience and exposure to medicine and physician leadership in communities and in primary care. Reducing the undue burden of this high stakes scored examination is one step that should help allow that exploration. This removal of numeric scoring also paves the way for a better, more holistic residency application and evaluation process, and the AAFP is committed to working with medical schools and residency programs to help evolve the selection process.

    “Pass/fail scoring is also vitally important for creating a more equitable student evaluation and residency selection process, as it will reduce the impact of racial and other biases on residency selection. Factors that impact student experience with standardized testing (such as access to test preparation) perpetuate inequities and disparities that impact test performance, but do not predict or capture competency or skills for future physicians.

    “A more holistic approach must ensure consistent medical school preparation of students while promoting learner and teacher wellness, ultimately evolving the specialty evaluation and selection process. This will strengthen the specialty of family medicine by reducing disparities and attracting the right students into family medicine, resulting in better care for our patients.” 


    More Holistic Process Would Lead to Better Options for Specialty Selection

    Statement attributable to:
    Clif Knight, MD
    Senior Vice President, Education
    American Academy of Family Physicians

    “The change in Step 1 to a pass/fail score will significantly impact the AAFP’s medical student and academic family medicine faculty members.

    “The Step 1 exam, meant to demonstrate qualification for medical licensing, was never intended to have such as strong impact on residency selection, but that has become the problem. Step 1 numeric scores have become a driver for specialty choice, essentially dictating specialty options based solely on a standardized exam.

    “The stress of performing well on the United States Medical Licensing Examination test comes at the cost of wellness and well-roundedness for medical students and residency applicants. Focusing so much on preparation for one exam limits the capacity for medical students to participate in community service and career exploration and is a distraction from additional important learning opportunities.

    “Further, the ever-increasing pressure on schools to prepare students to do well on this exam comes at a cost to their curricula and extracurricular offerings and, therefore, to the personal and professional development of students.

    “The Step 1 scoring change is a good start, but there is more work to be done. The AAFP detailed other suggestions in our July 2019 letter to the USMLE parent organizations, including further study of the correlation between USMLE scores and future performance in residency, specialty board exams and clinical practice.

    “We are committed to working with medical schools and residency programs to monitor and rapidly correct situations that negatively impact medical students, resident career options, workforce diversity and professional development.

    “A physician is a whole person—and should be seen as much more than a single test score. A more holistic selection process would provide students better options to explore medical specialties that align with their career goals and differentiate themselves to residency programs.”

    Editor's Note: To arrange an interview with Dr. LeRoy or Dr. Knight, contact Megan Moriarty, 800-274-2237, Ext. 6052, or mmoriarty@aafp.org.

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    Founded in 1947, the American Academy of Family Physicians represents 134,600 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

    Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

    To learn more about the AAFP and family medicine, visit www.aafp.org/media. Follow us on Twitter, and like us on Facebook. For information about health care, health conditions and wellness, visit the AAFP’s award-winning consumer website, www.familydoctor.org.