Educational and Personal Opportunity Costs of Medical Student Preparation for the United States Medical Licensing Examination Step 1 Exam: A Single-Center Study

Nourish: A pilot program to support self-Efficacy, learning, and wellness during USMLE step 1 preparation

PURPOSE

Medical trainees experience significant exam-related stress, such as preparing for the USA Licensing Medical Examination Step 1, which often negatively affects emotional health. Nourish, a novel Step 1 support program, was designed to foster improved self-efficacy and well-being during the process of studying for and taking the exam. Nourish was piloted at Oregon Health & Science University between December 2018 and February 2019.

METHODS

Program elements were guided by Self-Efficacy Theory and included community building, wellness support, peer tutoring and social persuasion. Program evaluation included pre- and post-program surveys. Participation was optional and included 46 of 154 students (30%) with 40 of the 46 students (87%) completing pre and post evaluations. The pre-survey was given during the Nourish orientation in December prior to the Step 1 study period, and the post-survey was given in early February when most students had taken their exam but none had received their scores.

RESULTS

While summary self-efficacy scores increased between baseline and post program (24.9 vs 27.7, p < 0.001), summary emotional health scores worsened (8.15 vs 8.75, p = 0.03). Summary scores for physical health also dropped but this difference was not statistically significant. Summary perceived stress scores increased from 15.5 at baseline to 23.7 post program (p < 0.001). All students who routinely participated in Nourish passed their USMLE Step 1 exam. One student who participated only in the orientation session did not pass.

CONCLUSION

Nourish appeared to improve self-efficacy, even though students reported being stressed with low emotional health. The program appeared to help students align task demands with their own personal resources and set reasonable expectations and strategies to pass the exam. Medical schools should consider similar peer- and faculty mentor-based wellness and tutoring programs to support medical students while they work to achieve academic success.

Final-year medical student mental wellness during preparation for the examination for specialty in Turkey: a cross-sectional survey study

BACKGROUND

In Turkey, most final-year medical students prepare for the Examination for Specialty in Medicine in a high-stress environment. To the best of our knowledge, this is the first study on final-year medical student general psychological distress during preparation for the Examination for Specialty in Turkey. We aim to evaluate psychological distress and understand the variables associated with depression, anxiety, and stress levels among final-year medical students preparing for the Examination for Specialty.

METHODS

A self-reporting, anonymous, cross-sectional survey with 21 items consisting of demographic variables, custom variables directed for this study, and the DASS-21 was utilized. Survey results were expounded based on univariate analysis and multivariate linear regression analysis.

RESULTS

Our study revealed four variables associated with impaired mental wellness among final-year medical students during preparation for the examination for Specialty: attendance to preparatory courses, duration of preparation, consideration of quitting studying, and psychiatric drug usage/ongoing psychotherapy.

DISCUSSION

Considering that physician mental wellness is one of the most crucial determinants of healthcare quality, impaired mental wellness among future physicians is an obstacle to a well-functioning healthcare system. Our study targets researchers and authorities, who should focus on medical student mental wellness, and medical students themselves.

Medical student exam performance and perceptions of a COVID-19 pandemic-appropriate pre-clerkship medical physiology and pathophysiology curriculum

BACKGROUND

Medical schools were compelled to abruptly transition pre-clerkship curricula to remote learning formats due to the emergence of the Coronavirus Disease 2019 (COVID-19) pandemic. We evaluated student perceptions of remote learning, exam performance, and utilization of third-party learning resources to assess the implementation of a newly developed pandemic-appropriate physiology curriculum.

METHODS

This was an observational study based on a survey conducted in the Spring of 2021 at the University of California, Irvine, School of Medicine (UCISOM). This study aimed to assess first (MS1) and second year (MS2) medical students' perceptions of satisfaction, support, academic performance, and connectedness before and during the COVID-19 pandemic. The MS1 class began medical school during the first year of the COVID-19 pandemic, whereas the MS2 class did so prior to the start of the pandemic. A survey instrument was developed and validated to identify the impact remote learning had on student self-perceptions of the Medical Physiology and Pathophysiology course. Surveys were distributed to all students and responses were collected on a voluntary basis. Exam scores on a customized National Board of Medical Examiners (NBME) physiology shelf exam were also compared to objectively identify how the remote curriculum during the pandemic impacted academic performance.

RESULTS

Of 204 students enrolled, 74 responses were analyzed, with 42 MS1 (40% of MS1s) and 32 MS2 (31% of MS2s) responses. Overall, MS1s and MS2s were satisfied with the curriculum they received (95 and 97% respectively) and the school's support of their concerns (86 and 100% respectively). Notably, only 50% of MS1s felt connected to their peers, compared to 94% of MS2s. Lecture attendance and self-perception of their academic performance were similar between both classes. Interestingly, the intra-pandemic class's NBME exam average in 2020 (60.2% ± 8.9, n = 104) was significantly higher than the pre-pandemic class average in 2019 (56.8% ± 11.3, n = 100). Both classes primarily used course materials over third-party learning resources. An additional set of survey questions distributed only to the MS1 class found that the majority of MS1s reported minimal barriers with regards to accessibility, including internet connectivity, study-conducive environments, and balancing family commitments. Overall, pre-clerkship medical students had positive perceptions of the newly developed pandemic-appropriate physiology curriculum.

CONCLUSIONS

Changes to the pre-clerkship physiology curriculum during the COVID-19 pandemic were met with overall satisfaction from the students and an increase in NBME scores. More attention to student connectedness is needed to improve how remote learning can be best optimized into future curricula development.

Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams

BACKGROUND

Nearly 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.

METHODS

This 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.

RESULTS

A 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.

CONCLUSIONS

DPPs 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.

Application Fever: Reviewing the Causes, Costs, and Cures for Residency Application Inflation

Over the past decade, the number of residency applications submitted per applicant has nearly doubled. This epidemic of “Application Fever” is expensive for applicants, burdensome for programs, and ultimately does not improve overall Match outcomes. In this review, we discuss the phenomenon of Application Fever, with a focus on contributing factors and costs of this behavior. Application Fever has its origins in the early 1990s. At that time, the number of residency applicants began to outpace the number of available positions. Because an applicant who applies to more residency programs has a greater probability of securing a residency position than an otherwise equivalent applicant who applies to fewer, "overapplication" became a dominant strategy and residency applicants began to apply to more residency programs each year. This trend was enhanced and enabled by the introduction of the Electronic Residency Application Service (ERAS). Although Application Fever is a rational decision for applicants, it imposes a substantial evaluative burden on program directors and necessitates the use of convenience screening metrics. We then briefly review potential solutions, including informational strategies, application limits, and marketplace incentives to reduce application numbers. Although a fixed cap on applications would reduce application numbers and facilitate a holistic selection process, greater transparency from residency programs regarding their selection criteria would be required to help applicants choose where to apply. To improve the residency application process for programs and applicants alike, we call upon the medical community to further study Application Fever and carefully consider solutions, including fixed application caps.