The Rise and Fall of USMLE Step 1

How did the USMLE Step 1 exam get such an outsized role in medical education? Why did a multiple-choice question test of basic science attain such incredible importance - and then collapse under the force of its own weight? And perhaps most importantly, what are we gonna do once three-digit scores go away?

This is a virtual Grand Rounds presentation that I did for another institution in August 2020. I changed the initial slide, but the rest of it is exactly what they got.

NOTES

PROLOGUE (0:16)
Announcement of the USMLE Step 1 Pass/Fail decision

CHAPTER 1: In the beginning... (1:38)
The formation (and original goal) of the National Board of Medical Examiners

CHAPTER 2: Evolution of the NBME Exam (3:47)
Traces the history of the NBME’s licensure exams, from 1916 to 1991, and the decisions and forces that shaped the exam’s format

CHAPTER 3: 1992 (13:21)
Three critical events occurred in 1992 that set in motion the events of the coming decades: the first administration of the USMLE Step 1 exam; the plans for an Electronic Residency Application System (ERAS); and a decrease in the relative number of residency positions available for applicants

CHAPTER 4: Application Fever (16:53)
The drivers - and consequences - of residency application inflation

CHAPTER 5: Step 1 Mania (22:03)
The costs and consequences of our over-reliance on Step 1 scores in residency selection, leading up to the pass/fail decision

CHAPTER 6: The future (46:26)
How do we turn pass/fail into a net positive for residency selection? It’s not by using Step 2 CK. To move forward, we have to have a shared vision of reality; acknowledge that numbers alone will mislead us; embrace holistic review; advocate for application reform; and demand meaningful evaluation

[CocoBombLeche]

That Length of First Aid slide is soooo freaking true - I remember a classmate and I accidentally found an old 1993 First Aid book on our Internal Medicine rotation, and not only was the book super thin but the content was super basic! Like we're talking about content that is covered in a Biology 101 class. It blew our minds how low the bar was for aspiring doctors back then, compared to now.

[ThanhVu-oonv]

At 11:00, lol "Department of Health and Semen Services" I like the pun haha

[ryann]

Seeing the step 1 average of class of 2020 was 234 was good evidence that something needed to happen. it was getting to a point where the difference between average and above average performers would come down to luck. It's sad that it's the major determinant for residency selection but it needed to change. Med students put themselves through hell studying for this thing.

[randomdude]

USMLE has cumulatively increased in difficulty. Back in the days it wasn’t like this. It has failed students in the modern day. No wonder a lot of students want commit suicide with extreme expectations. Changing this exam to pass/fail is the best decidion