To the Editor:
As a medical student who has experienced the stress of preparing for the United States Medical Licensing Examination (USMLE) Step 1, I read the recent commentary by Moynahan1 with great interest. Moynahan discusses the consequences of emphasizing Step 1 scores in resident selection and highlights the emerging popularity of third-party resources designed for exam preparation. He depicts them in a negative light, a view voiced previously by others.2 I can appreciate their concerns, as students frequently resort to popular Step 1 review books as their primary learning resources and, in the process, sometimes fail to understand fundamental concepts from the curriculum. Nevertheless, this perspective fails to acknowledge possible strengths of third-party resources.
Several popular third-party resources, including question banks and the free flashcard program Anki, provide spaced retrieval practice for students. Many students begin using these resources early in medical school, allowing them to practice concept recall over months. This exercise has been shown to benefit students on the Step 1 exam,3 and it is well accepted as promoting long-term retention in general. Spaced retrieval practice may also support integration of concepts across courses. Typical medical school curricula, with noncumulative exams and respective courses isolated by blocks, often do not encourage this type of learning.
Even lecture-based third-party resources may be attractive to students. A course, like Pathoma, is taught by a single educator, and thus possesses significant cohesiveness, with concepts building upon themselves in a logical manner. This contrasts with the often fragmented nature of a typical medical school curriculum, where lectures are given by a multitude of instructors, many of whom have little idea of where their lecture fits within the curriculum at large, their audience’s background knowledge, or sometimes even their audience in general.
While the Step 1 exam content may unduly influence curricula, and third-party resources have limitations, these products should not be dismissed so readily without further consideration as to what educational benefits they may offer.
John E. Coda
Fourth-year medical student, Penn State College of Medicine, Hershey, Pennsylvania; [email protected]
1. Moynahan KF. The current use of United States Medical Licensing Examination Step 1 scores: Holistic admissions and student well-being are in the balance. Acad Med. 2018;93:963–965.
2. Prober CG, Kolars JC, First LR, Melnick DE. A plea to reassess the role of United States Medical Licensing Examination Step 1 scores in residency selection. Acad Med. 2016;91:12–15.
3. Burk-Rafel J, Santen SA, Purkiss J. Study behaviors and USMLE Step 1 performance: Implications of a student self-directed parallel curriculum. Acad Med. 2017;92:S67–S74.