Letters to the Editor
To the Editor:
As a medical student, I appreciate that Chen and colleagues’ Invited Commentary describes the student perspective on the rising issue of a “Step 1 climate”1 in preclinical education, particularly with regard to the consequences associated with the increased emphasis on numeric United States Medical Licensing Examination (USMLE) Step 1 scores in assessing competitiveness for residency. One solution offered by the authors is the elimination of numeric reporting, though it is questionable at what point such a shift may occur as residencies currently rely on Step 1 as an objective assessment of academic competency. An additional solution to lessen anxiety surrounding Step 1 may be to incorporate widely used Step 1 materials directly into medical school syllabi, which may provide more balance between board preparation and overall institutional objectives.
At least some of the anxiety surrounding Step 1 stems from the struggle to determine how to make the most effective and significant use of time and resources throughout preclinical courses. The incorporation of explicitly high-yield information into class lecture may provide apprehensive students with a feeling of more “meaningful” use of class time—all the competencies expected within their medical curriculum would be addressed in addition to specific review for the boards. Additionally, it may be noteworthy to see the impact of such change in curricula on live lecture attendance.
Increased integration of Step 1 materials into the foundation of medical school programs may positively impact student morale, time management, or subjective favorability for the institution’s curriculum structure since board preparation would be intimately tied into classes. A notable advantage for such a solution may be its relative practicality and immediate implication compared with other proposed solutions that may require a longer time frame for effectiveness. There are disadvantages to incorporating Step 1 resources as well, such as fear that it may detract from the importance of learning how to become an overall clinician rather than learning how to merely prepare for a standardized exam. Many of the proposed solutions are not without fault. Students should overall be encouraged to participate in discourse with faculty to produce ideas that may help alleviate anxiety surrounding board preparation within the local culture of their school.
1. Chen DR, Priest KC, Batten JN, Fragoso LE, Reinfeld BI, Laitman BM. Student perspectives on the “Step 1 climate” in preclinical medical education. Acad Med. 2019;94:302–304.