Medical Student Well-Being While Studying for the USMLE Step 1
The Impact of a Goal Score
Bibliographic Data
Purpose: The United States Medical Licensing Examination (USMLE) Step 1 is a critical milestone for medical students. Many medical students aim to achieve a high score to have the best chance of matching into a residency of their choice. 1–4 Although preliminary research suggests that a student’s Step 1 goal score may have a relationship to actual score, 5 no research has explored the relationship between students’ goal score and their wellness. As Step 1 begins to transition to pass/fail, it is interesting to consider the impact of score goal on wellness. This study examines the relationship between goal score, gender, and students’ self-reported anxiety, stress, and overall distress immediately following their completion of Step 1. Method: A web-based survey was administered in June 2019 to a random sample of 1,500 medical students at U.S. medical schools who had recently completed Step 1 for the first time but had not received their scores. The survey included validated measures of anxiety (Patient-Reported Outcomes Measurement Information System 4a, higher score indicates greater anxiety), stress (Perceived Stress Scale, higher score indicates greater stress), and overall distress (Medical Student Well-Being Index, higher score indicates greater overall distress). In addition, students were asked, “What is your Step 1 score goal?” followed by an open-ended item to further elaborate. t Tests and multiple linear regressions were used to examine the relationships between score goal, demographics, and well-being. A thematic analysis was conducted for open-ended responses. Results: Overall, 574 students provided usable responses (response rate 38.3%), 464 of whom (n = 235 female) responded yes to having a goal score. Men reported significantly higher score goals (mean = 243.9) than women (mean = 238.3), P < .001. In addition, men reported significantly lower stress (6.2 vs 7.4), distress (3.5 vs 4.2), and anxiety (10.3 vs 12.6) than women, respectively (all P < .001). The most frequently cited score goal was 240 (n = 141). When controlling for gender, a higher score goal was associated with lower stress (β = −0.14, P < .003) and anxiety (β = −0.11, P < .02). Open-ended responses suggested 3 subpopulations: (1) those concerned with passing, (2) those who want to be close to the median to keep most residency options open, and (3) those who want to achieve a high score to be competitive for particular residency programs or locations. Analysis by open-ended response subpopulation will be reported during the presentation. Discussion: Despite the pressure associated with aiming for a high score, 4 students with higher score goals were less stressed than those with lower score goals. With nearly one-third of residency program directors indicating they would never interview a candidate if they failed Step 1, 2 perhaps the implications of not passing are so great that students concerned with passing are at greatest risk for decreased wellbeing. Significance: Although the drive to achieve a high Step 1 score may have had an impact on student well-being, 1,4 students who are primarily concerned about passing the exam may be at greater risk for continued stress and anxiety, despite the change to pass/fail reporting
Anxiety · Distress · Medical education · Medical school · Milestone · Perceived Stress Scale · Psychiatry · United States Medical Licensing Examination · Clinical Psychology · Healthcare professionals’ stress and burnout · Innovations in Medical Education · Medical Education and Admissions · Medicine · Psychology
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