Purpose
The current system of integration of the United States Medical Licensing Examination (USMLE) within medical education has evolved to the point that performing well on licensing exams is not only necessary for graduation from medical school, but also the most important factor utilized in residency consideration. To avoid this overreliance, we proposed that USMLE exams be deferred until after medical school graduation and the residency match process, thereby disconnecting them from medical school curricular requirements.

Methods
We completed a narrative review of existing literature concerning the current challenges of USMLE implementation within medical school curriculum. We reviewed literature within the following areas: (1) current impact of integrating graduation requirements and licensing examinations, (2) utilization of USMLE performance within residency selection, (3) potential benefits of separating the USMLE from medical school curriculum, and (4) unintended consequences that may arise from separation.

Results
The USMLE has effectively become the “de facto” medical school curriculum, promoting rote memorization over curiosity and critical thinking. This high-stakes environment ties student engagement and perceived competence to exam performance, leading to anxiety, depression, and social isolation while diminishing personal and professional gratification. Increased focus on USMLE favors compartmentalization of knowledge over holistic learning and preparedness for residency. As an increasing number of institutions are postponing the Step 1 exam until after clerkships, deferring it for an additional year is not a radical proposition.

Conclusion
We proposed the separation of USMLE from medical school curriculum and subsequent postponement of licensing exams until after the residency match, with alternative pathways for students who do not pass on their first attempt. We aimed to enhance well-being, increase emphasis on intrinsic motivation for the practice of medicine, and encourage reevaluation of residency selection criteria to allow for full realization of student potential as holistic physicians.