Session Handouts

The original intention of the USMLE was to serve as the primary assessment tool for state medical board physician licensing. Gradually, USMLE (in particular reliance on Step 1 scores) has been adopted as the primary screening and selection tool for the transition of candidates from UME to GME by residency directors and selection committees. Consensus has been developing that the current UME-GME transition reliance on USMLE Step 1 is inherently flawed since the results of a high stakes exam designed to qualify physicians for state licensing is not relevant in either holistically evaluating residency candidates or in providing an equitable means fairly distributing residency positions.  This culminated in the Invitational Conference on USMLE Scoring (InCUS) conference in March 2019, where it became clear that USMLE Step 1 was no longer serving the stakeholders in what has become a flawed UME-GME transition system. Although the was general consensus of inCUS was that changes were needed, USMLE alone would not be the only component requiring a "fix". However, several suggestions included implementing a "pass/fail" , composite, or categorical USMLE scoring system, as well as minimizing racial demographic difference affecting USMLE performance, among others.

From the program director's perspective, it is unclear that  changes in USMLE scoring alone would provide significant additional guidance in residency selection.  Equitable selection of  residency applicants has become major challenge, in view of the absence of hard data to reliably predict residency performance. In addition to USMLE part 1, our traditional tools have included letters of reference, medical school grades, election to AOA,  Deans letter, and clinical course evaluations. Unfortunately, notwithstanding the MSPE and Dean's letter,  critical factors such as professionalism, accountability, social responsibility, team performance, peer interactions, and clinical skills cannot adequately be assessed.   For many candidates, the most important determinants of future resident performance are observed during clinical rotations in the chosen subspecialty, either at the home school or as away rotations. Unfortunately, most students are faced with the challenge of a limited number of clinical elective rotations, and hence exposure to potential residency programs. As a consequence, most residency directors overly rely on the USMLE part 1 as a surrogate of clinical performance for students that have not rotated with them. During the COVID pandemic, the absence of in person away rotations has made clinical assessment of resident candidates even more challenging for programs. 
 
Potential solutions could include incorporating a standardized residency assessment tool (RAT) utilized by all medical schools, that may include milestone - type assessments that correlate to the six core competencies, as well as evaluation of skills relevant  to the type of residency applied to ( e.g spatial coordination, technical ability for surgical specialties). Other tools such as the Jefferson Scale of Empathy and Crowd sourcing of clinical skills to assess potential candidates are being piloted in some programs. 

This webinar will review the current challenges of resident candidate assessment and selection.The pandemic coming on the heels of the planned conversion of USMLE conversion to Pass/Fail has magnified the importance of developing alternative and viable candidate assessment tools and will be a major factor informing our discussion.

Session Handouts

This session will explore the impact of the USMLE Step 1 exam moving to pass/fail on a foundational science department. Focus will be on the potential and expected impacts on our faculty, curriculum and students.

This session will review the anticipated impact of the shift of USMLE Step 1 on the undergraduate medical education curriculum and on medical students’ experience of the residency application process.

Session Handouts

In recent years there has been growing concern about the potential negative impact of USMLE Step 1 scores being used as determinants as to who is invited to interview for residency positions, a step taken as the number of applications for each residency program became unmanageable.  Concerns included the medical students focusing more on Step 1 study versus the curriculum of the medical school, and the general learning environment of Step 1 “frenzy” amongst the students.  The announcement by the National Board of Medical Examiners in February 2020 that USMLE Step 1 is going to a pass/fail scoring system in 2021 was both applauded and condemned by medical educators and students.  The president and immediate past-president of the Alliance of Clinical Education, the organization of medical school clerkship director organizations from Pediatrics, Internal Medicine, Family Medicine, Ob/Gyn, Neurology, Psychiatry, Surgery and Emergency Medicine will discuss the impact of USMLE Step 1 not having a numerical score, including the concern that with USMLE Step 2 CK remaining scored, are we just shifting the concerns to a different time in the life of a medical student.

"Reporting a Pass/Fail Outcome for USMLE Step 1: The Challenges Faced by International Medical Graduates"

On February 12, 2020, after extensive stakeholder discussion, the National Board of Medical Examiners (NBME) announced that the United States Medical Licensing Examination (USMLE) Step 1 will transition to pass/fail.  For program directors, the scores from this examination have been one of the most important factors in deciding which residency candidates to interview. The lack of scores will force changes to the residency selection process, some of which could have both positive and negative consequences for International Medical Graduates (IMGs).  In this session, I will discuss some of the relevant issues associated with the transition to Step 1 pass/fail and how they are likely to impact IMGs.  I will also provide insights on how this change could help motivate the medical community to develop a more efficient and effective pathway for medical school graduates to transition to postgraduate training.

"USLME Transitions, An Osteopathic Perspective"

Dr. Cain will review the Osteopathic medical community reactions to USLME moving to Pass/Fail and the challenges of a dual licensing system."

Over the past few years, increasing attention has been devoted to identifying trends negatively impacting the UME-GME transition. InCUS (Invitational Conference on USMLE Scoring) laid important ground work for the efforts ahead. The decision to change the scoring of the USMLE Step I examination to pass/fail has accelerated the timeline for solutions, and the UME-GME community is energized to more comprehensively improve the UME-GME transition for all stakeholders. In follow-up to InCUS, the Coalition for Physician Accountability convened a UME-GME Review Committee (UGRC) in September 2020 with a one year charge to develop recommended solutions to identified challenges in the UME-GME transition. The UGRC is to act with transparency, consider stakeholder engagement, and utilize data when available. Assuring learner competence and readiness for residency, wellbeing, and equity are primary goals. 

Learner Objectives: 
At the end of this session, attendees will be able to:
--describe the history and background leading to the creation of the UME-GME Review Committee (UGRC)
--identify the goals, work process, and timeline of the UGRC