The Cost of Board Examination and Preparation: An Overlooked Factor in Medical Student Debt

Abstract

Objective Board examinations in undergraduate medical education are imperative for competency assessment and a standard licensure process. While the cost of attendance and mean indebtedness of medical students have been quantified, the financial burden experienced by medical students from board preparation and examination has never been quantified. Materials and methods A total of 290 fourth-year osteopathic medical students from 38 osteopathic medical schools completed an anonymous survey that asked them to select the resources they had purchased for board preparation. Along with demographic information, respondents were asked which board examinations they had taken during their medical school education. The price for each resource was located by going to the resource website and finding the "list price" of a brand-new copy/version of that resource. If a price was not found, a current Amazon.com "list price" was utilized. These prices best approximate the maximum a student would spend per resource. Response and statistical analysis such as analysis of variance, post hoc comparison (Scheffé and Bonferronis test), and chi-square tests were conducted using the Statistical Package for Social Sciences (SPSS) Statistics, version 25.0 (IBM SPSS Statistics, Armonk, NY). Results This study found that osteopathic medical students spent, on average, $7,499 (s.d.=$2,506) for board preparation and examination. This cost when isolated is $3,370 for the cost of taking board examinations and $4,129 for the cost of board preparation. Respondents from the West were found to spend most at $9,432, while students from the Northeast spent the least, $7.090. Additionally, non-traditional medical students, those who matriculated after the age of 30 were found to spend more than individuals who began when they were under the age of 25 or between the ages of 25-30. The two most commonly used resources for both Level 1/Step 1 and Level 2/Step 2 examinations were COMBANK and UWorld. Conclusions/relevance This study is the first of its kind to quantify the mean cost of board preparation and examination in undergraduate medical education at $7,499. When considering the mean indebtedness of the osteopathic graduating class of 2017-2018, 2.94% of medical education debt can be attributed to the cost of board preparation and assessments. As competitiveness for graduate medical education increases, individuals will spend more money to ensure a competitive board exam performance, a key selection factor. Stakeholders in undergraduate medical education are encouraged to further understand the interplay between medical student debt and the cost of board examinations and preparation.

Keywords: board examinations; medical education; medical student debt.

Figure 1. Geographic locations of the participating osteopathic medical schools

Figure 2. Demographic data

This figure illustrates the demographic data of the survey respondents by gender, race/ethnicity, age of matriculation, and regional location of medical school. With regards to Race/Ethnicity, individuals were given multiple options to select all that applied. Due to the low sample count for American Indian or Alaska Native, and Native Hawaiian or Pacific Islander, they were aggregated as "Other".

Figure 3. Timeline of board examinations and the various average costs incurred for taking and preparing for board examinations

This illustration provides a simplistic understanding of when osteopathic medical students take board examinations and the average cost of taking examinations, average cost of board preparation, and the average total cost of both taking and preparing for board examinations.

Figure 4. The top five resources utilized in preparation for each set of board examinations

Blue highlights the resources used in COMLEX-USA Level 1 and/or USMLE Step 1, while red indicates resources utilized in COMLEX-USA Level 2 CE/PE and/or USMLE Step 2 CK/CS preparation. Percentage of resource frequency is listed in white within each column.