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. 2023 Feb 27;33(2):401-407.
doi: 10.1007/s40670-023-01749-4. eCollection 2023 Apr.

The Impact on Medical Student Stress in Relation to a Change in USMLE Step 1 Examination Score Reporting to Pass/Fail

Kahlo Baniadam  1 , Seleem Elkadi  1 , Parhom Towfighi  1 , Nathan Aminpour  1 , Ronak Sutariya  1 , H Carrie Chen  1   2
Affiliations

The Impact on Medical Student Stress in Relation to a Change in USMLE Step 1 Examination Score Reporting to Pass/Fail

Kahlo Baniadam et al. Med Sci Educ. .

Abstract

The United States Medical Licensing Examination (USMLE) Step 1 was designed to be a benchmark measure of knowledge and has been used heavily in the residency application process. Step 1 has moved from 3-digit scoring to a pass/fail scoring system, in part to decrease the stress associated with the exam. Emerging literature suggests that this transition has led to other stresses for students. Our study compared student stress levels, both overall and in relation to Step 1, leading up to the exam between a scored cohort and pass/fail cohort. We administered to each cohort a 14-item survey that included demographics, the PSS-4 stress scale, and 6 other potential stressors. Data was analyzed using two-tailed t test for independent means and analysis of variance. We found that while there was no difference in general overall stress between the students who took Step 1 for a score and students who took Step 1 pass/fail, we did see differences in stress related to the Step 1 exam. Step 1 stress was significantly lower for the pass/fail cohort than the score cohort during the second year of medical education leading up to the exam. However, this difference in Step 1 stress between the cohorts disappeared by the dedicated study period immediately before the exam. The change in scoring appears to have decreased stress specifically related to Step 1, but this reduction was not sustained as students entered their study period to prepare for Step 1.

Keywords: Fail; Pass; Score; Step; Stress; Student.

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Conflict of interest statement

Competing InterestsThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survey time point. The survey was administered at the beginning of each cohort’s second year of medical school (M2), halfway through their M2 year, at the beginning of their dedicated study period for Step 1, and halfway through the dedicated study period. Traditionally, most students take their exam 6–8 weeks into their dedicated period
Fig. 2
Fig. 2
Average PSS-4 stress levels over time. This figure details the average PSS-4 stress level for each cohort over all time points. We conducted a two-sample t test at each time point comparing both cohorts. Error bars represent a 5% confidence interval. There was no significant difference between groups at any time point
Fig. 3
Fig. 3
Average Step 1 stress levels over time. This figure details the average stress level related to Step 1 for each cohort over all time points. We conducted a two-sample t test at each time point comparing both cohorts. Errors bars represent a 5% confidence interval. At time points one and two, there was a significant difference in stress related to Step 1 between the cohorts
Fig. 4
Fig. 4
Average Step 2 stress levels over time. This figure details the average stress level related to Step 2 for each cohort over all time points. We conducted a two-sample t test at each time point comparing both cohorts. Error bars represent a 5% confidence interval. At time point one, there was a significant difference in stress related to Step 1 between the cohorts
See this image and copyright information in PMC

References

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