The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity

Abstract

Purpose: Given the significance of the US Medical Licensing Exam (USMLE) Step 1 score moving from a 3-digit value to pass/fail, the authors investigated the impact of the change on students' anxiety, approach to learning, and curiosity.

Method: Two cohorts of pre-clerkship medical students at three medical schools completed a composite of four instruments: the State-Trait Anxiety Inventory, the revised two-factor Study Process Questionnaire, the Interest/Deprivation Type Epistemic Curiosity Scale, and the Short Grit Scale prior to taking the last 3-digit scored Step 1 in 2021 or taking the first pass/fail scored Step 1 in 2022. Responses of 3-digit and pass/fail exam takers were compared (Mann-Whitney U) and multiple regression path analysis was performed to determine the factors that significantly impacted learning strategies.

Results: There was no difference between 3-digit (n = 86) and pass/fail exam takers (n = 154) in anxiety (STA-I scores, 50 vs. 49, p = 0.85), shallow learning strategies (22 vs. 23, p = 0.84), or interest curiosity scores (median scores 15 vs. 15, p = 0.07). However, pass/fail exam takers had lower deprivation curiosity scores (median 12 vs. 11, p = 0.03) and showed a decline in deep learning strategies (30 vs. 27, p = 0.0012). Path analysis indicated the decline in deep learning strategies was due to the change in exam scoring (β = - 2.0428, p < 0.05).

Conclusions: Counter to the stated hypothesis and intentions, the initial impact of the change to pass/fail grading for USMLE Step 1 failed to reduce learner anxiety, and reduced curiosity and deep learning strategies.

Supplementary information: The online version contains supplementary material available at 10.1007/s40670-023-01878-w.

Keywords: Curiosity; Learner anxiety; Learning behaviors; USMLE Step 1 examination.

Fig. 1

Summary of the study design and rationale. The change to a pass/fail would decrease student anxiety, increasing curiosity, and result in deeper learning strategies. Grit was measured as a covariant given its influence on several of these factors. STA-I, State-Trait Anxiety Inventory; R-SPQ-2F, revised two-factor Study Process Questionnaire

Fig. 2

Grit, anxiety, learning approaches, and curiosity prior to taking a 3-digit or pass/fail Step 1. Survey responses to the Short Grit, STA-I, R-SPQ-2F, and I-D Curiosity scales by medical students about to take numeric scored — or pass/fail Step 1 exam. Median values are shown and labelled with interquartile range (boxes) and ranges (whiskers). *Significant difference (one-tailed, Mann–Whitney U)

Fig. 3

Path diagram of the relationships between deep learning approaches and exam format (3-digit score or pass/fall), anxiety (STA-I), grit, deprivation curiosity, and interest curiosity of second year medical students prior to taking either a 3-digit scored or pass/fail Step 1 exam (n = 240). Significant paths and their b coefficients are in bold; nonsignificant paths are dashed. The model has an adjusted r.² of 0.5 and includes a constant (shown in the circle)