The Timing, Factors, and Impact of USMLE Step 1 Becoming Pass/Fail on the Process of Choosing a Specialty

Abstract

Background Choosing a medical specialty is an important decision. A combination of factors influenced this decision. Student characteristics and examination performances can influence this decision. With the transition of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, it is important to analyze the specialty decision process. Objective The purpose of this multimethod study is to assess when in the curriculum students choose a specialty, what factors influence their decision, and the impact of USMLE Step 1 scores on a student's assessment of competitiveness. Methods In February 2022, a survey was prepared and approved by the University of Nevada, Las Vegas (UNLV) Institutional Review Board (IRB). The survey contained multiple-choice questions and a free-response section. The survey was sent to the Class of 2022 and 2023 students at Kirk Kerkorian School of Medicine who follow a Longitudinal Integrated Clerkship. Descriptive statistics and one-sample t-tests were calculated. Results A total of 89 students completed the survey: 42 out of 60 students (70%) from the Class of 2022 and 47 out of 61 students (77%) from the Class of 2023. This study found that 78.8% of longitudinal interleaved clerkship (LInC) students committed to their specialty during the second half of the clinical year. The effects of positive and negative experiences during clerkships were most significantly different (p < 0.001). Conclusion The majority of LInC students arrive at their decision by the latter half of the clinical year. A variety of factors help students arrive at their decision. Our findings suggest that the pass/fail grading system will make it more difficult for students to assess their personal competitiveness.

Keywords: clinical clerkship; medical education curriculum; medical specialty; pass/fail usmle step 1; usmle step 1 pass/fail.

Figure 1. Cumulative percentage of KSOM students who finalized their specialty choice by respective points in the clinical curriculum

KSOM: Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas

Figure 2. Percentage of KSOM students who changed their original specialty choice

KSOM: Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas

Figure 3. Mean and standard deviation of survey questions assessing the importance of lifestyle factors in specialty decision

Figure 4. Mean and standard deviation of survey questions assessing the impact of clerkships on specialty decision

Figure 5. Mean and standard deviation of survey questions assessing the perception of factors affecting competitiveness