Decoupling the United States Medical Licensing Examinations (USMLEs) From the Medical Curriculum to Promote Student Well-Being and Professional Identity Development

Abstract

The United States Medical Licensing Examination (USMLE) program administers a series of longitudinal assessments across medical education to ensure that future physicians meet baseline competency for independent clinical practice. Through the current system of USMLE integration within medical school education, passing the Step 1 and 2 Clinical Knowledge (CK) exams is required for both application to residency programs and graduation from undergraduate medical education (UME). While the original intentions of such standardized exams were to establish benchmarks for medical knowledge and clinical competence, the current high-stakes system has diverged to the point that USMLE performance is now the single most defining factor utilized in residency consideration. Over-prioritization of USMLE exams by curriculum developers and program directors (PDs) alike has heightened stress levels and intensified reliance on parallel curricula, where the use of third-party resources far outweighs genuine engagement in formal medical school curriculum and education due to perceived inadequacy of classroom didactics in preparing students for board exams. For this reason, we have proposed the separation of USMLE from the medical school curriculum and the transition toward a new system where both Step 1 and 2 CK are postponed until after the residency match. In doing so, we aim to promote enhanced well-being of medical students and increased emphasis on holistic learning based on curiosity and intrinsic motivation for the practice of medicine. There may be unintended consequences to this proposition, particularly with regard to internal assessment of minimum standards for medical school graduation and changes in the residency application process. However, we hold that our proposal, combined with a reevaluation of criteria used in the residency selection process, would support well-roundedness among students and the full realization of their potential as the next generation of physicians.

Keywords: curricular reform; professional identity formation; student well-being; undergraduate medical education; united states medical licensing examination.

Figure 1. The proposed reformed timeline of USMLE exam administration

MS: medical student. Image Credit: Authors' original creation.