USMLE Prep @ AMS

Brought to you by the Senate Progress Committee, “Progress Notes” are student-driven, topic-specific, newsletters that bring together voices from within our community and integrates them with available data to provide a holistic view of what strides we have made and continue to make in the pursuit of excellence at Alpert Medical School. USMLE Prep @ AMS is the first in this series.

The United States Medical Licensing Examination (USMLE) aims to assess whether medical school students or graduates can apply important concepts of the foundational sciences fundamental to the practice of medicine. Over time, Step 1 of the USMLE has become notorious and important not only for solidifying knowledge but for its score’s ability to influence future opportunities in medical training.

Basics of Step 1 Prep at AMS

Number of weeks designated for Prep:
- Across other medical schools, it varies from 4-10 weeks. Although we are on the high end of the spectrum, it is still recommended that, if possible, students take the exam after 6 weeks. If needed, the remaining time can be used either to extend the study period, or for vacation prior to clerkships.

Flexibility:
- Students can take Step 1 during the designated time, or wait until an opportune time during or after 3rd year. The AMS philosophy is designed to prioritize flexibility and individual readiness.
- Certain schools do not let students commence clerkships until they have passed Step 1. AMS does not do this and tries to best accommodate individual student’s needs.
- Take Step when you can! If you need additional time (if it takes you a long time to process information, if this isn’t the right time for you, if you’re a visual learner who needs to see the presentation in patients during clerkship to learn the material etc), it is available for you. Advising will support you if you need to take it during or after third year, though there are some downsides to taking it after third year which sometimes result in the need to take a year away from medical school to be able to fit everything in.

Resources available to students:
- Each year, AMS faculty works with Pathoma and other third party board material vendors to negotiate student deals and discounts.
- Diane Green, Learning Specialist at AMS is available to all students and provides consultation regarding learning differences, alternative approaches to studying, and information about resources that might be helpful for specific learning styles.

Curriculum integration in preparation for Step 1:
- Multiple choice exams are given throughout the pre-clerkship and clerkship years in preparation for the question style of board exams.

Advising Structure:
- During the second year, two meetings with advisors in student advising groups are required. Additional individual meetings are scheduled as needed.

It is difficult to imagine a time when Step 1 prep will be described by students as being ‘fun and easy’. Nevertheless, there are efforts to make the process seem less daunting, as well as help students feel more supported and confident as they endure the study period, with the ultimate goal of helping students make it to the other side successfully. So how have we made progress towards those goals in the last several years?

“So what about the….” Common USMLE Myths:

“It is better to take Step 1 after third year.” A small number of other schools have transitioned to taking it during or after third year. Why not AMS?
- A recent study comparing Step 1 scores in 2nd and 3rd year showed only a 2 point increase in the scores of the students who waited and took the exam after clerkships. This was most likely due to improvements in pre-clerkship advising as well as curricular changes that occurred to the pre-clerkship curriculum, rather than the timing change resulting in students being better prepared after 3rd year.
- Taking Step 1 at the end of 3rd year means it can encroach on Step 2 CS and CK preparation along with away electives and sub-internships (additionally, some away electives require a Step 1 score to be able to apply).
- Delaying may be the right choice for some students, but AMS encourages that students attempt to take it following second year if they feel ready.
- Waiting for more research suggesting what is better. No hard evidence right now that student performance greatly improves either way with regards to the timing of the exam.
“Are more questions necessarily better?” Some schools like Yale stopped giving shelf exams during clerkship. Are we heading that way?
- Studies have shown that shelf exams prepare students for similar question styles on Step 2.
- According to Dr. George, the shelf exam only makes up 15-20% of the clerkship grades
  - At the moment it is the one national, standardized score that factors into the student assessment. OSCEs and Student Performance evaluations also factor in, but there is some degree of subjectivity inherent in their evaluation

A note on Step 2 from Drs. Rougas and George:

CK: Recommendations on how to study for the exam, when to register, links to example study calendars, advice from prior students are sent from faculty nearing the end of the 3rd year. Additionally OME and OSA staff are available for individual consultation meetings as needed. The basic recommendations for CK preparation are:

UWorld for questions
At least one NBME practice exam

CS: The 4th year OSCE, required by all students completing the 3rd year curriculum, is catered to preparing students for the format and difficulty level of Step 2 CS. As the main advisor for this exam, Dr. Rougas communicates recommendations on time allocation, when to register for the exam within the 4th year curriculum, what to do if you’re taking time off/gap year etc, via email or through 3rd year general class meetings.

What’s next for USMLE Prep at AMS?

Longitudinal mentoring program: Currently in the works for the 2019-2020 academic year. This will allow each student to have one primary mentor throughout their time at AMS, in addition to the advising and mentoring currently in place.
Step 1 may be changing in the next 5-10 years, AMS plans to accommodate and change with it. The National Board of Medical Examiners has invited a group of 45 leaders representing the nation’s key medical education and medical licensing organizations for an important discussion about USMLE scoring and reporting. The sponsors of this meeting, set to occur later this spring, include the AMA, AAMC, ECFMG, FSMB, and the NBME. We are lucky that one of our very own, Dean Tunkel, has been invited to attend these discussions.

We encourage you to continue the conversation with your classmates, your instructors, your clinical teams and with us by leaving a comment in the comment boxes. We appreciate constructive feedback as well as ideas for new topics for future editions of “Progress Notes”.

A special Thank You to Drs. Emily Green, Jordan White, Luba Dumenco, Paul George, Sarita Warrier and Allan Tunkel for their assistance on this issue.

USMLE Prep @ AMS

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