USMLE Program Will Benefit Future Women Physicians
As many of you have likely heard, today, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners, co-sponsors of the United States Medical Licensing Examination® (USMLE®), announced upcoming policy changes to the USMLE program that will take effect over the next 11-24 months. These changes include
- Changing Step 1 score reporting from a three-digit numeric score to reporting only pass/fail;
- Reducing the allowable number of exam attempts on each Step or Step Component from six to four; and
- Requiring all examinees to successfully pass Step 1 as a prerequisite for taking Step 2 Clinical Skills.
The goal of these changes is to continue to assure competency of those seeking licensure while also attempting to improve the wellbeing of medical students and residents. These changes have occurred as a result of significant discussion over the past several months. Dr. Kim Templeton, MD, FAAOS, FAMWA developed and provided input on behalf of AMWA regarding these changes during initial discussions last year. Part of her input was that “AMWA represents women in medicine across the continuum of education and practice. Imposter syndrome and stereotype perception threat are among the issues facing women in medicine at all levels, including medical students. Imposter syndrome is manifested by thinking that, despite evidence to the contrary, one is not qualified for his/her position; sufferers feel like frauds. This is typically noted among high achievers, especially when faced with new challenges- a constant issue during medical training and practice. Perception of negative stereotypes, such as the capabilities of a woman physician, may impact performance; those suffering from stereotype perception (threat) work harder so that their performance does not reinforce negative stereotypes held by themselves, others, and society, often working to the point of negative returns. While these phenomena are noted among men and women, both issues, especially stereotype perception (threat), are more common among women. These conditions are risk factors for the development of burnout, anxiety, and depression. While there is no data directly linking specific exam scores to the development or exacerbation of pre-existing impostor syndrome or stereotype perception threat, the emphasis that is placed on scores by both students and others- with students “becoming” their scores and having these scores impacting their self-worth- would seem to make this connection plausible. Additional research is needed in this area.
“In discussion with student members of AMWA, the concern was raised that once a student does not achieve a high USMLE score, other opportunities are taken from them, such as membership in AOA or competitive away elective rotations. This “snowball” effect compounds on the score itself and may result in the student needing to change careers plans regarding specialty. It may also result in them leaving medicine. In addition, the emphasis on a specific score for residency application and future career plans diminishes the other accomplishments of students, including their performance in courses and on clerkships, as well as their volunteer activities to address social issues and effect societal change.
“Scores on licensing exams are intended to assure that the student is prepared for the next step in training and responsibility. A pass/fail or 3-tier system should be sufficient for this purpose. In terms of graduate medical education, residency applications should be assessed in toto, with a licensing exam score as only part of the overall picture of the student. A pass/fail or 3-tier system would seem to be sufficient for that purpose, also. With less focus on specific scores being used almost exclusively to reflect the capabilities of students, issues of impostor syndrome and stereotype perception threat and related burnout, anxiety, and depression may start to decrease. This change will require significant discussion with the graduate medical education community but hopefully will result in healthier physicians who remain in the profession.”
In addition to providing this input, Dr. Templeton is continuing to work on an NBME task force (RENEW) that is looking at Step 1. She is leading a qualitative project to determine the impact of studying for and receiving Step 1 scores and how these impact the health and wellbeing of students, especially any impacts based on student gender or race/ethnicity. The results of this have been accepted for presentation at a variety of AAMC GEA meeting across the country over the next few months.
