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The Three Upcoming Policy Changes in the USMLE: An Overview

Discussion in 'USMLE' started by Karthikeyan Y, Mar 10, 2020.


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  1. Karthikeyan Y

    Karthikeyan Y New Member

    Feb 24, 2020
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    How many of you aware that there are a few drastic policy changes in the United States Medical Licensing Examination (USMLE)? If you aspire to practice medicine in the United States, you must be aware of this USMLE program. USMLE, co-sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), is a three-step exam for medical licensure to practice medicine in the USA.

    On February 12, 2020, NBME and FSMB announced the upcoming policy changes in the USMLE. They had announced three policy changes to provide high-quality assessments and to address certain considerations.

    The Upcoming Policy Changes in the USMLE

    The curriculum of USMLE follows a professional testing standard to provide fairness and equity to examinees while providing vital data to medical legislation and education. The USMLE program engages with institutions and medical educators, practicing clinicians, and licensing authority members, in the development, design and, constant development of these assessments.

    Following are the three policy changes in the USMLE that will be implemented in the forthcoming days:

    • The Step 1 exam of the USMLE is going to adopt a ‘Pass’ or ‘Fail’ score reporting system, unlike the traditional three-digit score reporting system. However, Step 2 will retain the three-digit score reporting system. (This policy change will come into effect after January 1, 2022.)
    • The USMLE program is also implementing an examination prerequisite for Step 2 Clinical Skills. Specifically, all candidates will be required to pass Step 1 to move on to Step 2. (This policy change will come into effect after March 1, 2021.)
    • The number of attempts will also be decreased from six to four. (This USMLE attempt limit policy will come into effect after January 1, 2021.)
    Top Reasons Behind USMLE Policy Changes

    While taking this game-changing decision, the USMLE’s co-sponsors considered various inputs and recommendations. Following are the major reasons for bringing these policy changes in the USMLE:

    • The change in Step 1 score reporting will reduce too much emphasis on USMLE performance and also create a balance between student learning and student well-being.
    • According to NBME and FSMB, the primary purpose of these new policies is to enable the USMLE program to deliver secure, high-quality assessments and to address certain considerations (e.g., exam safety and unintended consequences of subsequent use of score).
    • The reduction in the number of attempts is to protect the integrity of the USMLE and to match the attempt limits imposed by state medical boards.
    Will It Affect Your Preparation for Step 1?

    Technically, no. It should not affect your preparation currently as the new policy will kick in no earlier than January 1, 2022. You just continue your preparation for the Step 1 exam as you had initially planned. After all, Step 1 is still one of the toughest medical exams for any aspirant to crack, and that will not change.

    How Does It Impact the Way You Approach Other Parts of Medical School?

    Earlier, an impressive Step 1 score would place you in higher regard while applying with medical schools. Since that is no longer possible, the change in the grading system will force medical schools to look at other aspects of the candidate’s profile with a keen eye. Elements such as grades in clerkships, letters of recommendation (LOR) in the specialty, and your Step 2 score, which is still in the standard three-digit format, will carry more weightage in your profile for their consideration.

    Cracking USMLE requires an intensive learning and practicing. Certain medical universities like Texila American University, Guyana (Texila), offers in-built training along their Doctor of Medicine program. Therefore, the USMLE aspirants can start their preparation while doing their medical degree. Besides, there will be options to have clinical rotation in the USA that will fetch you LOR.

    Or take up a “Residency in USA” program that offers you LOR and better clinical knowledge that will help you perform well in the USMLE.

    Arguments for and against the USMLE Policy Changes

    As of now, the medical community is split on this decision of upcoming policy changes:

    • Those in favor of Step 1 transitioning to a pass-fail system
    • Those who like it to remain the same
    Those who are in favor of the change argue that the difference in the grading system will reduce the pressure on the students and promote an equal playing field for those who wish to pursue a higher tier specialty.

    In contrast, those who are against it argue that moving to a pass-fail system does not address the underlying issue and could make the selection process worse than it already is. Objectors also point out that the scoring system is the only objective measurement there is in the USMLE, and removing it would negatively impact the quality of residents in the selection process.

    No matter which side you identify with, rest assured that the medical residency landscape is in for a change in the coming years. If you are planning to attempt USMLE in the coming years, the Step 1 exam may not be the primary area of focus for selection.


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