Step 1 Exam in Medical School
Every year thousands of medical students around the world nervously prepare for and take the United States Medical Licensing Exam Step 1. The exam has a very broad scope and covers all organ systems from cardiology to neurology. It even includes several subjects which outsiders may not consider part of medicine such as statistics or ethics.
Medical schools have transitioned to pass-fail grading over the past several years. Interestingly, a few weeks ago, the NBME announced that scores will no longer be reported to residency programs and only a pass/fail designation will be seen. Several critics of the exam state that success on Step 1 does not correlate to the skills needed for the clinical side of medicine.
Pass/Fail Impact on Placement
Nevertheless, the loss of this screening tool begs the question of how applicants will now be evaluated. This may put more weight on the evaluation of other aspects of a candidate’s application which may be more subjective.
Although these changes will not take place until 2022 and not affect current medical school students, the changes will affect future generations of doctors. We hypothesize with these report changes that a greater emphasize may be placed on an applicant’s research productivity.
Of note, Neurosurgery applicants already often have a very high research output. Last year’s class of accepted applicants had a median of 18.3 publications and abstracts. However, this may further disadvantage students who come from smaller medical schools without large neurosurgical departments or access to research endeavors.
Rotation Reviews and Application Decisions
The shift to pass/fail will put even more pressure on medical students to publish papers while working on the rigorous medical school curriculum. Furthermore, we also believe that the ranking of medical schools will start to matter more. The quality of each candidate’s rotation reviews and recommendations will undoubtedly play a larger role in application decisions.
Ultimately the recent changes to Step 1 do not make neurosurgical residency applications less competitive or stressful as each program still has a limited number of spots. However, the changes may allow students the time necessary to take more control of their medical education to develop skill sets more applicable to a career in neurosurgery.
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