What’s the news: The uncertainty surrounding United States Medical Licensure Examinations (USMLE)—particularly the Step 1 and Step 2 Clinical Knowledge (CK) portions taken by medical students—caused by the COVID-19 pandemic continued last week.
With the USMLE’s exam proctoring vendor—Prometric—having its testing centers closed for much of the spring, a substantial backlog of test-takers has accumulated. That backlog has resulted in confusion for students and a test-taker volume that cannot be handled by Prometric alone. In response to that reality, the USMLE has looked for other methods, including event-based testing, during which the exam is administered concurrently to thousands of examinees in sittings at medical schools across the country.
On June 4 the USMLE program—overseen by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB)—announced “for event-based testing, USMLE Step 1 and Step 2 CK will not include unscored pretest items, resulting in a slightly shorter exam.”
Although the USMLE program did clarify that the unscored pretest items are used for the purpose of obtaining statistics on question performance before those items were to be included in the actual exam, the fact that students taking exams at Prometric testing centers would be required to take exams with those items was met with displeasure from medical students preparing for the tests. One of many students who vocalized displeasure to the NBME through social media channels and emails was AMA member Russyan Mark Mabeza, a rising third-year medical student at David Geffen School of Medicine at UCLA who took Step 1 in a California Prometric testing center on May 9.
“One of the things that we are taught to prepare for is the length of the exam,” Mabeza said. “The stamina we need to build in order to maintain focus throughout the entire exam is key. If some people take it in the original length and some people take it in the shortened length, we’d be losing any form of standardization in this process.”
In response to negative feedback from test-takers, the USMLE reversed course on June 9.
“When the announcement dropped there was a huge backlash,” Mabeza said. “There was a huge wave of folks addressing the USMLE directly and saying this is problematic. That’s why they overturned it so quickly.” The USMLE’s statement on the reversal defended the use of unscored questions and comparability of scores while acknowledging the opinions med students offered.
“After hearing the concerns of examinees about perceived inequities, we have decided to administer standard length forms that include unscored questions at all testing sites,” a statement on the USMLE website read. “While we have evidence to support the score comparability and test fairness of the original plan, we do not want to take an action that may cause additional stress or confusion. We appreciate the feedback and remain committed to supporting fair and standard testing conditions to every extent possible while we address the situation this pandemic has created.”
Why it’s important: With students pulled from campus and clinical clerkships, the COVID-19 pandemic has been a significant disruption to the medical education process. Licensing exams are no exception.
Step 1 and Step 2 CK are slowly coming back online, through new testing alternatives in support of social distancing. The USMLE program has announced that the Step 2 Clinical Skills portion of the exam, which requires travel and significant person-to-person contact with standardized patients, will be suspended for at least a year.
Regarding Step 1 and Step 2 CK, the NBME and FSMB have made clear that their biggest priority is addressing the capacity issues created by test-date cancellations. Their plan includes regional testing centers at medical schools and event-based testing at medical schools.
In a late May webinar, data presented by the NBME indicated that about 17,000 medical students and residents waiting to take their USMLE exams were displaced. According to the NBME, Since May 1, more than 10,000 administrations of USMLE examinations have taken place, though it’s unclear how many were taken by displaced test-takers.
Mabeza, one of the fortunate few able to take the exam, credited the organizations behind the exam for the about-face on shortening the tests. “It is difficult to have to retract a statement like that so quickly,” he said. “I recognize that NBME is in a position I don’t envy. There are so many stakeholders that they are listening to that they have to balance. I appreciate that some of the advocacy efforts of medical students have been acknowledged."
The AMA has curated a selection of resources to help manage the shifting timelines, cancellations and adjustments to testing, rotations and other events.
