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An Op-Ed on the Shift to a Step 1 Pass-Fail Model

By OnlineMedEd February 18, 2020

We can all agree on one thing: becoming a doctor is one of the single most difficult pursuits on the planet. The mental, emotional, and physical anguish it takes to succeed in med school is something indescribable to anyone who hasn’t lived it. Not to mention that it comes at a massive financial cost—and all because you CHOSE to do it.

And, although everyone is valedictorian-level intelligent, many students find themselves struggling academically, possibly for the first time in their lives. They memorize, study, and memorize some more. After all, just as the reality of med school is beginning to sink in, Step 1 is already looming in the not-so-distant future. 

Not to mention the pressure of knowing that Step 1 scores have ended up determining residency placement. So it makes sense that students push themselves to the brink of memorizing and regurgitating facts to get the highest possible score. But the consequence is not actually retaining the information. And worst of all, losing sight of the end result—to become an outstanding physician. 

Well, imagine if that strain was alleviated. Instead of focusing the first few years on simply getting a great Step 1 score, you could focus on the connections between information, and on really understanding how the information you’re taking in will help you down the road. 

In essence, taking off the score blinders and truly learning how to become the best physician possible. 

That is what OnlineMedEd believes the Step 1 moving to a pass-fail model will do for students, and we are behind it all the way.


Less Stress, More Retention

Though the information learned in Basic Sciences is vitally important, it doesn’t test your ability to be a doctor. Yet, Step 1 has defined so many doctors’ career paths. The pass-fail model will allow Basic Sciences proficiency to be ascertained, without allowing a specific score to determine actual ability. The emphasis moves from studying for the test to being the best-educated physician you can be. 

 With less weight put on Step 1, students can focus on truly understanding the information, not memorizing as much as possible, something that has always been a guiding principle at OnlineMedEd. Students will also have more mental space to focus on becoming better physicians; building healthy habits, focusing on the specialities that interest them, and preparing for residency. 


Comparison: No Longer the Thief of Joy

Med school is a collection of some of the most intelligent and academically impressive students on the planet. Everyone who makes it in was the smartest in their class, and suddenly, they are compared to everyone who is on or above their level.

This sudden shift from being the best to being average can lead many students to focus more on competing for the best score to stand out vs. truly learning the information for the means of becoming a great doctor. 

Yes, competition can lead to motivation, but what does that motivation get applied to? If we incentivize students to get good scores, that’s what they are going to do. We hope that getting good scores means engaging with the material in a meaningful way. But that’s not necessarily what getting a good score means. Without the pressing need for a high score, the learner can stay focused on learning the information rather than preparing for an exam. And it removes the possibility that a low Step 1 score could be demoralizing to a student already pushing themselves to the extent of their ability.

In the end, the move to pass-fail means students can focus on learning, not on who can memorize, regurgitate, and then forget the most facts as soon as the test is over.


Un-Templatizing Basic Sciences 

The shift to pass-fail also has the opportunity to change the Basic Sciences curriculum from med school to med school. When schools build what they teach on simply checking off boxes for Step 1, schools can end up seeming the same. 

This shift has the ability to differentiate schools and takes Basic Sciences from a cookie-cutter template to a standout reason why med students might be drawn to certain schools over others.


Final Thoughts

Of course, any major institutional shift takes a while to come together and work smoothly. There will be growing pains, and kinks will need to be ironed out. Whether or not the increase of stress for scoring well in Step 2 will have a major impact on performance, or lower motivation for first-year students is yet to be seen. But we do know one thing—that the students who work harder will always rise to the stop, whether that’s reflected in a Step 1 score or not. 

We feel hopeful about this change and hope that it will support students in the same way we have always aimed to—to help them move through med school with confidence and hold onto their north star, the ultimate reason why they’ve chosen this less-than-easy and admirable path. In the end, this is worth more than any specific Step 1 score. 


Deep dives into real issues impacting medical education, brought to you by OnlineMedEd.


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