Title

Assessment of Medical Students' Mental Health, Perspectives, Attitudes, and Extracurricular Adaptations due to the USMLE Step 1 Exam Pass/Fail Scoring Change amid the COVID-19 Pandemic

Authors

Ireoluwatomiwa Opayemi, Dr. Adam Perrin

Introduction

In January 2022, the USMLE Step 1 transitioned from a numerical score to a pass/fail system, primarily to reduce the stress associated with the exam. We conducted a study in 2021, titled "The Familial and Community Burden on Medical and Dental Students' Education and Mental Health Status amid the COVID-19 Pandemic”. The study investigated the multiple issues that arose due to the pandemic and their impact on students’ mental health and wellness. Survey items assessed students’ mental health status through the Patient Health Questionnaire (PHQ-9), and General Anxiety Tool (GAD-7). Our present study investigated two primary areas of focus: exploring the perspectives and mental health status of medical students affected by the pass/fail score change of USMLE Step 1 and the additional modifying effects of the COVID-19. We will then compare these results to the survey administered in 2021.

Methods

The survey measured students' mental health status, their perceptions of the pass/fail change and COVID-19's impact. We employed the PHQ-9, GAD-7, and the Perceived Stress Scale to evaluate mental health status. Participants were drawn from the classes of 2024-2026. The survey included items from the initial questionnaire to assess evolution with the additional items concerning USMLE Step 1, its scoring change, and perceived residency application readiness impact. Data analysis was conducted using SPSS software.

Results

62% (n=120) of students believed the change reduced their stress when studying for Step 1, yet 84% of students felt more stressed when trying to add more items to their resumes for residency applications. In total, 46% of students viewed this change as positive and 19% considered it negative. Comparing this survey to the 2021 survey, the PHQ9 and GAD7 scores for students were similar. 25.2% to 23.9% (2021 to 2023) reported mild depression and 15.2 to 15.9% of students reported moderate to severe depression. 22.5% to 21.5% reported moderate to severe anxiety. There was no statistically significant difference between classes or between the surveys for PHQ9 and GAD. The PSS9 indicated that 70.45% of the respondents reported moderate stress, and 4.55% having high perceived stress. There was no statistically significant difference between classes (p=.940). Comparing the two surveys, a significant decrease in issues faced by students was observed, including family members' health, boredom, and educational delays. Loneliness remained constant, but a new increase in difficulty accessing healthcare emerged.

Conclusion

Our survey reveals a mixed response to change with a large portion of students perceiving a reduction in stress due to the change. However, the majority expressed increased stress due to residency application pressures. Although depression and anxiety rates remained relatively stable between 2021 and 2023, a significant proportion of students (40%) still require intervention. Stress is highest in 1st years, possibly attributed to the initial challenges of Medical School. Certain issues that plagued students during the COVID-19 pandemic have decreased, but stressors related to difficulty accessing healthcare have increased. Loneliness remains an issue. The results highlight the need for continued efforts to enhance medical students' educational experience, mental health, and overall well-being.

References

[1] Nicole M. Mott, Jacquelyn B. Kercheval & Michelle Daniel (2021) Exploring Students’ Perspectives on Well-Being and the Change of United States Medical Licensing Examination Step 1 to Pass/Fail, Teaching and Learning in Medicine, 33:4, 355-365, DOI: 10.1080/10401334.2021.1899929 [2] Halperin SJ, Henderson MN, Prenner S, Grauer JN. Prevalence of Anxiety and Depression Among Medical Students During the Covid-19 Pandemic: A Cross-Sectional Study. J Med Educ Curric Dev. 2021 Feb 15;8:2382120521991150. doi: 10.1177/2382120521991150. PMID: 33644399; PMCID: PMC7890732. [3] Willett, Lisa. (2020). The Impact of a Pass/Fail Step 1 — A Residency Program Director’s View. New England Journal of Medicine. 382. 2387-2389. 10.1056/NEJMp2004929. [4] Mun, F., Scott, A. R., Cui, D., Chisty, A., Hennrikus, W. L. & Hennrikus, E. F. (2021). Internal medicine residency program director perceptions of USMLE Step 1 pass/fail scoring. Medicine, 100 (15), e25284. doi: 10.1097/MD.0000000000025284.