Medical Science Educator

, Volume 23, Issue 4, pp 588–594 | Cite as

The Impact of Process-Oriented Preparation on High-Stakes Testing in Medical School

  • Roy E. StrowdIII
  • H. Randall Beard
  • Barbara Gorney
  • Gregory B. Russell
  • Ann Lambros
Original Research


Introduction: High-stakes testing is deeply engrained within current medical education. The United States Medical Licensing Exams (USMLE) significantly impact medical student promotion in the United States. Studies have demonstrated varied impact of content-enriching programs on Step 1 performance. This study investigates the impact of process-oriented preparation on such high-stakes testing. Materials and Methods: A retrospective multivariate analysis was conducted after implementation of a peer-led seminar series on process-oriented preparation. Age, gender, ethnicity, medical college admission test scores (MCAT), and USMLE Step 1 scores were collected. Results: 557 students were included, 210 before and 347 after course implementation. Median Step 1 scores were 216 before and 223 after (p=0.19). When stratified by pre-enrollment MCAT score, students performing in the 25th–75th percentile showed significant improvement in Step 1 scoring (215 versus 223, p=0.016), which was not observed for students scoring below the 25th or above the 75th percentiles (p=0.53 and p=0.32, respectively). Discussion: Overall, Step 1 scores did not significantly differ for the pre- and post-seminar groups. There is suggestion of an impact on performance in certain student subgroups but further evaluation is necessary. Results from this study suggest that peer-led coaching can impact performance for some.


Medical education USMLE Step 1 standardized testing process-oriented preparation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Bowles LT, Melnick DE, Nungester RJ, Golden GG, Swanson DB, Case SM, Dillon GF, Henzel TR, Orr NA, Thadani RA. Review of the score-reporting policy for the United States Medical Licensing Examination. Acad Med 2000;75(5):426–431.CrossRefGoogle Scholar
  2. 2.
    Green M, Jones P, Thomas JX. Selection Criteria for Residency: Results of a National Program Directors Survey. Acad Med 2009;84(3):362–367.CrossRefGoogle Scholar
  3. 3.
    Berner ES, Brooks CM, Erdmann JB. Use of the USMLE to select residents. Acad Med 1993;68(10):753–759.CrossRefGoogle Scholar
  4. 4.
    Kleshinski J, Khuder SA, Shapiro JI, Gold JP. Impact of preadmission variables on USMLE step 1 and step 2 performance. Adv Health Sci Educ Theory Pract 2009;14(1):69–78.CrossRefGoogle Scholar
  5. 5.
    Julian ER. Validity of the Medical College Admission Test for predicting medical school performance. Acad Med 2005;80(10):910–917.CrossRefGoogle Scholar
  6. 6.
    Thadani RA, Swanson DB, Galbraith RM. A preliminary analysis of different approaches to preparing for the USMLE Step 1. Acad Med 2000;75(10 Suppl):40–42.CrossRefGoogle Scholar
  7. 7.
    McGaghie WC, Downing SM, Kubilius R. What is the impact of commercial test preparation courses on medical examination performance? Teach Learn Med 2004;16:202–211.CrossRefGoogle Scholar
  8. 8.
    Zhang C, Rauchwarger A, Toth C, O’Connell M. Student USMLE Step 1 preparation and performance. Adv Health Sci Educ 2004:9:291–294.CrossRefGoogle Scholar
  9. 9.
    Werner LS, Bull BS. The effects of three commercial coaching courses on Step 1 USMLE performance. Med Educ 2003;37:527–531.CrossRefGoogle Scholar
  10. 10.
    Tekian A, Hruska L. A review of medical school records to investigate the effectiveness of enrichment programmes for ‘at risk’ students. Teach Learn Med 2004;16:28–33.CrossRefGoogle Scholar
  11. 11.
    Sawyer SJ, Sylvestre PB, Girard RA, Snow MH. Effects of supplemental instruction on mean test scores and failure rates in medical school courses. Acad Med 1996;71:1357–1359.CrossRefGoogle Scholar
  12. 12.
    DeVoe P, Niles C, Andrews N, Benjamin A, Blacklock L, Brainard A, Colombo E, Dudley B, Koinis C, Osgood M. Lessons learned from a study group pilot programme for medical students perceived to be ‘at risk’. Med Teach 2007;29:37–40.CrossRefGoogle Scholar
  13. 13.
    Segal SS, Giordani B, Gillum LH, Johnson N. The Academic Support Programme at the University of Michigan School of Medicine. Acad Med 1999;74:383–385.CrossRefGoogle Scholar
  14. 14.
    Wilkerson L, Wimmers P, Doyle LH, Uijtdehaage S. Two perspectives on the effects of a curriculum change: student experience and the United States medical licensing examination, step 1. Acad Med 2007;82(10 suppl):S117–S120.CrossRefGoogle Scholar
  15. 15.
    Hecker K, Violate C. Medical school curricula: do curricular approaches affect competence in medicine? Fam Med 2009;41(6):420–426.Google Scholar
  16. 16.
    Hecker K, Violate C. How much do differences in medical schools influence student performance? A longitudinal study employing hierarchical linear modeling. Teach Learn Med 2008;20(2):104–113.CrossRefGoogle Scholar
  17. 17.
    Alcamo AM, Davids AR, Way DP, Lynn DJ, Vandre DD. The impact of peer-designed and — led USMLE Step 1 review course: improvement in preparation and scores. Acad Med 2010;85(10 Suppl):S45–S48.CrossRefGoogle Scholar
  18. 18.
    Wong JG, Waldrep TD, Smith TG. Formal peer-teaching in medical school improves academic performance: the MUSC supplemental instructor program. Teach Learn Med 2007;19(3):216–220.CrossRefGoogle Scholar
  19. 19.
    Strowd R, Lambros A. A Five-Part Seminar Series on USMLE Step 1 Preparation. MedEdPORTAL; 2010. Available from: Last assessed 06/01/2013.
  20. 20.
    Strowd RE, Lambros A. Impacting student anxiety for the USMLE Step 1 through process-oriented preparation. Med Educ Online 2010 Feb 24;15. Doi:10.3402/meo.v15i0.4880. 29 Last assessed 06/01/2013.
  21. 21.
    Cuddy MM, Swanson DB, Clauser BE. A multilevel analysis of examinee gender and USMLE Step 1 performance. Acad Med 2008;83(10 suppl):S58–S62.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2013

Authors and Affiliations

  • Roy E. StrowdIII
    • 1
  • H. Randall Beard
    • 1
  • Barbara Gorney
    • 1
  • Gregory B. Russell
    • 1
  • Ann Lambros
    • 1
  1. 1.Medical Center Boulevard Department of NeurologyWake Forest School of MedicineWinston-SalemUSA

Personalised recommendations