Skip to main content
SpringerLink
Log in

The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity

  • Original Research
  • Published:
Medical Science Educator Aims and scope Submit manuscript

Abstract

Purpose

Given the significance of the US Medical Licensing Exam (USMLE) Step 1 score moving from a 3-digit value to pass/fail, the authors investigated the impact of the change on students’ anxiety, approach to learning, and curiosity.

Method

Two cohorts of pre-clerkship medical students at three medical schools completed a composite of four instruments: the State-Trait Anxiety Inventory, the revised two-factor Study Process Questionnaire, the Interest/Deprivation Type Epistemic Curiosity Scale, and the Short Grit Scale prior to taking the last 3-digit scored Step 1 in 2021 or taking the first pass/fail scored Step 1 in 2022. Responses of 3-digit and pass/fail exam takers were compared (Mann–Whitney U) and multiple regression path analysis was performed to determine the factors that significantly impacted learning strategies.

Results

There was no difference between 3-digit (n = 86) and pass/fail exam takers (n = 154) in anxiety (STA-I scores, 50 vs. 49, p = 0.85), shallow learning strategies (22 vs. 23, p = 0.84), or interest curiosity scores (median scores 15 vs. 15, p = 0.07). However, pass/fail exam takers had lower deprivation curiosity scores (median 12 vs. 11, p = 0.03) and showed a decline in deep learning strategies (30 vs. 27, p = 0.0012). Path analysis indicated the decline in deep learning strategies was due to the change in exam scoring (β = − 2.0428, p < 0.05).

Conclusions

Counter to the stated hypothesis and intentions, the initial impact of the change to pass/fail grading for USMLE Step 1 failed to reduce learner anxiety, and reduced curiosity and deep learning strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Barone MA, et al. Summary report and preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS), in Invitational Conference on USMLE Scoring (InCUS) Burlington, VT. 2019;p. 20.

  2. Tackett S, et al. Student well-being during dedicated preparation for USMLE Step 1 and COMLEX Level 1 exams. BMC Med Educ. 2022;22(1):16–16.

    Article  Google Scholar 

  3. Dyrbye LN, et al. Medical school strategies to address student well-being: a national survey. Acad Med. 2019;94(6):861–8.

    Article  Google Scholar 

  4. Dyrbye LN, et al. A multi-institutional study exploring the impact of positive mental health on medical students’ professionalism in an era of high burnout. Acad Med. 2012;87(8):1024–31.

    Article  Google Scholar 

  5. Humphrey HJ, Woodruff JN. The pass/fail decision for USMLE Step 1-next steps. JAMA. 2020;323(20):2022–3.

    Article  Google Scholar 

  6. Quek TT, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16(15).

  7. Dunn LB, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008;32(1):44–53.

    Article  Google Scholar 

  8. Ward PJ. Influence of study approaches on academic outcomes during pre-clinical medical education. Med Teach. 2011;33(12):e651–62.

    Article  Google Scholar 

  9. Cipra C, Muller-Hilke B. Testing anxiety in undergraduate medical students and its correlation with different learning approaches. PLoS ONE. 2019;14(3): e0210130.

    Article  Google Scholar 

  10. Hattie JAC, Donoghue GM. Learning strategies: a synthesis and conceptual model. NPJ Sci Learn. 2016;1:16013.

    Article  Google Scholar 

  11. Newble DI, Entwistle NJ. Learning styles and approaches: implications for medical education. Med Educ. 1986;20(3):162–75.

    Article  Google Scholar 

  12. Schumacher DJ, Englander R, Carraccio C. Developing the master learner: applying learning theory to the learner, the teacher, and the learning environment. Acad Med. 2013;88:1635–45.

    Article  Google Scholar 

  13. Litman JA. Interest and deprivation factors of epistemic curiosity. Personality Individ Differ. 2008;44(7):1585–95.

    Article  Google Scholar 

  14. Richards JB, Litman J, Roberts DH. Performance characteristics of measurement instruments of epistemic curiosity in third-year medical students. Med Sci Educ. 2013;23(3):355–63.

    Article  Google Scholar 

  15. Berlyne DE. A theory of human curiosity. Br J Psychol. 1954;45(3):180–91.

    Google Scholar 

  16. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014;89(9):1252–8.

    Article  Google Scholar 

  17. Duckworth A, Gross JJ. Self-control and grit: related but separable determinants of success. Curr Dir Psychol Sci. 2014;23(5):319–25.

    Article  Google Scholar 

  18. Isenberg GA, et al. The relationship between grit and selected personality measures in medical students. Int J Med Educ. 2020;11:25–30.

  19. Lee DH, Reasoner K, Lee D. Grit: what is it and why does it matter in medicine? Postgrad Med J. 2023;15;99(1172):535–41.

  20. Jumat MR, et al. Grit protects medical students from burnout: a longitudinal study. BMC Med Educ. 2020;20(1):266.

    Article  Google Scholar 

  21. Miller-Matero LR, et al. Grit: a predictor of medical student performance. Educ Health (Abingdon). 2018;31(2):109–13.

    Article  Google Scholar 

  22. Park D, et al. Fostering grit: perceived school goal-structure predicts growth in grit and grades. Contemp Educ Psychol. 2018;55:120–8.

    Article  Google Scholar 

  23. Lee D, et al. The relationships between grit, burnout, and demographic characteristics in medical students. Psychol Rep. 2022; Apr 14:332941221087899.

  24. Wilkinson T. Pass/fail grading: not everything that counts can be counted. Med Educ. 2011;45(9):860–2.

    Article  Google Scholar 

  25. LePine JA, LePine MA, Jackson CL. Challenge and hindrance stress: relationships with exhaustion, motivation to learn, and learning performance. J Appl Psychol. 2004;89:883–91.

    Article  Google Scholar 

  26. Brenneisen Mayer F, et al. Factors associated to depression and anxiety in medical students: a multicenter study. 2016;16(1):472–6920.

  27. Biggs JC. The revised two-factor Study Process Questionnaire: R-SPQ-2F. Br J Educ Psychol. 2001;71:133–49.

    Article  Google Scholar 

  28. Lauriola M, et al. Epistemic curiosity and self-regulation. Personality Individ Differ. 2015;83:202–7.

    Article  Google Scholar 

  29. Binu KG, et al. Influence of epistemic curiosity on the study approaches of first year engineering students. Procedia Comput Sci. 2020;172:443–451.

  30. Richards JB, Litman JA, Roberts DH. Performance characteristics of measurement instruments of epistemic curiosity in third-year medical students. Med Sci Educ. 2013;23:355–63.

    Article  Google Scholar 

  31. Musumari PM, et al. Grit is associated with lower level of depression and anxiety among university students in Chiang Mai, Thailand: a cross-sectional study. PLoS ONE. 2018;13(12): e0209121.

    Article  Google Scholar 

  32. Hilliard RI. How do medical students learn: medical student learning styles and factors that affect these learning styles. Teach Learn Med. 1995;7(4):201–10.

    Article  Google Scholar 

  33. Chen DR, et al. Student perspectives on the “Step 1 Climate” in preclinical medical education. Acad Med. 2019;94(3):302–4.

    Article  Google Scholar 

  34. Girard AO, et al. US medical student perspectives on the impact of a pass/fail USMLE Step 1. J Surg Educ. 2022;79(2):397–408.

    Article  Google Scholar 

  35. Mott NM, Kercheval JB, Daniel M. Exploring students’ perspectives on well-being and the change of United States Medical Licensing Examination Step 1 to pass/fail. Teach Learn Med. 2021;33(4):355–65.

    Article  Google Scholar 

  36. Cangialosi PT, et al. Medical students’ reflections on the recent changes to the USMLE Step exams. Acad Med. 2021;96(3):343–8.

    Article  Google Scholar 

  37. Miller BM, et al. Can a pass/fail grading system adequately reflect student progress? Virtual Mentor. 2009;11(11):842–51.

    Google Scholar 

  38. Baniadam K, et al. The impact on medical student stress in relation to a change in USMLE Step 1 examination score reporting to pass/fail. Med Sci Educ. 2023;33:401–7.

  39. Blamoun J, Hakemi A, Armstead T. Perspectives on transitioning Step 1 of the United States Medical Licensing Examination to a pass/fail scoring model: defining new frameworks for medical students applying for residency. Adv Med Educ Pract. 2021;12:149–54.

    Article  Google Scholar 

  40. Pascarella L. USLME Step 1 scoring system change to pass/fail-perspective of a clerkship director. JAMA Surg. 2020;155(12):1096–8.

    Article  Google Scholar 

  41. Salehi PP, Azizzadeh B, Lee YH. Pass/fail scoring of USMLE Step 1 and the need for residency selection reform. Otolaryngol Head Neck Surg. 2021;164(1):9–10.

    Article  Google Scholar 

  42. Willett LL. The impact of a pass/fail Step 1 — a residency program director’s view. N Engl J Med. 2020;382(25):2387–9.

    Article  Google Scholar 

  43. Pontell ME, et al. The change of USMLE Step 1 to pass/fail: perspectives of the surgery program director. J Surg Educ. 2021;78(1):91–8.

    Article  Google Scholar 

  44. Kracaw RA, et al. Predicting United States Medical Licensing Examination Step 2 clinical knowledge scores from previous academic performance measures within a longitudinal interleaved curriculum. Cureus. 2021;13(9): e18143.

    Google Scholar 

  45. Shih AF, Maroongroge S. The importance of grit in medical training. J Grad Med Educ. 2017;9(3):399.

    Article  Google Scholar 

  46. Sternszus R, Saroyan A, Steinert Y. Describing medical student curiosity across a four year curriculum: an exploratory study. Med Teach. 2017;39(4):377–82.

    Article  Google Scholar 

  47. Salles A, Cohen GL, Mueller CM. The relationship between grit and resident well-being. Am J Surg. 2014;207(2):251–4.

    Article  Google Scholar 

  48. Adashi EY, Ahmed AH, Gruppuso PA. The importance of being curious. Am J Med. 2019;132(6):673–4.

    Article  Google Scholar 

  49. Coda JE. Third-party resources for the USMLE: reconsidering the role of a parallel curriculum. Acad Med. 2019;94(7):924.

    Article  Google Scholar 

  50. Burk-Rafel J, Santen SA, Purkiss J. Study behaviors and USMLE Step 1 performance: implications of a student self-directed parallel curriculum. Acad Med. 2017;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S67-S74.

  51. Scouller K. The influence of assessment method on students’ learning approaches: multiple choice question examination versus assignment essay. High Educ. 1998;35(4):453–72.

    Article  Google Scholar 

  52. Choudhary A, et al. Impact of pass/fail USMLE Step 1 scoring on the internal medicine residency application process: a program director survey. J Gen Intern Med. 2021;36(8):2509–10.

    Article  Google Scholar 

  53. Deitte LA, et al. The pass/fail United States Medical Licensing Examination Step 1: impact on radiology residency selection. J Am Coll Radiol. 2021;18(3 Pt A):435–37.

  54. Drake E, Phillips JP, Kovar-Gough I. Exploring preparation for the USMLE Step 2 exams to inform best practices. PRiMER. 2021;5:26.

    Article  Google Scholar 

  55. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283(6):516–29.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dani Backus and Dr. Aubrey Knight for their project assistance, Drs. Richard Schwartzstein and Jed Gonzalo for their insightful comments, and Dr. Allison Tegge for statistical consultation and data review.

Funding

This project was funded in part by the Virginia Tech Center for Teaching and Learning.

Author information

Authors and Affiliations

  1. Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA

    Renée J. LeClair & Andrew P. Binks

  2. Office of Academic Affairs, Tulane University School of Medicine, New Orleans, LA, USA

    Cecilia T. Gambala

  3. Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Judith M. Brenner & Joanne M. Willey

  4. New York University Grossman Long Island School of Medicine, Mineola, USA

    Judith M. Brenner

Authors
  1. Renée J. LeClair
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew P. Binks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia T. Gambala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Judith M. Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joanne M. Willey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renée J. LeClair.

Ethics declarations

Ethical Approval

The study was approved on March 9, 2021, by the Virginia Tech Internal Review Board (IRB), Protocol #21-241. It was deemed exempt under 45 CFR 46.104(d) category 2(i). VT approval was accepted by the IRBs at ZSOM and TUSOM.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 133 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

LeClair, R.J., Binks, A.P., Gambala, C.T. et al. The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity. Med.Sci.Educ. 33, 1197–1204 (2023). https://doi.org/10.1007/s40670-023-01878-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40670-023-01878-w

Keywords

Search

Navigation