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PGMJ Online First, published on April 24, 2015 as 10.1136/postgradmedj-2014-133081 Original article
Preparing to take the USMLE Step 1: a survey on medical students’ self-reported study habits Andre D Kumar,1,2 Monisha K Shah,3 Jason H Maley,2,4 Joshua Evron,2,5 Alex Gyftopoulos,2,6 Chad Miller7 1
Department of Medicine, Stanford University, Stanford, California, USA 2 School of Medicine, Tulane University, New Orleans, Louisiana, USA 3 University of California, San Francisco, San Francisco, California, USA 4 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA 5 Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA 6 Department of Medicine, University of Chicago, Chicago, Illinois, USA 7 Department of Medicine, Tulane University, New Orleans, Louisiana, USA Correspondence to Dr Andre D Kumar, Department of Medicine, Stanford University Hospital, 300 Pasteur Drive, Lane 154, Stanford, CA 94305-5133, USA; [email protected] Received 15 October 2014 Revised 30 March 2015 Accepted 4 April 2015
ABSTRACT Background The USA Medical Licensing Examination Step 1 is a computerised multiple-choice examination that tests the basic biomedical sciences. It is administered after the second year in a traditional fouryear MD programme. Most Step 1 scores fall between 140 and 260, with a mean (SD) of 227 (22). Step 1 scores are an important selection criterion for residency choice. Little is known about which study habits are associated with a higher score. Objective To identify which self-reported study habits correlate with a higher Step 1 score. Methods A survey regarding Step 1 study habits was sent to third year medical students at Tulane University School of Medicine every year between 2009 and 2011. The survey was sent approximately 3 months after the examination. Results 256 out of 475 students (54%) responded. The mean (SD) Step 1 score was 229.5 (22.1). Students who estimated studying more than 8–11 h per day had higher scores ( p8000 No of hours spent studying per day 0–3 4–7 8–11 12–15 16–19 No of preparation days ≤20 21–40 41–60 61–80 >80 Percentage of study time in group 0 ≤20% 21–40% 41–60% 61–80% 81–100%
247 84 68 35 60 240 107 99 29 2 3 256 11 42 124 72 7 252 35 146 63 3 7 252 147 44 30 8 12 11
2009 Mean score (SD)
p Value 0.41
230.1 231.3 229.1 224.9
(22.6) (19.1) (25.4) (24.9)
221.5 233.3 239.1 239.0 247.0
(24.8) (20.4) (18.3) (9.9) (7.6)
Point estimate (95% CI) −1.7 (−4.2 to 0.7)
2000 practice questions may correlate with improved performance on the USMLE Step 1. ▸ However, taking additional time to prepare may not necessarily lead to improved performance, as those who spent >11 h per day or those who took >40 preparation days did not have significant improvements in score. ▸ Group studying does not appear to improve Step 1 performance.
Data sharing statement Our survey also collected data related to test taker attitudes relating to the USMLE Step 1. These data have not been formally analysed yet and are being kept in a secure spreadsheet by the primary author (ADK). These data will be analysed at a future time.
REFERENCES 1 2
3 4
Current research questions
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▸ Which study habits, when assessed prospectively, correlate with improved performance on the USMLE step 1? ▸ Do students’ perceptions of their study habits match what was actually undertaken when preparing for a licensing examination such as the USMLE Step 1? ▸ Is there a model for ‘ideal’ test preparation based on research regarding effective study habits?
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Key references ▸ NRMP. Charting outcomes in the match. Washington, DC: National Resident Matching Program and Association of American Medical Colleges, 2011. ▸ Thadani RA, Swanson DB, Galbraith RM. A preliminary analysis of different approaches to preparing for the USMLE Step 1. Acad Med 2000;75:S40–2. ▸ Pohl CA, Robeson MR, Hojat M, et al. Sooner or later? USMLE step 1 performance and test administration date at the end of the second year. Acad Med 2002;77(10 Suppl): S17–19.
Kumar AD, et al. Postgrad Med J 2015;0:1–5. doi:10.1136/postgradmedj-2014-133081
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Examiners NBME. USMLE Bulletin of Information. 2013. Lewis CE, Hiatt JR, Wilkerson L, et al. Numerical versus pass/fail scoring on the USMLE: what do medical students and residents want and why? J Grad Med Educ 2011;3:59–66. Green M, Jones P, Thomas JX Jr. Selection criteria for residency: results of a national program directors survey. Acad Med 2009;84:362–7. Makdisi G, Takeuchi T, Rodriguez J, et al. How we select our residents: a survey of selection criteria in general surgery residents. J Surg Educ 2011;68:67–72. NRMP. Charting outcomes in the match. Washington, DC: National Resident Matching Program and Association of American Medical Colleges, 2011. Paolo AM, Bonaminio GA, Durham D, et al. Comparison and cross-validation of simple and multiple logistic regression models to predict USMLE step 1 performance. Teach Learn Med 2004;16:69–73. Coumarbatch J, Robinson L, Thomas R, et al. Strategies for identifying students at risk for USMLE Step 1 failure. Fam Med 2010;42:105–10. Thadani RA, Swanson DB, Galbraith RM. A preliminary analysis of different approaches to preparing for the USMLE Step 1. Acad Med 2000;75:S40–2. Pohl CA, Robeson MR, Hojat M, et al. Sooner or later? USMLE step 1 performance and test administration date at the end of the second year. Acad Med 2002; 77(10 Suppl):S17–19. Kulik JA, Kulik CLC, Bangert RL. Effects of practice on aptitude and achievement-test scores. Am Educ Res J 1984;21:435–47. Kiewra KA, Benton SL. The effects of higher-order review questions with feedback on achievement among learners who take notes or receive the instructors’ notes. Hum Learn 1985;4:225–31. Roediger HL, Karpicke JD. Test-enhanced learning—taking memory tests improves long-term retention. Psychol Sci 2006;17:249–55. Sokolove P, Marbach-Ad G. The benefits of out-of-class group study for improving student performance on exams: a comparison of outcomes in active learning and traditional college biology classes. J Excellence Coll Teach 1999;10:49–67. Kolb DA, Boyatzis RE, Mainemelis C. Experiential learning theory: previous research and new directions. Perspectives on Thinking, Learning, and Cognitive Styles. Department of Organizational Behavior, Weatherhead School of Management, Case Western Reserve University, 2001:227–47. Plant A, Ericsson KA, Hill L, et al. Why study time does not predict grade point average across college students: implications of deliberate practice for academic performance. Contemp Educ Psychol 2005;30:96–116. Hecker K, Violato C. How much do differences in medical schools influence student performance? A longitudinal study employing hierarchical linear modeling. Teach Learn Med 2008;20:104–13.
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Downloaded from http://pmj.bmj.com/ on May 2, 2015 - Published by group.bmj.com
Preparing to take the USMLE Step 1: a survey on medical students' self-reported study habits Andre D Kumar, Monisha K Shah, Jason H Maley, Joshua Evron, Alex Gyftopoulos and Chad Miller Postgrad Med J published online April 24, 2015
Updated information and services can be found at: http://pmj.bmj.com/content/early/2015/04/23/postgradmedj-2014-133 081
These include:
References Email alerting service
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PGMJ Online First, published on April 24, 2015 as 10.1136/postgradmedj-2014-133081 Original article
Preparing to take the USMLE Step 1: a survey on medical students’ self-reported study habits Andre D Kumar,1,2 Monisha K Shah,3 Jason H Maley,2,4 Joshua Evron,2,5 Alex Gyftopoulos,2,6 Chad Miller7 1
Department of Medicine, Stanford University, Stanford, California, USA 2 School of Medicine, Tulane University, New Orleans, Louisiana, USA 3 University of California, San Francisco, San Francisco, California, USA 4 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA 5 Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA 6 Department of Medicine, University of Chicago, Chicago, Illinois, USA 7 Department of Medicine, Tulane University, New Orleans, Louisiana, USA Correspondence to Dr Andre D Kumar, Department of Medicine, Stanford University Hospital, 300 Pasteur Drive, Lane 154, Stanford, CA 94305-5133, USA; [email protected] Received 15 October 2014 Revised 30 March 2015 Accepted 4 April 2015
ABSTRACT Background The USA Medical Licensing Examination Step 1 is a computerised multiple-choice examination that tests the basic biomedical sciences. It is administered after the second year in a traditional fouryear MD programme. Most Step 1 scores fall between 140 and 260, with a mean (SD) of 227 (22). Step 1 scores are an important selection criterion for residency choice. Little is known about which study habits are associated with a higher score. Objective To identify which self-reported study habits correlate with a higher Step 1 score. Methods A survey regarding Step 1 study habits was sent to third year medical students at Tulane University School of Medicine every year between 2009 and 2011. The survey was sent approximately 3 months after the examination. Results 256 out of 475 students (54%) responded. The mean (SD) Step 1 score was 229.5 (22.1). Students who estimated studying more than 8–11 h per day had higher scores ( p8000 No of hours spent studying per day 0–3 4–7 8–11 12–15 16–19 No of preparation days ≤20 21–40 41–60 61–80 >80 Percentage of study time in group 0 ≤20% 21–40% 41–60% 61–80% 81–100%
247 84 68 35 60 240 107 99 29 2 3 256 11 42 124 72 7 252 35 146 63 3 7 252 147 44 30 8 12 11
2009 Mean score (SD)
p Value 0.41
230.1 231.3 229.1 224.9
(22.6) (19.1) (25.4) (24.9)
221.5 233.3 239.1 239.0 247.0
(24.8) (20.4) (18.3) (9.9) (7.6)
Point estimate (95% CI) −1.7 (−4.2 to 0.7)
2000 practice questions may correlate with improved performance on the USMLE Step 1. ▸ However, taking additional time to prepare may not necessarily lead to improved performance, as those who spent >11 h per day or those who took >40 preparation days did not have significant improvements in score. ▸ Group studying does not appear to improve Step 1 performance.
Data sharing statement Our survey also collected data related to test taker attitudes relating to the USMLE Step 1. These data have not been formally analysed yet and are being kept in a secure spreadsheet by the primary author (ADK). These data will be analysed at a future time.
REFERENCES 1 2
3 4
Current research questions
5 6
▸ Which study habits, when assessed prospectively, correlate with improved performance on the USMLE step 1? ▸ Do students’ perceptions of their study habits match what was actually undertaken when preparing for a licensing examination such as the USMLE Step 1? ▸ Is there a model for ‘ideal’ test preparation based on research regarding effective study habits?
7 8 9
10 11
Key references ▸ NRMP. Charting outcomes in the match. Washington, DC: National Resident Matching Program and Association of American Medical Colleges, 2011. ▸ Thadani RA, Swanson DB, Galbraith RM. A preliminary analysis of different approaches to preparing for the USMLE Step 1. Acad Med 2000;75:S40–2. ▸ Pohl CA, Robeson MR, Hojat M, et al. Sooner or later? USMLE step 1 performance and test administration date at the end of the second year. Acad Med 2002;77(10 Suppl): S17–19.
Kumar AD, et al. Postgrad Med J 2015;0:1–5. doi:10.1136/postgradmedj-2014-133081
12 13
14
15
16
Examiners NBME. USMLE Bulletin of Information. 2013. Lewis CE, Hiatt JR, Wilkerson L, et al. Numerical versus pass/fail scoring on the USMLE: what do medical students and residents want and why? J Grad Med Educ 2011;3:59–66. Green M, Jones P, Thomas JX Jr. Selection criteria for residency: results of a national program directors survey. Acad Med 2009;84:362–7. Makdisi G, Takeuchi T, Rodriguez J, et al. How we select our residents: a survey of selection criteria in general surgery residents. J Surg Educ 2011;68:67–72. NRMP. Charting outcomes in the match. Washington, DC: National Resident Matching Program and Association of American Medical Colleges, 2011. Paolo AM, Bonaminio GA, Durham D, et al. Comparison and cross-validation of simple and multiple logistic regression models to predict USMLE step 1 performance. Teach Learn Med 2004;16:69–73. Coumarbatch J, Robinson L, Thomas R, et al. Strategies for identifying students at risk for USMLE Step 1 failure. Fam Med 2010;42:105–10. Thadani RA, Swanson DB, Galbraith RM. A preliminary analysis of different approaches to preparing for the USMLE Step 1. Acad Med 2000;75:S40–2. Pohl CA, Robeson MR, Hojat M, et al. Sooner or later? USMLE step 1 performance and test administration date at the end of the second year. Acad Med 2002; 77(10 Suppl):S17–19. Kulik JA, Kulik CLC, Bangert RL. Effects of practice on aptitude and achievement-test scores. Am Educ Res J 1984;21:435–47. Kiewra KA, Benton SL. The effects of higher-order review questions with feedback on achievement among learners who take notes or receive the instructors’ notes. Hum Learn 1985;4:225–31. Roediger HL, Karpicke JD. Test-enhanced learning—taking memory tests improves long-term retention. Psychol Sci 2006;17:249–55. Sokolove P, Marbach-Ad G. The benefits of out-of-class group study for improving student performance on exams: a comparison of outcomes in active learning and traditional college biology classes. J Excellence Coll Teach 1999;10:49–67. Kolb DA, Boyatzis RE, Mainemelis C. Experiential learning theory: previous research and new directions. Perspectives on Thinking, Learning, and Cognitive Styles. Department of Organizational Behavior, Weatherhead School of Management, Case Western Reserve University, 2001:227–47. Plant A, Ericsson KA, Hill L, et al. Why study time does not predict grade point average across college students: implications of deliberate practice for academic performance. Contemp Educ Psychol 2005;30:96–116. Hecker K, Violato C. How much do differences in medical schools influence student performance? A longitudinal study employing hierarchical linear modeling. Teach Learn Med 2008;20:104–13.
5
Downloaded from http://pmj.bmj.com/ on May 2, 2015 - Published by group.bmj.com
Preparing to take the USMLE Step 1: a survey on medical students' self-reported study habits Andre D Kumar, Monisha K Shah, Jason H Maley, Joshua Evron, Alex Gyftopoulos and Chad Miller Postgrad Med J published online April 24, 2015
Updated information and services can be found at: http://pmj.bmj.com/content/early/2015/04/23/postgradmedj-2014-133 081
These include:
References Email alerting service
This article cites 13 articles, 2 of which you can access for free at: http://pmj.bmj.com/content/early/2015/04/23/postgradmedj-2014-133 081#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
