The high-stress nature associated with the transition from medical school to residency training has been a topic of concern at the highest levels within the medical community.
In early March of 2020, the AMA, along with multiple other key organizations, announced the first of many changes aimed at making positive systemic changes to medical education — and it was a big one. For the first time ever, in January of 2022, the USMLE Step 1 examination would be eliminating its numeric scoring and moving to a Pass/Fail scoring format.
From the AMA’s perspective the numeric scoring system for Step 1 was problematic in three areas:
- Residency programs had become too reliant on the exam’s numeric score for screening candidates through the NRMP Match
- The high-stakes nature of the exam had led to the perceived development of a competing parallel curriculum
- The exam distracted students from developing other core competencies such as team building and communication skills.
See, these licensure exams were never originally designed to distinguish between candidates; they were solely designed to protect the public by ensuring minimal competency levels.
The quantifiable importance placed on the numeric 3-digit scores of both USMLE Step 1 and COMLEX-USA Level 1 is well-documented in the candidate selection process. Year after year Program Directors across all specialties of medicine note these scores to be the single most important factor in determining candidates to interview for residency spots, placing a supreme emphasis on high performance. It’s well-known that the higher the 3-digit score, the more options one will likely have. If you are in the Classes of 2021 – 2023, you will most likely still be reporting your numeric 3-digit step 1 and Level 1 scores.
But times are changing, and hopefully for the better. Last week the NBOME announced that it would be following suit and confirmed that, after much thought and debate, they would also be moving COMLEX-Level 1 to a Pass/Fail format in 2022.
This announcement follows a sequence of announcements made by the NBOME to stand behind a committed effort to prioritize the wellness of Osteopathic medical students nationwide by making the COMLEX examination series less stressful for students and residents taking these exams.
These recent changes include the following announcements made by NBOME in recent months:
- The NBOME announced early in 2020 that it would be reducing the total number of items on COMLEX-USA from 400 to 352, ultimately improving the time-per-item allotment to nearly 82 seconds (up from it’s prior 72 second-per-item format. This change was already implemented in the June 2020 testing cycle and will continue in future exams.
- In 2020, the NBOME also committed to moving up its testing cycle 3-weeks (starting May 5th, 2020) to provide students with more testing options.
- In addition to item-reduction and changes to the testing window, the NBOME also announced that it would be normalizing it’s Prometric testing experience across Level 1, Level 2 CE, and Level 3.
- And finally….the NBOME has now taken its largest step by newly announcing that COMLEX-Level 1 will eliminate a numeric scoring format taking on a Pass/Fail system that will align with the 2022/2023 testing cycle.
So how will we navigate through all of these changes? Well, first and foremost, we’ll do it together.
Since COMBANK’s inception ten years ago, we’ve taken a vigilant and responsive approach to navigating through changes made to the COMLEX series. So this is nothing new for us. Our commitment to serving Osteopathic students nationwide to best position them for success in the match is core to our DNA. We will continue our unwavering approach to advancing the success of our profession. We will be working closely with Deans, faculty, administrators, and most importantly, students, to provide the most accurate and up-to-date simulation of COMLEX so there are no surprises going into test day. We not only support, but also celebrate the focus on student wellness and share in the advocacy of medical students nationwide.
Over the coming weeks and months, we expect new announcements to be released by the NBOME in regards to details surrounding the changing scoring system to COMLEX-USA. Our organization will be following those closely and will be putting our periodic updates to ensure that all students and their respective COMs are fully aware of the changes being made.
We expect there to be a lot of speculation in the near future surrounding the impact changes will have on the residency selection process. While this is normal, we are committed to taking a data-driven approach to better understanding the downstream impact of this important decision.
Given the need for both MD and DO candidates to objectively differentiate themselves during the ERAS process, the obvious impact to residency programs would be to replace the importance of the Step 1 / Level 1 numeric score with the numeric score of Step 2 CK / Level 2 CE. While this simplistic outcome makes sense, it simply shifts the paradigm to placing even heavier importance on the reliance of a single numeric metric as the sole determinant for programs to differentiate candidates. Given that this would go against the mission of the ACGME to improve student well-being and create a better transition process from medical school to residency, we believe there will be more to the story. As new developments are made, we will be posting them on a timely basis.
To summarize, as it relates to the NBOME and changes to COMLEX-USA, here’s what we know so far:
- What do we know so far?
NBOME stated that the change to pass/fail would take effect starting May 1, 2022, which will align with the beginning of the 2022-2023 testing cycle. NBOME reports that more information will be shared by July 2021.
- How does this news impact the class of 2023 students and beyond?
The 2020 NRMP Program Director Survey data has consistently listed Step 1 and Level 1 scores as the most important factor when evaluating applicants for interviews. Now that Level 1 no longer will report a 3-digit score it will likely increase other factors for students in residency match. Based on the 2020 NRMP survey, the most important criteria after board scores are Letters of Recommendation in the specialty, Clinical year board scores, Personal Statement, MSPE, and perceived commitment to the specialty. In the future, we expect new important factors to emerge.
- What should we recommend to current 2nd year students?
Students testing before May 1, 2022, should continue to prepare and test as planned. Regardless of Level 1 or Step 1 going pass/fail, the series of both NBOME and NBME exams build on your knowledge and your ability to effectively apply that knowledge. Dedicating adequate time to preparing for Level 1 is critical to future exam success. Students testing in the 2021 season will still be receiving numeric scores for both Step 1 and Level 1 and we anticipate those scores holding the same weight as they have in years past. We expect the future rankings of the match evaluation criteria will evolve over the coming months and we commit to reporting those findings as we uncover them. In the meantime, we recommend using resources and strategies that ensure long-term retention during your first 2 years of medical school, which will help ensure success on licensing exams in your third year and beyond.
Our organization is constantly monitoring reports and changes that come from NBOME and NBME. As the leaders in COMLEX-USA preparation, partnering with more than 40 COMs and over 93% of Osteopathic students, we are dedicated to ensuring COM and continued student success. Our commitment to aligning specifically to COMLEX-USA exams remains unwavering, and we will continually evolve to mirror the new changes reported. Here at TrueLearn, we ALWAYS strive to advocate for the student first and will remain committed to this important mission. We thank you for your trust and partnership and will keep you posted as we learn more.
Joshua Courtney, DO
Founder and CEO