Despite Stress and Burnout, Most Students Feel that Medical School Prepared Them Well for Board Exams and Residency

In Medscape’s 2022 Medical Student Lifestyle report, which included responses from over 2,000 medical students, many respondents reported experiencing burnout: 37 percent of students reported occasional burnout, while a full third of respondents (33 percent) reported frequent burnout, and 12 percent reported constant burnout. And while 37 percent said that they rarely or never experience doubt about becoming a doctor, many said they did experience doubt sometimes (44 percent), frequently (15 percent), or constantly (4 percent).

Despite many medical students experiencing stress and even doubt, most reported feeling that their medical schools prepared them for the future. The majority of students (64 percent) noted that they felt prepared or very prepared for the USMLE, with half favoring the move to a pass/fail format for the test. Just over two-thirds of students, 67 percent, reported satisfaction with the relationships they formed with their professors. And 59 percent reported feeling prepared or very prepared for residency, with that proportion increasing to 75 percent among fourth year respondents. 

Many students also reported that they found meaning during the pandemic. Over one-third of respondents, 39 percent, reported that Covid reinforced or strongly reinforced their drive to become a doctor. In terms of specialty selection, 24 percent noted that Covid slightly or somewhat influenced their specialty choice, and 12 percent said that Covid influenced or strongly influenced their selection of a specialty. The majority of students (54 percent) said that they felt satisfied or very satisfied with how their medical school handled Covid. 

Trends in Medicine: Shortening the Preclinical Timeline

American medical schools have traditionally followed a similar structure: two years of preclinical work followed by two years of clinical rotations. But there is an emerging trend within medical education, which accelerates preclinical studies in order to allow students more time to gain clinical experiences. According to the Liaison Committee on Medical Education, during the 2019-2020 academic year, six percent of medical schools ended pre-clinicals after one year, 29 percent ended them after 1.5 years, and 56 percent retained the traditional two year structure. 

Kim Lomis, MD, and Vice President for Undergraduate Medical Education Innovations at the American Medical Association, explains that the reasoning for the curriculum update is so that students are better able to contextualize learning within patient care. “Proponents argue that learners are able to better anchor their learning of foundational sciences in a meaningful context, fostering professional identity formation as well as knowledge base,” she said. Early adopters include the elite medical schools at Harvard, Duke, Vanderbilt, and NYU Grossman. Each of these schools now condense preclinical learning into the first year, with students beginning clinical clerkships at the start of their second year. 

Rutgers Robert Wood Johnson Medical School recently launched its updated curriculum, which starts the clerkship after 18 months. Carol A. Terregino, MD, and Senior Associate Dean for Education and Academic Affairs at Rutgers, notes that the curriculum change is beneficial because it puts an emphasis on “knowledge for practice.” 

“Anything that is going to increase students’ clinical knowledge and ability to apply that knowledge to clinical practice is going to make students stronger as future physicians,” she said. She also noted the presence of unknowns related to the recent pass-fail update of the USMLE Step One exam, which could potentially increase the importance of the Step Two exam. “To make sure my students are able to do well and prepare for the licensing exam, I want a longer launching pad to get them there,” she said.

Others say that looking just at “preclinical” and “clinical” years oversimplifies medical education. Students at Ohio University Heritage College of Osteopathic Medicine, for example, follow the traditional two and two calendar, but are exposed to clinical experiences through observations and interactions during the first two preclinical years. “Distilling a college’s program to the length of time in preclinical or clinical curriculum misses all the nuances of what each college does to prepare its students. We emphasize patient-centered care from the first day of medical school, making our students well-rounded when they engage in their clinical rotations,” said Jody M. Gerome, DO, and Heritage College’s Senior Associate Dean for Medical Education.

Related Blog: U.S. Medical Licensing Examination’s (USMLE) Step One Moves to Pass-Fail Scoring

U.S. Medical Licensing Examination’s (USMLE) Step One Moves to Pass-Fail Scoring

Last month, for the first time, the U.S. Medical Licensing Examination (USMLE) administered the Step One exam to second-year medical students in a pass-fail format. The USMLE finalized the decision to replace the scoring last December, explaining that the exam was intended for use as a benchmark and not to differentiate between students. They also acknowledged that students were prioritizing Step One preparation “at the expense of other curricula and their own well-being.”

Priya Jaisinghani, MD, an endocrinology fellow at New York-Presbyterian Weill Cornell Medical Center, called the move, “a step in the right direction” in an interview with MedPage Today. She suggested that early medical students can now re-prioritize critical medical skills as opposed to burying themselves in test preparation. "There was so much onus on the exam. Now [students can] shift focus to experiences, organizations, community health, and research," she said. DO students may also feel some relief at the update. While they are required to take the COMLEX, many elect to take the Step One in order to increase the competitiveness of their residency applications. 

Others suggest that the move will negatively affect some students seeking to differentiate themselves as applicants to highly-competitive residencies. While unofficial, many specialties are known to have score cut-offs for residency applicants. Among the 2019-2020 first-year residents, Step One scores among thoracic surgery, orthopedic surgery, and otolaryngology averaged 247.3, 246.3, and 246.8, respectively. Residents in emergency medicine (230.9), family medicine (215.5), and internal medicine pediatrics (235.5) received lower scores on average. A 2021 survey of orthopedic surgery program directors confirms this point, with 68 percent calling the Step One score “extremely or very important” for applicant interview selection. 

According to USMLE, removing the scores will encourage programs to review candidates more holistically. Practically, however, it is unclear what that may look like in the near term. Some students, speaking to Medpage Today, suggested that letters of recommendation and school rankings may play a more outsized role in residency considerations. "It makes it harder if you are coming from smaller institutions. It becomes more about who you know and who's making phone calls for you. Students with great medical pedigrees may have more advantages,” Lena Josifi, MD, a fourth-year orthopedic surgery resident at Southern Illinois University, said. 

A survey of orthopedic surgery program directors confirms Josifi’s hunch. Over one-third (37.7 percent) agree that the changes to Step One scoring would “probably” or “definitely” decrease the likelihood that applicants from lower-ranked medical schools would be selected for interviews. The majority, 81 percent, also agreed that Step Two results will grow in importance.