Schwartz Lindsay F, Lineberry Matthew, Park Yoon Soo, Kamin Carol S, Hyderi Abbas A
a Department of Pediatrics , University of California , Los Angeles, Los Angeles , California , USA.
b Zamierowski Institute for Experiential Learning and Department of Health Policy and Management , University of Kansas School of Medicine , Kansas City , Kansas , USA.
Teach Learn Med. 2018 Apr-Jun;30(2):193-201. doi: 10.1080/10401334.2017.1386106. Epub 2017 Dec 14.
Studies have documented performance on the United States Medical Licensing Examination® (USMLE) Step 1 exam as an important factor that residency program directors consider when deciding which applicants to interview and rank. Therefore, success on this exam, though only one aspect of applicant evaluation, is important in determining future career prospects for medical students. Unfortunately, mean test scores at the University of Illinois College of Medicine at Chicago (UIC) have historically been below the national average.
This retrospective and quasi-experimental mixed-methods study describes the development, evaluation, and effects of a student-initiated USMLE Step 1 preparatory program at UIC. The program provided second year students with First Aid for the USMLE Step 1 at the beginning of the academic year, as well as a six month subscription to the USMLE World question bank midyear. In addition, optional peer review sessions covering basic sciences and organ systems were taught by high-performing upperclassmen. The goals of the program were to raise mean USMLE Step 1 exam scores and increase the percentage of students passing the exam on their first time.
The program premiered during the 2012-13 academic year. Data from this cohort as well as four others (N = 830; 2010-2014 examinees) were gathered. Performances between preintervention (2010-12 examinees) and postintervention (2013-14 examinees) cohorts of students were compared. Focus groups and interviews with staff and students were conducted, recorded, and analyzed to investigate the impact that the program had on student interactions and perceptions of the learning environment.
There was a significant difference in exam performance pre- versus postintervention, with average USMLE Step 1 scores improving by 8.82 points following the implementation of the student-initiated program, t(5.61) = 828, p < .001. The average first-attempt pass rate also increased significantly by 8%, χ(1) = 23.13, p < .001. Taking age, sex, Medical College Admission Test® scores, and undergraduate grade point average into account, students who participated in the program scored 6.57 points higher than students who did not participate in the program (R = 0.3), F(5, 886) = 76.71, p < .01, and had higher odds of passing USMLE Step 1 (odds ratio = 3.08, SE = 1.07, p < .01). Students and staff commented on the sense of community and empowerment the program created as well as the unique student-driven nature of the program.
This study demonstrates the efficacy of a student-initiated curriculum and provides guidance for development and implementation of examination preparatory efforts at other institutions.
研究表明，美国医师执照考试第一步（USMLE）的成绩是住院医师培训项目主任在决定面试和排名申请人时考虑的一个重要因素。因此，尽管这项考试的成绩只是申请人评估的一个方面，但对医学生未来的职业前景至关重要。不幸的是，芝加哥伊利诺伊大学医学院（UIC）的平均考试成绩历来低于全国平均水平。
这项回顾性和准实验性的混合方法研究描述了UIC一项由学生发起的USMLE第一步备考项目的开发、评估和效果。该项目在学年开始时为二年级学生提供了《USMLE第一步急救手册》，并在学年中期为他们订阅了为期六个月的USMLE World题库。此外，由成绩优异的高年级学生举办了涵盖基础科学和器官系统的选修同伴互评课程。该项目的目标是提高USMLE第一步考试的平均成绩，并提高学生首次通过考试的百分比。
该项目于2012 - 13学年首次推出。收集了该队列以及其他四个队列（N = 830；2010 - 2014年考生）的数据。比较了干预前（2010 - 2012年考生）和干预后（2013 - 2014年考生）学生队列的表现。对工作人员和学生进行了焦点小组访谈，并进行记录和分析，以调查该项目对学生互动和学习环境认知的影响。
干预前后的考试成绩存在显著差异，在实施学生发起的项目后，USMLE第一步的平均成绩提高了8.82分，t(5.61) = 828，p <.001。首次通过率平均也显著提高了8%，χ(1) = 23.13，p <.001。考虑到年龄、性别、医学院入学考试成绩和本科平均绩点，参与该项目的学生比未参与该项目的学生得分高6.57分（R = 0.3），F(5, 886) = 76.71，p <.01，并且通过USMLE第一步的几率更高（优势比 = 3.08，标准误 = 1.07，p <.01）。学生和工作人员对该项目营造的社区感和赋权感以及该项目独特的学生主导性质发表了评论。
本研究证明了学生发起的课程的有效性，并为其他机构开发和实施考试备考工作提供了指导。
