How much basic science material from USMLE Step 1 will I end up remembering in the long term?
The retention and relevance of basic science material learned during medical school has long been a concern. This is why there has been a shift in medical education toward including more clinically relevant material during the first two years of medical school. There has also been a shift toward more patient cases being included in USMLE Step 1; previously, only 30% of cases used a patient-based format, whereas now roughly 70% of cases do.
A 2008 study examined the results of including unscored Step 1 questions on the Step 2 CK exam. Students answering the questions as a component of the Step 2 CK exam (ie, later in their medical training) performed approximately 6%-7% poorer than students answering the questions as a component of the Step 1 exam. This decline was greater for questions that were presented in a style other than a patient vignette. The question category with the largest drop in performance was biochemistry, followed by microbiology and pharmacology. The drops were less dramatic for physiology, anatomy, and pathology. Performance actually increased for human behavior-related questions. Changes in performance likely reflect emphasis placed during clinical clerkships, where biochemical principles are rarely discussed but aspects of human behavior such as communication and mental disorders are frequently discussed.
Similar studies have been conducted over the past three decades. Interestingly, the results of the most recent study were similar to those of earlier studies despite the changes made to medical education. In fact, the magnitude of decline was actually worse on the more recent study than those from years prior to changes in medical school curricula. Some of this may be secondary to fourth year medical students taking Step 2 later in the year, therefore increasing the interval since Step 1 and decreasing retention of the material.
Ling Y, Swanson DB,
Holtzman K, Bucak SD. Retention of Basic Science Information by Senior Medical Students.
Academic Medicine, Vol. 83, No. 10 / October 2008 Supplement, 582-585.