1. UT Southwestern Step 1 Course Arlene Sachs, Ph.D. Director, Student Academic Support Services Assistant Clinical Professor, Department of Psychiatry University of Texas Southwestern Medical School

2. What We Know The intensity of the high stakes USMLE® Step 1 exam creates concerns among all medical students. When combined with undecided study strategies, faulty reasoning and poor wellness habits, students struggle with their preparation. Study Strategies Faulty Reasoning Wellness Where to begin Reading inaccurate blogs Interpersonal drama Which resources to use Making assumptions about data Lack of resilience and motivation How to structure time Blindly follow upper class advice Lack of physical care

3. What We Do for All Students UT Southwestern requires all students to complete a 6-week Step 1 preparation course Course Structure 6 weeks long Completed online Pass/Fail transcript grade with receipt of Step 1 score Requirements Create and submit a study plan/calendar by first day of course Report progress via weekly survey Complete a minimum of three practice tests Sit for Step 1 within 6 week course period

4. What We Do for At-Risk Students Prior to the Course Identify at-risk students who performed below 70% on pre-clinical course exams Identify at-risk students with wellness concerns Meet with the identified students individually to help them choose a Step 1 course pathway that is flexible and wedged between elective time or spring break

5. How We Assess and Intervene Course Director tracks progress via required weekly survey data Practice exams scores Q-bank completion and accuracy rate First Aid completion Course Director intervenes with students who need/request assistance Student below passing score (194) on practice exams in week 4 Student below 50% with q-bank completion and accuracy in week 3 Student comments expressing concern about their progress

7. How We Make Extension Decisions During the Course Students diagnosed with significant medical conditions (includes mental and physical health) during the Step 1 course Students with two or more failed practice tests in the last two weeks of Step 1 course

8. What We Found Panel A: Step 1 scores correlate with Average pre-clerkship performance Panel B: Risk of Step 1 score 3 course final exams <70%

9. Comparison to National Scores Panel A: UT Southwestern Students have a lower percentage of scores <215 and higher top-tier scores than the nation Panel A Panel B Lower percent of Class in Bottom 10 % Higher percent of Class in Top Tiers Shift to Higher Scores in 2017 Panel B: Top-tier scores improved in 2017 when Step 1 Course began

10. Step 1 Scores Before and After Step 1 Prep Course Panel A: Comparison of Step 1 pass rates before (2015 and 2016) and after (2017 and 2018) the Step 1 course Panel B: Mean Step 1 scores increase to 239 in 2018

11. Key Lessons We Learned Students reported that weekly surveys and encouragement helped them stay focused, connected and confident Weekly surveys identified students in need of additional time to prepare and pass the exam The accountability of a required preparation course reduced the failure rate and increased the class average for Step 1 in 2018

12. What Our Students Told Us Thank you so much for all of your help and council during the last few months. You helped me keep my head on straight and not lose sight of the end goal! I sincerely appreciate you speaking with me when I was feeling overwhelmed and giving me advice about how to proceed with tackling this exam. Thank you for all of your help, support and encouragement throughout the Step process. Thank you for all the advice and support…at whatever time crisis may strike, you are there to offer us wise advice. Thank you for getting us through Step and giving us perspective on life.

13. References Giordano C, Hutchinson D, Peppler R. A Predictive Model for USMLE Step 1 Scores. Cureus. 2016;8(9):e769. https://login.foyer.swmed.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN =27738569&site=eds-live&scope=site. Accessed September 26, 2018. Kumar AD, Shah MK, Maley JH, Evron J, Gyftopoulos A, Miller C. Preparing to take the USMLE Step 1: a survey on medical students’ self-reported study habits. Postgraduate Medical Journal. 2015;91(1075):257-261. doi:10.1136/postgradmedj-2014-133081. Schwartz LF, Lineberry M, Park YS, Kamin CS, Hyderi AA. Development and Evaluation of a Student-Initiated Test Preparation Program for the USMLE Step 1 Examination. Teaching & Learning in Medicine. 2018;30(2):193. https://login.foyer.swmed.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=12 8617911&site=eds-live&scope=site. Accessed September 26, 2018.

14. Course Contributors Blake Barker, M.D., Associate Dean Student Affairs Angela Mihalic, M.D. Dean of Medical Students and Associate Dean Student Affairs Robert Rege, M.D., Associate Dean for Undergraduate Medical Education Dorothy Sendelbach, M.D., Professor, Office of the Dean Carol Wortham, M.Ed., Manager, Student Academic Support Services