Webinar in Review: Level 1 vs. Step 1 Prep for Success

November 11, 2019

In our most recent webinar titled “Level 1 vs. Step 1: Differences and Similarities in Preparing for Success,” we discussed how to guide and support the preparation of your students for COMLEX-USA Level 1 and if applicable USMLE Step 1 exams. The overall message of the webinar is this: your students can and potentially should take both exams, but they need your help to understand their differences (in-conjunction with all of the information about the exams) and to help them understand how to prepare for the exams differently. 

In order to understand this message we need to start with some of the basics: 

  • what are the goals of board success
  • comparing and contrasting the exams
  • comparing and contrasting curricula
  • what are the perceptions of our students  

From there we can then shift our focus to how we can support the success of your students. With that in-mind, this blog post will address a few basics of these topics to help guide your effort in supporting the success of your students.

Comparing Level 1 to Step 1 Exams and Education

Level 1 and Step 1 are minimal-competency based exams as a requirement in the preparation for practicing medicine.  Both exams contain material referencing foundational biomedical sciences in a body-systems based, clinical vignette presentation of multiple choice questions, each looking for a single-best answer. Some questions contain multimedia and others are sequential in that the first question is required to answer a follow-up question. The questions are, furthermore, written as an application of medical competencies.

Historically speaking, Level 1 has been perceived and written as a knowledge-based exam while Step 1 has advanced into what has been called a problem-solving or critical-thinking based exam. The exams themselves, however, continue to develop blueprints or outlines to present material based upon specific competencies to ensure readiness of future medical professionals.  With that in mind, Level 1 has most recently defined a blueprint based upon specific osteopathic integration of competencies in a definitive clinical-presentation based format. This blueprint pushes the knowledge-base of this exam to be much more integrated in a clinical problem-solving format aligning the two exams more closely, with the difference of osteopathic integration remaining.

Education of future physicians at medical schools is, furthermore, similar. All medical school curricula involve some type of foundational basic science knowledge, with an application of this knowledge in a systems-based or clinical-based context, integrated with education based upon clinical diagnosis and treatment to help train future physicians to think like and problem-solve like physicians. The biggest differences in these curricula, therefore, occur at various institutions depending on their own culture of learning and integration techniques.

Comparing Student Perceptions of Level 1 to Step 1

Learning is a process where we acquire knowledge or skills through experience, study, or by being taught.  This process is not limited to the walls of a medical school, but in the 21st century involves a variety of educational-support resources as well as social community-building.  With this in mind, many future physicians receive their knowledge regarding preparation for Level 1 and Step 1 from educational support companies, Student Doctor Network, and a variety of sub-Reddit community posts. Students turn to these areas to understand the differences in the exams and guidance to determine if they should take Level 1 alone or both Level 1 and Step 1. Combing through these communities, the results indicate that the student message is this: USMLE is a ‘better’ exam and therefore they should take it.  This goes against the statements of the AMA that the exams are equivalent and does not always take into account their qualifications or readiness.  This, therefore, is why it is so critical for educators to become involved in this process. 

Ways to Support Your Students to Success in Level 1 and Step 1

How we, as a collective community of medical educators, support your students to succeed on Level 1, and if necessary Step 1, is crucial.  Although there are a lot of similarities between the exams, they are different and the preparation for your students varies for the two exams.  Furthermore, it is not always realistic for all learners to take both exams with success. With that in mind, therefore, it is critical to be honest with your students regarding their potential for success and to help them see the differences in the exams.  

Supporting students honestly, in conjunction with practice assessments and a realistic approach to their residency goals, is imperative to their ultimate success.  We support learners in all aspects of their preparation and we need to, therefore, continue with a message of honest preparation and how they will likely perform on both exams. We are a part of their success team and owe it to learners to guide them with-regards to anticipated scores and time necessary to prepare. This as an institutional message should be timed to ensure optimal success for your learners.  

With regards to preparation, it is important to guide the learners to experience the differences so that they can prepare knowing their end-expectations. In the same way that learners subconsciously shift their studying when they first learn what exams will be like in medical school, if we offer them assessments early in their board preparation for both Level 1 and Step 1, students can shift their studying to prepare for both exams simultaneously. The COMLEX-USA Level 1 exam integrates osteopathic presentations and, therefore, students should ensure that they are incorporating this information into their studies.  The USMLE Step 1 exam integrates a greater level of scientific data in graphs and tables and, therefore, students preparing for that exam need to be incorporating that into their question practice as well.  

In conclusion, preparing successful physicians is our goal - one that we work together to achieve.  In regards to preparing successful osteopathic physicians, that goal is complicated by the multiple exams students may choose to take. However, if we collectively address this in partnership with our students, we can help guide them towards the direction that will help them find the achievements they seek and we wish for them, allowing everyone to relish in their success!

To learn more about the differences and similarities between Step 1 vs. Level 1, click here to watch the full webinar. And if you have any questions, please contact your local Kaplan representative or request a demo today.

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