USMLE Tests Resume May 1, Sparking Student Concerns

What your doctor is reading on Medscape.com:

APRIL 25, 2020 — United States Medical Licensing Examination (USMLE) testing will resume in some centers on Friday. The announcement made earlier this week caught some students unaware and sparked a flurry of questions on social media.

USMLE Step 1, Step 2 Clinical Knowledge (CK), and Step 3 testing will begin this Friday at certain centers. Testing for Step 2 Clinical Skills (CS) has been suspended until at least June 1.

In response, students posted questions about whether taking tests during a pandemic is safe or advisable. They are also concerned about whether they will get a spot; the number of slots have been cut in half as a result of social distancing. Worry about scheduling a test time is now inflaming the general academic stress already compounded by a pandemic, some say.

Announcements Spark Confusion

Confusion stemmed from two announcements made on Thursday. One was from the company that manages the test centers, Prometric. It read: “In accordance with the changing local and federal governance and advice from the CDC and WHO, we have determined it is necessary to further extend the closure of test centers in the US and Canada through May 31. This applies to all testing programs, with the exception of a limited set of essential services programs.”

When USMLE’s parent organizations saw the Prometric announcement and began fielding questions about whether USMLE tests were considered essential, the program issued its own release  to clarify the test status. The USMLE emphasized that Prometric had determined their testing was essential and that the date was approaching. Prometric had previously stated the USMLE tests would be suspended until May 1 or later.

Half the Slots Removed

Tom Warren, spokesman for Prometric, told Medscape Medical News that their ability to resume testing at some centers  — in the United States and globally — depends on numerous factors. These include local, state, and federal guidelines and stay-at-home orders; the readiness of systems that have been shut down for weeks; and the availability of personal protective equipment (PPE) and necessary staff.

“This is a highly dynamic process and we have a team of dedicated experts working each of these areas to confirm our ability to resume operations at the earliest possible time,” he said.

He said social distancing means that only “every other” workstation at the test center will be active. Prometric acknowledges this will result in some test takers having appointments rescheduled.

As to how to determine whether a specific center is open, Prometric says via its website, “If your test has been canceled or rescheduled due to our COVID-19 preventative measures, Prometric will send you an email as soon as possible with further instructions.”

Student Fears Test Taking Could Have Consequences

Abigail Schirmer, a second-year medical student, told Medscape Medical News that she was scheduled to take Step 1 on April 1, but her appointment was postponed. She is now scheduled to take the test May 4.

“The exam is stressful in itself but the cancellations, lack of communication, and risk of randomly being removed from examination lingers in the pit of my stomach,” she said.

Schirmer noted that some students who live in COVID-19 hotspots will want to travel to states with more test openings and lower COVID-19 risk to take the test, which is problematic both from a public health perspective and because that puts those who can’t afford to travel (or who aren’t comfortable traveling) at a disadvantage.

“Students want to help in any capacity that they can during this pandemic,” she said. “But studying for a test with no official date or guarantee of taking the exam can leave students hopeless.”

She said she also recognizes that although taking the test in a pandemic may have public health implications, so does choking off the physician pipeline.

“You can’t stop making doctors,” she said. “We need these tests.”

Schirmer said some students have wondered if the introduction of a pass/fail option for the test, scheduled to start January 1, 2022, as reported by Medscape Medical News, could be moved up.

That’s not an option, according to Dave Johnson, chief assessment officer at the Federation of State Medical Boards (FSMB), which is one of two cosponsors of the USMLE program.

“There are no plans to accelerate that timeline,” Johnson told Medscape Medical News. “There’s enough uncertainty in the system without us introducing another variable. We thought it would be even more disruptive.”

He said they are examining other options that “could supplement Prometric’s brick-and-mortar delivery of exams. At this point I can’t say anything further, because we have to make some decisions ourselves.”

He acknowledged that it is possible students could leave COVID-19 hotspots to travel to areas where more testing spots may be open because they are not assigned centers for testing.

“The decision to resume testing rested with Prometric itself,” he said. Once Prometric made the decision to open the centers, “we felt that we needed to leave the decision to test — or not to — with the individual examinees.

“We encourage students to be talking directly with their faculty advisers or the student affairs deans as to if or when they should proceed with testing. I’ve heard of some instances where schools are counseling that perhaps their students that have finished up preclinical should defer taking Step 1 until next spring, when they have some clinical [training] under their belt.”

He also advised students who have slots not to move them before clarifying their status, although he acknowledged the information is hard to follow under the fluid conditions in the pandemic.

“We are very cognizant of the disruption at this point,” Johnson said. “We are definitely working as best we can to come up with solutions.”

Prometric Taking Precautions

On its website, Prometric describes the following safety precautions for testing:

• Requiring all test takers to bring and wear a facemask (medical mask or cloth face covering) while in the testing center. Those without masks will be marked a “no show” and won’t be eligible for a free reschedule

• Permitting test takers to use gloves while they are testing

• Enforcing social distancing throughout check-in and testing

• Providing masks to all Prometric staff at test centers

• Limiting points of physical contact between staff and test takers

Students took to social media with a flurry of questions and concerns. Among them was one from Simran Kripalani, who tweeted: “(A)re we really going to sit in a closed room, breaking quarantine for 8 hrs…as future healthcare professionals? are we expected to quarantine after that? what about our families at home?”

Prometric advises watching for any changes on its website. It cautions: “If you choose to contact Prometric for assistance, hold times may be extended due to the volume of individuals we are attempting to support.”