Academic Board resolution provides additional structure for USMLE prep

For OUM students intent on practicing in the United States, it is impossible to over-emphasize the importance of passing the USMLE exams on first attempt. Preparing students for the USMLE and creating options for students with a poor prognosis in this regard, are frequent topics of discussion among OUM’s leadership.

Hearing the concerns of students looking for additional resources to help them prepare for the In-House Exam, the Academic Board recently approved a resolution that will pave the way for practice exams, provide correct answers to missed questions, and suggest timetables to help students understand what they need to do to pass the exam.

Since it was introduced in 2011, the In-House Exam (IHE) is strongly correlated to the USMLE Step 1 score, thus serving as a gateway exam to gauge USMLE Step 1 readiness. Every OUM student earning a passing score of 80% or higher on the exam has passed Step 1.

“Few medical schools can brag of a 100 percent USMLE first-time pass rate among its students, but that is the case at OUM since the IHE was established,” says Randell Brown, PhD, Deputy Vice Chancellor, and co-sponsor of the resolution.

“The purpose of the In-House Exam is to measure the student’s fund of knowledge prior to registering for USMLE Step 1,” says Scott Cunningham, MD, PhD, who originally developed the exam to ensure that OUM students are truly ready to take and pass USMLE Step 1.

Eight years of experience have demonstrated that the higher the IHE score, the higher the Step 1 score. However, it became evident that taking the IHE too early and scoring a low grade was not productive. The new resolution eliminates self-enrollment for the IHE and restricts access until after a student has completed the system-based modules.

“With the average early score on the In-House Exam hovering around 40%, we knew we needed to add some structure to the process to ensure that students were taking it when they were truly ready,” says Dr. Brown.

University approval required for USMLE

OUM students are not allowed to register for USMLE without approval from the University, and that approval is contingent upon getting a passing score on IHE (80 percent or higher).

The University gives students three months to prepare for USMLE after completion of the system-based modules. If a student has been diligent in supplementing the coursework, three months is ample time. However, the Student Affairs Committee may give an extension if the student shows objective evidence of making progress toward USMLE readiness.

Beginning in Term 2002 (March 2020), the following structure will be in place for when in the curriculum students may take the exam:

  • Self-enrollment no longer will be possible. For those granted access to the IHE, that exam remains available only on the last Friday of every month, opening at 1:00 am and closing at 11:00 pm, Eastern Time, North America. Students must request enrollment at least 24 hours in advance, with access approved by the Director of Curriculum.
  • Students no longer will be permitted to take the IHE at the time of matriculation or during the e-Foundations.
  • Students will be asked to take the IHE when USMLE-ready after completion of the SBMs, based on Interval Performance Exam performance, external test scores, and/or recommendation from the USMLE Study Hall Committee.

Available soon: answers, sample and practice exams

Thanks to the new resolution, a sample IHE with answers will be posted on Moodle (Pre-clinical Curriculum/Practice IHE), allowing students to get a sneak preview of the test.

A practice IHE will be available for student self-enrollment at any time. Answers will be available after the exam is completed. Upon completion of the practice exam, a brief score interpretation summary will be included.

The corrected exam for all attempts of the practice IHE will be available for the student’s review after the exam is completed.

For students scoring <50 percent

When the IHE originally was implemented, it was anticipated that students would not attempt the exam until USMLE-ready.

A student scoring 50% or below on the IHE will require many months, if not a year or more, to become USMLE-ready. The University recommends that a student scoring within this range on the IHE should immediately move on to clerkships or apply for a master’s degree. In order to master the material needed to pass USMLE Step 1, the prognosis is poor for a student with an IHE score of 50% or below. Therefore, students scoring ≤50% will not be permitted to re-attempt the IHE in less than six months and will be required to submit a detailed study plan to the Study Hall Committee.

However, students who want to pass the USMLE Step 1, compete for residencies in teaching hospitals and ultimately get licensed in the United States, and are willing to put in the required hard work, may retake the IHE per the procedure below:

  • A student scoring 50% or lower on the IHE, who wishes to eventually take the USMLE and practice in the US, will be required to wait six-months before taking the IHE again. Such a student wishing to prepare for another attempt of the IHE should apply to the Student Affairs Committee for an extension in order to remain in good standing for the required six-month period of active preparation, including enrolling in Basic Science Immersion, Structured Study Protocol, or another IHE/USMLE prep resource.
  • If a student who scores 50% or lower on the IHE would like to retake the IHE in less than six months, the student who has been working diligently to prepare for the exam should submit an appeal to the Study Hall Committee to retake the IHE.
    • If the Study Hall Committee approves the appeal, the student will be permitted to retake the IHE.
    • If the Study Hall Committee denies the appeal, the student may appeal to the Student Affairs Committee for a USMLE extension.

“This provision is not intended to delay the prepared student from taking or passing the IHE; rather, the intent is to be realistic about what is needed to keep the underprepared student moving forward,” says Dr. Cunningham.

For students scoring >50 percent

The time periods for students scoring higher than 50 percent allow for less time between the intervals during which the exam may be taken:

  • Students who score 51-70% will not be permitted to re-attempt the IHE in less than three months and will be required to submit a detailed study plan to the Study Hall Committee.
  • Students who score 70% or higher will be permitted to re-attempt the IHE monthly.

If a student’s previous score was lower than 70% and improved by more than 10% to a passing score (> 80%), the student will be required to achieve an additional passing score on a future IHE, prior to approval to take USMLE Step 1.

The Study Hall Committee may review an individual student’s performance to adjust re-attempt timing, as appropriate. Students with a reasonable and well-executed study plan showing promise may convince the Study Hall Committee to amend the above timetable.

If a student feels strongly that the IHE does not reflect their USMLE readiness, they may request a waiver from the Study Hall Committee by providing objective evidence of their readiness.

A Student’s Perspective

“The IHE can be a very daunting test for students, and repeated low scores are demoralizing,“ says Heather Grant, a second-year student from North Carolina and a member of the Academic Board. “The proposal allows for a practice IHE and then development of a study plan under the guidance of the USMLE Study Hall Committee, if needed, once the IHE is taken as predictor of USMLE preparedness. The proposed time restrictions for retakes may seem to be counterproductive; however, when you review expected retention over the set time frame, you realize these are very realistic and reasonable restrictions. It gives students a realistic picture of the time needed to achieve long term retention. And in the end, it’s the long-term retention that counts as we will need all this information as we move forward in our clerkships, residencies, and careers.”

Comprised of faculty, senior leadership, students, and a graduate, the Academic Board meets bi-monthly to consider academic policies for the University. All resolutions approved by the Academic Board are then ratified by the OUM Council, OUM’s governing body.