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STEP 1 exam now asks open-ended questions

STEP 1 exam now asks open-ended questions

Philadelphia, PA—Calling the change in exam format “a step to a better STEP,” members of the National Board of Medical Examiners (NBME) announced Tuesday that the USMLE Step 1 would soon include open-ended questions. The announcement noted the importance of the technique for future physicians, stating that “because open-ended questions do not limit a subject to just a few multiple-choice answers, they encourage the test-taker to give more detail about the condition of their knowledge.”

Open-ended questions, questions that can be answered with more than a word or two, have long been used in interviews, interrogations, and medical examinations to compel a subject to provide more in-depth and insightful responses. Dr. Jessica Bennett, curriculum developer for the USMLE Step 1 exam, explained that the open communication would also have the benefit of building trust in the examiner-examinee relationship.

Dr. Bennett went on to explain how the changes build on previous changes for the exam: “You can already see the benefits from our 2015 decision to emphasize the role of silence, by forcing students to wear earplugs during the 8 hour exam.” This shift came shortly after the infamous 2013 addition of a section in which students must answer using only appropriate non-verbal communication, such as facial expressions, gestures, and eye-contact.

Although this move has been lauded by many physicians for introducing their younger colleagues to an important technique, many students have been more critical. Jeffrey Zhao, a first year at Northwestern’s Feinberg School of Medicine explained “I was taking the new practice test that [NBME] put out, and the third question was just ‘how do you feel about lupus and why?’ What am I supposed to say to that? I just wrote that I disliked it. Do you think that’s alright?”

The exam changes are projected to roll out in the November 2018 test. Still, this is not expected to be the last change to the Step 1 exam. “The main thing that we are going to work on next is eliminating any hints towards the correct answer in the question stem in order to avoid leading questions,” explained Dr. Bennett. She noted that her work is far from over: “We will continue to adapt and improve the test to be more clinically applicable over the next decade.”

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