Information Seeking Behavior of Students Studying for USMLE Step 1

Background: While the USMLE Step 1 has not changed significantly in content over the past 20 years, the context in which the exam is offered has changed drastically. In fact, a 2016 survey of Program Directors cited USMLE Step 1 as one of the most important factors in selecting applicants for interviews1. Though medical institutions provide evidence-based preparatory materials, online resources have become more available and accessible. Much of the current literature regarding the USMLE Step 1 exam is dedicated to content resources and their efficacy. Less is known, however, about students’ information-seeking behaviors. At our urban, large campus medical school, students rely on a variety of resources for assistance with content, test-taking strategies, and score prediction tools. These resources include school provided evidence-based curriculums, peers who have previously taken the exam, and online anonymous platforms like Reddit and Student Doctor Network (SDN)3. We sought to analyze students’ information-seeking behavior and identify patterns within this behavior. We hypothesize that students are turning increasingly more frequently to anonymous online platforms like Reddit and SDN. This poses a challenge to medical education institutions, as these platforms may lack regulation and monitoring for accuracy. Methods: Our 19-question online survey was sent out via email. The survey inquired about resources used for information about the exam (not content sources), perceived advantages and disadvantages of online vs. university sources, and exam scores. Primary outcomes were the perceived strengths and weaknesses of university provided and online resources as well as prevalence and reasons of online resource use. Secondary outcomes were Comprehensive Basic Science Exam (CBSE) score at the beginning of the dedicated study period, target score, and USMLE Step 1 score. Results: 51 students responded and answered all questions, giving a response rate of 17.33%. Average dedicated study time was 6 weeks. Mean CBSE score was 200 while the class mean was 211 (p=0.018) and mean Step 1 score was 236 while class mean was 232 (p=0.047). Students reported getting information from peers (80.77%), online platforms (80.77%), and university-provided information (69.23%). They rated the most useful resource as their peers (50%) and online platforms (17.3%). When asked what made online resources appealing, study advice (33.3%), score predication tools (15.4%), and freedom to discuss test scores anonymously (20.6%) were most common. Reasons students used university information included convenience (45.9%), tailored to curriculum (25%), and ability to meet in person (16.7%). Conclusions: Anonymity, score prediction, and review of practice exam questions led most students to utilize online resources. However, despite this changing dynamic, university provided information remains valued for its evidence based nature, convenience, and tailoring to curriculum. Medical schools need to use the changing medical education climate to improve their USMLE exam information to provide students with evidence based approaches to the current desired attributes of online platforms. Resources: 1 National Residency Matching Program. Results of the 2016 NRMP Program Director Survey. http://www.nrmp.org/wp-content/uploads/2019/09/NRMP-2016-Program-Director-Survey.pdf. Accessed January 13, 2020. 2 Burk-Rafel, J., Santen, S.A., & Purkiss, J.A. (2017). Study Behaviors and USMLE Step 1 Performance: Implications of a Student Self-Directed Parallel Curriculum. Academic Medicine, 92, S67–S74. 3Ajayi N. Library use and information-seeking behavior of medical students. Anthropologist. 2004;6(3):209–213