For Your Health

News from the University of North Dakota School of Medicine & Health Sciences

From the Dean

As we welcome the new academic year and many of our students back to campus next week, I hope that you will join me in also welcoming Minnie Faith Kalyanasundaram, M.D., to campus as a new associate professor in the Department of Family and Community Medicine and director of the Academic Success Program (ASP). Dr. Kalyanasundaram began her employment with us about a week ago on Jan. 2, 2020. Her primary duties will be as leader of the ASP, with an initial focus on helping to prepare better our medical students for the first part of the United States Medical Licensing Examination (USMLE Step 1) and concomitantly to develop various pre-matriculation programs. She will work closely with Drs. Carr and Basson, and our team in Education Resources in supporting our medical curriculum renewal process. Dr. Kalyanasundaram has extensive experience in medical student education, including teaching biochemistry and directing curriculum design. She also has organized an 18-month hybrid distance-learning and in-person training program for trainees in family medicine.

Given that our students perform well on the exam as it is—99 percent pass it without difficulty (the average pass rate across the country is around 96 percent)—you might be wondering why we’re emphasizing preparation for the USMLE Step 1 exam. The answer relates to the evolving use and importance of the exam scores themselves—and not just passing the exam. First, some background: The USMLE is a three-part exam used as the standard tool to qualify for a license to practice medicine in a given state. Step 1 typically is taken after the second year of medical school (although increasingly students are taking it later in their training after some degree of clinical experience), while Step 2 typically is taken during the fourth year of medical school and Step 3 following the first year of post-MD residency training. And while the USMLE exam is intended to be a tool to help establish competency to practice medicine, and thus passing it is a criterion for medical licensure, the Step 1 scores are now used as an important arbiter for selection to enter post-MD residency training. Back when I was applying to residency programs, USMLE scores did not play a major role in the post-graduate selection process. But now as the cohort of medical students applying to residencies has grown much more rapidly than the number of residency slots, the competition for residency slots—especially in highly desired residencies like ophthalmology—has become fierce.

That, coupled with the natural response of applicants to apply to more and more programs as the competition has become more intense, has led to the current situation where a residency program may be faced with dozens of applicants for every residency slot they have open. Since it is impossible to interview so many applicants, many residency programs use the Step 1 score as an initial screening tool to decide whom they will interview. Thus, passing the Step 1 isn’t enough—applicants want to get as high a score as possible so they can interview at the very best residency programs they select.

In view of the heightened importance of the Step 1 scores, we want to do everything possible to assist our students in getting into the residencies of their choice—even though I and many others feel that this use of the USMLE exam is somewhat wayward. Be that as it may, until we as a profession come up with an alternative approach—and none is on the horizon as far as I can see—I’m all for helping our students optimize their Step 1 performance. We have already taken substantial steps in this regard, including hiring Dr. Valeria Becker, our learning specialist who helps students with study techniques and test-taking strategies, and the purchase of access to retired USMLE test bank questions, which we are increasingly incorporating into a variety of student assessments to give students more experience with these sorts of questions. However, we hope to do even more. We believe that Dr. Kalyanasundaram’s background and extensive prior medical student experience will be invaluable as we strive to do the very best for our students and trainees.

Joshua Wynne, MD, MBA, MPH
Interim President and Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences