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Background 94% of program directors cited the USMLE Step 1 score as the most important factor in determining an applicant’s competitiveness for residency. Thus, medical students are motivated to attain the highest possible score. With the recent announcement of Step 1 switching to a pass/fail standard, it is important to analyze factors which predict meeting this goal. Objective To investigate the factors which can influence or predict performance on USMLE Step 1. Methods We conducted a systematic literature search on PubMed, Web of Science, Scopus and ERIC in 2019. The key words were “USMLE”, “Step-1”, “score”, “success” and “predictors.” The search included articles published between 2005 and 2019.  Studies that did not focus on Step 1 outcome or allopathic medical students in the United States were excluded. Results 275 articles were found, 29 of which met our inclusion criteria. Analysis from these articles demonstrated that predictors of USMLE Step 1 score can be divided into unmodifiable and modifiable factors. Unmodifiable factors include gender, MCAT score, pre-clinical grades and NBME/CBSE scores. Modifiable factors include taking USMLE Step 1 within two months of completing pre-clinical courses, motivation from anxiety, multiple-choice questions completed, unique Anki cards seen and complete passes of First Aid for the USMLE Step 1. Conclusion Our review suggests that although students can focus on modifiable factors to increase their score, the energy expenditure required to increase Step 1 score by one point is unrealistic. This may have impacted the NBME’s decision to change Step 1 to a pass/fail exam.

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Background: Evaluations of public health campaigns demonstrate that stroke symptom knowledge is necessary but not sufficient for timely patient activation of emergency services in acute stroke. Incorporating behavioral and psychological factors into stroke preparedness interventions may reduce pre-hospital delay. Methods: We developed and tested the feasibility of patient-based educational interventions “Control Stroke” (CS) and CS plus self-affirmation, in two pharmacies. The interventions drew on theory and methods in psychology and behavioral science, including self-affirmation and self-regulation theories. We enrolled 50 higher risk subjects, defined as age > 50 and having prescriptions for at least two drugs across 7 stroke-associated conditions. Consecutive patients were randomized to receive the (CS) intervention or CS plus self -affirmation, a strategy that reduces defensive message processing. Using a survey, we measured satisfaction with the intervention, openness to its message, self-efficacy, and knowledge of stroke symptoms immediately post-intervention and at 1 month. Results: We recruited 28 female and 22 male subjects over eight weeks. 86% of participants completed the 1-month survey. 45% of subjects were over 75 years old. CS took 10-15 minutes to complete. Satisfaction with the intervention was high: mean net promoter score was 8.9 (of 10) (CI 8.4,9.5); 96% (CI 86,99) were satisfied or completely satisfied with the program; 96% (CI 86,99) felt the session was useful, and 100% reported the information was clear and easy to understand. Stroke symptom knowledge on the validated Stroke Action Test was comparable to other stroke education studies. There was a trend towards persistence of some program benefits in the one month follow up in the CS + self-affirmation group. Conclusion: It was feasible to recruit community pharmacy subjects to participate in a brief educational intervention for stroke. Participants reported high likelihood to recommend, easy to understand content, and symptom knowledge comparable to other studies. Self-affirmation showed evidence of prolonging some benefits. Future work will validate this in a larger population intervention and measure impact in simulated stroke scenarios.

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