In the face of COVID-19, leaders at the Warren Alpert Medical School worked with the U.S. Medical Licensing Examination on a solution enabling medical students to take essential licensing exams that had been cancelled.
PROVIDENCE, R.I. [Brown University] — Disheartened. Upset. At a loss.
When students at medical schools nationwide learned this spring that testing sites administering the U.S. Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) exams would close and cancel test appointments given the COVID-19 pandemic, many were overwhelmed by the uncertainty.
Both tests are essential milestones in the academic careers of every medical student. Step 1 enables students to proceed following their first two years. The Step 2 CK exam is a critical moment for students near the end of medical school, who need to pass the test and a corresponding skills assessment on the way to earning an M.D. and applying for residency programs.
In a team effort to support students at Brown and well beyond, faculty and staff at the Warren Alpert Medical School joined forces with colleagues across the University to envision and execute a plan to become a test site for students taking the Step 1 and Step 2 exams — making it the first site of its kind in the nation, and still the only one in New England.
By the time the testing period at Brown ends on June 30, nearly 500 students from medical schools around the region will have taken their licensing exams at the site.
“It is no coincidence at all that Brown was chosen to be the first school to pilot the regional testing model,” said Constance Panton, a fourth-year medical student at the Warren Alpert Medical School. “And it is all because of the incredible dedication of our administration in advocating for us.”
In search of a solution
As COVID-19 spread across the country in March, the company commissioned by the National Board of Medical Examiners (NBME) to administer the exam abruptly shuttered its test sites to comply with stay-at-home orders issued nationwide. With closures lasting weeks into months, a backlog of students needing to take these exams resulted. Once sites were allowed to reopen, physical distancing guidelines mandated that they operate at half-full capacity, so the company, Prometric, didn’t have the ability to immediately re-seat all students.
The intense period of study required to prepare for the exams, which on average takes up to 8 hours a day for eight to 12 weeks, was already weighing heavily on students — and the profound consequences of not being able to take the licensing exams on time compounded their worries.
So leaders at Brown’s medical school reached out to the NBME to see what could be done.
“In speaking with our students and hearing their concerns, that was really the impetus for us having our initial conversations,” said Roxanne Vrees, associate dean for the medical school’s Office of Student Affairs and associate professor of obstetrics and gynecology.
The first few conversations drummed up excitement and agreement, but no firm plans. At one point, Associate Dean of Medical Education Paul George and his colleagues floated the idea of having a medical school open as a testing center.
“The initial reaction was that the NBME can’t do that, unfortunately,” said George. “There was some pushback, and the logistics on their end seemed like they were insurmountable.”
But as the number of affected students continued to grow, and with increasing visibility of the issue on social media and in health and medicine news outlets, the situation soon changed.
“Within a couple of weeks of that initial meeting, the NBME contacted Allan Tunkel, who’s our senior associate dean for medical education and said, ‘Hey, what do you think about opening up a center at Brown?’” George said.
From that point forward, there were a few obstacles to overcome.
For one, Rhode Island had only recently ended its stay-at-home order, and restrictions were still in place for out-of-state visitors and gatherings of more than five people. And the USMLE exams are not quick affairs — Step 1 and Step 2 CK exams last 8 and 9 hours respectively, which means long days for students and even longer days for staff. Then there were questions about COVID-19 health and safety protocols.
Partnerships, at Brown and with external agencies, quickly became essential to turning the plan into reality.
The medical school team worked with the Rhode Island Department of Health to safely open the center, connecting with Facilities Management at Brown to ensure that each space designated for testing was cleaned and disinfected each night.
In addition to heightened custodial support, high-touch areas such as restrooms and door handles were sanitized throughout the day, masks were required, disinfectant wipes and hand sanitizer were provided in each of the testing suites, and social distancing measures were thoroughly enforced, said Director of Biomedical Facilities Planning and Operations Adam McGovern.
For the integrity of the testing process, the exams are also heavily regulated and require very specific technology. Prometric shipped all the necessary equipment to the medical school — nearly three pallets full of computers, monitors, headphones, cameras, servers and printers.
Geoffrey Greene, director of departmental systems in Brown’s Computing and Information Services division, said preparing the technology to go live took two weeks, with entire days dedicated to physical installation, troubleshooting, debugging, configuration and training for the exam proctors.
“The University did a fantastic job to stand up this test site in short order,” Greene said. “We received kudos from Prometric again and again.”
Panton, the fourth-year medical student, originally had two different exam dates cancelled, but said she was able to take the exam at Brown on the day the site opened.
“My first reaction was relief,” she said. “It’s nearly impossible to keep up the momentum of entire-workday study schedules required of these USMLE exams while also on clinical rotations, so I felt that I would have needed to drop a summer elective to allocate two or four weeks of full-time studying in order to re-prepare for the exam.”
George said that getting the USMLE testing center running smoothly and being able to seat on average 15 students a day in separate suites for testing was a challenging — but very necessary — undertaking. Based on the Brown model, five other regional testing sites in the U.S. were subsequently established.
“Thinking about doing what’s best for students and having that mindset applies to multiple other things as well,” he said. “Having schools think about prioritizing students’ needs now and into the future is really important.”
Vrees echoed the sentiment.
“We ventured into this pilot based on advocating for our students, which is something I think historically, the Warren Alpert Medical School has had a pretty clear track record for that, in a positive way,” Vrees said. “We listen to our students, and we respond to our students.”