USMLE step 1 and step 2 CK as indicators of resident performance.

BACKGROUND: The purpose of this systematic review was to (1) determine the scope of literature measuring USMLE Step 1 and Step 2 CK as predictors or indicators of quality resident performance across all medical specialties and (2) summarize the ability of Step 1 and Step 2 CK to predict quality resident performance, stratified by ACGME specialties, based on available literature. METHODS: This systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [16]. The original search strategy surveyed MEDLINE and was adapted to survey Cochrane Library and Embase. A study was deemed eligible if it provided all three of the following relevant information: (a) Step 1 or Step 2 CK as indicators for (b) resident outcomes in (c) any ACGME accredited specialty training program. RESULTS: A total of 1803 articles were screened from three separate databases. The 92 included studies were stratified by specialty, with Surgery (21.7% [20/92]), Emergency Medicine (13.0% [12/92]), Internal Medicine (10.9% [10/92]), and Orthopedic Surgery (8.7% [8/92]) being the most common. Common resident performance measures included ITE scores, board certification, ACGME milestone ratings, and program director evaluations. CONCLUSIONS: Further studies are imperative to discern the utility of Step 1 and Step 2 CK as predictors of resident performance and as tools for resident recruitment and selection. The results of this systematic review suggest that a scored Step 1 dated prior to January 2022 can be useful as a tool in a holistic review of future resident performance, and that Step 2 CK score performance may be an effective tool in the holistic review process. Given its inherent complexity, multiple tools across many assessment modalities are necessary to assess resident performance comprehensively and effectively.

Changes in fear-associated learning task brain activation over the COVID-19 pandemic period: a preliminary longitudinal analysis.

Background: The COVID-19 pandemic has had profound impacts on people worldwide. Previous studies have shown that fear learning, extinction, recall, and contextual information processing involve the activation of emotion and sensory brain systems, which can be modified. However, it remains unclear whether brain functions associated with these processes have been altered over the pandemic period. Methods: We compared pre- and peri-pandemic brain activation during a fear-associated learning task (FALT) using previously collected data. The participants were divided into two groups: the pandemic group (n = 16), who completed a baseline FALT before the pandemic and repeated the task during the pandemic, and the non-pandemic group (n = 77), who completed both sessions before the pandemic began. Results: Compared with the non-pandemic group, the pandemic group exhibited significant decreases in brain activation from baseline to follow-up assessments, including activation in the brainstem during early fear learning, the posterior thalamus/hippocampus during late extinction, and the occipital pole during late recall phases for contextual processing. Furthermore, activations associated with retrieving safety cues were reduced in the posterior cingulate, premotor, and calcarine cortices during the early recall phase, and activations associated with retrieving dangerous cues decreased in the occipital pole during the late recall phase. Additionally, correlations between decreased activation and elevated posttraumatic stress symptoms were observed. Conclusion: These findings suggest that activations associated with processing low arousal contextual information, safety cues, and extinguished fear cues decreased during the pandemic. These changes in brain activation may have contributed to the increase in mental health disturbances observed during this time.