tl;dr: The CUNY School of Medicine (CSOM) has amended previous Step 1 policies to seemingly accommodate for the COVID-19 pandemic by administering a separate, high-stakes exam that could decide if a second-year student has to delay their medical school graduation by a full year. The administration has failed to really listen to students' concerns regarding this new exam, and has equally failed to adjust their policies in light of a second public health crisis: racism. We call you to ask CSOM to amend their policies and allow all students to proceed onto their third year (clinical rotations). Otherwise, some 25% of the medical school class will have to take a year-long personal leave of absence.

What's happening:

The USMLE Step 1 exam is a standardized medical licensing exam that consists of seven 60-minute blocks of questions, administered over an 8-hour testing day. It is taken by medical students usually between or during their 2nd (M2) and 3rd (M3) years of medical school. Students often spend months preparing for this exam during a “Dedicated” study period, as it is currently a major deciding factor used by medical residencies in deciding which students “match” into their programs to become licensed physicians. 

In the past few years, the CUNY School of Medicine (CSOM) has upheld a policy that requires students to take their Step 1 exam after M2, with a deadline of May that respective year. In the year 2020, the M2 class started their Dedicated late February-early March. Although there was already kickback from the students regarding this May 2020 deadline, many agreed it was feasible. Extensions were also presented as an option, but many students recognized that this might have just been an empty promise.

In March 2020, Prometric, the company that administers Step 1 at their standardized testing locations, announced the closure of many testing centers around the world to abide by the government’s quarantine regulations. While this was understandable, the result of this was that scheduled appointments at those locations were immediately canceled without automatic rescheduling options at different locations. Furthermore, because of the social distancing rules, Prometric decided to randomly cancel about 50% of appointments so that each student would have appropriate distance between them in the testing centers. The closure of sites and cancellation of appointments forced students to reschedule their appointments at disappointingly further days in the year as well as farther locations throughout the country. With lack of any transparency from Prometric and USMLE, students relied on social media for updates as there was little to no e-mail correspondence whatsoever from official Prometric or USMLE representatives. What’s more, their helpline phone number was shut down due to the large volume of phone calls. Students were left to their own defenses to scramble for new available dates in any location they could find, often only being left with late-June to early-August appointments.

On April 20, 2020, CSOM’s Student Academic Progress Committee (SAPC) and the Faculty Council announced an amendment to their Step 1 policy in light of the COVID-19 pandemic. It was decided that the deadline for taking Step 1 would be pushed back. However, despite student pushback, it was also decided that a separate exam would be held as a proxy for Step 1 until students were able to sit for the actual Step 1. This exam, a Comprehensive Basic Science Examination (CBSE), would be administered at home and proctored over Zoom, a video conferencing application, and would be used as a sort of gatekeeping tool. If students failed this CBSE, they would be asked to take a personal leave of absence and delay their medical school graduation by one full year. Understandably, there were many points made against this by the students. These include, but are not limited to the following: The utility of the CBSE as a Step 1 proxy especially in the absence of a standardized environment has not been shown to be accurately backed by data. The various environments of students’ homes are far from standardized. In addition, the CBSE report itself says that it should be used in conjunction with additional measures to assess Step 1 readiness . To argue that CSOM students needed to be ready to pass a CBSE long before their actual Step 1 date was unreasonable. Students were asked to put aside their anxiety about the public health crisis and focus on passing an exam in less-than-ideal conditions. After a long meeting with the deans, the CSOM class of 2022 reached out to discuss possible collaboration to amend this policy. They were met with rejection. 

With the re-eruption of Black Lives Matter (BLM) protests in June of 2020 in light of recent and past police brutality and cases of murder based upon race (namely those of George Floyd, Breonna Taylor, Tamir Rice, Ahmaud Arbery, and countless more), anxiety, anger, fear, and helplessness ran deep around the world. CSOM students, many of whom are part of the Black and Brown communities so heavily affected by both COVID-19 and racism continuously plaguing our country, were once again asked to put aside their legitimate worries, mourning of deaths, and anxiety, and to focus on passing the CBSE. It goes without saying this was easier said than done. Not to mention that Black and Hispanic communities experienced the greatest rate of COVID-19 infection – communities many of us are a part of. Being forced to focus on studying for and then subsequently punished for not passing an exam that is not the actual Step 1 when families and communities are crumbling seems unjust and not in alignment with the mission of the school.

Whilst acknowledging the students’ struggles and issues with the CBSE through support groups, the administration still decided to go through with administering the most important exam of the M2 year. Many were not able to focus the days leading up to the exam because they were scared. They were scared for their safety and that of their families and friends. They were scared for their futures, knowing how this exam could affect their career paths.

Met without change of any policies, about half of CSOM’s M2 class took the CBSE on June 5th, 2020. Within a couple of days, students received their CBSE scores. About 50% of the students who took the exam did not pass. That is roughly 25% of the entire M2 class that is now being asked to take a year-long personal leave of absence. 

Most medical schools around the US have relaxed their Step 1 policies as well, just extending their test date deadline to some time in M3. These schools, unlike CSOM, had no other requirements. That is, there was no gatekeeping CBSE or other exam that students needed to pass in order to proceed into their 3rd year of medical school. They were simply allowed to progress forward and were told to take Step 1 at their earliest date of convenience before a previously decided deadline, most of which were a full year after their original deadline. 

The City College of New York, in which CSOM’s campus resides, was originally founded as an higher education institution catered to children of immigrants and the poor. CSOM itself was established to cater to high school graduates of diverse backgrounds, prioritizing students who wanted to become primary care physicians for the underserved communities. If the whole point of both CCNY and CSOM was to serve the underrepresented, it should undoubtedly also seek to protect and provide equity for its students, most of whom come from those exact communities. While persistently declining to cater to the unprecedented state of the world and to listen to the desperate pleas of their students, the CSOM faculty has failed their students. They have failed to uphold the standards of the missions of their school. 

What we need:

So we call you to sign and share this petition to show CSOM deans and faculty that you stand in solidarity with us in our protest against the school policies as they currently exist. We can’t accept the CBSE as a proxy for Step 1. We can’t accept these policies that were made before the recent outbreak of BLM protests during such a turbulent time for many Black and Brown students. We can’t allow around 25% of a medical school’s graduating class to take a personal leave of absence just because of this arbitrary exam. We call on CSOM deans to allow even students who did not pass the CBSE to proceed with their M3 year, start rotations in hospitals, and sit for and pass the actual Step 1 either before the end of the school year (June 5, 2021), or before in-person clerkships actually begin (August 10th 2020).

Thank you.