Remember when med school was supposed to be about learning medicine?
Now it’s 3 a.m., you’re 800 UWorld questions deep, and the only differential you can muster is “sleep vs. more Anki.”
Here’s how this carnival of insanity got built.

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“Back in my day…”

In the 1990s Step 1 was a box to tick, not a leaderboard to climb.
Most students leaned on lecture notes; there was no formal “dedicated” period, and commercial courses hardly moved the needle on scores.^[1]

Enter the profit engines

The 2000s lit the fuse. Kaplan packed hotel ballrooms with marathon review sessions, and in 2003 a dorm-room startup called USMLEWorld (now UWorld) lobbed its brutal Qbank onto the internet.
Suddenly “just pass” became “do every single question twice.”^[2]

The parallel-curriculum era

By the 2010s your real curriculum was Pathoma videos, Sketchy cartoons, and a brick-thick First Aid your school cheerfully hands you on Day One—because they know you’ll ignore their lectures anyway.
Eight-week lockdowns were baked into the academic calendar. Welcome to exam mania.^[3]

Well-being? LOL.

A Drexel survey showed those 4- to 6-week cram camps leave most students isolated, sleep-deprived, and thoroughly burned-out; 70 % reported clinical-level anxiety even in the shiny new pass/fail era.^[4]

Pass/Fail was supposed to help…

…and yet overall Step 1 pass rates slid from ~95 % pre-change to the low 90s once the score disappeared—hardly the wellness miracle we were promised.^[5]

The pressure just migrated

Residency program directors saw the vacuum and sprinted to Step 2 CK: 71 % now admit they’ll enforce a Step 2 cutoff when filtering applicants.
Translation: the hamster wheel just moved down the hallway.^[6]

Voices in the wilderness

Educators and bloggers (see Bryan Carmody’s aptly titled “Step 1 Mania”) keep shouting about the mental-health fallout and convenient profits—for everyone except students.^[7]

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So what now?

If you’re furious that medicine’s gatekeeping turned into a multi-year boss fight, you’re not alone.
The escalation was decades in the making—driven by residency bottlenecks and a booming prep industry.
Keep learning, keep pushing back, keep talking about the costs—because the next reform shouldn’t just reshuffle the anxiety to another exam.

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References

1. Academic Medicine. “Preparation for the USMLE Step 1 in the 1990s: Survey of Student Study Habits.” 2000.
2. UWorld. “Company History: From Dorm Room to Gold Standard Qbank.” Press release, 2023.
3. Northwestern Univ. Feinberg SOM. “USMLE Step 1 Study Habits Survey, Class of 2020.” 2019.
4. Topping N. et al. “Student Well-Being During USMLE Step 1 Dedicated Study.” Medical Science Educator, 2021.
5. National Board of Medical Examiners. “USMLE Performance Data 2023.”
6. AAMC / NRMP Program Director Survey. “Impact of Step 1 Pass/Fail on Selection Criteria.” 2023.
7. Carmody B. “Step 1 Mania.” The Sheriff of Sodium blog, 2019.