Evaluating the mental health of medical students during their dedicated study period for COMLEX Level 1 vs. Level 2 after the change of COMLEX Level 1 to pass/fail

CONTEXT: The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 transitioned to a Pass/Fail (P/F) designation in 2022. While this change is meant to improve medical students' mental health during their first-level licensure examination period, it is also critical to consider how this may affect students during their second-level licensure examination period. Because this scoring transition is relatively recent, limited studies have investigated how this change has affected student quality of life (QoL). Even fewer studies have analyzed COMLEX-USA specifically. OBJECTIVES: This study aims to investigate the QoL of osteopathic medical students during their designated study periods (DSPs) for COMLEX-USA Level 1 and Level 2 after the transition of COMLEX-USA Level 1 to a P/F designation. METHODS: The study design consisted of an online survey distributed to fourth-year osteopathic medical students in the Class of 2024 via the Council of Osteopathic Student Government Presidents (COSGP), with a total of 253 participants. Participants were included in the study if they were members of the Class of 2024 and if they took COMLEX-USA Level 1 as P/F and Level 2 as numerically scored. The survey included identical questions for COMLEX-USA Level 1 vs. Level 2 regarding QoL parameters during DSPs on a Likert scale, and the sign test was utilized to analyze the results. RESULTS: During their DSP for COMLEX-USA Level 2, participants reported better mental health (p=0.0017), more time for hobbies (p=0.0072), more time spent with loved ones (p<0.0001), higher levels of physical activity (p=0.0199), higher overall QoL (p=0.004), and higher confidence in passing (p=0.0003) compared to during their DSP for COMLEX-USA Level 1. Although the QoL parameters were nearly all significantly better for participants during their DSP for COMLEX-USA Level 2, a total of 137 participants (54.1 %) reported that they felt greater perceived stress for the COMLEX-USA Level 2 examination. However, this proved to not be statistically significant (p=0.1852). CONCLUSIONS: The newly established P/F designation for first-level licensure examinations was implemented to improve student well-being. This study's results indicate an overall better QoL for survey participants from the Class of 2024 during their COMLEX-USA Level 2 DSP as compared to QoL during their COMLEX-USA Level 1 DSP. Still, there is some suggestion that the mental burden previously associated with first-level licensure examinations has potentially been deferred to second-level licensure examinations. Further studies would be required to clearly delineate the impact of COMLEX Level 1 having a P/F designation on medical student wellness and the residency application process.