Date on Master's Thesis/Doctoral Dissertation

12-2025

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Educational Leadership, Evaluation and Organizational Development

Degree Program

Educational Leadership and Organizational Development, PhD

Committee Chair

Buckley, Jessica

Committee Member

Gross, Jacob

Committee Member

George, Casey

Committee Member

Shaw, Ann

Author's Keywords

Step1; medical education; learning; cognition; social

Abstract

This qualitative interpretivist case study explores, at a singular institution, medical students’ perspectives on the social and cognitive factors influencing the learning process as students prepare for the Step 1 examination. While prior research regarding medical students Step 1 preparation have focused primarily on wellness, stress, and career outcomes, limited studies have examined medical students' lived experiences to navigate what occurs during the learning process while they prepare for this critical exam. Utilizing a qualitative case study approach, this dissertation draws on fourteen student interviews, seven that passed Step 1 on their first attempt, and seven that failed. Findings reveal that students rely heavily on student expertise, online forums, and commercial study resources to interpret expectations and develop study strategies. Participants reported high levels of cognitive load, anxiety, and identity-based pressure tied to Step 1 performance. The experiences implied a broader perspective regarding learners' agency, how much control they have over their own learning, particularly in high-stakes settings. This study contributes to medical education literature by highlighting the social and cognitive dimensions of high-stakes exam preparation and offers recommendations for support structures.

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