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Several schools have moved the United States Medical Licensing Examination Step 1 exam after core clerkships and others are considering this change. Delaying Step 1 may improve Step 1 performance and lower Step 1 failure rates. Schools considering moving Step 1 are particularly concerned about late identification of struggling students and late Step failures, which can be particularly problematic due to reduced time to remediate and accumulated debt if remediation is ultimately unsuccessful. In the literature published to date, little attention has been given to these students. In this article, authors from 9 medical schools with a postclerkship Step 1 exam share their experiences. The authors describe curricular policies, early warning and identification strategies, and interventions to enhance success for all students and struggling students in particular. Such learners can be identified by understanding challenges that place them "at risk" and by tracking performance outcomes, particularly on other standardized assessments. All learners can benefit from early coaching and advising, mechanisms to ensure early feedback on performance, commercial study tools, learning specialists or resources to enhance learning skills, and wellness programs. Some students may need intensive tutoring, neuropsychological testing and exam accommodations, board preparation courses, deceleration pathways, and options to postpone Step 1. In rare instances, a student may need a compassionate off-ramp from medical school. With the National Board of Medical Examiner's announcement that Step 1 scoring will change to pass/fail as early as January 2022, residency program directors might use failing Step 1 scores to screen out candidates. selleck chemical Institutions altering the timing of Step 1 can benefit from practical guidance by those who have made the change, to both prevent Step 1 failures and minimize adverse effects on those who fail.The medical education community acknowledges the importance of including the humanities in general, and the liberal arts in particular, in the education of health professionals. Among the liberal arts, theater is especially helpful for educators wanting to bring experiences that are both real and challenging to the learning encounter in an interactive, engaging, and reflective way. In this Perspective, the authors share what they have learned after working together with a company of actors for 8 years (2012-2019) in different obligatory and elective curricular activities. Influenced by Freire's Pedagogy of the Oppressed and the ideas of Boal's Theatre of the Oppressed, Medical Education Empowered by Theater (MEET) embraces social accountability and applies the concept of sensible cognition to empower medical students as the protagonists of their learning and professional development to become agents of change-both in patients' lives and in health care systems. The MEET theoretical framework builds on the concepts of liberation, emancipatory education, critical pedagogy, and participatory theater to offer medical students and teachers an opportunity to problematize, criticize, and hopefully reform the hierarchical and often oppressive structures of medical education and practice. MEET sessions include activating previous knowledge and experiences, warm-up exercises, different improvisational exercises, debriefing, and synthesis. Vital to the praxis of MEET is applying theater-teaching traditions to develop capacities important in medicine presence, empathy, improvisation, communication (verbal and non-verbal), and scenic intelligence (i.e., the capacity to self-assess one's performance while performing). The authors believe that theater offers a venue to integrate both the personal and professional development of students into a process of reflection and action, targeting the transformation of the medical culture towards social justice.PURPOSE Vygotsky's zone of proximal development (ZPD) refers to the space between what learners have mastered and what they should master in the next developmental stage. Physicians' tasks are ZPD activities for medical students, with high-acuity tasks such as resuscitation representing activities at the ZPD's frontier. This type of task can be taught and assessed with simulation but may be demanding and stressful for students. Highly challenging simulation may lead to negative simulated patient outcome and can affect the participant's emotional state, learning, and motivation. This study aimed to increase understanding of the psychosocial and educational impact of simulation at the frontier of the ZPD. METHOD The authors conducted 11 phenomenological interviews between September 2016 and May 2017, to describe medical students' experiences with a challenging residency-level simulation test of acute care competence at the start of the final undergraduate year at University Medical Center Utrecht. Interviews took place within 2 weeks after the participants' simulation experience. The authors analyzed transcripts using a modified Van Kaam method. RESULTS Students experienced a significant amount of stress fueled by uncertainty about medical management, deterioration of critically ill simulated patients, and disappointment about their performance. Stress manifested mainly mentally, impeding cognitive function. Students reported that awareness of the practice setting, anticipation of poor performance, the debriefing, a safe environment, and the prospect of training opportunities regulated their emotional responses to stress. These stress-regulating factors turned stressful simulation into a motivating educational experience. CONCLUSIONS Simulation at the ZPD's frontier evoked stress and generated negative emotions. However, stress-regulating factors transformed this activity into a positive and motivating experience.Medical schools and other higher education institutions across the United States are grappling with how to respond to racism on and off campus. Institutions and their faculty, administrators, and staff have examined their policies and practices, missions, curricula, and the representation of racial and ethnic minority groups among faculty, staff, and students. In addition, student-led groups, such as White Coats for Black Lives, have emerged to critically evaluate medical school curricula and advocate for change. Another approach to addressing racism has been a focus on the role of professionalism, which has been variably defined as values, traits, behaviors, morality, humanism, a role, an identity, and even a social contract.In this article, the authors consider the potential role that professionalism might play in responding to racism in medical education and at medical schools. They identify 3 concerns central to this idea. The first concern is differing definitions of what the problem being addressed really is.