Rising rates of burnout and psychological distress among medical students have prompted institutions to pursue reforms in assessment, curriculum structure, and wellness initiatives. This review synthesizes recent literature on grading reform, wellness interventions, curriculum integration, and equity-focused considerations.
The 2022 transition of USMLE Step 1 and COMLEX Level 1 to pass/fail scoring was intended to reduce stress and narrow racial performance gaps. However, studies (English, 2024; Rothka et al., 2024; Twardowski et al., 2023; Warm et al., 2024) found little evidence of stress reduction, instead noting displacement of anxiety to Step 2 exams, research productivity, and uncertainty around residency selection. Others have raised concerns about diminished objectivity in residency selection and potential inequities in residency processes contributing to increased stress particularly on students from less traditional or prestigious backgrounds (Patel et al., 2022; Agolia et al., 2025).
Wellness interventions such as mindfulness, reflection, and compassion-based curricula have been well received generally by students and have shown variable benefits in reducing stress and burnout (Rojas et al., 2023; Prendergast et al., 2024; Sanchez-Campos et al., 2020). Yet effectiveness is limited when programs are fragmented, perceived as interfering with academic curriculum, or fail to address more systemic stressors (Dyrbye et al., 2019; Velez et al., 2024). Integration into the curriculum and student involvement appear critical, though outcome measures remain inconsistent.
Equity-focused studies highlight that underrepresented students often face additional burdens and stressors that go mostly unacknowledged and may not benefit equally from generalized reforms (Charles et al., 2024; Betancourt et al., 2024). Few interventions use culturally responsive approaches or disaggregate outcomes by identity.
Overall, evidence suggests that sustainable improvements require coordinated, equity-centered reforms that embed wellness into institutional culture, clarify evaluative metrics, and meaningfully involve students.
