Nearly 25 percent of second-year medical school students said they “almost never” attended class during their first two years, according to an Association of American Medical Colleges report on 2017 trends published in March.

The exact number, 23.5 percent, represents a more than 5-point increase from 18.2 percent in 2015.

Medical students do not typically start clinical work until their third year. Many students are skipping classes to focus on studying for Step 1, an intense multiple choice test that students take at the end of their second year, reported STAT. Students’ Step 1 results can determine what specialties they can study or what residency programs they get into.

Medical schools are beginning to respond to the disconnect between their classes and the material on Step 1. Harvard Medical School has instituted the “flipped classroom” model in which students learn the material at home and go over exercises with the class, reported STAT. At the Johns Hopkins University of Medicine, only 30 to 40 percent of students attend lectures during their first two years.

Step 1 plays a big role in the students’ decisions to skip, even though many of them pay more than $50,000 a year to attend.

“They have this parallel curriculum going along with what we’re teaching them,” Johns Hopkins associate dean for curriculum Dr. Nancy Hueppchen said according to STAT.

Medical schools are beginning to stress “problem-solving and critical thinking” over rote memorization, although the latter is a large part of the national licensing exam, Step 1. (RELATED: Feds Will End Extra Regulations For Gene Therapy Experiments Due To 2017 Successes, 700 Pending Proposals)

The difficult exam has led to a boom in online training tools to help students remember multitudes of facts for the exam. Kaplan charges about $4,000 for its prep courses, but students can also go a less costly route and sign up for SketchyMedical.com. The medical student-built website gives users a library of cartoonish visuals designed to help students recall facts about microbiology, pathology and more, reported STAT.

Approximately 18,500 students graduate from medical school each year.

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