In the 2012 National Residency Match Program survey, which is sent out to residency program directors around the country by the NRMP, the factor that was ranked highest with regards to criteria considered for receiving an interview — higher than honors in clinical clerkships, higher than extracurricular experiences or AOA election, and even higher than evidence of professionalism, interpersonal skills, and humanistic qualities — was the USMLE Step 1 score.
When considering where to rank an interviewed applicant, the score took a backseat to some of the aforementioned criteria that are perhaps more telling of what kind of person the interviewee is, although it was still one of the highest considered criteria for ranking applicants as well. When a single exam is given this level of importance in determining a future physician’s most critical period in career development — their residency — we have to look carefully at our system.
Two points of consideration come to mind. First, is it wise to weigh a test score so heavily? Many students and faculty could easily point out that student performance on exams by no means always reflects their clinical acumen and social skills when seeing patients. Medicine is, after all, an art far more than a science. Nonetheless, it would be foolish to assume that scores have no worth — a high score on an exam, particularly a behemoth such as the USMLE Step 1, points out many qualities in an individual: hard work, persistence, discipline, and frankly, an understanding of textbook medicine. And thus, we are left somewhere in the middle — perhaps we should weigh scores less than we do, but when you have to sort through thousands of applications, the only standardized metric to quickly compare is, in the end, a number somewhere between 192 and 300.
This brings me to my second point of cogitation — if we are to accept that the system will run with a heavy dependence on a single score, does the said exam test what is clinically essential and do medical schools teach their students what is needed for this exam? As a second year student currently beginning my boards preparation, I know there is a problem here. Most students in my class and around the country rely heavily on additional preparation materials that cumulatively cost nearly $1,000 in preparation for the USMLE. Recently, after completing two years of our clinical curriculum, many of us felt uneasy at best with regards to mastery of boards content when taking a practice NBME exam before our 1 month of allotted study time.
After paying thousands of dollars in tuition, I would expect more. My school, like many top research institutions, prides itself on not teaching to the boards. We have lectures from several world-renowned physicians and scientists, many who present cutting edge clinical and basic science research as part of our curricular program, but many lectures ultimately have superfluous minutiae when framing our educational objectives in the context of the USMLE. As students with an insatiable curiosity and passion for learning, we gladly and earnestly absorb from and appreciate the wisdom of our instructors, but as future applicants to extremely competitive residency programs, I can’t help but wonder if our medical education system is structurally misaligned.