Settling the Score
The debate over one of the most contested exams in medical education comes to a head.
The next few months may bring a seismic shift to a medical school milestone, the United States Medical Licensing Exam (USMLE) Step 1. Aspiring doctors typically take it after their second year of medical school, and a good score paves the way for them to become residents and eventually practicing physicians. But critics say the test has become a distraction, an all-or-nothing filter that doesn’t test for many of the qualities that make a physician great.
When the test was introduced in the early 1990s, its purpose was straightforward. The grueling eight-hour, multiple-choice exam provided an objective measure of a student’s command of two years of medical school, which largely focused on lecture and textbook materials. The score gave a clear answer to whether a student had mastered information that was vital to working as a doctor. State licensing boards require medical students to pass four USMLE exams in total.
“It was a national test that any board would accept, so rigorous that anyone who could pass it should be allowed to practice,” says Bryan Carmody, a prominent critic and pediatric nephrologist at the Children’s Hospital of the King’s Daughters in Norfolk, Va.
But Step 1 has now taken on an outsized significance, critics say. Residency program directors use high Step 1 scores to screen for the best applicants, and because a residency can determine the entire career trajectory of a student, getting the highest possible three-digit score on the Step 1 has become a high-stakes goal. Students now invest huge reserves of time and money in test preparation—an annual frenzy that Carmody calls “Step 1 Mania.”
Image: Proto.