I asked for it, I got it. Good conversation, but I want to pull a Glenn Loury and offer some pushback, specifically on Step 1.
This refers to Step 1 of the U.S. Medical *Licensing* exam. The stated purpose of the test is to qualify one for a license to practice medicine. A license is a binary thing. You either have one or you don't; every physician practicing in a state has the same license (with some marginal exceptions). So pass/fail makes perfect sense for the USMLE.
Residency applications are not the stated purpose of the USMLE; the exam was appropriated for that because it was standardized nationwide. Residency training is specialized; it is not a binary all or nothing. So it's actually quite strange to think that someone applying to be a psychiatrist is judged on the same USMLE score as someone applying for radiation oncology or urological surgery. Yes, medicine is about the whole person, but these training programs are very different. I would argue there ought to be residency entrance exams separate from the USMLE (as much as it would be expensive and miserable) which would be more specialized.
It was also a point of contention that Step 1 specifically was so important. There are 3 steps. The third is taken during residency (and thus is irrelevant to the competitive process of applying for residency training). However, Step 1 was often encouraged to be taken after year 2 of med school, before a medical student starts seeing patients in the traditional curriculum of two years of classroom science content followed by two years of clinical clerkships, and often before they've picked which residency they'll apply to. Step 1 is more of a basic science exam. Step 2 is taken later and is more applied.
For reasons unbeknownst to me, Step 1 scores were king in the residency application process; often a minimum score was set for consideration for a position. I would much rather be judged on the more clinical exam taken when I'm more mature and have had experience using my knowledge in actual clinical scenarios, and Step 2 is still scored, so presumably that's now the benchmark. (I'm speaking against interest; my own Step 2 score was not good for personal reasons).
It also used to be the case that Step 2 was divided into a multiple choice exam and a clinical exam (CS) on practice patients. In practice, CS had over a 95% pass rate and was failed mostly by immigrants who didn't speak fluent English, but it cost thousands of dollars to take and was a burden. I'm glad they got rid of it, and I think English language skills can be assessed in a less burdensome way.
There was a lot of criticism of medical schools "teaching to the test" for the basic science of Step 1. It disincentivized curricular innovation to get students more clinical skills earlier on. Many medical students (yours truly included) almost completely ignored their medical school curriculum and instead focused on test prep videos and question banks for Step 1. Classrooms were empty. University of Vermont removed lectures from their program completely, presumably because everyone was out studying for Step 1. There are a lot of problems with med school that have nothing to do with DEI.
Thus, I see clear arguments for making Step 1 pass/fail that do not undermine meritocracy (because we still have Step 2) and which could be argued to serve many other goals that aren't explicitly part of the diversity agenda.
I asked for it, I got it. Good conversation, but I want to pull a Glenn Loury and offer some pushback, specifically on Step 1.
This refers to Step 1 of the U.S. Medical *Licensing* exam. The stated purpose of the test is to qualify one for a license to practice medicine. A license is a binary thing. You either have one or you don't; every physician practicing in a state has the same license (with some marginal exceptions). So pass/fail makes perfect sense for the USMLE.
Residency applications are not the stated purpose of the USMLE; the exam was appropriated for that because it was standardized nationwide. Residency training is specialized; it is not a binary all or nothing. So it's actually quite strange to think that someone applying to be a psychiatrist is judged on the same USMLE score as someone applying for radiation oncology or urological surgery. Yes, medicine is about the whole person, but these training programs are very different. I would argue there ought to be residency entrance exams separate from the USMLE (as much as it would be expensive and miserable) which would be more specialized.
It was also a point of contention that Step 1 specifically was so important. There are 3 steps. The third is taken during residency (and thus is irrelevant to the competitive process of applying for residency training). However, Step 1 was often encouraged to be taken after year 2 of med school, before a medical student starts seeing patients in the traditional curriculum of two years of classroom science content followed by two years of clinical clerkships, and often before they've picked which residency they'll apply to. Step 1 is more of a basic science exam. Step 2 is taken later and is more applied.
For reasons unbeknownst to me, Step 1 scores were king in the residency application process; often a minimum score was set for consideration for a position. I would much rather be judged on the more clinical exam taken when I'm more mature and have had experience using my knowledge in actual clinical scenarios, and Step 2 is still scored, so presumably that's now the benchmark. (I'm speaking against interest; my own Step 2 score was not good for personal reasons).
It also used to be the case that Step 2 was divided into a multiple choice exam and a clinical exam (CS) on practice patients. In practice, CS had over a 95% pass rate and was failed mostly by immigrants who didn't speak fluent English, but it cost thousands of dollars to take and was a burden. I'm glad they got rid of it, and I think English language skills can be assessed in a less burdensome way.
There was a lot of criticism of medical schools "teaching to the test" for the basic science of Step 1. It disincentivized curricular innovation to get students more clinical skills earlier on. Many medical students (yours truly included) almost completely ignored their medical school curriculum and instead focused on test prep videos and question banks for Step 1. Classrooms were empty. University of Vermont removed lectures from their program completely, presumably because everyone was out studying for Step 1. There are a lot of problems with med school that have nothing to do with DEI.
Thus, I see clear arguments for making Step 1 pass/fail that do not undermine meritocracy (because we still have Step 2) and which could be argued to serve many other goals that aren't explicitly part of the diversity agenda.