Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What’s the biggest problem with medical education?

The Curious Radiologist, MD
Education
January 4, 2019
Share
Tweet
Share

There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way to me are a tiny subset of those that are struggling, nonetheless, I have been appalled deficiencies I find in their understanding of human physiology and pathophysiology. I believe that the single most important contributor to this deterioration is standardized testing as it exists in its current form and its increasing role in the residency application process.

High USMLE scores are near-unanimously perceived among medical students as decisive to their applications to residency programs. This is validated by NRMP data; USMLE Step 1 scores may be the most important determinant in gaining the attention of competitive residency programs. This is not to suggest that letters of reference, contributions to research, service and/or education and personal relationships/interpersonal skills are not important. However, a poor USMLE score may sabotage an otherwise solid application.

In a 2018 survey of 1,333 program directors, 94 percent and 70 percent of responses assigned the USMLE Step 1/COMLEX level 1 score and any associated failed attempt an average importance rating of 4.1 and 4.5 (out of 5), respectively, amongst factors dictating whether an interview would be offered. As a matter of perspective, no other factor was cited as often, and only three other factors had a substantially higher assigned scores: 1. Being flagged as in violation of the Match, 2. Evidence of professionalism and ethics and 3. Perceived commitment to the applied specialty.

Somewhat surprising is that USMLE scores and associated failed attempts continued to be decisive in creating rank-order lists of interviewed applicants with 78 percent and 47 percent of program directors assigning scores of 4.1 and 4.5, respectively. The only factors that scored higher at this stage were impressions of interviewees by faculty and house staff, feedback from residents and interpersonal.

Keep in mind that just gaining admission to a U.S. medical school is competitive; most recently only over 7 percent of 51,000 applications. This 7 percent compete among themselves and thousands of international medical graduates for a limited and proportionately decreasing number of residency positions across various specialties. As a surrogate of competitiveness, the overall unmatched rate for 2018 stood at 4.9 percent and 36.9 percent for U.S. and international medical graduates, respectively. For the six most competitive specialties in the same year, defined by the same, unmatched rates ranged between 10-13.7 percent and 50.3-61.5 percent for U.S. and international medical graduates, respectively. Within this strata, USMLE Step 1 and Step 2 CK scores below which applicants are seldom interviewed, ranged between 235-250, which, based on an off-the-cuff tabulation, reflects a percentile of > 85 percent, assuming a standard deviation of +/- 15.

I cite these numbers not to bore you with empirical data, but to illustrate the drive, discipline and academic excellence one must demonstrate in order to enter a U.S. medical school and obtain a residency position of choice. For those applicants with an eye on the more competitive specialties, preparation starts from day one of medical school, if not earlier and often at the expense of a solid foundation in basic medical science.

Think about it. Performance on the USMLE Step 1 — a single-day multiple-choice exam usually taken at the end of the second year of medical school, reportedly assessing competency (not achievement) in basic medical sciences — may be the most heavily weighted component of the residency application process.

This format and its misguided use as an achievement exam to discriminate between residency applicants are steering medical students and by extension medical education towards test performance. No longer are we interested in how a medical student thinks; no longer are we interested in how a medical student leverages their understanding of medicine to solve novel problems. Instead, test performance and ultimately the match result is the yardstick by which programs are reputed.

In my seven years of teaching students for the USMLE, I rarely encounter an American medical student who has voluntarily engaged the foundational texts of the basic medical disciplines or has been required to review the seminal scientific papers from which our understanding of medicine is derived. Rather, their education consists of lecture notes and USMLE focused review books that fail to capture and subsequently confer the foundational mechanistic and probabilistic way in which human biology operates.

Adding fuel to the fire, as an assessment, we ask for “single best answer” responses from a list, not a demonstration of one’s thought process or other skills more essential to the long-term practice of medicine. Few medical students ask the why and the how. The goal, it seems, is to memorize the needed facts and recognize key associations that will allow one to score the highest they can on the USMLE. The expense is curiosity, and the result is a generation of physicians entering clinical training with a knowledge base derived from test-preparation material.

My worry is we are spawning a generation of algorithmic “providers,” not physicians, ill-equipped to further advance medicine and its evolving practice.

“The Curious Radiologist” is a radiologist.

Image credit: Shutterstock.com

ADVERTISEMENT

Prev

It's time to study firearm morbidity and mortality as we do any other public health issue

January 4, 2019 Kevin 0
…
Next

It is time for emergency medicine to expand its circles

January 4, 2019 Kevin 0
…

Tagged as: Hospital-Based Medicine, Medical school

Post navigation

< Previous Post
It's time to study firearm morbidity and mortality as we do any other public health issue
Next Post >
It is time for emergency medicine to expand its circles

ADVERTISEMENT

Related Posts

  • The medical education system hates families

    Anonymous
  • America’s inadequate LGBTQ medical education

    Haidn Foster
  • Why positive role models are essential in medical education

    Robert Centor, MD
  • How medical education fails minority students

    Shenyece Ferguson
  • A medical student’s biggest fear

    Ariana Trautmann
  • One of the biggest lessons medical school can teach you

    Prerana Chatty, MD

More in Education

  • Why clinical research is a powerful path for unmatched IMGs

    Dr. Khutaija Noor
  • Dear July intern: It’s normal to feel clueless—here’s what matters

    Tomi Mitchell, MD
  • Why medical schools must ditch lectures and embrace active learning

    Arlen Meyers, MD, MBA
  • Why helping people means more than getting an MD

    Vaishali Jha
  • Residency match tips: Building mentorship, research, and community

    Simran Kaur, MD and Eva Shelton, MD
  • How I learned to stop worrying and love AI

    Rajeev Dutta
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

What’s the biggest problem with medical education?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...