“Who is the best resident in your program?”
If you ask this question at a residency program faculty meeting, the answers are rarely about board scores. You’ll hear discussions about the resident who stays calm during a difficult airway. The junior resident who notices subtle clinical changes before anyone else does. The senior resident others trust at 2 a.m. when the attending is exhausted. The trainee who inspires confidence in both patients and physicians.
And yet, throughout medical education, we continue to place enormous weight on standardized testing as though it alone can predict who will become an exceptional physician.
To be clear, testing matters. Medicine requires a strong foundation of knowledge, and exams offer objective assessments that help ensure competency and patient safety. They identify struggling learners and establish standards within a profession where mistakes carry life-threatening consequences. But somewhere along the way, many of us began confusing measurable performance with complete potential.
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“You will undoubtedly fail.”
I still remember overhearing those words spoken by a mentor to a resident preparing for an upcoming board exam. The resident had struggled on prior in-training exams and was working diligently to improve. What stayed with me was not simply the harshness of the comment, but the certainty with which a trainee’s future had already been reduced to a number.
A multiple-choice exam can assess knowledge of physiology. What it cannot measure is how someone responds when a patient suddenly becomes unstable. It cannot capture the judgment to know when to ask for help, the resilience to improve steadily month after month, or the dependability that makes an overnight shift more manageable for everyone else in the room.
Medicine asks physicians to function under conditions that standardized testing cannot fully reproduce. We expect trainees to absorb enormous amounts of information while navigating sleep deprivation, emotional stress, interpersonal conflict, and the unpredictability of patient care. We ask them to lead teams, communicate clearly during emergencies, recognize subtle clinical deterioration, and earn the trust of vulnerable patients, often all within the same shift.
Some of the most clinically gifted physicians are not extraordinary test takers. Some struggled with anxiety during exams. Some developed confidence later than their peers. Others simply think more clearly at the bedside than they do in a silent testing center under artificial time constraints.
Yet medical culture often assigns identity early. High scorers are labeled “stars.” Others quietly internalize that they are average, weak, or less promising, even while demonstrating the very qualities that make patients feel safe and teams function well.
The consequences extend beyond hurt feelings. When trainees begin to see themselves primarily through the lens of numerical performance, confidence erodes. They become hesitant to speak up, reluctant to lead, and increasingly doubtful of their own judgment. Some stop seeing their potential to become excellent physicians before they even had the opportunity to grow.
Medical training, by necessity, is evaluative. But our evaluation systems shape culture as much as they measure competence. What we choose to reward communicates to trainees what we value. If test scores dominate the conversation, trainees learn that measurable achievement matters more than interpersonal skill, resilience, adaptability, or compassion. Excellence becomes something quantified rather than something practiced daily in patient rooms, operating rooms, and overnight call shifts.
But ask nurses which residents they trust most, and the answers are often strikingly different from what a score report might predict. They trust the resident who treats everyone with respect during stressful situations. The one who notices when a patient “just doesn’t look right.” The trainee who remains calm when the rest of the room feels chaotic.
Patients, too, rarely experience physicians through the metrics medical culture emphasizes so heavily. No patient has ever asked what percentile a physician scored on an in-training exam or whether they qualified for Alpha Omega Alpha during medical school. Patients remember something else entirely. They remember who sat down. Who explained things clearly. Who remained calm. Who listened carefully. Who made them feel safe during one of the most frightening moments of their lives.
None of this means we should abandon standardized testing. Knowledge matters profoundly in medicine, and objective assessments serve an important role. But problems arise when scores become shorthand for worth, potential, intelligence, or future clinical excellence.
Medicine has always attracted high achievers, and many physicians carry perfectionism into every stage of training. In that environment, even small differences in scores can begin to feel like global judgments rather than limited data points. A trainee who scores slightly below peers may quietly conclude they do not belong, despite receiving strong clinical evaluations and demonstrating exceptional patient care skills.
At times, faculty may unconsciously interpret a trainee’s clinical performance through assumptions already formed from numerical evaluations. Once a resident is labeled “strong” or “weak” academically, that perception can shape how their clinical abilities are viewed. Over time, these assumptions can spread through a training culture, influencing not only faculty evaluations but also how residents perceive each other.
At the same time, some trainees who excel academically struggle in the real-world complexity of clinical medicine. Memorization and rapid recall are valuable skills, but they are not the same as judgment, leadership, adaptability, or emotional intelligence. They do not automatically translate into the ability to comfort a grieving family member or make difficult decisions amid uncertainty.
The truth is that becoming a physician is developmental. Many outstanding doctors were not fully formed during medical school or early residency. Some blossomed later after gaining confidence, mentorship, or experience. Some needed time to find their voice. Others learned medicine best through human interaction rather than standardized examination formats. Growth in medicine is rarely linear, yet our evaluation systems sometimes behave as though early metrics represent permanent ceilings.
The best educators understand this instinctively. They recognize potential alongside performance. They notice who works hard after difficult feedback. They pay attention to kindness, reliability, curiosity, and improvement over time. They understand that medicine is practiced by human beings caring for human beings, and that the qualities required for this work cannot always be reduced to numbers on a score sheet.
Perhaps the question is not whether testing should exist. It should. The better question is whether we have unintentionally allowed test scores to occupy too much space in defining who we believe will become excellent physicians. Because when physicians reflect on the colleagues they most admire, they rarely describe a percentile. They describe a person.
And often, the best resident in the room is not the one who tested the highest earliest. It is the one patients trust, teams rely on, and colleagues hope will be beside them when things become difficult.
DeAnna Pollock is an anesthesiologist.
