Letters to the Editor
To the Editor:
The timely importance of the article by McGaghie et al1 cannot be overstated. As a former residency program director and now as senior associate dean for medical education, I have long maintained that the common practice by certain subspecialty residency programs of using United States Medical Licensing Examination (USMLE) scores to screen and/or censor applicants is wholly unfair and seemingly without validity. With their article, McGaghie and colleagues have finally proved the lack of validity for this practice. For residency programs to persist in perpetuating the notion that high board scores = a better resident, when no correlation between USMLE scores and objective measures of trainees' clinical skills has ever been demonstrated, is wholly inconsistent with their teaching residents to adhere to practices that are evidence based.
I propose that we, as an academic medical community, take the implications of their work one step further and urge the National Board of Medical Examiners (NBME) to stop the release of students' numerical examination scores. The Step examinations were designed to contribute to medical licensure decisions. While the NBME acknowledges that there are concomitant secondary uses of the scores by third parties—such as in postgraduate residency selection—these uses are not validated. Shouldn't they be stopped? It is a travesty that student affairs deans are annually forced to explain to perfectly capable, sometimes truly outstanding, medical students that their career dreams of being in “X” specialty are categorically eliminated simply because their USLME Step 1 scores were insufficiently high.2
This change will be difficult for some residency programs. It may force them to identify those traits, skill sets, and attitudes that best predict excellence in their particular specialties rather than simply focusing on a number. It might free up medical schools to provide innovative educational opportunities for students rather than devoting excessive curricular time to board preparation. It could result in some previously “unqualified by board scores but otherwise excellent” students to achieve their dreams. It would be a fairer system all around.
Jeffrey G. Wong, MD
Senior associate dean for medical education and professor of internal medicine, Medical University of South Carolina, Charleston, South Carolina; firstname.lastname@example.org.