We appreciate the letters in response to our recent Commentary.1 We hope that our Commentary and this exchange continue to stimulate others to consider strategies that enhance medical education while clarifying the role of standardized testing in the holistic review of applicants for residency. A broader national conversation that includes those responsible for undergraduate medical education, graduate medical education, and regulatory standards governing medical education and licensure is critical for meaningful and sustainable education reform.
Mehta and colleagues suggest abandoning the United States Medical Licensing Examination (USMLE) three-digit scores in favor of a pass/fail score. We outlined in our Commentary the limitations of this approach, but it should be recognized that individual medical schools can choose to suppress the specific USMLE scores of their graduates in the Electronic Residency Application Service. Mehta and colleagues also suggest that evidence of medical student engagement in population health initiatives should be a factor considered in residency applicant selection. This is a good example of program directors deciding what specific characteristics of applicants are most critical to success in their programs, guiding their selection accordingly.
London and colleagues provide interesting medical student survey data that underscore the preponderance of students who rely upon third-party resources to prepare for their USMLE Step 1 examination. It has been suggested that medical students have three curricula: one that we are teaching, one that prepares them for their clinical clerkships, and a third that is relevant to Step 1. On behalf of optimizing learning, we must assume responsibility for harmonizing these curricula.
London and colleagues’ suggestion of a universal preclinical curriculum strongly resonates. Relevant to this point, we note that the content specifications for the USMLE are developed using such a national consensus to which faculty from most U.S. medical schools contribute. Furthermore, in a prior Commentary one of us (C.G.P.) proposed “the creation of a medical school collaborative, charged with the identification of material that would represent a consensus opinion on the core content of the curriculum.”2 We have initiated this process in one content area (microbiology) and a five-medical-school collaborative. If this were extended across the full curriculum and all medical schools, students would be assured that they are being tested on what is being taught, and they would not feel the need to rely on third-party sources to prepare for the USMLE.
Charles G. Prober, MD
Senior associate dean for medical education and professor of pediatrics, Microbiology & Immunology, Stanford School of Medicine, Stanford, California; [email protected]
Joseph C. Kolars, MD
Senior associate dean for education and global initiatives, University of Michigan Medical School, Ann Arbor, Michigan.
Lewis R. First, MD
Professor and chair, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont, and past chair, National Board of Medical Examiners, Philadelphia, Pennsylvania.
Donald E. Melnick, MD
President and chief executive officer, National Board of Medical Examiners, Philadelphia, Pennsylvania.
1. Prober CG, Kolars JC, First LR, Melnick DE. A plea to reassess the role of United States Medical Licensing Examination Step 1 scores in residency selection. Acad Med. 2016;91:14.
2. Prober CG, Khan S. Medical education reimagined: A call to action. Acad Med. 2013;88:14071410.