I thank de Haan and colleagues for their thoughtful comments on my Invited Commentary. I commend them for having developed a structured process to evaluate their residency applicants and look forward to them disseminating their process, as others have done.1 I share the authors’ goals of seeking residents with the motivation to achieve excellence and board certification. However, I am not aware of any research demonstrating that the United States Medical Licensing Examination (USMLE) Step 1 predicts motivation for excellence.
Even anesthesia residents who score below the Step 1 score that many residencies set to filter out candidates to review or interview are highly likely to pass boards.2 I may have greater confidence than the authors in the ability of faculty to teach and residents to learn. There are also more crucial dimensions to excellence than medical knowledge, such as empathy, communication, teamwork, conscientiousness, professionalism, and grit.
The authors and I also agree that our patients desire, and I would suggest deserve, excellence from their physicians, so residency selection committees should recognize all facets of excellence. Increasing the diversity of our physicians has been estimated to decrease the disparity in cardiovascular mortality between black and white men by 19% and life expectancy by 8%3—certainly an impact most patients would find laudatory. Medical educators increasingly recognize the benefits of cognitive diversity in solving complex tasks.4 Let’s design selection processes to identify residents who will excel in all dimensions, and avoid the tempting shortcut of using a test that measures only a single dimension of excellence, on a single day.
Step 1 is a test. As with any test that we employ in clinical medicine, such as laboratory or diagnostic imaging, let’s understand its true cost:benefit ratio and make sure we choose wisely.
Kathryn M. Andolsek, MD, MPH
Professor, Department of Family Medicine and Community Health, and assistant dean for premedical education, Duke University School of Medicine, Durham, North Carolina; [email protected]; ORCID: https://orcid.org/0000-0001-7994-3869.
1. Bandiera G, Abrahams C, Ruetalo M, Hanson MD, Nickell L, Spadafora S. Identifying and promoting best practices in residency application and selection in a complex academic health network. Acad Med. 2015;90:1594–1601.
2. Dillon GF, Swanson DB, McClintock JC, Gravlee GP. The relationship between the American Board of Anesthesiology part 1 certification examination and the United States Medical Licensing Examination. J Grad Med Educ. 2013;5:276–283.
3. Talamantes E, Henderson MC, Fancher TL, Mullan F. Closing the gap—Making medical school admissions more equitable. N Engl J Med. 2019;380:803–805.
4. Page S. The Diversity Bonus: How Great Teams Pay Off in the Knowledge Economy. 2017.Princeton, NJ: Princeton University Press.