By BRYAN CARMODY, MD
One of the most fun things about the United States Medical Licensing Examination (USMLE) pass/fail debate is that it’s accessible to everyone. Some controversies in medicine are discussed only by the initiated few – but if we’re talking USMLE, everyone can participate.
Simultaneously, one of the most frustrating things about the USMLE pass/fail debate is that everyone’s an expert. See, everyone in medicine has experience with the exam, and on the basis of that, we all think that we know everything there is to know about it.
Unfortunately, there’s a lot of misinformation out there – especially when we’re talking about Step 1 score interpretation. In fact, some of the loudest voices in this debate are the most likely to repeat misconceptions and outright untruths.
Hey, I’m not pointing fingers. Six months ago, I thought I knew all that I needed to know about the USMLE, too – just because I’d taken the exams in the past.
But I’ve learned a lot about the USMLE since then, and in the interest of helping you interpret Step 1 scores in an evidence-based manner, I’d like to share some of that with you here.
If you think I’m just going to freely give up this information, you’re sorely mistaken. Just as I’ve done in the past, I’m going to make you work for it, one USMLE-style multiple choice question at a time._
By BRYAN CARMODY
Recently, I was on The Accad and Koka Report to share my opinions on USMLE Step 1 scoring policy. (If you’re interested, you can listen to the episode on the show website or iTunes.)
Most of the topics we discussed were ones I’ve already dissected on this site. But there was an interesting moment in the show, right around the 37:30 mark, that raises an important point that is worthy of further analysis.
ANISH: There’s also the fact that nobody is twisting the arms of program directors to use [USMLE Step 1] scores, correct? Even in an era when you had clinical grades reported, there’s still seems to be value that PDs attach to these scores. . . There’s no regulatory agency that’s forcing PDs to do that. So if PDs want to use, you know, a number on a test to determine who should best make up their class, why are you against that?
BRYAN: I’m not necessarily against that if you make that as a reasoned decision. I would challenge a few things about it, though. I guess the first question is, what do you think is on USMLE Step 1 that is meaningful?
ANISH: Well – um – yeah…
BRYAN: What do you think is on that test that makes it a meaningful metric?
ANISH: I – I don’t- I don’t think that – I don’t know that memorizing… I don’t even remember what was on the USMLE. Was the Krebs Cycle on the USMLE Step 1?
I highlight this snippet not to pick on Anish – who was a gracious host, and despite our back-and-forth on Twitter, we actually agreed much more than we disagreed. And as a practicing clinician who is 15 years removed from the exam, I’m not surprised in the least that he doesn’t recall exactly what was on the test.
I highlight this exchange because it illuminates one of the central truths in the #USMLEPassFail debate, and that is this:
Physicians who took Step 1 more than 5 years ago honestly don’t have a clue about what is tested on the exam.
That’s not because the content has changed. It’s because the memories of minutiae fade over time, leaving behind the false memory of a test that was more useful than it really was.
I’m speaking from experience here.