Opinion: Making Step 1 cross/fail is ‘root rot’ that can undermine the medical career

Among the limitless metrics for assessing the standard of well being care, one that’s exceedingly essential for measuring doctor high quality is on the chopping block.

I’m speaking about turning the U.S. Medical Licensing Examination Step 1, which all medical college students take on the finish of their second 12 months of research, right into a cross/fail check. This proposed change was quietly introduced by the house owners of the check and has acquired virtually no media protection. Such a pivotal change, which I discover troubling, deserves larger consideration and debate. In the event you, too, suppose it’s an unwise transfer, make your voice heard earlier than feedback on the proposal are closed on July 26.

Over the previous 20 years, medical colleges have mimicked bigger developments in increased schooling to turn out to be extra various by deemphasizing standardized testing for admissions. As soon as medical college students are within the door, directors have tried to handle disparate ranges of accomplishment by embracing cross/fail grading methods that emphasize experiential studying over foundational ideas.


The dearth of goal metrics has led to a larger reliance on numerical scores from the Step 1 examination. For the administrators of residency and fellowship applications, these scores function simply quantifiable proxies of means. A change to cross/fail would characterize the end result of years of watering down medical schooling in ways in which have vital repercussions for medical coaching and affected person care.

In idea, these well-intended efforts intention to scale back strain on medical college students and improve range. But they’re more likely to have the other impact.

With out goal requirements like standardized testing or grades, residency administrators must concentrate on who you already know and what you’re. Utilizing the who-you-know commonplace will place much more strain on college students to safe entrance into prestigious faculties and medical colleges as a result of the proxy of educational pedigree and community of elite establishments will carry extra weight relating to placement in residency and fellowship applications. It will improve the medical college rat race by forcing college students to concentrate on accumulating secondary laurels corresponding to pursuing myriad management actions or pledging indentured servitude to analysis professors who could have outsized affect on shaping their residency prospects as a result of absence of different goal requirements.

With out goal methods like grades and Step 1 scores to measure means, the what-you-are commonplace will make it simpler to justify race-based quotas in residencies and fellowships. Marginalizing the significance of standardized testing could make it simpler to broaden alternatives for people who can examine the appropriate gender and race packing containers. But it surely comes at a price for individuals who shouldn’t have the “proper” networks and fall exterior of the “proper” classes.

Admission to residency applications primarily based on networks and classes is, by definition, arbitrary. In a world with out requirements, individuals could merely assume that medical trainees acquired into their applications due to their elite connections, race, or gender. This could delegitimize medical college students’ efforts and the method itself. Standardized testing, for all of its alleged flaws, is the important thing to real equal alternative. By having goal metrics, medical college students can focus their energies on mastering the fabric and demonstrating they’ve the power to succeed as physicians even when they don’t come from essentially the most prestigious establishments or well-connected households.

If elite networks and pedigree had been the important thing a era in the past, Asian-American college students like me would have had restricted entry to medical college or residency slots and would have been on the skin trying in — simply as Jewish college students have been a era earlier when elite universities and hospitals had quotas to restrict the variety of accepted candidates who have been Jewish. In a career the place extremely refined expertise, impeccable judgement, and swiftness of thoughts could make a distinction between life and demise, requirements that depend on networks and classes of race and gender undercut the purpose of medical coaching.

Medication and benefit ought to go hand in hand. Whenever you face vital sickness, you need to see physicians whose many years of rigorous coaching in medical college, residency, and fellowship function proxies for his or her competence. The advice for cross/fail reporting of Step 1 scores represents an unvarnished try to abolish the final benefit examine in drugs. Whereas this method could open the door for larger range in residency and fellowship placements, it perpetuates a sample of evisceration in high quality and requirements.

Nobody needs to see a doctor who will get diagnoses proper solely half of the time. Watering down the system by eliminating numeric scores on Step 1 equates to root rot that can steadily undermine the medical career.

Kim-Lien Nguyen, M.D., is a heart specialist and assistant professor of drugs on the David Geffen College of Medication at UCLA. The views expressed are these of the creator’s.