The evaluation of Medical Students and the United States Medical Licensing Exam (USMLE) are charted here by L. Maximilian Buja, MD, Professor of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth) The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) (Wikipedia, 2020). The stated goal of the USMLE is to assess a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centred skills that are important in health and disease and that provide a basis of safe and effective patient care. The USMLE exam has three steps Step 1, Step 2 Clinical Knowledge (CK), Step 2 Clinical Skills (CS), and Step 3. All three steps of the USMLE exam must be passed before a physician with an M.D. degree is eligible to apply for an unrestricted license to practice medicine in the United States. U.S. osteopathic medical school graduates are permitted to take either the USMLE or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) exam for medical licensure. Students who have graduated from medical schools outside the U.S. and Canada must pass all three steps of the USMLE to be licensed to practice in the U.S., regardless of the title of their degree. USMLE Step 1 assesses whether medical school students or graduates understand and can apply important concepts of the basic sciences to the practice of medicine. Step 1 is constructed according to an integrated content approach and includes the following subjects: Anatomy, Behavioral Sciences, Biochemistry, Microbiology, Pathology, Pharmacology, Physiology, and interdisciplinary topics such as nutrition, genetics, and ageing. U.S. medical students take Step 1 at the end of the Basic Sciences portion of the curriculum, usually after the second year of medical school. The content and timing of the Step 1 exam is the reason it is broadly viewed as a most arduous and high stakes examination for medical students. Its three-digit quantitative result has had a substantial bearing on the specialities and status of the healthcare system for which a residency applicant is competitive. Medical education The traditional medical education system widely adopted throughout most of the twentieth century has produced generations of scientifically grounded and clinically skilled physicians who have served medicine and society well. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in undergraduate medical education (UME) and graduate medical education (GME) (Buja. 2019). The core goal is the production of physicians with modern clinical reasoning and decision-making skills. The construct to achieve this overarching goal is the so-called fully integrated spiral curriculum encompassing both horizontal and vertical integration across time and disciplines (Brauer and Ferguson, 2015). The fully integrated curriculum resulting from the redesign does away with the distinction between the critically important pre-clinical (basic medical sciences) two-year period and the apprenticeship-like clinical two-year period. It brings in additional content called Health Systems Science, as a co-equal to basic and clinical sciences, to cover topics from population health to interdisciplinary care. There also has been a push in recent years for undergraduates to demonstrate competencies rather than solely cognitive knowledge. How students function in an educational program is inextricably linked to how they are evaluated. Recurrent movements to abolish grades, exams and honour societies to mitigate undue competitiveness, stress and general malaise are prevalent today. For many years, the standard system of student evaluation was based on numerical grades in every course and led to a cumulative numerical score and class ranking. This objective evaluation system has largely been replaced in medical schools by summative pass-fail systems. The movement away from meaningful grades for medical school courses also has led to an increasingly elaborate subjective evaluation in “dean’s letters”. The AAMC has introduced the Medical Student Performance Evaluation (MSPE) as a refinement of the “dean’s letter.” Approaches to evaluation of student performance generally involve formative and summative exams in the pre-clinical years, and subject exams coupled with faculty assessment of performance, in the clinical clerkships. Then, these evaluations (honours, high pass, pass, etc.) are integrated into lengthy MSPEs or dean’s letters that provide commentary and largely subjective impressions. Despite the AAMC guidelines of comparative information about applicants be included, dean’s letters or MSPEs often continue to lack specificity regarding student performance. Further thoughts on the United States Medical Licensing Exam This has led to the rise of the exaggerated importance of United States Medical Licensing Exam (USMLE) scores, particularly, USMLE Step 1 scores, as the major or sole objective evaluation of the cognitive achievement of medical students. Proponents argue that the new curricula are successful because students are performing at least as well on USMLE Step 1 as they did in the old curricula, and that they do as well in pass-fail systems as in systems with grades. However, these advocates, in essence, are contributing to the perpetuation of the undue importance of USMLE Step 1. An undue emphasis on a single high stakes summative evaluation creates a dilemma for medical educators and students. An excessive focus develops on preparing students for the USMLE Step 1 examination and “teaching to the test”. This milieu is counterproductive to in-depth assimilation of subject matter in the biomedical sciences. Unintended consequences in multiple domains include conflict with holistic undergraduate medical education admission practices, student well-being, and medical curricula. Medical students have become increasingly aware of the ”USMLE issue.” In an Invited Commentary, medical students from various institutions across the country have reflected on their shared experiences and have postulated that the emphasis on USMLE Step 1 for residency selection has fundamentally altered the preclinical learning environment, creating a “Step 1 climate” (Chen et al, 2019). They have commented on how the Step 1 climate negatively impacts education, diversity, and student well-being, and they have urged a national conversation on the elimination of reporting Step 1 numeric scores. Educators also have articulated similar recommendations regarding making the USMLE results reporting as pass/fail. But concern has also been voiced that pass/fail can be a disincentive to motivation for broad knowledge acquisition. Also, the development of an alternate, more holistic standardised metric by which to compare students’ applications for residency positions has been proposed but is currently not operative. In recent years, an applicant’s Step 1 score has been cited by residency program directors as their most important criterion in selecting graduating medical students for their residency program (Willett, 2020; Makhoul et al. 2020). The current use of Step 1 scoring as a major determinant for granting residency interviews has been met with tremendous criticism by the medical community, citing that the Step 1 exam was intended to be one of four licensing tests. It was never designed to be a predictor of medical knowledge for which cut-offs or barriers could be justified and instead enables racial bias. In response to public outcry, in February 2020, the USMLE program announced a plan to change Step 1 score reporting to a pass/fail system in an effort “to reduce overemphasis on Step 1 performance while allowing licensing authorities to continue the original intention to use the test to determine medical license eligibility.” However, this transition will occur no earlier than January 1, 2022. However, critics of this decision argued that this would just shift the importance of the three-digit number score on to Step 2 CK, as well as putting international medical graduates (IMGs) at a disadvantage, as traditionally IMGs scored exceptionally high on Step 1 to distinguish themselves and obtain residency positions in coveted specialities or hospitals. The movement of the USMLE Step 1 to a pass/fail exam is being viewed as a golden opportunity to recalibrate medical education priorities in UME and to improve the residency selection process. This view is generally taken by medical educators (Prober, 2020). However, this view comes up against the practical realities faced by residency program directors in dealing with the large number of applicants to individual residency programs (Willett, 2020). Programs receive thousands of applications and have only a few weeks to review them and decide on whom to invite for interviews. This phenomenon, dubbed “application inflation” has made holistic applicant review not practical. The change of Step 1 scores to pass/fail removes one of the few objective data points that program directors use for filtering. With the change to Step 1, Step 2 CK will inevitably become the highest-stakes test for students. To characterise residency program directors’ responses to binary Step 1 result reporting, a 19-item survey has been developed and validated (Makhoul et al, 2020). A total of 2,095 unique responses (response rate, 44.5%0 were obtained. Only 15% of program directors agreed with changing Step 1 to pass/fail, and 77% expected this change to make objective comparison of applicants more difficult. Concluding remarks I think that the dilemmas about the “USMLE issue” can be diffused by a return to providing meaningful grades for medical school courses and an overall summative evaluation for the four years of medical school. My definition of meaningful grades encompasses either numerical or letter grade equivalents which reflect actual performance relative to other students and objective norms. Students must compete and excel to gain admittance into medical school. This shouldn’t be any different when students are training to be physicians. Safeguards can be put in place to deal with excess competition. Nevertheless, competition within bounds promotes excellence. Medicine needs to remain a meritocracy.
This is just one of the STEP exams and may people complained that the high pass rate in STEP 2 and low efficiency to assess clinical skills with in the one-set exam in last years. Doctors still will have to take board exams to be certified in their society of medical field. So look for your doctor later to be titled "FACXX" for their credentials.
medical students from various institutions across the country have reflected on their shared experiences and have postulated that the emphasis on USMLE Step 1 for residency selection has fundamentally altered the preclinical learning environment, creating a “Step 1 climate” (Chen et al, 2019). They have commented on how the Step 1 climate negatively impacts education, diversity, and student well-being, and they have urged a national conversation on the elimination of reporting Step 1 numeric scores.
medical students from various institutions across the country have reflected on their shared experiences and have postulated that the emphasis on USMLE Step 1 for residency selection has fundamentally altered the preclinical learning environment, creating a “Step 1 climate” (Chen et al, 2019). They have commented on how the Step 1 climate negatively impacts education, diversity, and student well-being, and they have urged a national conversation on the elimination of reporting Step 1 numeric scores. ehhe 发表于 2021-01-28 14:09
回复 55楼lucky2020的帖子 说得非常对 现在的改革是把资质不够的学生送到hao的residency program去，又没有其他配套资源跟上（不用假想有额外资源，现状已经很差）。如果这些住院医跟不上培训强度，他们的职业发展会怎么样？如果他们不能如期完成训练呢？任何一个less qualify的住院医到了一个自己跟不上的项目，培训结果一定堪忧。如果很多人禁不住培训的压力，直接quit了呢？或者导师不得不降低要求？还有另外一部人觉得自己怀才不遇，也相继转行了呢？把医生的筛选机制做这么大幅的修改，很可能会导致市场失灵，最后医生总数和质量统统下降。那倒霉是谁？穷人的社区没有好医生，甚至会没有医生！这些轻飘飘修改考试机制的精英和这些缺医少药的贫困人口是没有交集的，而且灾祸发生在他们不需要负责的“遥远未来”。 the road to hell is paved with good intentions. 有时候连good intention都没有，就是为了自己觉得“自己做了一件好事”
Because there aren't enough patients in real-life per nurse for those skill practice. There are only so many. Many nurses will work in areas where they never start an IV in their whole career.
It''s easier to get good grades when you don''t have to worry about where the next meal is coming from, that is all I''m going to say. I''ve worked with many kids, none as determined and focused as kids from disadvantaged families. Their grades usually aren''t the best, because they''ve had the odds against them in the academic system since they were in kindergarten, but man do they try, while the rich kids look for every loophole they can find. You want those disadvantaged kids to be your doctor, because they know what it feels like to struggle, like you, or your parents. If they can''t sympathize with you, you''re nothing but a bunch of lab results to them; they don''t see you.
It''s easier to get good grades when you don''t have to worry about where the next meal is coming from, that is all I''m going to say. I''ve worked with many kids, none as determined and focused as kids from disadvantaged families. Their grades usually aren''t the best, because they''ve had the odds against them in the academic system since they were in kindergarten, but man do they try, while the rich kids look for every loophole they can find. You want those disadvantaged kids to be your doctor, because they know what it feels like to struggle, like you, or your parents. If they can''t sympathize with you, you''re nothing but a bunch of lab results to them; they don''t see you. teddysan 发表于 2021-01-28 16:54
You probably don't work in the system so not your fault that you feel this way. Your perception might change once you're in the system. Grades of a certain period of one's life are only one aspect of a person, a mere screenshot, and having good grades isn't everything in the operating room.
You probably don't work in the system so not your fault that you feel this way. Your perception might change once you're in the system. Grades of a certain period of one's life are only one aspect of a person, a mere screenshot, and having good grades isn't everything in the operating room. teddysan 发表于 2021-01-28 17:05
链接在此。 以后医学院学生的临床技术只是让学校负责监督了，呵呵。
🔥 最新回帖
unbelievable..it happened in blue stateS?
他们就是担心以后看不到白人医生了，着急。
🛋️ 沙发板凳
这意味着什么？
就和如果SAT取消会怎么样，就看学校的成绩，一个道理
AA 变种 。。。。你不服 ！！
为啥不干脆取消医院得了，有病就等死，和现在差不多啊
楼上说的，要命的来了。
看到diversity
Step1 及其有用，但是要取消了
step1 已经改成p/f了,现在取消step 2 的cs,下一步就是取消step 123了
https://forums.huaren.us/showtopic.html?topicid=2504980&fid=398&page=1
你高估了许多AA上来的本土医学院学生的能力.我认识的本土医学生没过cs的就不止一个. 排名前30的医学院
现在的老人还有的选放水前的医生，等我们老时，就都是放水后的滥竽充数医生，没得选啦。原来还以为就说说而已，没想到，这么快就革命啦!
现在医学生都提前考，这样就算2023年match 也有分数成绩， 2024年以后应该都没有了以后
考试早晚都会易化，以后就是主观的，录取标准有多方面的subjective reason决定
所以，diversity 其实就基本是low standard/low quality的同义词了
mark mark.
绝对的，而且这一天的到来会相当的快。今天立此贴为证，看看多久变成现实。
不用有生之年,照现在这个屎样子,不出十年就会过,而且再配合全民医保,不要太酸爽
不用有生之年，很快了
pc正确的叫法
想想就觉得酸爽，当然了，有人觉得医生好不好没区别，呵呵，那开刀的呢？
记得以前wxc有个帖子控诉贵人牙医把好牙当坏牙拔了
再继续china virus下去估计你看医生的权力都不会有，那时候希望你也不要生病
华人不在贵人之列，政治地位不够哈
这你误会了吧，美国护士很多抽血技术都比较差，一针没找到血管很正常，就算我讨厌川粉，也没见过任何川粉会去故意折磨小孩子。你想多了
说得非常对 现在的改革是把资质不够的学生送到hao的residency program去，又没有其他配套资源跟上（不用假想有额外资源，现状已经很差）。如果这些住院医跟不上培训强度，他们的职业发展会怎么样？如果他们不能如期完成训练呢？任何一个less qualify的住院医到了一个自己跟不上的项目，培训结果一定堪忧。如果很多人禁不住培训的压力，直接quit了呢？或者导师不得不降低要求？还有另外一部人觉得自己怀才不遇，也相继转行了呢？把医生的筛选机制做这么大幅的修改，很可能会导致市场失灵，最后医生总数和质量统统下降。那倒霉是谁？穷人的社区没有好医生，甚至会没有医生！这些轻飘飘修改考试机制的精英和这些缺医少药的贫困人口是没有交集的，而且灾祸发生在他们不需要负责的“遥远未来”。 the road to hell is paved with good intentions. 有时候连good intention都没有，就是为了自己觉得“自己做了一件好事”
看医生的资格也没有？你哪里来的敢说这个话？美国的ER都不会拒绝病人，你凭什么说这话来吓唬华人？
那以后就只能看医学院排名了。
应该是为了贵命的人可以拿到本来拿不到的执照
Step 1 如果再取消的话，我觉得对外国医生来说，就很难再拿到住院医机会了。因为基本只能考医学院的排名了。
那就看毕业的医学院呗，起码进医学院还有那道坎，MCAT还在。
那你知不知道亚裔38分(99%)和某些27分(61%)同时上藤校医学院.而且MCAT指不定哪天就取消了
这类人不就是天天华人进集中营之类的言论吗？你何必较真呢
此话怎讲？一直以为美国都是最聪明的那些学生中的人才能当医生
这不见得， 以前cs也是很卡外国人的。。。
从来都不是这样
真是这样的
技术这么差的护士为什么有资格上岗？
That would hurt IMD for sure since only P/F will be given for STEP 1. The score would make a few IMD stand out before.
如何才能在看医生时候挑出那些最优秀的？
The rich kids with family support get to be doctors. It's a very biased system.
以后全民医保，哪轮得到选医生？
Rich kids也要够勤奋努力啊，当然以后就另当别论了
Because there aren't enough patients in real-life per nurse for those skill practice. There are only so many. Many nurses will work in areas where they never start an IV in their whole career.
It''s easier to get good grades when you don''t have to worry about where the next meal is coming from, that is all I''m going to say.
I''ve worked with many kids, none as determined and focused as kids from disadvantaged families. Their grades usually aren''t the best, because they''ve had the odds against them in the academic system since they were in kindergarten, but man do they try, while the rich kids look for every loophole they can find. You want those disadvantaged kids to be your doctor, because they know what it feels like to struggle, like you, or your parents. If they can''t sympathize with you, you''re nothing but a bunch of lab results to them; they don''t see you.
Rich Kids真的不用足够努力 你看医学院里那些吊儿郎当的，照样能让家长塞进好地方。
简直是扯淡，不管是什么原因，成绩差就是差，就是业务水平低，学艺不精！
什么时候开始，看一个人的水平如何还要考虑这人的家庭条件，父母条件了。
你这就是脑残的结果公平。 别丢人现眼的来给人洗脑了。
你去找医生的时候还会看，哦，这个人小时候家里穷，虽然做手术经常失败，但是我就要选他？！！那就祝你早日碰到这种医生！
You probably don't work in the system so not your fault that you feel this way. Your perception might change once you're in the system. Grades of a certain period of one's life are only one aspect of a person, a mere screenshot, and having good grades isn't everything in the operating room.
上岗并不需要考抽血啊... 而且很多地方都有专人抽血
天啊！这问题问的有些可笑了。美国护士静脉取血技术差的不要太多啊！而且，就我个人经历来讲，不是歧视非裔，还真的就是年轻一点的非裔护士技术最差劲。
但是，连基本的grades都达不到的话，那医生这条路就不应该为他/她打开。凭什么让普通人用自己的健康甚至生命为代价，去成就那些连基本门槛都够不到的那些人的人生梦想？人生道路并不是只有当医生这一个选择，如果成长背景家庭条件无法使自己具备基本的医生资格，那就不要做医生去草菅人命。
好医院不用太担心，虽然也有diversity因素但是能挑到最合适的人，特别是专科医生竞争激烈。 家庭医生就要小心了 。没其他意思不过大内科很难衡量医生水平。。。
多挣钱把
I hope you know they still have to pass the board...
就是缺人而已， 六万刀一年你想找什么样的护士？