Most of us in medicine are aware of the fact that quantitative scores are beginning to disappear for the new generation of burgeoning practicing doctors. I started to think a little bit more about the ramifications of this over the past coupe of years and it really struck me this past week. Is this truly a good thing? For medicine? For medical students and residents? And for the field as a whole?
The answer is not as simple as you may initially think.
Let’s take a look…
Some background
I’ve talked before on this blog about all of the hoops that doctors have to jump through before actually becoming…well a real doctor.
Among these are:
- Undergraduate classes
- MCAT
- Medical School classes
- Steps 1-3
- Residency
- Fellowship
It’s a lot! And along each step in the path, you are evaluated. And those evaluations help determine if you are successful moving along to the next step in the path. Sometimes these evaluations determine if you move on at all. And other times they determine the degree of success you have moving along – do you go to the top medical school or a lower tier one, for example.
And this largely worked because the evaluations, whether test scores, clinical rotation grades or anything else were scored quantitatively.
But then things changed…
A few years ago, Step 1 – the big test medical students need to take before matching into residency – went from a scored text to a Pass/Fail test.
And over the past few years, many medical schools have stopped grading classes along a High Honors/Honors/Pass/Low Pass/Fail continuum in favor of a Pass/Fail binary.
And then, this past year, general surgery stopped reporting percentile marks in the scoring of its yearly In-Service exams.
Why this got me thinking about the value of quantitative scores in medicine
This past week, my partners and I concluded our interviews for plastic surgery residents hoping to match into our Independent Plastic Surgery residency program. Our interviewees were an impressive bunch who were all in the process of completing their general surgery residencies and desired to complete an additional 3 years in training to become a plastic surgeon.
From the program’s perspective, choosing the right candidate is super important. And the process of determining who is the right candidate is challenging. Before we even get to interviews, we have to pare down the list based on their applications – a conglomerate of their personal statements, letters of recommendations, and – yes – scores and evaluations.
And while quantitive scores are imperfect, they do give us a marker of someone’s aptitude and – in my opinion – ability to work hard, study, and score well. This often correlates to more successful applicants and future residents.
However, this year things got a bit harder without the percentiles being reported.
So, is this good or bad?
Like I said at the start, the answer is nuanced and all I can give you here is my opinion. But I think it is bad. For medical students and residents. And medicine in general.
First of all, let me start by saying that I know tests are evaluations like these are imperfect. There will be “false positives” in people that score better than they may be as an actual doctor as well as “false negatives,” those who score poorly but will be amazing doctors. And I understand the socioeconomic issues involved.
However, we don’t have anything better right now. And it helps programs choose the best fit. For instance, I don’t always look for just the highest score. Seeing a trajectory of improvement in in-service scores for our applicants is more important for me.
But I really think this is most unfair to the applicants. Even though on first glance it seems to be in their benefit.
My example
I matched into an Integrated Plastic Surgery residency, notoriously one of the hardest residencies to match into for a medical student. And I’ll be honest, some of my application was pretty weak. I was not AOA. I had good grades in my non-clinical classes but not amazing. And I also discovered plastic surgery late and had very little research.
So how did I get in and match?
Well, I recognized the importance of Step 1 scores in the application process as well as clinical grades. So I worked my tail off to study and prepare and did really well on both.
This “got my foot in the door” so to speak as programs saw these numbers and took a deeper dive into my application, seeing great letters of recommendation and inviting me for an interview, where I also prepared and excelled.
Honestly, if all I had on Step 1 was a “pass” grade, I’m not sure I would have been able to distinguish myself.
Simpler is not always better, even when nothing is perfect
This is my message.
Quantitative scores in medicine are imperfect. But nothing better currently exists. And unfortunately, by seeking to find a more equitable solution, we just found a simpler one. Or maybe it is better put as just a less troubling solution. And easier one.
Unfortunately I don’t think this made things any better. And maybe made it worse.
For everyone involved…
What do you think? Do the recent changes in quantitative scores in medicine change things for better or worse? Why or why not? Let me know in the comments below!
One Response
I agree with your opinion about Pass-Fail. There has to be some quantitative assessment of a physicians credentials. Getting the interview for any residency program is the biggest step, and something has to set the students/physicians apart from each other. Truly, the commitment to becoming a doctor can start as early as the SAT’s in high school, and whether you change paths in college to become a doctor you still need to demonstrate aptitude and abilities for preparing. The other parts that are also critical to selecting the best resident for the program is; leadership, teamwork, mental sharpness and communication, all of which can be gleaned during the interview process…provided you get to that.