Getting rid of USMLE?

[surag]

---

Members don't see this ad.

If there were no tests in medical school and everything was based on a subjective score, I bet a sizable portion of students will stop pursuing medicine on that alone 🙄... medical school will be like art class, soft and fluffy.

no...it would be like law school or business school. unless u got into the top 10 your degree would b meaningless for the most part.

 

[Gabby]

I dont buy into this one bit....and I do believe that the concept of 'bad test taking' is an excuse. let me explain...

test taking requires a different mental preparation than information studying. There are several purposes of a test-(im not a med student yet but I have taken the MCATs...)- in many cases for such standardized tests(and this pertains to STEPS though Im not sure about her schoole exams)- in many cases, the purpose is severalfold-

1. to ensure that the distribution of students is such that only a small percentage can succeed in the exam off the charts, i.e. make sure the exam is hard enough that its a valid examination. basically the test is made so that you make mistakes.
2. to test material(obvious)
3. as a way to compare students on several levels not just knowledge based. I dont agree that the MCAT and SATs are true IQ examinations, but they are passage dependant and require you to APPLY what you have learned in some manner(while the effectiveness of addressing critical thinking through this method may be controversial you cannot deny that these exams are NOT straight up knowledge tests)

As a result, students who have command of INFORMATION, may not have a command of APPLICATION. Thats different from concepts. you're friend may be a master of concepts but applying them in unique situations may be a difficulty for her. reading through a passage and then finding out ONLY the relevant information and ignoring the rest is a form of reading comprehension/application. this sort of thing is usually NOT covered by ur information studying. that could be only one of the issues at hand here.

In any case, my point is that saying one is 'not a good test taker' is a trivialization of the test taking process. It implies somehow that this individual has not done as well only because of some un important aspects that the test seems to examine and the person would be a good doctor/student otherwise.


On that note, just because there is a strong correllation between the step 1 and good residents doesnt mean that the step 1 is a good indicator. there are a lot of confounding variable involved(didnt you guys take stats for crying out loud?) maybe...students who study hard do well on step 1s and residency because they are HARD WORKERS not because the step 1 perpares them or measures the same variables necessary for residency success. and thats just one (haphazard and obvious) example i came up with.

So you don't think someone can be a hard worker and good student, but would have trouble with timed multiple choice exams? Nothing I can do to convince you, I guess. You just have to meet one of these people.

 

[Gabby]

If the USMLE is no longer used for residency placements, watch everyone aim for the bare minimum to pass. Matching will also become even more of a crapshoot, ever-dependent on subjective 3rd year grades as more and more schools are P/F.

I thought the whole point of modifying the USMLE was to ensure greater basic science coverage in the later "steps," since right now basic sciences is mostly clustered in Step 1 and program directors are tired of residents forgetting their basic sciences.

Where are you hearing that? The basic sciences have little correlation to the daily practice of medicine, from what I'm told. You learn real medicine in third year.

 

[Gabby]

Who wants to bet that program directors will be asking for MCAT scores if they don't have access to the board scores anymore...

I seriously doubt it. That would be asinine.

 

[ChimpanzeeMinky]

Where are you hearing that? The basic sciences have little correlation to the daily practice of medicine, from what I'm told. You learn real medicine in third year.

Having a solid foundation in the basic sciences is what separates physicians from mid-tier providers. The former understand the basis of disease and can address those problems that don't fit neatly into algorithms.

Approach medicine with the attitude that the first two years are not necessary and you will be a mediocre physician.

 

[Gabby]

Having a solid foundation in the basic sciences is what separates physicians from mid-tier providers. The former understand the basis of disease and can address those problems that don't fit neatly into algorithms.

Approach medicine with the attitude that the first two years are not necessary and you will be a mediocre physician.

I never said the first two years weren't necessary, but thank you for putting words in my mouth. Of course they're necessary. That's your foundation. What I said was there's no correlation between the first two years and the daily practice of medicine, *from what I've been told.* Obviously, as someone who's only worked as a volunteer in the clinical setting, I can only go by what others have told me and that is that as a practicing physician, you won't be reciting all the molecules in the Krebs cycle every day.

 

[ChimpanzeeMinky]

I never said the first two years weren't necessary, but thank you for putting words in my mouth. Of course they're necessary. That's your foundation. What I said was there's no correlation between the first two years and the daily practice of medicine, *from what I've been told.* Obviously, as someone who's only worked as a volunteer in the clinical setting, I can only go by what others have told me and that is that as a practicing physician, you won't be reciting all the molecules in the Krebs cycle every day.

Hard to be necessary if they have "little correlation to the daily practice of medicine."

Your words.

Some residency programs already are interested in learning your MCAT scores, btw.

 

[Perrotfish]

A good test taker can read the question and pull out the pertinent information to answer the question, while also picking up on tricks here and there. A bad test taker, for one reason or another, has a problem getting from the question to the answer. It has absolutely nothing to do with intelligently guessing.

But if the only problem is getting from the question to the answer, how does that seperate them from someone who just doesn't understand the material? To me, a bad test taker is someone who, compared to their fellow students, has a poor ability to perform on scantron tests relative to their ability to perform in a clinical setting. If, on the other hand, a student just flat out can't convert the information given to them into a diagnosis and treatment plan then that's a great example of someone who should fail the test.

 

[womp]

Where are you hearing that? The basic sciences have little correlation to the daily practice of medicine, from what I'm told. You learn real medicine in third year.

"Changing the USMLE" (2009):
http://weill.cornell.edu/mdphd/bm~doc/changes-to-the-usmle-an-a.pdf

"A particular concern relating to the present USMLE structure was the observation that student performance in the basic sciences deteriorated between Steps 1 and 2. This deterioration could be ascertained because the National Board of Medical examiners (NBME) over the years have inserted Step 1 questions into the Step 2 exam. These questions are not used for grading purposes but instead, for evaluating how well the students retain their basic science knowledge. Apart from Biochemistry, where the retention historically has been low and the Behavioral Sciences and Pathology, where the retention generally has increased, the trend is a decrease in the retention of basic science knowledge. Though this could reflect "binge and purge"study habits, as has been argued by some, the seemingly systematic decrease in the performance in Microbiology, Pharmacology and Physiology should be cause for concern. Basic science departments need to examine how the teaching material has been selected and presented—and whether the curricular reforms, with the move toward more integrated curricula, have had unintended negative consequences, in particular with respect to the learning and retention of basic science information.

"Another reason for the decreased retention may be that the material is not reinforced in the students' clinical training because the clinical faculty is under increasing pressure to generate income and may not have sufficient time (interest or, perhaps, knowledge) to teach and reinforce basic science information, such as pathophysiological mechanisms, molecular basis of clinical features and therapeutic rationale."

"Students taking Steps 2 and 3 will soon notice that increased numbers of clinical test questions will draw on scientific materials and reasoning processes that were emphasized in the pre-clinical curriculum. To an increasing extent candidates taking Steps 2 and 3 will be tested in their ability to integrate fundamental science with medical knowledge—with increased emphasis on biostatistics, epidemiology, qualitative and quantitative reasoning ability and use of the literature plus, of course,their clinical skills. Competency in medical knowledge, clinical reasoning and judgment and the ability to integrate the advances in translational science into clinical practice is likely to become increasingly important in Step 3."


http://www.apcprods.org/mtg/2008/Sat.FocusGroup3.ppt

"Basic science now more important than ever in medical practice."
"Not all basic science knowledge can be effectively 'embedded' in a clinical context"
"Emphasize importance of basic scientific foundations of medicine in all components, in a clinical context 'to the greatest extent possible'"

 

[Ableton]

But if the only problem is getting from the question to the answer, how does that seperate them from someone who just doesn't understand the material?

It doesn't - that is what makes the individual a bad test taker. Their score is not a true reflection of their knowledge.

To me, a bad test taker is someone who, compared to their fellow students, has a poor ability to perform on scantron tests relative to their ability to perform in a clinical setting.

This is what I am saying. What you don't seem to understand is that being a good test taker has very little to do with being better at guessing.

 

[Gabby]

Hard to be necessary if they have "little correlation to the daily practice of medicine."

Your words.

Some residency programs already are interested in learning your MCAT scores, btw.

Yes, those were my words and I explained what they meant. If you want to twist them to mean something other than that, that's your right, but I'll call you on it in a heartbeat. I never said they weren't necessary.

 

[Gabby]

But if the only problem is getting from the question to the answer, how does that seperate them from someone who just doesn't understand the material? To me, a bad test taker is someone who, compared to their fellow students, has a poor ability to perform on scantron tests relative to their ability to perform in a clinical setting. If, on the other hand, a student just flat out can't convert the information given to them into a diagnosis and treatment plan then that's a great example of someone who should fail the test.

Yes, I agree.

 

[Lokhtar]

It doesn't - that is what makes the individual a bad test taker. Their score is not a true reflection of their knowledge.

If they can't get to the answer from the question, then they don't have the knowledge.

 

[surag]

So you don't think someone can be a hard worker and good student, but would have trouble with timed multiple choice exams? Nothing I can do to convince you, I guess. You just have to meet one of these people.

No...I completely agree with that. I agree that one can be a hard worker and a good student and have trouble with standardized exams. However, I disagree with your trivialization of the exams. By saying "timed multiple choice exams" you are deconstructing what these tests are into very simple terms-turning the whole thing into a farce. You make it seem like these tests are not relevant or at least not as important as knowledge, hardwork, and being a 'good student'. I disagree...these exams test something that hardwork and being a good student do not: READING COMPREHENSION.

That is entirely different from mastering complicated concepts and reading a well written and difficult textbook. nuances are inherently missed if not tested for in exams. So a student maybe able to master the information in a complicated textbook but may miss out on critical aspects of its application. These can only be tested through some sort of rigoruos examination that expects you to find out the key information for the appropriate answer. That is not tested nor even taught in textbooks or class whether it is in college or medical school. Both merely provide you with guidance, knowledge, and to a certain extent the tools to succeed on the exam.

One must make the effort to both be knowledgeable and develop the capacity to apply this knowledge in any situation.

Now you might say...well she's good at clinicals and isnt that applying knowledge in a more appropriate(and more relevant) setting? yes you're correct...but its also not as abstract as reading a passage, breaking it down, and figuring out what is being asked for. Those are only found in peer reviewed, exams designed SPECIFICALLY to test what i just mentioned. A good clinician on the other hand is good based off several factors, including knowledge and application. however, most of the time, clinicians rarely come across complicated or puzzling 'tests' in real life that require them to apply their knowledge in some unique, abstract, and difficult way(and in a safe manner-no1 wants a new smart doctor treating the most difficult cases anyway). instead, these standardized exams offer such an opportunity.

As a result, I do believe it is very possible for someone to be a hardworker and student and yet still struggle on standardized tests. Im not saying she/he is dumb, im saying they lack some critical reading/comprehension skills that a more succesful student may have(and it very well maybe something that can be practiced for and acquired-and if so...its a good thing to be able to develop it[instead of it being inherent only])

 

[surag]

now to clarify, I dont want to trivialize what being a clinician is. I'm not a medical doctor, but i dont want that limitation to be used against me in my argument.

I understand that clinicians come across difficult instances...its a nature of the job. but I am also saying that abstract thinking is not a routine part of the job-at least on the level that say the MCAT or STEPs may test. (I could be wrong, but I always felt like hte MCATs asked questions you wont necessarily come across regularly even as a physician-isn't that the whole point of hte test?)

 

[MSSM2013]

If they can't get to the answer from the question, then they don't have the knowledge.

agreed.

 

[ChimpanzeeMinky]

If they can't get to the answer from the question, then they don't have the knowledge.

Or they can't apply it. Either way, it's clear why there would be a correlation found between basic science test results and clinical performance.

 

[Lokhtar]

Or they can't apply it. Either way, it's clear why there would be a correlation found between basic science test results and clinical performance.

Yea, I see it as the same thing. I can memorize a chinese phrase and still have no idea what it means. I don't think that qualifies as knowledge. You must be able to apply it to novel situations.

 

[Blesbok]

Lets make med school pass fail and then lets make boards pass fail. That way the best residencies in the most difficult specialties will have no idea what kind of student they are getting other than...he/she's a nice guy/girl at the interview. 🙄

 

[MilkmanAl]

Lets make med school pass fail and then lets make boards pass fail. That way the best residencies in the most difficult specialties will have no idea what kind of student they are getting other than...he/she's a nice guy/girl at the interview. 🙄

That'd be fine with me!

 

[surag]

That'd be fine with me!

or hot. a lot of women love me. maybe the female interviewer will appreciate my good looks and accept me as a result. in fact, thats how it should be. then the hospital would only be a sex crazy building of hotness!!!