Newsflash: The test writers who write the USMLE are on the NBME.
Once again, this isn't something we didn't already know. The point is that the USMLE/NBME's official institutional statement may differ from what the individual test-writers feel or what the individual state authorities feel. That doesn't really change the discussion here.
Of all people who would know what exactly the test measures, it would be the people who actually write it. I don't see how that is a difficult concept for you to grasp.
Because it's simply not true - at least not the way that you're extrapolating it. The question-writers write questions to assess medical competency. Clearly that's what those questions are doing - no argument there. If the question-writers knew that the exam would be used to differentiate candidates for residency selection, would they change those questions? I doubt it. And if they did, how would they do it?
Statisticians then use those questions to come up with a score to determine how well candidates perform on those same questions. If you're looking to differentiate candidates, why wouldn't you use a score based on how they perform on questions of medical competency? Just because the USMLE specified some arbitrary cutoff to say someone is minimally competent, doesn't mean you can't take it one step farther and say these people perform better than their peers - especially when they give you a metric to do just that.
The USMLE doesn't need to tell us how to think for ourselves. If an exam gives a standardized score to different examinees, you can use it to differentiate those applicants. Whether you actually should is a judgment call and one left up to the individual PDs. So in reality, it's the PDs (not the question-writers) that are actually in the best position to evaluate if the exam measures the qualities that they're looking for in their program.
You realize for the longest time basic sciences was taught together with dental students and medical students in the same room right? In fact, Harvard still does this with HMS med students and Harvard dental students learning basic scieences together. You can parse it by saying we're "different", but that's obviously not the case as medicine doesn't work in a vaccuum. Unlike other professions, medicine purposefully doesn't look to others to see if they're doing it better and we can adopt the good parts. It's why the federal govt. has now said enough is enough, and the medical profession doesn't get a monopoly over giving medical care to the nation - see: NPs and PAs.
No argument with anything you've said here. I just don't see how dentists "are doing it better."
Again with respect to "level expected of individual specialties or programs" - do you actually think that Internal Medicine has changed so much to where a certain score demanded now is different from that a few years ago? What about Radiology?
The USMLE seems to think so, because they've increased the passing score almost every year.
Programs demand a certain score not bc it's actually needed for a certain specialty, but bc they're responsing to the level of competition, pure and simple.
Yep, and same thing happened with the MCAT - another exam that institutions use to differentiate candidates.
A specialty being competitive doesn't mean that a higher Step score is required to be successful in that specialty - esp. when it can be gamed - i.e. IMGs taking months to years to study to blow out the Step.
Right, but IMGs don't perform as well as USMGs in the match, probably because PDs already know this. Either way, it goes to show that these scores aren't everything, otherwise IMGs would dominate the top sub-specialty programs.
