Medical education has favored the children of doctors for many decades.
I believe it's easy to see and well known in medicine that these legacy docs have far more problems than those who legitimately earned their way into medicine. Just ask any nurse!!
However there is no study of this effect on medical quality.
I want to counterpoint a bit. I do think there is a general decline in the quality of medical education.
The USMLE, like the name says, was created with the purpose of determining whether someone is worthy of medical licensure, which is a yes/no process by definition. It has always had a pass/fail cutoff for this purpose. The use of the test for residency applications was not its intended purpose, and NBME and ACGME are separate bodies with a different set of goals.
Furthermore, of Step I and Step II, Step I is typically taken early in one’s career with little or no clinical experience, depending on the school, while Step II is taken later in school, the content is less basic science and more clinical medicine, and is still scored. It was always odd that residency programs focused on Step I; I would have preferred to have been judged on Step II (even though I personally had struggles during that time and it didn’t go great for me), and this is now the standard.
My last point is that it is strange to use a general medicine test to evaluate candidates for training in medical specialties. I hate to be the one advocating for more thousand-dollar standardized tests, but it would make more sense to me to have content-specific exams geared towards specialties, or groups of specialties. Perhaps the Board of Psychiatry and Neurology could just do one exam for applicants to its specialties. Is it crucial for a psychiatrist to know how to recognize a heart attack? Sure, but I think the USMLE content overall is not great in its applicability towards more focused specialties. It also might be worth considering having some objective tests of hand-eye coordination or other physical skills for applicants to surgical specialties.
Looked at globally, making Step I pass-fail could be a part of an overall trend of declining standards which delegitimizes medical education, but looked at as an isolated decision I don’t feel that bad about it.
Not to argue with you, just for my knowledge: What score do you need to pass? (I certainly hope that is above 60% which is a low passing score in many regular college classes).
The USMLE sets this every year. They say typically around 60% (https://www.usmle.org/bulletin-information/scoring-and-score-reporting). The benchmark for passing has increased over time; I suspect due to people prepping hard for this test, so it's possible that with the pass-fail being implemented that trend may reverse.
The benchmark for passing a medical school class varies of course, but is generally quite low, and medical schools have moved to pass-fail grading. I got a 50% exactly on the last exam I needed for my degree, under significant duress at the time. The old saying in medical school is: What do you call the person who graduates with the lowest grade? Doctor.
Dear Mr Edwards....was not aware of legacy doc phenomenon. Interesting research question. Thanks for commenting. SLS
thanks so much Dr BIngham for answering GenderRealistMom!
Medical education has favored the children of doctors for many decades.
I believe it's easy to see and well known in medicine that these legacy docs have far more problems than those who legitimately earned their way into medicine. Just ask any nurse!!
However there is no study of this effect on medical quality.
Wonder why?
I want to counterpoint a bit. I do think there is a general decline in the quality of medical education.
The USMLE, like the name says, was created with the purpose of determining whether someone is worthy of medical licensure, which is a yes/no process by definition. It has always had a pass/fail cutoff for this purpose. The use of the test for residency applications was not its intended purpose, and NBME and ACGME are separate bodies with a different set of goals.
Furthermore, of Step I and Step II, Step I is typically taken early in one’s career with little or no clinical experience, depending on the school, while Step II is taken later in school, the content is less basic science and more clinical medicine, and is still scored. It was always odd that residency programs focused on Step I; I would have preferred to have been judged on Step II (even though I personally had struggles during that time and it didn’t go great for me), and this is now the standard.
My last point is that it is strange to use a general medicine test to evaluate candidates for training in medical specialties. I hate to be the one advocating for more thousand-dollar standardized tests, but it would make more sense to me to have content-specific exams geared towards specialties, or groups of specialties. Perhaps the Board of Psychiatry and Neurology could just do one exam for applicants to its specialties. Is it crucial for a psychiatrist to know how to recognize a heart attack? Sure, but I think the USMLE content overall is not great in its applicability towards more focused specialties. It also might be worth considering having some objective tests of hand-eye coordination or other physical skills for applicants to surgical specialties.
Looked at globally, making Step I pass-fail could be a part of an overall trend of declining standards which delegitimizes medical education, but looked at as an isolated decision I don’t feel that bad about it.
Not to argue with you, just for my knowledge: What score do you need to pass? (I certainly hope that is above 60% which is a low passing score in many regular college classes).
The USMLE sets this every year. They say typically around 60% (https://www.usmle.org/bulletin-information/scoring-and-score-reporting). The benchmark for passing has increased over time; I suspect due to people prepping hard for this test, so it's possible that with the pass-fail being implemented that trend may reverse.
The benchmark for passing a medical school class varies of course, but is generally quite low, and medical schools have moved to pass-fail grading. I got a 50% exactly on the last exam I needed for my degree, under significant duress at the time. The old saying in medical school is: What do you call the person who graduates with the lowest grade? Doctor.