Stepping Back: Re-evaluating the Use of the Numeric Score in USMLE Examinations
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COMMENTARY
Stepping Back: Re-evaluating the Use of the Numeric Score in USMLE Examinations Paul George 1 & Sally Santen 2 & Maya Hammoud 3 & Susan Skochelak 4
# International Association of Medical Science Educators 2020
Abstract There are increasing concerns from medical educators about students’ over-emphasis on preparing for a high-stakes licensing examination during medical school, especially the US Medical Licensing Examination (USMLE) Step 1. Residency program directors’ use of the numeric score (otherwise known as the three-digit score) on Step 1 to screen and select applicants drive these concerns. Since the USMLE was not designed as a residency selection tool, the use of numeric scores for this purpose is often referred to as a secondary and unintended use of the USMLE score. Educators and students are concerned about USMLE’s potentially negative influence on curricular innovation and the role of high-stakes examinations in student and trainee well-being. Changing the score reporting of the examinations from a numeric score to pass/fail has been suggested by some. This commentary first reviews the primary use and secondary uses of the USMLE scores. We then focus on the advantages and disadvantages of the currently reported numeric score using Messick’s conceptualization of construct validity as our framework. Finally, we propose a path forward to design a comprehensive, more holistic review of residency candidates.
Commentary There are increasing concerns from US medical educators about students’ over-emphasis on preparing for a high-stakes licensing examination during medical school, especially the US Medical Licensing Examination (USMLE) Step 1, typically taken after foundational curricula, and USMLE Step 2 clinical knowledge (CK), typically taken during the 4th year. These examinations are scored using a three-digit score typically in a range from 140 to 260, with higher scores representing a stronger examination performance [1]. Each examination has a specific cut-off score that is used for the pass mark. The primary goal is to pass the examination.
* Paul George [email protected] 1
Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912, USA
2
Virginia Commonwealth University School of Medicine, 1201 East Marshal Street, Box 980565, Richmond, VA 23298, USA
3
University of Michigan Medical School, 1540 E Hospital Dr, SPC 4276, Ann Arbor, MI 48109-4276, USA
4
American Medical Association, 330 N. Wabash-43rd Floor, Chicago, IL 60611-5885, USA
However, three-digit numeric score is used by program directors for residency selection. Student emphasis has its primary basis in how residency program directors use USMLE numeric scores for screening and selecting applicants. Since the USMLE was designed as a tool for licensing and not as a residency selection tool, the use of scores for this purpose is often referred to as a secondary and unintended use of the USMLE numeric score. Medical students who desire to compete successfully for residency programs may no
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