D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d Di s c ove ry w ith H um anis m in Me dicine
Vol. 8 Issue 3 July 2019
MisStep, or Step in the Right Direction?
The impact that one’s Step 1 score has on one’s future causes enormous anxiety in medical students. Scores below a particular threshold effectively rule out consideration by certain schools and specialties, and (with some exceptions) students cannot retake a Step exam that they have previously passed. With stakes that high, the time and effort students devote to doing well on the Step 1 exam can be at the expense of participation in classes, as well as their health and relationships. Additionally, the current system appears to result in unintended discrimination against financially less well-off students due to the high cost of additional study prep materials. Dr. Mark Rasnake, Program Director for the Internal Medicine residency, describes himself as ambivalent about the proposal. “On the one hand, standardized tests don’t predict who will be a good resident, or a good doctor,” he notes. However, the Step 1 exam does predict the likelihood that a student will pass the American Board of Internal Medicine (ABIM) exam. The fact that it is objective and nationally-recognized can help some students. “Performing well on Step 1 is a way for students from less well-known schools and international schools to distinguish themselves,” observes Transitional Year Program, Director Dr. Daphne Norwood. With the high volume of applications to residency programs, stellar Step 1 scores allow students from these schools to capture the attention of residency program directors. Changing to a pass/fail reporting system could backfire and result in less diversity, more stress, and more applications to residency programs, which would then have fewer criteria to sort them out. If Step 1 scores are reported as pass/fail, what other criteria could be used to evaluate candidates for residency programs? “In many ways,
The first of the three United States Medical Licensing Examinations (USMLE), known as the Step 1 exam, is taken after the second year of medical school. It was designed as a pass/fail test to ensure that students have adequate knowledge of basic science for the purpose of licensure. However, numeric scores have come to be widely used to screen and rank applicants to residency programs. In March of this year, key stakeholders met to discuss whether to report Step 1 results simply as pass/fail, without disclosing scores. The change is being considered due to concerns that a “Step 1 climate” -- that is, a disproportionate emphasis on the exam -- is interfering with the preclinical learning environment and student well-being.
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Points of View
numbers could be a matter for debate, it is clear that the death rates due to medical errors are unacceptably high. While errors occur in all industries, health care has a much higher error rate compared to other complex enterprises, such as airlines, banking, or courier delivery. In fact, I was shocked to learn that medical errors are now ranked as the third leading cause of death just behind cardiovascular diseases and cancer being the first and second leading causes respectively in the United States! Medical errors may arise from a variety of sources including: failure to diagnose, wrong diagnoses, errors in treatment, failure to provide preventative care, inadequate monitoring, poor follow up treatment, as well as laboratory errors, or equipment failure. However, in my opinion, the most common underlying problem that results in serious medical errors leading to a fatal outcome is a breakdown in communication at multiple levels. Most hospitals, including ours, are making strong efforts to reduce all potential sources of medical errors with a strong emphasis on patient
Physicians strive to do the best for their patients by constantly giving their best to provide high quality, timely, and patient-centered medical care. On most occasions, we are successful in this mission so patients and their families are very grateful for the care they receive. However, in some instances the health care system falls short of providing optimal care for our patients. We in Rajiv Dhand, MD, Chair the medical profession need to be very concerned about the significant error rate in the care we provide. In a widely quoted study, experts at Johns Hopkins analyzed medical death rates in U.S. hospitals over eight years and concluded that medical errors account for more than 250,000 deaths each year. Other studies have also reached similar conclusions. While the exact
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