The Archives

In chronologic order…

Checking the references: the evidence in support of Step 1

  • We’re told that Step 1 scores predict measures of physician quality. But do they? Let’s check the references.

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USMLE Step 1: leveling the playing field – or perpetuating disadvantage?

  • Do students from “lower tier” medical schools benefit from a scored USMLE? Or would they be better off by playing a different game altogether?

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USMLE Step 1: the “antidote to implicit bias”?

  • Under-represented minorities in medicine score lower on Step 1. So why do NBME executives think it’s a cure for bias?

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Raising the bar: encouraging trends in USMLE Step 1 performance, 1997-2017

  • Are rising Step 1 scores just “score creep” – or a sign of improving physician quality?

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A peek inside the USMLE sausage factory: setting the Step 1 minimum passing score

  • Why is the minimum passing score for Step 1 frequently increased? To understand why, we first need to understand how the passing standard for is set. Let’s find out how the sausages get made.

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A two-step plan for a better USMLE Step 1

  • If you turned Step 1 over to me, here’s what I’m gonna do.

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A non-MBA’s guide to NBME revenue in 9 simple charts

  • The NBME has a financial conflict of interest in maintaining a scored USMLE. Here’s why.

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A MCQ exam on the USMLE

  • I’ve studied the business of the NBME. Ready to take the exam?

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The new USMLE score report

  • Since January 2019, USMLE score reports have looked different. What changed – and why?

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On pi and Step 1 Mania

  • What would happen if we asked medical students to memorize digits of pi?

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The intellectual opportunity cost of USMLE Step 1

  • Students spend a lot of time studying for Step 1. What else could we do with that time?

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The etiology of Application Fever

  • Medical students are submitting more residency applications than ever before. Why? Who benefits?

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Symbiosis: the USMLE, ERAS, and medical education

  • Step 1 Mania and Application Fever need each other.

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The mythology of USMLE Step 1 scores and board certification

  • Do Step 1 scores predict success on the boards? Yes… but maybe not in the way you expect.

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The InCUS is coming – are we ready?

  • The corporate sponsors of the USMLE have organized an invitation-only conference to determine the future of USMLE scoring. The InCUS is nigh.

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InCUS wrap

  • What happened at InCUS? Who knows. Attendees have been asked to stay silent.

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What’s on USMLE Step 1?

  • Physicians who took Step 1 more than 5 years ago honestly have no clue what’s on the exam. Want to remind yourself what’s really tested on Step 1?

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Stonewalled: A brief update on InCUS, the NBME, and financial COI

  • I asked the NBME whether InCUS attendees received financial compensation. The answer? Silence.

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What can the NFL Draft teach us about residency selection?

  • Getting into residency programs is competitive… but nowhere near as competitive as the NFL. What can we learn from the metrics used to select NFL players?

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Step 1 Mania: The Case for #USMLEPassFail

  • Links to a video podcast of a Grand Rounds presentation with an overview of the case for a pass/fail USMLE.

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Another MCQ Test on the USMLE

  • Most of us do not interpret USMLE Step 1 scores appropriately. They’re not as precise and reliable as you might imagine.

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What’s the Antipyretic for Application Fever?

  • We have a major problem with Application Fever. The question is, what do we do about it?

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A Field Guide to USMLE Step 1 Apologists

  • You know what you never hear in the USMLE Pass/Fail debate? The full-throated defense of USMLE Step 1 as a great test. Here’s your field guide to the various USMLE Step 1 Apologists.

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Application Fever: The Movie

  • It’s not really a movie. More like a video podcast compiling my thoughts on the mess we’ve made with residency application inflation – and how we can get out of it.

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InCUS: The Conversation Continues

  • Preliminary recommendations from InCUS were just released. Unfortunately, they don’t tell us much – and what they do tell us isn’t what I hoped to hear.

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Applying Smarter, Part I: Breaking Down the AAMC’s Apply Smart Campaign

  • The AAMC’s Apply Smart campaign perpetuates misinformation, employs faulty logic, presents biased probabilities of residency entry, and is likely to encourage medical students to submit even more residency applications.

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As more essays are posted, I’ll continue to update this page.

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