Thread by @jbcarmody

The @NBMEnow has a task force to study whether high-stakes exams like the USMLE contribute to student burnout.

It sounds to me like their inclination is just to blame students for their lack of resiliency.

Am I misunderstanding something here?

Here’s the link to the interview so you can listen to the whole thing for yourself.

missinglogic.com/podcast

It’s striking to me how the interviewee poignantly shares his own story of burnout from his internship - which occurred “before duty hours were truly implemented” - but seems largely oblivious to the fact that *systems* contribute to student burnout today.

He fondly describes the USMLE as a “rite of passage” - but overlooks the fact that students taking the USMLE have a completely different experience today than students did even a few years ago.

Don’t know what I’m talking about?

Let me introduce you to USMLE #scorecreep ...

The NBME executive being interviewed took Step 1 around 1996.

In 1996, a Step 1 score of 230 gave you the keys to the kingdom for residency. (Your score would be in the 90th percentile, analagous to a 255 today.)

In 2018, the *national mean* score was 230.

Or consider this:

In 1996, the *national mean* USMLE Step 1 score was 205.

Know what a 205 gets a student nowadays?

A score in the 11th percentile, and screened out of most competitive specialties and programs.

Bear in mind, scores on the USMLE don’t get “recentered” like those on the old SAT. Students today score higher because they answer more questions correctly than students in the past.

thesheriffofsodium.com/2019/05/13/ano…

Now, do students today have access to better study resources? Sure.

But that ignores the fact that they are under much more pressure to score higher and higher to distinguish themselves from their peers. And that pressure is nonstop.

I see M1’s carrying around First Aid from the moment classes start in August, or who essentially live in UWorld - to the detriment of the rest of their medical education.

You can feel the pressure they’re under - because they know that if they’re not studying, SOMEONE ELSE IS.

(And please spare me the comments about how MDs have to work hard, so medical students need to suck it up.

I get it. I am one, and I work hard. That doesn’t mean we should force students onto an educational hampster wheel that burns them out before they even see a patient.)

And I get this, too: burnout is complicated, and there’s more to it than just the USMLE.

But as I have pointed out before, the NBME has a financial conflict of interest related to USMLE policy.

Of course they’re gonna say their test isn’t the problem.

ncbi.nlm.nih.gov/pubmed/31850948