The Match: A Numbers Game
This hyperinflation has left programs to rely on United States Medical Licensing Examination (USMLE) score thresholds well above the passing mark to screen applicants, and program directors rate USMLE Step 1 scores as more important than core clerkship grades, leadership/volunteerism, and the Medical Student Performance Evaluation.1 Yet screening thresholds are not validated, and USMLE scores capture a narrow picture of applicants. Nevertheless, we understand why many programs use the USMLE for screening: No other standardized measures exist, and clinical grades are virtually incomparable between institutions. Thus, as USMLE scores have emerged as a dominant factor in the application process, high achievement on these exams has become a primary focus for many students, often at the expense of our core curricula and emotional well-being. As we await residency interview offers, we are struck by the harsh, dehumanizing reality that these numbers—coldly calculated based on our performance on several hundred multiple-choice questions—are uncompromising gatekeepers to our continued training and care of patients.
Many “solutions” have been offered. Purely pass/fail USMLE grading would likely alleviate some performance stress, but it would not address the underlying hyperinflated application process, leaving programs to screen using other ill-suited measures with unforeseen deleterious consequences. Similarly, limiting application numbers, while tempting, may adversely affect select groups, such as couples and international applicants. Clearly, no single countermeasure will be a panacea. Rather, we urge the Association of American Medical Colleges, the American Medical Association, the National Board of Medical Examiners, and others to partner with student leaders in a holistic reassessment of the process. Only a multifaceted approach addressing the myriad root causes of the hyperinflated residency application process will reign in this numbers game—and provide needed respite to applicants and programs alike.