14 April 2013


Today I sat for my Step 1 national boards exam. Every MD student in the country sits for this exam, and as such, residency programs tend to use it as a harsh initial screen to whittle down their applicant pool. Some specialties are considered to be out of reach if a student doesn't score at least a standard deviation above the national mean. Students who pass the test are not allowed to retake it, meaning that one's score is fixed for life. Those that fail typically cannot begin their third year of medical school until they have eked out a passing score.

The test is an 8-hour affair: 7 hour-long blocks of 46 multiple-choice questions, plus an hour for break. Each person's questions are culled at random from a large bank, leaving them at the mercy of the luck of the draw. Some major topics I studied in depth were never asked. And sometimes I received multiple questions about the same obscure medical topic (for example, I was asked five questions about conditions that cause women to have facial hair). I agonized over some questions because several of the answer choices seemed equally reasonable (or equally unreasonable).

A medical student friend warned me that I would emerge from the test feeling like I was hit by a truck. It's true. I still feel like I'm in a daze.

High-stakes standardized testing always struck me as a poor way to go about assessing learning, aptitude, and career potential. And I don't just say this because I'm sour grapes: I do well on standardized tests, even notching a perfect score on my college entrance exams. But these tests are an abomination, with multiple-choice answers that are starved of complexity. When a lot rides on one's standardized test score, it has a corrosive effect on learning and teaching. Learning becomes a game, at the expense of fostering curiosity and original thought. Many medical schools tailor their curricula to the boards exam, and make their course exams entirely multiple-choice to prepare students for the boards format. And so, what once was a means of assessing students' learning now dictates what we learn and how.

It frustrates me that my profession puts so much stock in this one lousy test, taken on a single day.