Why is this transition so earth-shattering? The USMLE Step 1 is a one-day test, taken at the end of the second year of medical school, that caps the “preclinical” medical school experience-the culmination of all the knowledge doctors-in-training should know before they can safely set foot in a hospital, learning to care for real live patients. The decision, announced on February 12, 2020, has engendered much praise-and a significant amount of criticism-in the medical community on social media. The two most recent presidents of the NBME, Donald Melnick and Peter Katsufrakis, are white men in their 60s-a demographic not particularly associated with radical change. It was a move that was sudden and unexpected, though there had been rumblings of discontent amongst much of the medical community about the USMLE Step 1 examination for years. This is a seismic shift in the medical education community, and one that has numerous downstream effects in training doctors. I felt emboldened to “out” my less-than-stellar performance, on a daylong examination I took nearly 10 years ago, with the recent announcement by the National Board of Medical Examiners (NBME) that the USMLE Step 1 will only be reported as pass/fail, with no numerical score, starting as early as 2022. I’m in a job I love, that challenges me and excites me-and 210 was my score on the USMLE Step 1. I am now on medical faculty at a highly regarded academic medical center double board certified in internal medicine and geriatric medicine. If they are able to match into post-graduate medical training at all. A score that destines young doctors-to-be to a life of ennui in a job they do not enjoy, because they could not match into the competitive specialty of their dreams. It is a score on the United States Medical Licensing Exam (USMLE) Step 1 examination. Is it an area code for a phone number (for San Antonio, to be exact)? A number on the side of a house? But if you are a medical student or physician, even decades out from your medical training, you know exactly what that number means.
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