The academic diet of the 21st-century medical student | Scope Blog

Mihir Gupta:

The two most popular resources [for med students on their internal med rotation] were both banks of practice questions, while the next two included a review book and a pocket handbook. (The top four resources: MKSAP question book, USMLE World question bank, Step Up To Medicine review book, and Pocket Medicine.)

This is in no way surprising. Look at almost any med school grading rubric and you will see that for clinical rotations, the Shelf Exam (a multiple-choice test) accounts for the majority of the grade. Medical schools do a poor job of evaluating how well students care for patients and develop clinical reasoning.

…As one surgery faculty put it, “Would you really want your life in the hands of a doctor who aced his multiple-choice boards questions but hasn’t read a textbook?”

I don’t want my life in the hands of a doctor who only aced his multiple-choice boards questions nor one who just read textbooks [1]. I want a doctor that did both of those things, but also completed intensive clinical training under the guidance of expert clinicians. We can easily measure performance on multiple-choice exams and even textbook content; it’s very difficult to objectively measure clinical expertise.

Until medical schools and the National Board of Medical Examiners develop methods other than multiple-choice exams for evaluating students [2], students will continue to use the most expedient resources to learn material for such exams (e.g.—question banks).


  1. I wonder how much this surgical faculty member has relied on Step scores and class rank for choosing residency candidates for his program. The high stakes of Step scores for residency selection drives students to study in terms of exams instead of clinical knowledge.  ↩

  2. Let’s be clear—multiple-choice exams are problematic for evaluating students. It’s not because our heavy reliance on them incentivizes students to use question banks instead of in-depth studying with textbooks. Multiple-choice exams are problematic because they limit the scope of topics to well-characterized diseases and treatments. For example, chloramphenicol is an antibiotic developed 1949 and one student’s studying for Step 1 typically memorize as it may appear on the test. Why? Because it has a well-characterized and unique side-effect—gray baby syndrome—that lends itself to biochemistry questions. Unfortunately, chloramphenicol is rarely used in clinical practice. The only people who may use are infectious diseases doctors and only as a last resort. So, students spend time learning about this drug they may never encounter in practice instead of dedicating time to more commonly used antibiotics.  ↩

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