Monday, October 4, 2010

Suboptimal Outcomes for Medical School Matriculants

In the annual JAMA education issue of September 15, 2010, Drs. Andriole and Jeffe address the topic “Prematriculation variables associated with suboptimal outcomes for the 1994-1999 cohort of US medical school matriculants.” The paper is a comprehensive and scientifically sound look at what factors that existed prior to medical school enrollment were associated with students who achieved less than optimal outcomes. Poor outcomes were defined as failure to pass the United States Medical Licensing Examination (USMLE) Step 1 or 2 on the first attempt and withdrawal or dismissal from medical school for academic or non-academic reasons. The study involved over 84,000 matriculants from 1994-1999 with just over 11% falling into the suboptimal outcome category.

Major variables associated with first-time failure to pass the USMLE or academic withdrawal/dismissal were low Medical College Admission Test scores, race (Asian or Pacific islander), under-represented minority or debt of more than $50,000 before entering medical school.

But the most interesting part of this paper is that 178 matriculants in the group who started medical school from 1994-1999 had to be excluded from the study because they were still in medical school. In case you don’t get it, this means they had been in medical school for at least 10 years. [Medical school usually takes four years to complete.] I was apparently prescient in my blog post [rant] on medical education of August 10, 2010 in which I marveled that I once had received an application for a residency training position from a student who had been in medical school for 10 years, and I speculated that it must be very difficult to flunk out of medical school. This was confirmed by the prematriculation variables study which states that only 1049 (1.2%) of students withdrew or were dismissed from medical school for academic reasons.

To be fair, it is possible that some of the 178 long-term medical students could be taking 10 or more years to finish for reasons other than failure to advance because of academic difficulties. I asked Dr. Dorothy Andriole, the lead author of the study, if she knew why these individuals were in school for so long. She did not have specifics but speculated that “…some students enrolled in dual advanced-degree programs (such as MD/PhD, MD/JD, etc.) may be engaged in research-related or other degree-related activities that can substantially lengthen the time from medical school matriculation to medical school graduation [and] some students, unfortunately, experience very serious, life-threatening medical illnesses personally or within their families and must take a prolonged leave of absence from medical school.”

I hope to see a follow-up article on the fate of those 178 medical students. Maybe it could focus on such issues as how was the 10 or more years of tuition funded, how did these people perform on the USMLE, what specialties did they eventually wind up in and how competent were they?

Question: What do they call the person who finishes last in his/her class in medical school?
Answer: “Doctor”

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