A.C. Jones is an MD-PhD trainee, Department of Epidemiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; ORCID: https://orcid.org/0000-0003-3827-2426 .
A.C. Nichols is a recent graduate, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
Acad Med. 2021 Feb 1;96(2):176-181. doi: 10.1097/ACM.0000000000003837.
The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.
成绩差距是指在学术和标准化考试成绩方面，白人和代表性不足的少数族裔（URM）学生之间存在的差距，这种差距早在幼儿园就开始存在，并随着学生在教育系统中的进步而加剧。医学教育也不能免受这种不平等的影响。URM 医学生更有可能延迟毕业和课程失败，即使考虑到科学平均绩点和医学院入学考试成绩也是如此。此外，URM 学生在执照考试中更有可能获得较低的分数，这会对他们的职业轨迹产生重大影响，包括专业选择和住院医师竞争力。在 USMLE 评分邀请赛（InCUS）发布初步建议和对这些建议的公开评论之后，国家医师考试委员会和州医学委员会联合会宣布，美国医师执照考试（USMLE）第一步将从三位数数字分数过渡到通过/失败分数。鉴于 InCUS 的另一个建议是“尽量减少 USMLE 成绩中存在的种族人口差异”，因此必须特别考虑这一评分变化对 URM 医学生的影响。整体招生是朝着承认 URM 学生通常需要走更远的路才能进入医学院的正确方向迈出的一步。然而，当住院医师计划尽管存在持续的考试成绩差距，但仍强调 USMLE 成绩（或任何标准化考试成绩）时，医学教育会加剧 URM 学生面临的不成比例的伤害，并在医学专业之间加剧隔离。本观点简要解释了成绩差距、其心理后果以及其在医学教育中的后果；讨论了 Step 1 评分变化对 URM 医学生的潜在影响；并回顾了纠正这种差异的策略。
