No Money-Back Guarantees

Jul 14 2011 Published by under [Education&Careers], [Medicine&Pharma]

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Today's Bastille Day issue of New England Journal of Medicine includes a piece aptly titled Money for Nothing? The Problem of the Board-Exam Coaching Industry. Science journalist and medical student Joshua Tompkins reviews the pressures that drive students to seek teaching to the test, both for medical college entry and to achieve maximal scores on Step 1. The latter has become quite important since competitive residency programs may have an arbitrary cut-point for inviting applicants for interview.

Virtually every medical student buys some sort of review book or access to a question bank. Of course, such self-study aids are the bottom rung of the coaching ladder. Online and classroom courses can run as much as $10,000. Medical graduates already leave for residency with ~$158,000 in loan debt; adding an additional few thousand may seem trivial. Of course, one could argue that medical school, for which students already shell out the bucks, should adequately prepare them to PASS THE DAMN TEST.

At least the classes improve your score, right? This has been studied, and the benefit to course-takers is negligible from the commercial vendors. Because of demand for review courses,  The Ohio State University tried a free peer-coaching system recently. Participants scored 8 points higher on Step 1 than nonparticipants, so some sort of prep effort to review material and reduce student's anxiety may be of value.

The United States Medical Licensing Exam will be undergoing an overhaul in the near future, a process almost guaranteed to increase students' anxieties and drive more of them toward the test-prep firms. As long as the latter do not require accreditation of any sort, they will gladly collect funds from willing students hoping for a perfect future.

2 responses so far

  • Interesting that these medical board test-prep courses supposedly don't work, because bar-review courses definitely are effective at helping would-be attorneys pass the bar exam.

    • WhizBANG! says:

      The efficacy has not been studied with sufficient rigor since students self select and are not randomly assigned. Perhaps students who choose the courses would have done worse without them, and the course brought them up to the level of their classmates.

      In my experience (n=1 institution) providing intensive board review over the final month of residency has improved our pass rate. Clinical training does have a "hit or miss" component (did the resident see a patient with condition X or was s/he off duty when topic Y was presented). Reminding them what is key to study may be the primary role of this exercise, but it does seem to help.

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