Will This Be On The USMLE? Teaching to the Test

  • /Reviewed by: Amy Rontal, MD
  • A fundamental crux to medical education during the preclinical curriculum is the oft held misconception that basic sciences education is largely irrelevant to clinical practice. Drifting back to my first year of medical school, I remember frustratingly shuffling through stacks of flashcards on the TCA cycle bemoaning why I would ever need to understand this in order to treat a patient. Moreover, I found myself asking the all too common question: Will this be on the USMLE?

    For many medical students, this is the ultimate question asked when attempting to learn basic sciences material during the first two years of medical school. In my experience talking with students, many believe that only material relevant to the COMLEX or USMLE should be covered in the preclinical curriculum. (“Learning about cardiac physiology is fine, but do I really need to learn the steps in ketogenesis?”) As such, I have seen many students develop the belief that they need only learn the basic science material for the test or choose to focus only on those concepts helpful for the USMLE and merely hope to get by in classes.

    Let’s be clear: Basic sciences are very important to becoming a quality physician. My personal belief is that if you are going to prescribe a medication to a patient, you should be able to explain to the patient how the medication works and why certain side effects can occur. While autopilot is likely flying the plane I sit in as I write this, I certainly hope that the pilot understands how the plane works and could take over if needed. My strong understanding of physiology, biochemistry, and microbiology allows me to work through complicated clinical situations where the answer might not be readily apparent. The understanding of disease processes is not something that can be ignored in favor of maximizing student satisfaction and simply teaching to the USMLE.

    That being said, a school must recognize that the USMLE is an important exam and will play a large role in determining a young physician’s career opportunities. As such, there is an obligation to ensure that students are receiving adequate preparation for this test. Here, the difficulty may often be that the basic sciences curriculum is largely designed and taught by PhD’s with limited exposure to clinical medicine and/or limited understanding of the USMLE. For many students, frustration develops in situations where coursework is rarely relevant to the knowledge needed for the USMLE.

    Ultimately, I believe that PhD’s are excellent teachers of the basic sciences and I have been exposed to countless educators far more brilliant than myself. However, I would always encourage each of them to learn about the audience they are teaching to and to strive to ensure that students are prepared for the USMLE. For instance, one common complaint is that coursework exams are often times far easier and more straightforward than the USMLE. As such, I encourage basic sciences educators to look at the style of questions on the NBME and to purchase accounts on UWorld.  This research can help you learn to author questions that are more challenging and better preparation for your students and can help guide you towards what material is relevant on the USMLE or COMLEX.  Furthermore, I would advocate collaborations with clinical faculty and joint lectures that tie basic sciences to clinical concepts.  Learning about heme synthesis may become much more relevant to students when tied in to porphyria or thalassemia. It may even help solidify their understanding of these diseases by being able to reason through the concept.

    At the end of the day, students need to be taught to appreciate the basic sciences and need to understand that their mastery will only improve their clinical skills while educators must ensure that their students are receiving adequate preparation to be placed in a position to succeed on the USMLE and COMLEX examinations. I believe that we can all work together to improve not only this issue but medical education on the whole—ultimately creating the next generation of great physicians.