Measuring success As top-notch medical schools are putting less stock in national ranking slots, what does this mean to the newer generation of DO students? In looking at motivations behind these withdrawals, one of the primary critiques of national ranking systems is the focus on standardized testing, which has often been linked to bias against diversity and students from disadvantaged backgrounds. June 21, 2023WednesdayJune 2023 issue Miko Rose, DO Miko Rose, DO, is a psychiatrist. She serves as the Assistant Dean of Clinical Education at Pacific Northwest University of Health Sciences and an associate professor at Michigan State University. Contact Dr. Rose Facebook Twitter LinkedIn Email Topics medical schoolrankingstudents On Jan. 17, Harvard Medical School publicly denounced U.S. News and World Report’s annual medical school rankings. The school stated that it would no longer contribute data to or put any weight behind the lists. Since then, 12 additional medical schools have followed suit. “My concerns and the perspectives I have heard from others rest on the principled belief that rankings cannot meaningfully reflect the high aspirations for educational excellence, graduate preparedness and compassionate and equitable patient care that we strive to foster in our medical education programs,” said Harvard Medical School Dean George Q. Daley, MD, in a statement. Since January, medical schools across the country have challenged official national ranking pools, refusing to release data on standardized tests to the national ranking review boards. The 2023-2024 U.S. News Best Med School lists regarding research and primary care were released on May 11. In looking at motivations behind these withdrawals, one of the primary critiques of national ranking systems is the focus on standardized testing, which has often been linked to bias against diversity and students from disadvantaged backgrounds. Amid this development, I was curious about how my Gen Z and Millennial osteopathic medical students perceive medical school and institutional rankings and prestige. When asked, “what does institution ‘ranking’ mean to you,” students from Pacific Northwest University of Health Sciences College of Osteopathic Medicine (PNWU-COM) responded in a variety of ways. “I went to a big-name university and did really well,” said Angie Youssef, OMS III. “Then after college I went to a smaller, community-based training institution, and I was much happier with the impactful, close relationships I built with my mentors.” A number of students responded that they had not even considered their school’s rank and could not answer the question. They asked if this mattered, and asked me to explain the significance of the rankings, as they had not considered the criteria in the framework of residency planning. Most responded they are more concerned about work-life balance, parity/social justice within medical education and a sense of belonging on their teams. Related “Ranking is a means to an end, and I work really hard,” said Nikolay Lifshaz, OMS III. “If I need to get into a high-ranking institution to get into the fellowship track I desire, I will. Other than that, it’s not a priority.” Over the 13 years that I’ve worked with students, I have found through mentoring and advising them that inquiries have shifted from “how do I gain acceptance to ____ program” to “how will I find a career path that is right for me?” The new generation of medical students seems to be more concerned with finding a good fit than being associated with a high-ranking institution. Rankings and success Three days after the Harvard announcement, Katrina Armstrong, MD, dean of The Vagelos College of Physicians and Surgeons at Columbia University, noted, “Rankings perpetuate a narrow and elitist perspective on medical education. Their emphasis is on self-reinforcing criteria such as reputation and institutional wealth, rather than measuring a school’s success in educating a diverse and well-trained cohort of doctors able to change medicine for the better and meet society’s needs. “Their focus on standardized test scores comes at a time when it is widely understood that prioritizing these scores rewards well-resourced applicants without regard for selecting the individuals who can best serve the future needs of a diverse and changing world.” This isn’t solely an issue of social justice and eliminating elitism within medicine—it’s also about enhancing the performance of teams. Higher-performing teams equals better patient care, as has been reflected in the data and recent trends toward medical care team-collaborative models. This reasoning stretches across schools withdrawing from national ranking data pools, leading many to believe that board scores do not indicate likely success and perpetuate bias. The old-school medical model/stereotype of a cantankerous opiate-addicted brilliant physician yelling at attendings is certainly evolving. Rather than focusing on performance as an individual sport, increasingly, medicine is embracing team-based models of care. From a business strategy perspective, this makes sense. McKinsey reports have demonstrated diverse workforce teams are 35% more likely to outperform teams with less diversity. Similarly, medical schools have reported enhanced performance of student teams for classes admitted when MCAT scores were waived due to COVID. Rankings and DO students For osteopathic students, this makes even more sense. Disease-based process-focused exams forced trainees to choose from multiple-choice items, which often do not fit the osteopathic approach to solving complex medical cases with a holistic, patient-centered approach. It’s not that DO students don’t do “as well” on standardized tests—it’s that they don’t tend to perform as well on tests written by the standards based on decades-old philosophies that do not completely align with an osteopathic approach to medicine. It would be like asking a rugby player to join football—a lot of similarities in the game, and yet, the playing field and arena in which all are playing is entirely different. With the Level 1 and Step 1 scores going pass/fail, a more “holistic” approach to reviewing student applications for residency is needed. Sound familiar? The recent updates in the residency application process have inherently become more osteopathic in their approach to looking at applicants. This is something our profession has known to be true for decades: no human can be deduced to a single number—either a lab value or a standardized national exam score. To achieve outstanding placement on teams, as osteopathic physicians, we have been trained to look at the whole person. For the newer generation of students, particularly osteopathic medical students, the withdrawal of medical schools from the national ranking databases will likely give DO students a better chance of being seen by residency programs that might not have looked at them closely in prior years. Considering our osteopathic roots of enhanced diversity—our profession accepted women and diverse trainees from very early on—this movement of increased diversity in teams is also more in alignment with the values of the osteopathic profession. This trend is even in alignment with the foundational values of Gen Z and Millennial generations. In comparison to boomers and Gen X, where the emphasis of teaching and medicine is you work hard, pay your dues and do what you’ve known to do in the past. Particularly in medicine, tradition and hard work are deeply valued. The script is now “flipped.” The younger generations’ fundamental values now center around social justice, parity, self-determination, autonomy and lifestyle. So, these experiences of DO students being treated unequally in comparison to MD students actually hit upon some of this generation’s core values of fundamental parity. I have personally been seeing this for years in medical education, and it’s now being called out in more measurable forms, like schools pulling from national ranking databases. “National rankings can provide value for students when they evaluate the right metrics,” said Andy Tianfu Shang, OMS II at PNWU-COM. “Historically, ranking algorithms have focused on factors that provide an advantage for students from higher socioeconomic backgrounds. Schools should push for better metrics that are reflective of the characteristics of successful physicians. “Some examples would be board pass rate, match rate into desired specialty, diversity of students, financial assistance, mental health assistance, accreditation status, time taken to graduate, match rate to desired geographical region, research productivity and national leadership.” All these factors mean the newer generation of osteopathic trainees will have more support than DO trainees have experienced in the medical profession in decades. “Overall, students at all levels desire more transparency and data,” said Shang. “Condensing it into a simple ranking is great for headlines, but does not address the needs of current applicants.” Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA. Related reading: DO schools make U.S. News & World Report’s 2023 best medical schools lists Pass/fail COMLEX: Considerations and outlook from a student’s perspective More in Profession In Memoriam: Dec. 1, 2023 View the names of recently deceased osteopathic physicians. Curiosity in medicine: An interview with JOM’s editor in chief The Journal of Osteopathic Medicine recently received a Journal Impact Factor (JIF), which has bolstered the journal’s credibility and prestige in the research world. JOM Editor-in-Chief Ross Zafonte, DO, shares his journey into research and the journal’s goals. Previous articleArtificial intelligence: Why it doesn’t belong in medicine Next articleThe DO Book Club, July 2023: 'Darkness Visible: A Memoir of Madness'