Would USMLE Step 1 becoming pass/fail be a good or bad thing?

USMLE Step 1變成pass/fail是好事還是壞事？

What are the pros and cons of each side of the argument?

爭論的雙方各有什麼利弊？

Stay tuned to find out.

敬請關注，一探究竟。

Dr. Jubbal, MedSchoolInsiders.com

醫學界內幕網朱波醫生。

The United States Medical Licensing Examination or USMLE is a three-part test

美國醫學執照考試（USMLE）由三部分組成。

designed to assess one's medical knowledge and application of said knowledge to patient care.

旨在評估一個人的醫學知識和將上述知識應用於病人護理的能力。

Step 1 as it currently stands is arguably the most important test a future physician will ever take.

目前的步驟1可以說是未來醫生最重要的測試。

Even more important than the MCAT.

甚至比MCAT更重要。

It is typically taken at the end of the second year in medical school,

一般在醫學院第二年末進行。

and is followed by Step 2 in the third or fourth year.

並在第三年或第四年進入步驟2。

If you'd like to know more about the USMLE Step exams and their timelines,

如果你想了解更多關於USMLE階梯考試及其時間安排。

check out my Four Years of Medical School Explained video.

查看我的四年醫學院解釋視頻。

The USMLE was officially designed

USMLE是官方設計的

to assist state authorities in granting medical licenses

協助國家當局發放醫療執照；

but it has grown in significance far beyond the intended pass/fail indication of competence.

但它的意義已經遠遠超出了預期的合格/不合格的能力指標。

USMLE scores are now heavily weighted during residency applications to assess a candidate's strength

現在在住院醫師申請中，USMLE成績在評估考生的實力時佔有很大的權重

and low scores often prohibit students from pursuing highly competitive specialties

而低分往往使學生無法攻讀競爭激烈的專業。

such as dermatology or plastic surgery.

如皮膚科或整形外科。

Before we dive in,

在我們潛入之前。

I hope that this video serves as a lesson in how to approach controversial topics.

希望這段視頻能對如何處理有爭議的話題起到借鏡作用。

When people asked me where I stand on the issue, I said "I don't have a strong opinion yet!"

當人們問我對這個問題的立場時，我說："我還沒有強烈的意見！"

I need to first do my research, think through the subject,

我需要先做研究，把課題想清楚。

and follow up with questions that I have.

並跟進我的問題。

Too many people first choose a side based on limited information

太多的人首先根據有限的資訊來選擇陣營

and then seek out data to bolster their argument.

然後尋找數據來支撐自己的論點。

That's the Confirmation Bias.

這就是確認偏見。

Learn to think for yourself and not just echo what people around you are saying.

學會自己思考，而不是一味的附和周圍人的說法。

Also a disclaimer, I am the founder of Med School Insiders

另外聲明，我是醫學院內部人士的創始人。

which offers pre-med and medical student admissions consulting and tutoring services,

該公司提供醫學預科和醫學生入學諮詢和輔導服務。

and we do offer tutoring for Step 1 amongst other pre-med and medical student exams.

我們提供醫學預科和醫科學生考試的步驟1輔導。

That being said, it will not influence my argument as you will soon see.

這就是說，它不會影響我的論點，你很快就會看到。

One of the biggest reasons I left plastic surgery was

我離開整形外科的最大原因之一是

to have a positive impact on the Medical Education Process

對醫學教育過程產生積極影響。

as I described in my video explaining my decision to leave the hyper competitive and highly lucrative field.

正如我在視頻中所描述的那樣，我決定離開競爭激烈、利潤豐厚的領域。

My priority is helping medical trainees.

我的首要任務是幫助醫學學員。

I am a firm believer in Objective and Rational Discourse not clouded by biases.

我堅信客觀理性的話語不被偏見矇蔽。

Seek facts first then develop an argument, not the other way around.

先尋求事實，再發展論點，而不是相反。

The bubbling conversation boiled over and blew up after the CEOs of the NBME and FSMB released this:

在NBME和FSMB的CEO們發佈了這個消息後，這段冒泡的對話沸騰了，炸開了鍋。

"If students reduce time and effort devoted to preparing for Step 1, they may indeed devote attention to other activities

"如果學生減少用於準備步驟1的時間和精力，他們可能確實會把注意力放在其他活動上。

that will prepare them to be good physicians.

這將為他們成為優秀的醫生做準備。

However,

然而，

if students were to devote more time to activities that make them less prepared to provide quality care

如果學生將更多的時間投入到那些使他們在提供優質護理方面準備不足的活動上

such as binge watching the most recent Netflix or compulsively updating their Instagram account,

比如狂看最近的網劇，或者強迫性地更新自己的Instagram賬號。

this could negatively impact residency performance and ultimately patient safety."

這可能會對住院醫師的表現和最終的患者安全產生負面影響。"

How Doctors Katsufrakis and Chaudhry could release such a tactless statement as CEOs

Katsufrakis醫生和Chaudhry醫生作為首席執行官，怎麼會發布如此沒有技巧的聲明？

to alienate their audience is beyond me.

疏遠他們的觀眾是我無法理解的。

The ensuing conversation blew up in their face

接下來的對話在他們面前炸開了鍋

with large criticism over the rapidly increasing annual compensation of the NBME executives.

在NBME高管年薪迅速增長的情況下，遭到大量責備。

In short, given the current importance of USMLE Step 1,

總之，鑑於目前USMLE Step 1的重要性。

medical students and medical schools have been strongly incentivized

大力鼓勵醫學生和醫科大學。

to purchase more and more prep materials such as practice tests from the NBME.

以購買更多更多的NBME的模擬測試等預習資料。

Drastically increasing the organization's revenue year after year.

使組織的收入逐年大幅增加。

As it stands, there are now two camps:

目前來看，現在有兩個陣營。

those in favor of transitioning the USMLE to pass/fail

贊成將美國醫學考試過渡到合格/不合格的人。

and those wishing to maintain the status quo with continuous scoring

和那些希望維持現狀，持續計分的人。

We've already touched on the outrageous profiteering of the not-for-profit NBME

我們已經提到了非營利性的NBME令人髮指的暴利。

but beyond that there are several other reasons for a pass/fail test.

但除此之外，還有其他幾種原因導致測試合格/不合格。

First, the current Step 1 climate is highly stressful and creates a rift in medical education.

首先，目前的第1步氛圍壓力大，造成醫學教育的裂痕。

A recent article in academic medicine states "many students opt to disengage from institutional curricula

醫學學術界最近的一篇文章指出："許多學生選擇脫離院校課程。

in favor of intensive exam preparation and are rewarded with a high Step 1 score."

而偏向於強化備考，並以階梯1的高分獲得回報。"

Second, the importance of Step 1 scores is argued to reduce diversity for a few reasons.

其次，認為步驟1分數的重要性會降低多樣性，原因有以下幾點。

It contributes to a destructive culture of hierarchy among specialties

它助長了各專業之間等級森嚴的破壞性文化。

where you're perceived as scoring higher on step and therefore being "Smarter"

在那裡，你被認為是更高的分數，是以 "更聰明"。

if you chose a surgical subspecialty rather than primary care.

如果您選擇了外科亞專業而不是初級保健。

Additionally, some claim that to perform well on Step 1 requires spending a thousand dollars

此外，有人稱，要想在步驟1中表現出色，需要花費千金

on test prep materials and not all students are able to afford that.

在備考材料上，並不是所有學生都能負擔得起。

Lastly, underrepresented minorities and those coming from low-income families, on average,

最後，代表性不足的少數族裔和來自低收入家庭的人，平均。

score lower on Step 1.

在步驟1中得分較低。

Third, and in my opinion most importantly, Step 1 may be contributing to a harmful learning environment.

第三，也是我認為最重要的，步驟1可能會造成有害的學習環境。

Some say the Step 1 climate contributes to the mental health crisis affecting the medical community.

有人說，第1步的氣候造成了影響醫學界的心理健康危機。

As you all probably know, I'm incredibly passionate about addressing

你們可能都知道，我對解決以下問題充滿了熱情

the epidemic of burnout, depression and suicide

倦怠、抑鬱和自殺的流行

amongst medical trainees and it's why I started the #SaveOurDoctors movement,

在醫學實習生中，這也是我發起#拯救我們的醫生運動的原因。

and lastly,

最後是：

despite Step 1 being a heavily weighted factor in residency admissions,

儘管步驟1在住院醫師錄取中佔有很大的比重。

it's not a reliable indicator of one's abilities as a Physician.

這不是一個人作為醫生能力的可靠指標。

Rather than a USMLE Step 1 score, other important qualities

與其說是USMLE Step 1的成績，不如說是其他重要的素質。

such as clinical reasoning,

如臨床推理。

professionalism,

專業性。

and the ability to work in a team should be prioritized.

和團隊工作能力應優先考慮。

Those in favor of maintaining the status quo with a continuous scoring system raised several counter points.

贊成以連續計分制維持現狀的人提出了幾點反駁意見。

Status quo proponents admit that USMLE Step 1 is far from perfect

現狀支持者承認USMLE Step 1遠未達到完美狀態

but moving to a pass/fail system doesn't address the underlying issue

但改用合格/不合格制度並不能解決根本問題。

and could actually make the residency selection process worse.

並且實際上可能會使住院醫師的選拔過程變得更糟。

To be an effective physician,

要做一個有效的醫生。

we would need to reliably measure communication skills, empathy, professionalism, and other qualities

我們需要可靠地測量溝通技巧、同理心、專業精神和其他素質。

but we currently do not have any tests to adequately assess these.

但我們目前沒有任何測試來充分評估這些問題。

Pass/fail proponents point to emphasizing heavier weighting on clinical grades for evaluation,

合格/不合格的支持者指出，強調臨床成績的評價權重要重一些。

which brings us to the second point.

這就涉及到第二點。

In residency admissions, your Step 1 score is heavily weighted, likely weighted more than it should be.

在住院醫師錄取中，你的Step 1分數的權重很大，很可能權重過大。

However, status quo proponents argue that Step 1 is the only objective measurement that we have.

然而，現狀支持者認為，步驟1是我們唯一的客觀衡量標準。

With pass/fail during pre clinical courses and highly subjective clinical evaluations

臨床前課程中的合格/不合格以及高度主觀的臨床評估。

that may be heavily influenced by chance,

可能受偶然因素影響較大的。

there is no other reliable objective measurement to replace it.

沒有其他可靠的客觀測量方法可以替代。

There is also a complete lack of standardization amongst clinical clerkships

各個臨床實習組織、部門之間也完全沒有標準化的規定

with some schools practicing hard quotas but others handing out honors and high pass to almost every student

有的學校實行硬性配額，但有的學校幾乎對每個學生都發放榮譽和高分。

making the clerkship grade close to meaningless and a terribly inaccurate indicator of true performance.

使得書記員的成績接近於毫無意義，成為衡量真實業績的一個非常不準確的指標。

Those in favor of continuous grading argue that moving to a pass/fail grading system would lead to nepotism,

贊成連續評分的人認為，改用合格/不合格的評分制度會導致裙帶關係。

making residency selection more about who you know or what school you came from.

讓住院醫師的選擇更多的是看你認識誰或你來自哪個學校。

With continuous grading, students from less prestigious schools are able to get noticed

在連續的評分下，名校的學生也能得到關注。

should they excel on the exam.

如果他們在考試中取得優異成績。

Under a pass/fail system, school prestige, your personal connections

在合格/不合格的制度下，學校的聲望，你的人脈關係。

and other far less equitable factors would be prioritized.

和其他遠不那麼公平的因素將被優先考慮。

Some argue that with a pass/fail system, students would lose the motivation to study hard first Step

有人認為，實行合格/不合格制度，學生會失去努力學習的動力，首先步

and ultimately lack medical knowledge.

並最終缺乏醫學知識。

While I understand where this line of reasoning comes from, it's purely speculation,

雖然我明白這條理由的來源，但這純屬猜測。

and I'd argue we don't actually know how medical knowledge would be influenced one way or another.

而我想說的是，我們其實並不知道醫學知識會受到怎樣的影響，這樣或那樣。

After considering both sides of the argument and upon closer examination,

在考慮了雙方的論點後，經過仔細研究。

It's apparent that the truth is somewhere in the middle and I'm glad that we're having this conversation.

很明顯，真相是在中間的某個地方，我很高興我們有這樣的對話。

It points to a larger issue.

它指向了一個更大的問題。

Medicine and medical education is broken and we need to do something about it.

醫學和醫學教育已經壞了，我們需要做一些事情。

Proponents of moving Step 1 to a pass/fail system are fed up and we all should be

支持將步驟1改為合格/不合格制度的人已經受夠了，我們都應該這樣做。

but that frustration is misguided.

但這種挫折感是被誤導的。

Moving Step 1 to a pass/fail system would only make the issues within medical education worse, not better.

將步驟1改為合格/不合格制度，只會使醫學教育內的問題更加嚴重，而不是更好。

If you're confused, allow me to explain.

如果你有疑惑，請允許我解釋一下。

First, my most important consideration is the well-being of medical students and residents.

首先，我最重要的考慮是醫學生和住院醫師的福祉。

Some would argue that patient care and safety is the first priority

有人會認為，病人的護理和安全是第一要務

but I say if you don't have healthy doctors, then you don't get healthy patients.

但我說如果你沒有健康的醫生，那麼你就得不到健康的病人。

You must first take care of yourself before you're able to take care of others.

你必須先照顧好自己，才能照顧好別人。

The fact that suicide rates are the highest amongst physicians is appalling.

醫生中自殺率最高的事實是令人震驚的。

Again, I'd point you to the #SaveOurDoctors movement. More information in the description below.

再次，我想告訴你#拯救我們的醫生運動。更多資訊請看下面的描述。

But while step one is highly stressful, it's not the cause of the burnout, depression and suicide epidemic.

但是，雖然第一步的壓力很大，但這並不是倦怠、抑鬱和自殺流行的原因。

It's one element of a larger cultural issue

這是一個更大的文化問題的一個因素

But pointing to a single standardized exam as the root cause is not only a naive

但將其指向單一的標準化考試作為根本原因，不僅是一種天真的

and misguided interpretation of the facts

和對事實的錯誤解釋

but could ultimately prove harmful as well.

但最終可能證明也是有害的。

There are countless stories of students being devastated by a suboptimal performance on Step 1.

學生因第一步成績不理想而一蹶不振的故事不勝枚舉。

Rather than blaming the test, take responsibility for your life.

與其埋怨考試，不如對自己的人生負責。

Figure out what went wrong and act on it.

弄清楚出了什麼問題，然後採取行動。

Sometimes its factors outside of your control and life is not fair.

有時候，它的因素不在你的控制範圍內，生活是不公平的。

I get it.

我明白了。

That doesn't preclude you from taking responsibility.

這並不妨礙你承擔責任。

Learn how to learn more effectively.

學習如何更有效地學習。

Learn how to be a better test taker and then go crush your shelf exams, honor your clerkships and a Step 2 CK.

學會如何成為一個更好的考生，然後去粉碎你的架空考試，榮譽你的文案和一個第二步CK。

The 100% free advice on this YouTube channel

這個YouTube頻道上的100%免費建議

has helped thousands of students radically improve their performance.

已經幫助成千上萬的學生從根本上提高了他們的成績。

Why wouldn't it help you?

為什麼對你沒有幫助？

The victim mentality is becoming more and more prevalent.

受害者心態越來越普遍。

Trust me.

相信我吧

Making Step 1 pass/fail won't solve your issues.

讓步驟1通過/失敗並不能解決你的問題。

Residency will still be competitive under a different set of metrics

在不同的指標下，住院醫師仍將具有競爭力。

and you'll blame those new metrics for your problems as well.

你也會把你的問題歸咎於那些新的指標。

I recommend you start with my Stoicism for Students video

我推薦你從我的《學生的斯多葛主義》視頻開始。

which many of you have commented on and told me was my best ever video.

你們很多人都評論說這是我有史以來最好的視頻。

Check out Jocko Willink's Extreme Ownership while you're at it too, links in the description below.

趁此機會也去看看Jocko Willink的《極致所有權》，鏈接在下面的描述中。

Several other arguments from the pass/fail proponents don't hold any water.

其他幾個支持通過/失敗的人的論點都不成立。

They say Step 1 implements a destructive hierarchy of specialties and a negative stigma.

他們說，第1步實施了破壞性的專業等級制度和消極的恥辱。

News flash, self-victimizing Victor, competitive things are competitive because of supply and demand.

新聞快訊，自作孽不可活的維克多，競爭性的東西因為供求關係而競爭。

More competitive specialties will always be more competitive, regardless of Step 1.

更有競爭力的專業永遠是更有競爭力的，不管是第1步。

Making step one pass/fail does not change competitiveness

讓第一步通過/失敗並不能改變競爭力。

It just makes it so that other metrics will replace Step 1.

它只是讓其他指標將取代步驟1。

Even more importantly, why does it matter that someone assumes your step score is lower because you went into primary care?

更重要的是，為什麼有人認為你的步數分數較低，是因為你去了基層醫療機構？

Your self-worth shouldn't be tied to your Step score. Let alone what someone assumes your step score to be.

你的自我價值不應該和你的步數分數掛鉤。更不要說別人假設你的步數分數是多少了。

Don't blame the test, that's on you.

別怪考試，那是你的責任。

Pass/fail proponents quote that to perform well on Step 1,

通過/失敗的支持者引用，要想在步驟1上有好的表現。

You need to spend a thousand dollars and this is a significant barrier

你需要花一千塊錢，這是一個重要的障礙。

to those from less financially privileged backgrounds.

經濟條件較差的人；

This doesn't make sense for two reasons.

這說不通，原因有二。

First, the average medical student graduates with $200,000 in debt.

首先，醫學生畢業時平均負債20萬元。

There are many students who graduate without debt, further skewing the average,

有很多學生畢業後沒有負債，進一步向平均水平傾斜。

meaning the average debt for students that need to take out loans is actually much higher than $200,000.

意味著需要貸款的學生的平均債務其實遠高於20萬元。

At that point, a thousand dollars is just a drop in the bucket.

這時，一千元只是杯水車薪。

Plus these costs are taken into account in your medical school budget and student loan offerings

另外，這些費用也會被考慮到你的醫學院預算和學生貸款的提供中。

Second, who says you even need to spend a thousand dollars?

第二，誰說你連一千塊錢都要花？

Between six months of you UWorld, Pathoma, First Aid, and Sketchy,

半年之間，你UWorld、Pathoma、First Aid和Sketchy。

I spent less than $500 and you could spend even less if you're frugal and purchase second hand.

我花了不到500美元，如果你節儉，購買二手貨的話，你可以花更少的錢。

I do not come from a financially privileged background by any means,

我無論如何都不是出身於經濟上的優越背景。

I had to pay for my own college, my own medical school

我必須為我自己的大學，我自己的醫學院付錢

I did a work-study and I had to take out loans.

我做過勤工儉學，還得貸款。

I was financially strapped yet I still performed quite well on my USMLE.

我經濟拮据，但我的USMLE成績還是相當不錯的。

Possibly the most frustrating aspect of this entire debate is how short-sighted it is.

整個辯論中最令人沮喪的方面可能是它是多麼短視。

The problem isn't Step 1, but rather the medical education and training system.

問題不在於第1步，而在於醫學教育和培訓體系。

Why do residencies place such emphasis and screen with Step 1?

為什麼住院醫師會如此重視和篩選與步驟1？

They have so many applicants to sift through and meet an objective measurement to cut the pile down.

他們有那麼多的申請者要篩選，要滿足客觀的衡量標準，才能把這堆人減下來。

Even with pass/fail grading, program directors will face the same issue

即使有了合格/不合格的評分，項目負責人也會面臨同樣的問題。

and they will find other metrics to pare down the list.

而他們會找到其他的衡量標準來篩選名單。

You don't solve the problem with pass/fail, you simply shift that problem to somewhere else.

你不能用合格/不合格來解決這個問題，你只是把這個問題轉移到別的地方。

Pass/fail would place much more weight on clerkships which are far more subjective and biased.

通過/不通過會更重視文祕，而文祕的主觀性和偏向性要大得多。

Which preceptor did you get? Were they easy or the hard one?

你找的是哪個導師？是容易的還是難的？

Were you the type of personality that usually meshes well?

你是那種平時很合群的性格嗎？

Or did you get unlucky?

還是你運氣不好？

With pass/fail, you place more importance on the number of publications, who you know,

對於合格/不合格，你更看重的是出版品的數量，你認識誰。

and what school you come from.

以及你來自什麼學校。

Brown Nosing would be even worse than it already is.

褐鼻會比現在更糟糕。

would you rather have a meritocracy or nepotism?

你是要任人唯賢還是任人唯親？

I've even heard some pass/fail proponents say that we should place higher emphasis

我甚至聽到一些支持通過/失敗的人說，我們應該更加重視。

on Step 2 CK or the shelf exams.

在步驟2中考或架考中。

The exact same problems would simply transfer over.

完全相同的問題會簡單的轉移過來。

It doesn't take a rocket surgeon to know that.

這點不需要一個火箭醫生就能知道。

Proponents also point to the fact that many medical schools have

支持者還指出，許多醫學院都有以下事實

transitioned the preclinical classes from graded to pass/fail

將臨床前的課程從等級制過渡到合格/不合格。

without any negative effect on academic achievement.

而不會對學習成績產生任何負面影響。

I shouldn't have to explain why that's comparing apples to oranges.

我不應該解釋為什麼這是把蘋果和橘子比較。

And lastly, while Step 1 used to be a pass/fail exam,