Part 1: Why research matters now more than ever

On February 12th, 2020, the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME) announced that they would transition the Step 1 exam to pass/fail scoring. The move was subsequently formalized in September 2021, after some 18 months of test delays and cancellations in the wake of the COVID-19 pandemic.  

The announcement was generally favored by medical students across the country who had long viewed the examination as an anxiety-inducing, debt-producing, education-undermining endeavor. At the same time however, others decried the change as an “unvarnished attempt to abolish the last merit check in medicine.” One student wrote that “when Step 1 scores disappear, more emphasis will be placed on research experience, publication, and subjective evaluations from students’ preceptors,” as well as on institutional reputation. 

As such, the change means medical students who do not attend the most prestigious schools may face steeper odds in getting their dream residency than ever before. Likewise with medical students from communities of color, who tend to receive lower scores on subjective clinical evaluations. 

The change also means that—now more than ever—publications and research experience matters. Already, studies polling residency program directors show that research prowess is more and more of a focus during the selection process.  

Moreover, research is also playing an increasingly important role behind the scenes. That’s because scholarship also underlies other aspects of residency applications like recommendation letters, graduation awards, and election to Alpha Omega Alpha. With the elimination of Step 1 scoring, these qualitative aspects of the residency application are also receiving more weight in the selection process.  

Taken together, these trends imply that research—rather than test scores—has the potential to become the “great equalizer” for residency selection.  

But that development has its own problems. Namely, because opportunities for conducting and publishing one’s clinical research are not truly equal between medical schools or between students within medical schools. Indeed, a recent study in JAMA Network Open of over 30,000 medical school graduates found that women; non-white students; and those attending schools ranked outside of the top 40 were significantly less likely to have publications before graduation.  

The shift of academic journals towards so-called “open access” publication—at the cost of thousands of dollars to authors—is also raising barriers for those training at resource-constrained institutions. In so doing, it is reinforcing traditional hierarchies for trainees in environments with financial privilege. 

Hope, however, is not lost.  

In this series of blog posts, we will discuss strategies that medical students can take to build, launch, stand-up, analyze, and disseminate novel, digital and decentralized clinical research. Moreover, we will show how Sharecare’s Smart Omix platform can help empower medical students and budding clinical researchers to pioneer innovative studies capable of making a splash without massive upfront costs to students and universities—and, in so doing, helping to level the playing field. 

Our next blog will describe how medical students can leverage digital platforms for patient-centered, real-world studies that make an impact in their fields of interest. Sign up here to make sure you don’t miss a post.


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