Medical educators and the bodies that oversee medical schools have long been unenthused by publications that purport to rank the quality of medical schools. A recent shift in those rankings may be a step in the right direction, according to a Viewpoint column published in JAMA Health Forum, but there’s still much work to be done.
Here’s a look at why the contention that medical school rankings remain a “beauty contest” has some merit and why medical students advise pre-meds to look beyond the best-of lists to find the right fit.
Reputation still overweighted
The Viewpoint column, “Increasing Transparency for Medical School Primary Care Rankings—Moving From a Beauty Contest to a Talent Show,” was written by Robert L. Phillips Jr, MD, MSPH, Andrew W. Bazemore, MD, MPH, and John M. Westfall, MD, MPH, who are affiliated with the American Board of Family Medicine (ABFM) and other organizations that promote primary care.
In the column, the authors noted how the well-known U.S. News & World Report rankings have evolved with regard to primary care.
“The new overall Best Medical Schools for Primary Care rankings were modified in 2021 such that 30% of the score is now based on graduates practicing primary care after their residency training rather than those entering primary care training. Initial residency comprises 10% of the score, which still overestimates primary care, but this measure has been reduced from its previous weighting of 30%,” the commentary’s authors wrote. “The remaining score (60%) is still largely based on reputation.”
The reputation metric having such weight in the case study left schools that produce the most primary care physicians—but may not have the name recognition—out of the rankings.
Learn more about why when it comes to the best medical schools, fit is more important than rankings.
Rankings are self-perpetuating
Nearly 80% of respondents to the 2020 matriculating medical student questionnaire, conducted by the Association of American Medical Colleges, stated that the general reputation of a medical school was an important or very important factor when selecting a medical school.
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As highlighted in past critiques, the rankings themselves can be a flattering piece of marketing. A September 2019 commentary in the journal Academic Medicine—cited in the JAMA Health Forum Viewpoint column—called on several more important selection criteria that students should consider.
“Quality education, community service, professional diversity, research excellence, health advocacy, interprofessional care, fostering of student resiliency and well-being, and other outcomes are better metrics of medical school quality than the currently flawed rankings,” the authors wrote at the time.
The JAMA Health Forum commentary’s lead author, Dr. Phillips, cautioned any use of rankings as a primary evaluation metric for selecting a medical school.
“Students should be careful in using medical school rankings to inform their choices as many rankings are opinion-driven,” said Dr. Phillips, who directs the Center for Professionalism and Value in Health Care at the American Board of Family Medicine Foundation.
He said the more data-driven U.S News rankings, developed with data from the Robert Graham Center, does offer pre-meds a better tool to consider as they decide where to apply or enroll.
“We also hope that the new ranking heralds continued improvement of the information that help students make career decisions,” Dr. Phillips said.
Importantly, the revised rankings add four new data-driven measures to account for student diversity, the proportion of graduates who practice in primary care, and those who practice in rural or medically underserved areas. What matters most, however, is going to be up the individual medical school applicant.
What really matters
Alec Calac is an AMA member and MD-PhD student at the University of California, San Diego School of Medicine and Herbert Wertheim School of Public Health and Human Longevity Science. As a pre-med, he felt that personal interactions were far more important.
“Rankings really did not matter to me,” Calac said. “I wanted to train somewhere that valued not just what I had done, but who I was.”
“I knew that I would receive a great education wherever I went. But at the end of the day, it was not about rankings. It was about the interactions that I had with students, staff and faculty of color during revisit programs,” added Calac, of the Pauma Band of Luiseño Indians.
Check out these four tips for choosing the right medical school.
