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The council believes Texas’ basic rules


serve the state well, and part of the process of evaluating possible changes means finding “evidence that the current system is somehow broken or unfair,” he added. Having no limits to pass the test, however, is of no use. “The test is a minimum threshold. If you don’t have a certain percentage that falls out, what’s the point of the test? It’s supposed to identify people at the lower end of the spectrum.”


Following medical schools’ lead TMA leaders also say both TMA policy and state law should follow the lead of the state’s medical schools. “As someone who evaluates candi-


dates for residency, I’m not excited to see an application that says ‘fail, fail, fail.’ That does not bode well for someone’s likely success in a program and should raise caution flags about fitness for prac- tice,” Dr. Young said. On the other hand, “I have had good residents with solid clinical performance, no evidence they were substandard, and terrible problems demonstrating that knowledge on stan- dardized tests.” That’s where medical schools step up


in their commitment to work with stu- dents to help them pass their exams, Dr. Cable says. But those same schools have a number of checks and balances to en- sure they are graduating well-prepared doctors.


Most Texas medical schools won’t


promote students from the second to third year of medical school if they have not passed Step 1 of the USMLE, and won’t graduate them until they pass Step 2, he explained. Nor do most residency programs accept graduates until they’ve passed Step 2. Lastly, most graduate medical education [GME] programs won’t advance students to a higher level of residency needed for board certifica- tion until residents pass Step 3. TMA leaders also pointed to National


Board of Medical Examiners data that show high passage rates on the first test- ing attempt of the USMLE, ranging from 94 percent to 97 percent. Those who repeated the exam, however, had lower passage rates overall in the 60-percent to 70-percent range.


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