Deans: Dump that USNWR ‘best medical school’ survey

Yale and Harvard Law Schools recently announced they would no longer participate in U.S. News & World Report’s (USNWR) flawed ranking system, followed closely by additional schools. The nation’s medical schools need to follow their lead.

Why? The USNWR ranking system is in direct opposition to medical schools’ goal of educating a well-trained, diverse, and culturally competent medical workforce.

For more than 15 years, as the dean for medical education and the associate dean for medical school administration at the University of Chicago Pritzker School of Medicine, we had the unique and unenviable experience of contributing to the USNWR’s Best Medical School ranking process for the school.

For too long, leaders in medical education have done a disservice to medical school applicants and to medical education itself by emphasizing and valuing an elitist emphasis on the reputation and wealth of schools, which have little or nothing to do with supporting the future physician workforce in achieving the highest standard of clinical skills and scientific acumen.

While a few medical schools have chosen not to participate in this annual travesty, the nation’s most well-known and highly visible medical schools have not taken the same courageous stance. The leaders of U.S. academic medical centers should stop participating in misleading the American public, particularly students who dream of the chance to become doctors.

It is hardly a secret among medical school deans that the USNWR rankings are based on data not directly related to educational process, quality, and outcomes. Nor can they trust the veracity of the data that are provided, given the recent scandals reported in other professional schools and colleges that manipulate the formula to their own advantage.

But more importantly, the rankings fail to describe or measure any outcome of importance related to the quality of education provided by medical schools. In fact, the USNWR rankings do little more than reaffirm prestige and the financial prosperity of schools, promoting a cycle by which the wealthiest schools seek those students with the most privilege and wealth and vice versa, exacerbating disparities and creating competition that does nothing to advance the health of the public or the education of future physicians.

That the emperor has no clothes is not a secret. Comprehensive analyses of USNWR rankings have long demonstrated that the methodology is ill-conceived, that the response rate of those completing the questionnaires that feed into the ranking formula would not meet the standards of a peer-reviewed publication, and that the most important aspects of educational quality are largely ignored.

It is not simply that the methodology USNWR uses lacks utility and value. It does a grave disservice to medical school applicants and reinforces biased, even racist practices that should be antithetical to the values and professional standards of academic medicine. The sole beneficiary of these rankings? That would be USNWR itself, which reaps a substantial financial reward — medical schools and hospitals pay money to license the USNWR “Best Of” badge — for enthralling medical schools into participating in a flawed system that ultimately misleads students who aspire to become physicians.

What does USNWR measure in assessing the country’s “best” medical schools? It relies on these data points:

Federal research dollars, for which it gives a disproportionate preference to larger schools over smaller, while at no point considering what benefit is accruing to medical students or how this flow of research dollars into an institution supports their experiences or education or even their participation in this research enterprise.

Reputation, which is assessed by a survey (with an abysmal response rate) of medical school deans, department chairs, and residency program directors who could not possibly possess the necessary familiarity to provide a knowledgeable judgment regarding the quality of education conducted at every medical school in the country, thus perpetuating a focus on “name brand recognition.”

The ratio of full-time faculty to students, regardless of faculty involvement in student education, which values larger institutions over smaller ones.

Students’ median scores on the Medical College Admission Test and their undergraduate grade-point averages, quantitative measures that are strongly influenced by economic and societal factors such as family wealth and educational opportunities, as well as bias and discrimination in the educational environment itself.

The acceptance rate — the proportion of students offered admission compared to the number of who apply — which incentivizes schools in the hypocritical practice of encouraging applications (and application fees) from those they have no intention of seriously considering for admission.

What isn’t part of these rankings? There is no evaluation of the quality of the education provided to students or of the quality and abilities of those who graduate from these schools and become the nation’s doctors. The educational excellence of a medical school should not be boiled down to a number for comparison, valorizing some schools and disadvantaging others without any real reference to the quality of the medical education provided.

We know it won’t be easy for medical schools to step away from the allure of the USNWR list because we personally experienced the pressure to participate by those for whom these rankings have meaning and significance, such as board members, alumni, faculty, and admissions officers. There is peer pressure to stay within the system and to compete for the top prize because it feels good to see your school on top, no matter how flawed the measuring stick.

Rejecting these rankings means risking backlash, but it is the right thing to do — and every medical school leader knows it. They owe it to their students (and their families) to be honest and forthright and to do all they can to assist them as they navigate the process of finding the right school to help them become the doctors they aspire to be. These are the future physicians who will be taking care of all Americans.

We applaud Yale and Harvard law schools, and all other schools in every discipline, that have chosen not to participate in a ranking system that is flawed at best and misleading at worst.

Medical schools: your survey form is about to arrive from U.S. News and World Report for the 2024 Best Medical Schools issue. On behalf of the country’s students and their future patients, throw it away.

Holly J. Humphrey, a pulmonary and critical care physician, is president of the Josiah Macy Jr. Foundation, which is dedicated to improving the education of health professionals. Dana Levinson is the chief program officer of the Josiah Macy Jr. Foundation.

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