Obesity in the USMLE Step 1 examination: A call to action.
Obesity in the USMLE Step 1 examination: A call to action.
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USMLE步骤1考试中的肥胖症：采取行动。
DOI：
10.1038/s41366-023-01308-2
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发表时间：
2023-07
影响因子：
4.9
通讯作者：
Butsch, W. Scott
中科院分区：
文献类型：
--
作者：
Olson, Amber;Stanford, Fatima Cody;Butsch, W. Scott
作为医学院最艰苦的部分之一，美国医学执照考试 (USMLE) 是迈向医生职业的必经之路。它包括三项考试：第一步，评估科学概念在医学实践中的应用；第二步，临床知识（CK），评估临床医学；第三步，评估医学知识的应用。对于所有医生来说，这些测试都会唤起长时间准备、极度焦虑和追求卓越的巨大压力的记忆。尽管步骤 1 最近改为通过/失败，但全国各地的医学生仍然花数周至数月的时间准备为期 7 小时的考试，该考试标志着临床前和临床阶段之间的过渡，并为学生作为医生的职业生涯做好准备。尽管医学生花费了无数时间准备 USMLE Step 1 考试，但准备材料和考试本身都明显缺乏肥胖内容。考虑到肥胖的患病率、健康影响和经济成本，这一点令人困惑。肥胖影响超过 42.4% 的美国成年人口，并与身体的每个器官相互作用 [1]。它是造成非传染性疾病负担的最重要因素之一，并被认为是 COVID-19 发病率和死亡率最关键的风险因素之一[1]。此外，2019 年美国肥胖症的直接医疗费用估计为 1,730 亿美元，预计未来十年将增加 48-660 亿美元 [2, 3]。尽管如此，USMLE Step 1 考试中没有任何问题直接测试医学生对肥胖的了解。当然，问题会说明患者的体重指数（BMI）或描述患有肥胖并发症的“肥胖”患者，但它们未能涵盖肥胖的发病机制和治疗。与此同时，第一步对医学生进行罕见代谢疾病的测试，如糖原贮积症、溶酶体脂质贮积症和同型半胱氨酸尿症，而大多数未来的医生在他们的职业生涯中永远不会遇到这些情况。但每位有执照的医生都会接诊肥胖患者。最近的医学突破也改变了未来医生治疗肥胖的方式。在过去的两年里，两种治疗肥胖症的高效药物（其中一种于 2021 年获得 FDA 批准）为这种通常很少受到医学界关注的疾病的治疗选择带来了新的活力 [4]。医学生应该接受这些针对肥胖的药物治疗方案的测试，就像他们接受其他慢性疾病的药物治疗方案的测试一样。如何测试医科学生如何应对大多数其他慢性疾病，而不是最常见和最昂贵的肥胖？Kushner 及其同事在 2015 年进行的一项研究检查了 USMLE 考试的肥胖内容，发现肥胖相关问题的覆盖率相对较低，大多数问题集中在与肥胖相关的合并症（例如 2 型糖尿病、阻塞性睡眠呼吸暂停和多囊卵巢综合征），而不是肥胖疾病本身 [5]。作者假设了缺乏覆盖范围的几个原因，包括肥胖不适合特定的器官系统、肥胖医学实践和亚专业的新颖性以及 USMLE 写作委员会中缺乏肥胖专家 [5]。根据他们的发现，作者建议将肥胖纳入 USMLE 第 1 步框架内的主题，包括遗传学、流行病学、生理学、行为科学和药理学 [5]。但八年后，Step 1 测试仍然没有改善其对肥胖的覆盖率。不幸的是，缺乏……
As one of the most grueling aspects of medical school, the United States Medical Licensing Examination (USMLE) serves as a rite of passage toward a career as a physician. It comprises three exams: Step 1, which assesses the application of science concepts to the practice of medicine; Step 2, Clinical Knowledge (CK), which assesses clinical medicine; and Step 3, which evaluates the application of medical knowledge. For all physicians, these tests evoke memories of long hours of preparation, extreme anxiety, and significant pressure to excel. Although Step 1 was recently changed to pass/fail, medical students across the country still dedicate weeks to months preparing for the seven-hour exam that marks the transition between preclinical and clinical years and prepares students for careers as physicians. Despite the countless hours medical students spend preparing for the USMLE Step 1 exam, there is an apparent paucity of obesity content in both the preparation materials and the exam itself. This is perplexing given the sheer prevalence, health impacts, and economic costs of obesity. Obesity affects more than 42.4% of the US adult population and interacts with every body organ [1]. It is one of the most significant contributors to the burden of noncommunicable diseases and has been touted as one of the most critical risk factors for COVID-19 morbidity and mortality [1]. Further, the direct medical cost for obesity in the United States was estimated at $173 billion in 2019, and it is projected to increase by $48–66 billion over the next decade [2, 3]. Despite this, no questions on the USMLE Step 1 exam directly test medical students on their knowledge of obesity. Sure, questions state a patient’s body mass index (BMI) or describe an “obese” patient with a complication of their obesity, but they fail to cover obesity pathogenesis and treatment. Meanwhile, Step 1 tests medical students on rare metabolic conditions—like glycogen storage diseases, lysosomal lipid storage disorders, and homocystinuria—that most future physicians will never see in their careers. But every licensed physician will see patients with obesity. Recent medical breakthroughs have also changed the way obesity will be treated by future physicians. In the last two years, two new highly effective medications to treat obesity—one FDA approved in 2021—have provided new life to treatment options for a disease that typically receives little attention from the medical community [4]. Medical students should be tested on these pharmacotherapy options for obesity, just like they are tested on the pharmacotherapy options for other chronic diseases. How can medical students be tested on managing most other chronic diseases but not the most common and costly one—obesity?A 2015 study by Kushner and colleagues examined the obesity content of USMLE exams and found the coverage of obesityrelated questions to be relatively low, with most questions focused on obesity-related comorbidities (eg, type 2 diabetes, obstructive sleep apnea, and polycystic ovarian syndrome) rather than the disease of obesity itself [5]. The authors hypothesized several reasons for the lack of coverage, including obesity not fitting within a particular organ system, the novelty of the practice and subspecialty of obesity medicine, and the lack of obesity experts on USMLE writing committees [5]. Based on their findings, the authors recommended that obesity could be included in topics within the framework of USMLE Step 1, including genetics, epidemiology, physiology, behavioral science, and pharmacology [5]. But eight years later, the Step 1 test still has not improved its coverage of obesity. Unfortunately, the lack of …
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