Friday, April 15, 2016

Ranking Game

Published in VC's Notes on April 15, 2016

Playing the U.S. News Rankings Game

Good morning!

Exactly one month ago, U.S. News & World Report published its annual list of “Best Graduate Schools,” which included rankings of most medical schools and nursing schools in the country, as well as business, law and engineering schools.  Other U.S. News publications annually rank the “best hospitals” and the “best colleges” in America.

US News Magazine Rankings 2016If I'm not mistaken, this is the 25th year U.S. News has published these rankings.  Indeed, even as the company's news magazine has encountered rough sailing in the digital era, its consumer rankings business seems to be going strong.

As dean of a medical school, most of my experience has been with those rankings, so my comments generally apply to the best medical schools listing.

These rankings have changed through the years.  Back in the 1990s, to complement its ranking of research-intensive medical schools, U.S. News created a second list of schools that placed more emphasis on producing primary care physicians.  And more recently, the company has incorporated osteopathic medical schools into both lists.  

It should be noted that to be ranked, medical schools have to submit data about their activities to U.S. News - metrics like faculty-student ratio, dollars spent on research, and number of total applicants versus total number accepted (supposedly a measure of selectivity). 

As you might expect, the people who actually run medical schools have mixed feelings about the rankings.  

There's no doubt that some deans see them as a marketing opportunity and are eager to take steps to enhance their respective school's ranking.  The leaders of schools that perennially appear at the top of the list of the best research-oriented schools - the likes of Harvard, Stanford, Yale, Johns Hopkins and Duke, among others - may have issues with the rankings but they apparently continue to submit their data to U.S. News. 

And then there is a growing contingent of deans who have decided to opt out of the rankings.  That group now encompasses more than 50 schools, including the University of Mississippi School of Medicine.  In fact, to my knowledge, our medical school has never participated in the rankings, a stance that has continued under five consecutive deans.

Last week, a colleague and friend of mine, Dr. Arthur Kellerman, co-wrote an article in the blog of Health Affairs magazine titled “Why We Stopped Participating in U.S. News' Medical School Rankings.”  The dean of the F. Edward Hebert School of Medicine of the Uniformed Services University, Dr. Kellerman gave voice to what a lot of us feel are the problems with the rankings.

Dr. Kellerman and co-author Charles Rice cite a comprehensive analysis of U.S. News' approach done by two academic researchers 15 years ago, which concluded that the medical rankings were “ill-conceived,” “unscientific,” “conducted poorly,” “do not consider social and professional outcomes,” and “have no practical value.”

They go on to say:  “After scrutinizing what is known about the process, we concluded that continued participation [in the U.S. News rankings] is a disservice to medical school applicants.”

To cite just one glaring weakness, about 40 percent of a school's overall score is based on reputation.  To measure reputation, U.S. News sends out two surveys a year - one to deans and senior administrators and the other to residency program directors. The survey lists ALL of the medical schools and asks the respondent to rate them from 1 (marginal) to 5 (outstanding).  

It's highly unlikely that a busy dean or administrator even has time to complete such a survey, let alone give a thoughtful evaluation of schools he or she knows almost nothing about.  As one might expect, more than two-thirds of deans and a higher percentage of residency directors do not return the surveys.  

Even some of the objective metrics U.S. News considers convey a bias toward larger and better-resourced programs.  Faculty-student ratios, for example, tell you very little about how much contact students may actually have with their teachers.  At schools with a 10-to-1 ratio, a large percentage of the faculty may be in research labs and rarely encounter a medical student. 

From our perspective at UMMC, there is concern that the U.S. News methodology doesn't value some of the things that matter a great deal to us in medical education.  We have been leaders of the trend toward holistic admissions - looking beyond merely MCAT scores and GPAs to consider other experiences and gifts that may contribute to the formation of a successful physician.  U.S. News, however, still places a premium on high academic achievement alone.  

For those schools that have opted out of the rankings, our shared perspective is that there are excellent schools that rank near the top of the U.S. News list and excellent schools that rank near the bottom of the list (or not on the list).  These schools may have dramatically different missions, but they may be equally competent and successful in achieving their respective goals.  To try to rank them against a common set of criteria is, well, somewhat like ranking apples and oranges on the “Best Fruit” list.

Both the Association of American Medical Colleges and the medical school accrediting body, the Liaison Committee for Medical Education, have encouraged medical schools to move away from popular rankings like those of U.S. News.  The AAMC has developed tools that help applicants assess and compare the offerings of medical schools and that help medical school leaders benchmark their programs against others.  

Still, the popular rankings persist.  As Americans, we like lists.  We like things boiled down.  And particularly when the subject is complex, we seek some expert opinion that differentiates between bad, good, better and best.  

There's nothing wrong with responding to that need.  But let the buyer beware.  As we strive to teach every day, what is the evidence for the conclusion?  And is the evidence sufficient to support to the conclusion?

Life - and higher education - is not always that simple.  We have a lot of work to do to achieve A Healthier Mississippi, and I'm just glad our medical school's ranking in U.S. News & World Report is one less thing we have to worry about.



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