Students, Docs Ponder Med School Rankings After Harvard Quits

When weighing medical schools, Hannah Gewaid admits she kept in mind the annual rankings from US News & World Report (USNWR). "If I could get into a school of higher prestige, then I could have better odds for a good residency placement," the pre-med student at the University of California San Diego told Medscape Medical News.

Although Gewaid considered other factors, she ultimately chose the highest-ranked medical school to which she was accepted, Rocky Vista University in Ivins, Utah. But it was the school's environment that appealed to her most, she said. "Medical school can be pretty cut-throat, and I felt like the community at Rocky Vista was supportive. They also have one of the highest pass rates for boards in the nation, so it felt like the right combination for me."

Likewise, Ramie Fathy, MD, a PGY1 internal medicine resident at Pennsylvania Hospital in Philadelphia, considered the report's rankings when applying to medical schools. He chose the Perelman School of Medicine at the University of Pennsylvania, which ranked fifth in the nation at the time, and graduated a year ago.

In January, Harvard Medical School pulled out of the popular US News rankings that many students use to guide their application decisions. Soon afterwards, other top-ranked medical schools — Columbia and Stanford — dropped out, setting off a spate of hopeful medical students and physicians questioning the value of the rankings and prospective students' reliance on them.

This week, US News announced delaying release of its medical and law school rankings amid an "unprecedented number" of questions from schools, including whether they could update their data after the collection period. "The level of interest in our rankings, including from those schools that declined to participate in our survey, has been beyond anything we have experienced in the past," US News stated in a press release.

Although Fathy doesn't regret selecting Perelman before it joined the list of exiting schools, he wonders if he was shortsighted using the rankings as criteria. "It's hard to know what makes a school unique from others, and the rankings serve as a metric to guide you," he said. "But in the end, it's not a reliable or reflective way to judge a school."

Fathy said he is proud that Perelman opted out of the rankings "I think it will help ensure that they prioritize what is best for the students and the quality of their training, rather than aspects that are relevant to rankings but don't translate to a better overall student experience."

Fathy's viewpoint seems to be shared by the medical schools that announced they will no longer participate in the US News rankings. The Association of American Medical Colleges (AAMC) recently reported that more than a dozen of the top 20 medical schools in the 2023 report have publicly exited the rankings.

USNWR's chairman and CEO Eric Gertler said in a prepared statement that students turn to the rankings for help in making a key career decision in the face of competitive admissions and high tuition costs.

"We know that comparing diverse academic institutions across a common data set is challenging, and that is why we have consistently stated that the rankings should be one component in a prospective student's decision-making process."

The schools' reasons for exiting vary. In Harvard's case, Dean George Q. Daley, MD, PhD, said in a statement that the rankings don't align with the school's high standards of the school's medical education programs.

Critics of the rankings say they rely too much on the grades and test scores of accepted students, AAMC reported. Stanford Dean Lloyd Minor, MD, said the rankings fail to "capture the full extent of what makes an exceptional learning environment." A school's mission, curriculum, and other metrics should also be used to judge educational value, he said.

Medical schools that publicly announced their decisions to withdraw from the rankings also pointed to the extensive time and resources needed to gather data to submit to USNWR, rise in the standings, or remain at the top.

Bryan Carmody, MD, a Norfolk, Virginia-based pediatric nephrologist and pediatrics professor known for his medical school commentaries, told Medscape Medical News he doesn't see the value of the rankings. "If you look at the data and factors the report collects, it has almost no impact on the day-to-day experience and quality of the medical school. It doesn't assess meaningful educational outputs."

Using MCAT scores and the GPAs of incoming students is irrelevant to the value the school can provide a student, Carmody said.

"The stated idea of the rankings is to measure quality, but in reality, it's to maintain a certain hierarchy," he said. "The content of the MCAT is only peripherally relevant. Real patients don't come in as a multiple-choice question."

The withdrawal of Harvard — which held the top ranking — put the report's shortcomings in the spotlight, Carmody said. But Harvard wasn't the first to pull out. In 2016, the Uniformed Services University in Maryland exited the rankings. Some schools chose never to participate, including most Historically Black Colleges and Universities (HBCUs) as well as osteopathic medical schools.

Given the ripple effect of high-ranking schools like Harvard pulling out of the rankings, prospective students are left to find other criteria to measure their future med schools.

Weighing Other Factors

If he could apply again, Fathy said he has the experience to know he wouldn't have put as much weight in the US News rankings. "At the time I was applying, it was hard to understand exactly what the rankings stood for," he said. "I thought maybe a higher ranking meant better research opportunities and better connections. It's hard to let go of the prestige relative to it all."

His final two options had been Penn or Stanford. "Penn was the better choice for me, not because of its rankings, but because I had unique mentors and research opportunities there, and also because I had a scholarship," he said. "I also had no family on the West Coast, which would have made a difference had I chosen Stanford."

Fathy is happy the rankings have lost some of their prestige.

"I'm hoping that as schools pull out, it will demonstrate to applicants that the rankings aren't where they should focus," he said. "I also hope that down the line, it will prevent the name of a school from being such a big factor in residency applications."

Fathy added that applying to residency programs has been an inequitable process, as institutions seem to judge applicants based on where they went to medical school. "When you look at the match lists, I believe programs put preference on students coming out of higher-ranking institutions," he said.

Ahmed Mukhtar Ahmed, MPP, MSc, who will graduate soon from Harvard Medical School, said he hopes that the withdrawals from the ranking system will benefit future students. His initial choice of Harvard wasn't the result of the rankings, he said. His family came from Somalia in 1996. "My mom sacrificed so much for me to get where I am, and when I was choosing a school, Harvard was the only name she recognized. It meant so much for her that I was accepted here."

Beyond the emotional tie-in, however, Ahmed found Harvard the right fit for other reasons. "There's so much opportunity here for someone with a focus on public health and it has served me well."

Still, Ahmed was not ignorant of the rankings. "I don't know too many students who didn't have their fingers on the pulse of the rankings," he said. "There's awareness that it's not a good metric, but when applying to residencies, they keep in mind where you went to med school. So, we all have it in the back of our minds, for better or worse."

Like Fathy, Ahmed can see the cracks in the ranking system. "I think the exodus from the rankings is good for applicants and also for the landscape of institutions, in general," he said. "There's nothing that says the number-one school is the best school for you."

Ahmed points to other criteria, including financing opportunities, when judging a prospective school. "Talk to students and ask about how responsive administration is should a concern pop up," he said. "Are they invested in student well-being? Also look at the diversity of institutions and experiences you will have. That's something I didn't appreciate until I was a student. I learned new things from the different hospitals I rotated through."

What the Future Holds

Carmody recommends that students determine what information about a school matters to them. "What is their residency placement like, for instance? Keep in mind that most schools don't convey this entirely truthfully, but it's a measurement."

Ahmed points to the Medical School Admission Requirements database compiled by the AAMC. "Look in the database to filter out where you should apply without the numbers attached to it," he said. "Look at the faculty-to-student ratio, how much debt you might have to take on, and what housing is like, for instance. We should move toward a weighing system like that, rather than rankings."

If the withdrawals of medical schools eventually lead to the demise of the rankings, Carmody noted the downsides. "There's some concern that this will hurt pre-med students because it was the one place to find a certain amount of credible, objective data. There's a ring of truth to that and a worry that schools won't provide data in any sort of standardized way for an apples-to-apples comparison."

It would also take time — probably as much as a decade — for the legacy of the US News rankings to completely disappear, according to Carmody. Fathy agrees. "The rankings are ingrained on so many levels," he said. "The better the ranking, the better the funding, so it's self-reinforcing."

In the future, other factors should guide students' decision-making, including distance from family and friends, available research opportunities, and whether students are happy at the school, Fathy said. "There are so many experiential points to consider that go beyond the flawed ranking system."

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