David Altshuler, M.S.
(305) 978-8917 | [email protected]

Two Questions

One of my son’s friends consistently sets the curve in their medical school class. Ellen scored in the 99th percentile on STEP 1. Ellen scored in the 100th percentile on USMLE. (On the United States Medical Licensing Exam scores above 99.5 are rounded up.) Arguably the hardest and most competitive exam there is, USMLE determines where third year medical students do their residency. In a roomful of bright, motivated young adults, Ellen invariably stands out as the most knowledgable.

Where did Ellen go undergrad? Arizona State University in Tempe. ASU accepts 83% of its applicants, pretty much everyone who applies. Summary of the ASU application: “Do you currently or have you at any time in the past had a pulse?”

Could Ellen have gone to a “better” college, one that admits 10% rather than 83% of applicants? Could she have been admitted to a “good” undergraduate institution? If Ellen is as smart as all that, why didn’t she go to a more select institution?

If these are your questions, you’re not listening. It’s who you are, not where you go, that matters. 

To prove this point here are two questions, one of which appeared on a previously administered USMLE, one of which did not.

Question 1: A 30-year-old man is involved in a high-speed motor vehicle collision after driving while intoxicated. He is brought to the emergency department where he is stabilized. He appears to be hemodynamically stable with a temperature of 37.6 C (99.7 F), blood pressure of 126/82 mm Hg, pulse of 92/min, respiratory rate of 14/min, and 98% oxygen saturation on room air. Examination reveals a well-perfused individual with normal skin turgor and sternum capillary refill time. Abdominal examination reveals tenderness in the lower abdomen. Digital rectal examination is normal and assessment of the urethral meatus reveals no blood. A Foley catheter is inserted transurethrally with no difficulty, but there is blood in the collection bag. Trauma radiographs come back normal with no signs of fractures, and initial laboratory results are still pending.

Which of the following is the best next step in management?

A. Cystoscopy

B. Emergency surgical exploration

C. CT cystogram

D. Immediate blood transfusion

E. Urine cytology

Question 2: Where did you go undergrad?

A. A school with a well-known football team

B. A school with name recognition among my parents’ friends

C. A school where I learned how to pose, research, solve, and explain questions across a variety of disciplines. A school that gave me the requisite background so that I can read and understand questions like the endlessly complex one above.

Knowing what a cystoscopy does is part of earning a residency you desire in your preferred city in the specialty of your choice. Going to a big-name college undergrad—not so much.

I have been arguing for some time that what you know is more important than where you went undergrad. Given that life-saving decisions are also based on what your doctor knows rather than her undergraduate institution, isn’t it time we focus on our children’s education rather than what they are attending school?


Some readers have asked why I keep coming back to this topic. Haven’t I made my point? Haven’t I said what I have to say? Isn’t the case closed? Don’t all loving parents and readers now agree that who their child is matters more than where she attends?

If you have come around to my point of view on this critical parenting topic, consider these blog posts as affirmations. Know that you are not alone. Know that you are part of a community of like-minded folks. Whereas if you are still tempted to spend $6.5M on a scam artist who suggests that sending a sow’s ear to USC is the way to go, then come on back next week. I have more to say on the subject. In the meantime, you are welcome and encouraged to post dissenting opinions here.

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