PURPOSE
Modern medical education faces an ongoing challenge: balancing preparation
for high-stakes licensing examinations (i.e., Step 1) with ensuring
competency in treating clinically relevant conditions. The disproportionate
representation of rare disorders on foundational assessments has led
preclerkship curricula to emphasize these topics over more common conditions
encountered in practice.
METHODS
Neuroscience conditions were identified from four widely used Step 1
preparatory textbooks. These were compared with the curricula from two US
allopathic medical schools. Each condition was categorized by clinical
incidence or prevalence and by its frequency of inclusion in the sampled
materials. These data informed a national electronic survey, which was
distributed to accredited US allopathic and osteopathic medical schools in
2024. This yielded 41 responses from 22 states and territories.
RESULTS
A total of 129 conditions were identified. Of these, 7.0% were clinically
common and 19.4% were extremely rare. Seventy-three conditions appeared in
all four preparatory textbooks; 57.5% of these were rare or extremely rare.
Comparison with national curricula revealed significant discrepancies between
clinical prevalence and curricular emphasis, with rare conditions receiving
preferential attention. Osteopathic programs demonstrated greater alignment
between condition rarity and curricular representation compared to allopathic
programs.
CONCLUSION
Preclerkship medical curricula in the United States remain heavily
influenced by the content priorities of the USMLE Step 1 examination. This
influence favors test-oriented, low-prevalence conditions over those commonly
seen in clinical practice. These findings highlight the need for curricular
realignment to better reflect clinical realities. Extending this analysis to
other foundational science disciplines may further guide evidence-based
curricular reform that prepares students for patient care rather than test
performance.