A New Medical School Ranking Asks a Provocative Question: What Should Excellence Mean?

Written by Jessica Freedman, M.D., board-certified emergency physician, former admissions committee member and Associate Residency Director at the Icahn School of Medicine at Mount Sinai, and founder of MedEdits. 

An intriguing new medical school ranking is taking a very different approach from the traditional ones. As a former admissions committee member and Associate Residency Director at the Icahn School of Medicine at Mount Sinai, and after advising applicants privately with MedEdits for nearly 20 years, I pay close attention to trends and this one is worth your attention whether you are thinking about medical school or residency.

It is called The Medical School Excellence Index, and it is published by Do No Harm, an organization that openly advocates against diversity, equity, and inclusion (DEI) initiatives in medicine. Now in its second year, the 2026 edition ranks MD programs and, for the first time, DO programs. Whatever you think of the organization's politics, the Index raises questions that every applicant, educator, and residency program director should be asking.

What the Index Measures

The Index scores schools in three categories, and the weighting tells you a lot about its priorities.

The first and largest category, worth 60 percent of the total score, is admissions quality. Entering class GPA and MCAT scores each account for 20 percent, with schools earning points based on which quintile they fall into. The Index argues that decades of research link these cognitive measures to performance in medical school, and that schools that crowd them out in favor of softer, more subjective criteria invite lower standards.

The language of "standards" is interesting. Most traditional rankings call these "metrics." To me, the word "standards" implies that not every medical school holds very high ones.

Two admissions measures are new this year. The first is whether a school uses the AAMC's PREview Professional Readiness Exam, a situational judgment test. Schools earn full credit for not using it and zero for requiring it. The Index's rationale is that PREview was developed with significant input from diversity affairs officers and that evidence for its ability to predict later clinical performance remains limited. What is not explained is why Casper, a more widely used situational judgment test, is left out entirely. All situational judgment tests evaluate the same general territory of soft skills, so if the concern is that these tools function as a filter for specific professional competencies rather than ability, it is not clear why that concern wouldn’t include Casper. 

The second new measure evaluates secondary essay prompts. Schools lose points for prompts that ask applicants about race or ideological topics in a way that could be used to screen them. The Index cites examples from UC San Diego and Kaiser Permanente, arguing that such prompts invite applicants to racially or politically self-identify. Having read thousands of secondary essays, I can tell you that applicants often feel pressure to say what they think a school wants to hear. That pressure is worth examining no matter where you stand politically.

The second category, worth 25 percent, is DEI. Schools lose points for maintaining a DEI office or committee and for the intensity of DEI language in their mission statements. This is, without question, the most controversial part of the Index.

The third category, worth 15 percent, is transparency, meaning how openly a school distinguishes student performance. Grading policy accounts for 10 percent: fully differentiated grading earns full credit, hybrid systems earn half, and fully pass/fail systems earn nothing. The presence of an Alpha Omega Alpha (AOA) chapter accounts for the remaining 5 percent.

We have talked about the growing number of medical schools that use pass/fail grading, and to be honest, I am not a fan. Grades give students an incentive, and they give residency programs concrete data for evaluating applicants. AOA membership is a real distinction that program directors notice. Grades and AOA do what they are intended to do: they distinguish students based on academic performance and ability.

I will acknowledge that AOA has its critics. Published research has found disparities in who is selected, and some schools have paused or reconsidered their chapters as a result. That is a legitimate concern. But the answer to an imperfect measure of excellence is to make the measure fairer, not to stop measuring excellence altogether.

What the Results Show

USF Health Morsani College of Medicine in Florida again holds the top spot among MD programs with a perfect score. Albert Einstein College of Medicine in New York, the Perelman School of Medicine at the University of Pennsylvania, Dell Medical School at UT Austin, and Vanderbilt in Nashville tie for second. Five of the top ten MD schools are public institutions in Florida or Texas.

The most striking finding, to me, involves osteopathic schools. According to the Index, nearly four in five DO schools use fully differentiated grading, compared with fewer than one in five MD schools. Keep in mind that because Preview is an allopathic initiative, no osteopathic medical schools use it. Many do require Casper, however. Interestingly only 37 percent of DO schools maintain a formal DEI office, compared with 62 percent of MD schools. Osteopathic schools now educate more than a quarter of American medical students, and applicants who assume the two paths are interchangeable in philosophy should pay close attention.

Why Would Anyone Create a Ranking Like This?

Some people feel medicine has become too politicized and has drifted from what matters most in medical education: mastering the hard sciences and learning to care for patients. With so much emphasis on health equity, social determinants of health, and wellness, critics argue that medical schools are neither selecting nor training students to be excellent diagnosticians and clinicians.

That raises a real question. If medical schools focus more on "soft" skills in both selection and education, will they select for and train people with the intelligence and disposition to become excellent clinicians? I would argue that great physicians need both. The best doctors I have worked with in the emergency department (both emergency physicians and every type of specialist in medicine) were brilliant and humane. The danger is not in considering character, integrity, and empathy; it is in treating these qualities (and others) as a substitute for competence.

The Question I Keep Coming Back To

As a former residency director, this is what concerns me most. Is the move away from differentiation becoming systemic across medical education?

USMLE Step 1, which used to be an extremely important data point in the residency match process, became pass/fail in 2022. More schools have adopted pass/fail grading. Some have eliminated AOA. When medical schools stop distinguishing among their students, and the licensing exam that once did so stops reporting scores, how do program directors identify who is truly outstanding when deciding whom to interview and rank? The answer, increasingly, is that they rely on other indicators: Step 2 CK scores (a less distinguishing metric as most test takers score uniformly high), research output (so much of which is low quality), the reputation of the applicant's medical school, away rotation performance, and connections. None of those are more equitable than grades.

What This Means for Applicants

I do not think any applicant should choose a medical school based on a single ranking, including this one. The Index has its own limitations. Its information on grading and DEI infrastructure was gathered through AI-assisted internet searches, and it reflects a clearly stated point of view. UCLA is omitted entirely because Do No Harm is in active litigation against it.

But the Index does something useful: it forces a conversation about what we mean by excellence in medicine. When you evaluate schools, ask how they grade, whether they have an AOA chapter, and how their graduates fare in the residency match in the specialty you are considering. Those answers will tell you more about how you will be evaluated, and how you will be able to distinguish yourself. Pay attention to secondary essay prompts as an indicator of what is important to the medical school.

Excellence in medicine has always required both knowledge and humanity. The question this Index raises, and the one our profession has to answer honestly, is whether we are still measuring both.