Schools that take Step 1 after/during 3rd year have an unfair advantage?

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http://www.reddit.com/r/medicalschoo...er_third_year/

... it's a lot easier to remember path after you've had patients with various disease processes for a year. explaining pathophys to patients makes it stick, really stick. drugs are easier to remember when you've prescribed them, side effects are hard to forget once you see them.

Columbia does it. This was our first year with the new system and our Step 1 score average freaking SOARED. 240-250 as an average score, depending on your statistical analysis of choice.
Don't underestimate the importance of clinical context.

I'm not a huge fan of this. It kills the standardization aspect of the test. Of course your score are going to be higher...you've had an extra year that focuses heavily on path.
Maybe I'm a bit pissy because I'm not at one of these schools...but it doesn't seem fair. In fact, it seems like those schools are deliberately misrepresenting their students to residency programs.

http://forums.studentdoctor.net/showthread.php?t=502156

Originally Posted by tennisnr

I know talking to my deans that at Penn they saw a 10 -15 pt avg increase in their step 1 scores when they moved from taking it after MS2 to after MS3, with no MCAT difference between the two classes.

How true is this and is there any way for someone who goes to a school that takes Step 1 during the "traditional" time after 2nd year to not be at a disadvantage?
Would reading Harrison's and clinical cases books + volunteering in free clinics help out or is there no substitute for actual 3rd year rotations with regards to performance on Step 1?

I would caution against drawing conclusions based on your links. Reddit is undependable and should not be taken seriously. There is so much bad/wrong advice, even in that thread alone. And the guy crying about "fairness"... it's just sad when you see someone that delusional.

Also there are a lot of arguments against taking step after clinical years in your second post, which you seem to have ignored.

This is a non-issue. There are pros and cons of each approach and you are overanalyzing.

Originally Posted by flatearth22

http://www.reddit.com/r/medicalschoo...er_third_year/



http://forums.studentdoctor.net/showthread.php?t=502156



How true is this and is there any way for someone who goes to a school that takes Step 1 during the "traditional" time after 2nd year to not be at a disadvantage?
Would reading Harrison's and clinical cases books + volunteering in free clinics help out or is there no substitute for actual 3rd year rotations with regards to performance on Step 1?

Performance on Step 1 is largely dependent on the amount of time you put into it. Personally, I took about 1 month of dedicated study time before taking it (although I did study "casually" throughout the year) and after after 3 weeks or so I kindof felt like I was reaching the point of diminishing returns per unit time invested. I'm a DO student so I guess I could've probably held off on taking it until sometime during my third year. I really don't think I would've liked doing it though for the simple reason that it distracts you from your rotations and step 2 studying. On most of my rotations, I have reading assignments from my preceptors as well as readings I needed to do for my shelf/rotation exams. It's hard enough trying to pull an 8-5 workday (or more depending on the rotation) and then doing assloads of rotation/step 2 specific reading.

I think the references you made are more indicative of people having more opportunity to invest time into step 1 studying. If schools aren't giving students a fair amount of independent study time before step 1, than yeah, moving it to be sometime during 3rd year will probably help a lot. Is it unfair? Not really. 3-5 weeks of independent study time is work schools should aim for, IMO. At my school, we finished most of our hardcore systems in April and had fairly minor stuff like ACLS/OSCEs in early May. I think I really didn't go hardcore until after my last system and I was scoring fairly average on the NBMEs late-May/early-June (mid 250s). If I would've taken step 1 today after having studied all year around, I think I might've received a score <10pts higher but I don't think I would've gotten as much out of my rotations or prepared for step 2 as well.

Don't worry about getting clinic/real patient interaction before rotations for step 1 preparedness, imo. Just make a plan of how you're going to study in advance and try to execute it well.

Originally Posted by flatearth22

http://www.reddit.com/r/medicalschoo...er_third_year/



http://forums.studentdoctor.net/showthread.php?t=502156



How true is this and is there any way for someone who goes to a school that takes Step 1 during the "traditional" time after 2nd year to not be at a disadvantage?
Would reading Harrison's and clinical cases books + volunteering in free clinics help out or is there no substitute for actual 3rd year rotations with regards to performance on Step 1?

Sounds like BS. I'm always skeptical about self-reported average Step I scores, since they really aren't checkable, are generated inconsistently (ie do they factor in the scores of folks who failed?, how about folks who are in a different class due to off years for second degrees, etc) and every school claims they are well above average, while we all know half have to be below. I think it's safe to say that the further away from the preclinical courses you are, the more work it should be to prepare those subjects -- memories fade fast. So it's a relative disadvantage. You simply aren't going to use most of the Step I high yield stuff on the wards. Not buying it.

From what I remember about step 1 there was a great deal of minutia and random details that I'm not sure if clinical experience in 3rd year would help much. Definitely helps for step 2, but all the dumb specific micro/biochem questions you are only going to get right by sitting down and doing nothing but memorizing crap for 3-6 weeks (at least for us mere mortals). As for the extra "time" you would get from moving it to 3rd year, I'm doubtful. 3rd year was rough enough without trying to study for step 1. I don't think I can really describe the horror that enters my mind at thinking about doing rotations, studying for shelfs, doing learning issues, and somehow finding time to study for step 1.

Hasn't Step 1 been more and more clinically focused in recent years though?

I think the idea behind scores increasing for those that take it in 3rd year is that the biochem/pharm/micro stuff can be crammed back in but the stuff you learn on the wards is invaluable and really sticks in and is hard to obtain except by actually being out there and seeing patients on a daily basis.

Originally Posted by flatearth22

I think the idea behind scores increasing for those that take it in 3rd year is that the biochem/pharm/micro stuff can be crammed back in but the stuff you learn on the wards is invaluable and really sticks in and is hard to obtain except by actually being out there and seeing patients on a daily basis.

No. First of all where are you getting this "score increasing" data? I would like to see it.

I'd disagree. Unless they radically modify Step 1, I doubt having clinical knowledge is going to help you much. There's far too much useless biochem and physiology on that test which you'll forget between 2nd and 3rd year. As an above poster mentioned, doing well on Step 1 is far more about how you performed in 1st and 2nd year - the better you do in preclinical years, the better your Step 1 score usually is. Also, there are diminishing returns when studying for the test. Just based on my experiences and those of my classmates and others on this site, I'd recommend about 5.5 weeks as the ideal Step 1 study time. Anything more and you start burning out and forgetting the things you went over at the beginning of your study period.

Originally Posted by flatearth22

http://www.reddit.com/r/medicalschoo...er_third_year/



http://forums.studentdoctor.net/showthread.php?t=502156



How true is this and is there any way for someone who goes to a school that takes Step 1 during the "traditional" time after 2nd year to not be at a disadvantage?
Would reading Harrison's and clinical cases books + volunteering in free clinics help out or is there no substitute for actual 3rd year rotations with regards to performance on Step 1?

Step 1 is a competitive sport. Do boxers run marathons to train for their fight? To football players play hoops to prepare for the superbowl? To 5th graders do alebra to prepare for their spelling be? The answer is, of course, no.

Step 1 is, as many have said, a game of minutia. The first two years of medical school prepare the foundation for understanding how the body works and how it breaks. Very useful if you want to be a good to great physician. In fact, it is why we do what we do. Its what separates us from every other mid level provider. We know how and why things happen.

The clinical years prepare you for practice. You learn clinical reasoning, teamwork, systems, treatment, guidelines. The things you learn are different and serve a different purpose. Sure its easy to recall the patient with pancreatitis. But does that help you remember where chymotripsin cleaves proteins? Even if it did, you don't have access to 10,000 patients for the 10,000 nonsense questions they are going to ask you. So, the three things you remember better because of a patient are not worth the 15 things you forget as you learn how to fill out discharge paperwork or how to write a script.

The bottom line is that you have to train for the game you are playing. That is First Aid, and, more importantly, Qbanks. You have the knowledge from your first two years. Hone what you have to know FOR THE TEST by studying from books designed FOR THE TEST, and by studying the format OF THE TEST in qbanks. Eliminate "medicine" from your sights. Focus on "the test." Information you will learn, and then promptly forget. you have the foundation inside you already, you will use it on the wards, but FOR THE TEST, focus on materials designed to get you scoring well ON THE TEST.

In short, there is no advantage, and I would argue a disadvantage, from taking Step 1 after clinical years.

Here are some advantages IMO of taking step 1 after second year:

1. getting it over with! the lead-up to step 1 evoked much anxiety and i would've hated to have that anxiety throughout third year as well

2. more knowledge for the wards. there are so many things that clicked when studying for step 1. so many details that i hadn't bothered memorizing the first time around and so many concepts that i hadn't actually understood. the ~6wks of dedicated study time really built a foundation for clinical rotations. i feel i would've been woefully unprepared had i not had those 6 wks to go over stuff with a high stakes test at the end

3. being able to forget the silly details. for example histo is no longer emphasized and you can basically purge it from your brain after third year. there are a handful of factoids about histo that are useful and clinically relevant but i have yet to see a histo pic on a shelf exam or be pimped on histo. same goes for a subject like biochem.

Saying the same thing I said in the Reddit thread... it isn't helpful. Come on, look at all the stupid minutia in First Aid... you'll never 2/3 of that crap on the wards. The only reason some schools are reporting high averages probably has some kind of selection bias going on.

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Originally Posted by flatearth22

Hasn't Step 1 been more and more clinically focused in recent years though?....

Um no. Step 1 is still largely lots of minutiae, with emphasis on second year material. Steps 2 and 3 are more clinical. The biggest advantage, timing wise, for step 1 is to have it behind you. You have enough to deal with in the latter two years.

The reason the schools that have step 1 after 2nd year have high scores is due to selection bias. Look at the schools that do it: Columbia, Penn, Baylor, UVA, Duke. If you took four schools that did step 1 after m2 that were similarly ranked, for example, Northwestern, Vanderbilt, Wash U, U Mich, I bet their averages would be similar.

I believe our dean said at some point in the not too distant future they will be combining steps 1 and 2 in to one giant pass/fail test that is taken at the end of third year.

Personally I think it's a terrible idea and am very glad to already be through so I won't have to do it this way.

Originally Posted by Sheldor

I believe our dean said at some point in the not too distant future they will be combining steps 1 and 2 in to one giant pass/fail test that is taken at the end of third year.

Personally I think it's a terrible idea and am very glad to already be through so I won't have to do it this way.

This page:

http://www.nbme.org/403.html?aspxerr...nds/index.html

which is no longer working for me, used to have this as a common urban legend. It got brought up when I was a first year but never happend. If you believe the NBME then it never will happen.

Interesting to think about and even more fun to debate whether or not it would be a good idea though...

Originally Posted by Sheldor

I believe our dean said at some point in the not too distant future they will be combining steps 1 and 2 in to one giant pass/fail test that is taken at the end of third year.

Personally I think it's a terrible idea and am very glad to already be through so I won't have to do it this way.

This would be a deathblow for students at mid-low tier schools vying for competitive specialties/programs and for DO/Carib/IMG's vying for any residency spots period.

Originally Posted by flatearth22

This would be a deathblow for students at mid-low tier schools vying for competitive specialties/programs and for DO/Carib/IMG's vying for any residency spots period.

No it wouldn't.

Originally Posted by CatFactorial

No it wouldn't.

A student at a US school that barely passes Step 1 and Step 2 with scores below 200 would now be seen as "equal" (actually more than equal since he's not an IMG) to an IMG that gets >260 on both of them because all that program directors would see is "Pass" for their combined exam and not the extreme discrepancy in scores.

Same thing with a student at a top level school with low USMLE scores competing with a student at a mid-tier school with high USMLE scores for the same spot. Any advantage the mid-tier student would have previously had is now lost since it's just P/F.

There would be a lot more emphasis on clinical grades and preclinical grades though, but with no non-P/F standardized test to distinguish the applicants the prestige of the med school would play a larger role in how residency programs ranked applicants, favoring students at higher ranked schools.

Originally Posted by flatearth22

A student at a US school that barely passes Step 1 and Step 2 with scores below 200 would now be seen as "equal" (actually more than equal since he's not an IMG) to an IMG that gets >260 on both of them because all that program directors would see is "Pass" for their combined exam and not the extreme discrepancy in scores.

Same thing with a student at a top level school with low USMLE scores competing with a student at a mid-tier school with high USMLE scores for the same spot. Any advantage the mid-tier student would have previously had is now lost since it's just P/F.

There would be a lot more emphasis on clinical grades and preclinical grades though, but with no non-P/F standardized test to distinguish the applicants the prestige of the med school would play a larger role in how residency programs ranked applicants, favoring students at higher ranked schools.

It would be harder for a student from a lesser known school to impress program directors, but residency positions would still be based on clinical evaluations, research, interviews, what have you. Tougher yes, but devastating no.

Originally Posted by flatearth22

A student at a US school that barely passes Step 1 and Step 2 with scores below 200 would now be seen as ...more than equal since he's not an IMG, to an IMG that gets >260 ...

I'm pretty sure this is already how it works for most US allo residencies...

Originally Posted by Mr RADical

This page:

http://www.nbme.org/403.html?aspxerr...nds/index.html

which is no longer working for me, used to have this as a common urban legend. It got brought up when I was a first year but never happend. If you believe the NBME then it never will happen.

Interesting to think about and even more fun to debate whether or not it would be a good idea though...

This wasn't really "urban legend", it was really truly slated to happen by the NBME, but after a series of meetings and postponements it simply hasn't. I think when initially proposed they didn't appreciate the logistics and the impact on the residency selection process that would occur if they simply unveiled this. I wouldn't hold your breath.

Moving to pre-allo.

Originally Posted by Law2Doc

Um no. Step 1 is still largely lots of minutiae, with emphasis on second year material. Steps 2 and 3 are more clinical. The biggest advantage, timing wise, for step 1 is to have it behind you. You have enough to deal with in the latter two years.

I don't think you guys realize it, but there is a very large conspiracy brewing. Take a look at what schools have students take Step 1 (the most important, and in many ways sole factor in residency applications) after 3rd year rotations. You see, it all revolves back to the MCAT.

Soon all the schools with 34+ MCAT averages will move to this system (most have). NMBE will continue to instill the false idea that clinical knowledge will not help you with their test. Gradually, though, more and more questions will require you to have taken 3rd year rotations. They already have, based on the tests a few of my friends got this past summer. Only the MCAT heavy schools will succeed.

Yes, when you (older) dudes took the Step, it was minutiae. HOWEVER, things have changed and oh they are changing still. There will be a point in the not so distant future where all the "normal" non upper crust students will suffer from insufficient Board preparation. It all comes back to the MCAT, for those who couldn't get those illustrious 37s won't get into the duke and upenns (most of the kids who got in here last year really are u-PEN15(s)...) of the world and won't know the clinical knowledge to answer the impossible vignette on the Step 1.

There is a very dark future upon us.

Originally Posted by Knocked Up

I don't think you guys realize it, but there is a very large conspiracy brewing. Take a look at what schools have students take Step 1 (the most important, and in many ways sole factor in residency applications) after 3rd year rotations. You see, it all revolves back to the MCAT.

Soon all the schools with 34+ MCAT averages will move to this system (most have). NMBE will continue to instill the false idea that clinical knowledge will not help you with their test. Gradually, though, more and more questions will require you to have taken 3rd year rotations. They already have, based on the tests a few of my friends got this past summer. Only the MCAT heavy schools will succeed.

Yes, when you (older) dudes took the Step, it was minutiae. HOWEVER, things have changed and oh they are changing still. There will be a point in the not so distant future where all the "normal" non upper crust students will suffer from insufficient Board preparation. It all comes back to the MCAT, for those who couldn't get those illustrious 37s won't get into the hopkins and upends of the world and won't know the clinical knowledge to answer the impossible vignette on the Step 1.

There is a very dark future upon us.

I have to admit as someone who just took the step 1, I was shocked at how many of the questions resembled the clinical shelves versus the USMLE World type q's. Still plenty of the later, but way more what's the diagnosis/what's the treatment than I expected (my opinion as a student at one of the new curriculum schools).

Cuz there's so many Carib students with > 260 on step 1...

Last year 81 independent applicants had > 260 step 1; my guess is a good chunk are MD grads and another good amount are DOs. I'd be shocked if more than half of those were IMGs.

Originally Posted by flatearth22

A student at a US school that barely passes Step 1 and Step 2 with scores below 200 would now be seen as "equal" (actually more than equal since he's not an IMG) to an IMG that gets >260 on both of them because all that program directors would see is "Pass" for their combined exam and not the extreme discrepancy in scores.

Same thing with a student at a top level school with low USMLE scores competing with a student at a mid-tier school with high USMLE scores for the same spot. Any advantage the mid-tier student would have previously had is now lost since it's just P/F.

There would be a lot more emphasis on clinical grades and preclinical grades though, but with no non-P/F standardized test to distinguish the applicants the prestige of the med school would play a larger role in how residency programs ranked applicants, favoring students at higher ranked schools.

NYU seems to think that delaying Step 1 seems to help scores. I presume that when they refer to delay, they mean after a student's clerkship year.

[Second question]
Q:What is the advantage of taking Step 1 so long after students completed the courses that it tests on?
http://school.med.nyu.edu/faqpage/fr...ked-questions#

Originally Posted by flatearth22

Hasn't Step 1 been more and more clinically focused in recent years though?

In the sense that each question is a clinical vignette, yes. But that doesn't mean you need to know the minutae in the question in order to take care of the patient in the vignette.

And I took Step 1 4 months ago.

I would hate to have to study for Step 1 while being on clinical rotations. I can barely keep up with the studying I need for the rotation itself. And a lot of schools don't start (and thus end) third year until July, so that'd mean they'd get their Step 1 scores around the time they're applying for residency. At least knowing what I got on Step 1 can help me get into opportunities at an earlier time (research, etc), and I can focus more on what I want to go into during third year, rather than what I might or might not be eligible for based on board scores.

Of course, we take Step 1 in January, and start rotations at the end of February. So I guess if we just dived right into rotations in January, we could go a full year and have plenty of time to take off and study for Step 1 and Step 2 during 'fourth' year.