Step 1 after 3rd year?

Lanced · Mar 5, 2008

We have just been given the option to take step 1 after 3rd year, or anytime during it. UPenn, Baylor, and JHU (I think), do it this way, and some claim that it helps because some pharmacology and pathophys is learned.

On the other hand, basic science is clearly less fresh.

Could some people who've taken it after their 3rd year chime in on their experience?

Thanks

lankysudanese · Mar 6, 2008

at JHU, you can take Step 1 anytime before you graduate (actually, you don't even have to pass Step 1 - you just have to take the test). most people take it either immediately after MS2 ends, or after 1-2 basic clerkships (usually either medicine or peds). most of the people who took it after a couple of clerkships found that the clinical exposure was helpful, especially with the pharmacology (not so much with pathology, ofcourse). anatomy, physiology and biochem are so badly taught that it doesn't matter affect the choice of timing for Step 1 - you find yourself having to learn everything from scratch.

my opinion: if you can get some clinical exposure under your belt, it might help. it is also better to break the monotony of studying (from MS2) with some ward experience before returning to the books again.

RockShox · Mar 6, 2008

I did not take step I third year but at the end of second so I can't say first hand about the prep. But.....I will tell you that if I had to do third year and then still have step I hanging over my head I think I would have slit my wrists.

Really, the fun part of taking step I after second year was that it was like a graduation in a sense....a graduation from basic science to clinical experience and then taking step II after third year mid fourth was like another step of affirmation.

Also, I am sure that after a year of third year the level of detail that I retained for things like biochem and such was reduced. I will say from my own experience looking back that I would not have taking it any other time but right after second year. I did very well on it and think I would have actually done worse with the extra time.

Also the idea that clinical experience somehow helps with the pharmocolgy part of step I is total BS. For several reasons. First what pharmacology is on step I is almost always straight forward and by the book. And two actual clinical practice is never by the book with pharm. You will see that there are many different ways to treat and use the drugs and the side effects are never classic. So this will more than muddy the waters rather than help. IMHO

hj0517 · Mar 6, 2008

I'm a British medical student currently in second semester of my first clinical year (I guess that would be 3rd year for US medical school). I am planning to take step 1 this summer and have already begun a bit of work for it already because of time constraints owing to my clinical rotations.

What I can say is that during pre-med basic science was taught to me very thoroughly, however, I have found that in a ward environment a lot of that knowledge has either been lost or only vaguely remembered. Sure, everything with clinical applications day to day is very simple now - but step 1 also tests minutiae that you hardly come across in clinical situations.

If I could go back in time I would have taken step 1 last summer (which was my equivalent of the end of MS2) because amongst other things I have far less time now that I'm spending it in wards.

I know its not directly relevant, but I hope that helps.

ginger60 · Mar 6, 2008

There is a lot of emphasis on getting a great step 1 score and it seems natural to think that having more time and clinical experience would help you get a better score, but I see several reasons to not take step 1 during/after third year in addition to the reasons given by the above posters:

--The material you learn in most of the clerkships (surg, ob-gyn, family, emergency, peds) is so different that it wouldn't help you in step 1.
--Some clerkships (medicine, neuro, psych) may appear to overlap with step 1 material in regards to pathophys/pharm, but the emphasis of the learning you do during third year is so different from first and second year that I don't think enough of the learning you do during even those clerkships would be relevant or high yield enough to justify completing them before step 1. Rather, you should make sure you have a good foundation in the basic sciences by reviewing what you learned as an MS1/MS2 and taking step 1 before starting clinical clerkships.
--Step 2, not step 1, is designed to test what you learn during third year.
--There is already more than enough to learn for third year that it would be impossible to find the time to study for step 1 during third year unless you have a month of clerkship-free time that you could dedicate to studying for step 1 during/after third year. Even then, you would have to work harder and possibly require more time to remember the nitty-gritty details you learned 1-2 years before as an MS1/MS2.
--Unfortunately, a high step 1 score is pretty much required to enter some specialties, and I know that myself and several of my friends appreciated having our scores back before clerkships so that we knew whether we could even consider entering certain specialties.
--Third year grades and subjective evaluations (which contribute to your dean's letter) are often just as important as your step 1 score for residency applications--I can't help but think that trying to study for step 1 and clerkships during third year would cause your performance in one or the other to suffer.
--Most importantly, you should really make it a point to have the best experience you possibly can during third year and concentrate wholly on your clerkships because that is the best (and often only) time to figure out which specialties or aspects of medical practice you like and don't like and might want to consider for a career.

I am at the end of my third year right now, and if I had had to worry about taking step 1 at any point during my third year I think that it would have stressed me out more than anything and would have definitely hurt my clinical experiences. Sorry that I can't speak from experience about taking step 1 after third year--hopefully someone who has done so can confirm or refute our speculations about whether it would be a good or bad idea--but I for one am very glad that I did not have that test hanging over my head during third year.

PeepshowJohnny · Mar 6, 2008

I have to agree, take it before third year.

njbmd · Mar 6, 2008

The further you get from your pre-clinical stuff, the worst you do on this exam. A while back, many schools didn't even require Step I for graduation. The result was a large number of graduates who had to retake this exam (it's required along with Step IIs & III for licensure). For everyone who retook, it was a major headache.

Now, most residency programs require Step I scores so get this done as soon as you are eligible and prepared. Also, most schools require a pass on Step I before entering the clinical year and a pass on Step II before graduation. Another good reason to not wait until the end of your third year is that you will be busy getting your stuff ready for the MATCH. To be worrying about any exams at that point is a major pain.

Take every step of USMLE as soon as you are eligible. You eliminate loads of headaches by doing this. I can't tell you how valuable it was when I went to residency interviews with my Step II scores already in place. I also took Step III as soon as I was eligible (early in my PGY-1 year).

Lanced · Mar 6, 2008

Thanks for all the feedback thus far.

We get the option to take it any time third year -- either after 1, 2, or 3 clinical core blocks (one is research, not clinic). With any option we get 4-6 weeks of free time before it.

I guess I'm leaning towards after 1 clinical block but before research and the other clinical block(though it is a lottery).

diosa428 · Mar 6, 2008

Lanced said:
Thanks for all the feedback thus far.

We get the option to take it any time third year -- either after 1, 2, or 3 clinical core blocks (one is research, not clinic). With any option we get 4-6 weeks of free time before it.

I guess I'm leaning towards after 1 clinical block but before research and the other clinical block(though it is a lottery).

At Duke, we have one year of basic sciences and then one year of clinical rotations, and we take Step I after the year of clinical rotations. I haven't taken Step I yet, so I can't really comment on how I feel the wards helped me on the test, but I will caution you that, while on the wards, I often feel like if I had already taken Step I, and therefore solidified all the basic sciences in my brain, I would be performing better on the wards. Of course, all of my classmates are in the exact same situation, so it doesn't really matter for me. But I think one big, solid review of that material would be really helpful to do before starting clinical rotations. I also do feel that I have a better understanding of a lot of the things we learned during basic science now that I've done most of my rotations, but I don't know how the information on Step I is tested, so I'm not sure how helpful this will be.

ms. a · Mar 6, 2008

I really feel like you can go either way and be fine. I took Step I after one year of clinical rotations. For us at Baylor, that is when a lot of us take it. Because we do basic sciences in 1.5 years, one year of clinicals puts us at Jan/Feb of thrid year. Personally, I had a good experience taking it after a year of clinicals. Yeah, I had forgotten some basic sciences details, but it all came back rather quickly. Plus, I was able to "re-learn" it with a lot of real life examples I had come across to help solidify the details. Taking it in Jan/Feb seemed plenty of time in terms of residency applications. There is still enough time to alter your game plan if your scores aren't going to be competetive.

Law2Doc · Mar 6, 2008

ginger60 said:
There is a lot of emphasis on getting a great step 1 score and it seems natural to think that having more time and clinical experience would help you get a better score, but I see several reasons to not take step 1 during/after third year in addition to the reasons given by the above posters:

--The material you learn in most of the clerkships (surg, ob-gyn, family, emergency, peds) is so different that it wouldn't help you in step 1.
--Some clerkships (medicine, neuro, psych) may appear to overlap with step 1 material in regards to pathophys/pharm, but the emphasis of the learning you do during third year is so different from first and second year that I don't think enough of the learning you do during even those clerkships would be relevant or high yield enough to justify completing them before step 1. Rather, you should make sure you have a good foundation in the basic sciences by reviewing what you learned as an MS1/MS2 and taking step 1 before starting clinical clerkships.
--Step 2, not step 1, is designed to test what you learn during third year.
--There is already more than enough to learn for third year that it would be impossible to find the time to study for step 1 during third year unless you have a month of clerkship-free time that you could dedicate to studying for step 1 during/after third year. Even then, you would have to work harder and possibly require more time to remember the nitty-gritty details you learned 1-2 years before as an MS1/MS2.
--Unfortunately, a high step 1 score is pretty much required to enter some specialties, and I know that myself and several of my friends appreciated having our scores back before clerkships so that we knew whether we could even consider entering certain specialties.
--Third year grades and subjective evaluations (which contribute to your dean's letter) are often just as important as your step 1 score for residency applications--I can't help but think that trying to study for step 1 and clerkships during third year would cause your performance in one or the other to suffer.
--Most importantly, you should really make it a point to have the best experience you possibly can during third year and concentrate wholly on your clerkships because that is the best (and often only) time to figure out which specialties or aspects of medical practice you like and don't like and might want to consider for a career.

I am at the end of my third year right now, and if I had had to worry about taking step 1 at any point during my third year I think that it would have stressed me out more than anything and would have definitely hurt my clinical experiences. Sorry that I can't speak from experience about taking step 1 after third year--hopefully someone who has done so can confirm or refute our speculations about whether it would be a good or bad idea--but I for one am very glad that I did not have that test hanging over my head during third year.

Totally agree with this post. Get the thing over with before clerkships.

generic · Mar 6, 2008

I'm also at BCM, and took it in the middle of 3rd year, after 1 year of clinicals.

Before we started rotations, my projected score was 225 (EBSE). When I took the real deal (after studying ~5 wks), I got a 251.

I think it doesn't much matter. You forget some things over those clinical rotation times, but then you pick up some test-taking/pimping/critical thinking skills. Also, most of the info you learn for Step 1 is acquired right before the test...whether that's right after your basic sciences or after some clinical experience.

For example, I took the test 6 weeks ago, and today on Neurology we were discussing levels of Methylmalonic Acid in Vit. B12 deficiency/near-deficiency states. I KNOW I knew this on the test, but I couldn't dredge up that pathway and all those cofactors and stuff today. So, I feel like I would have had to cram that stuff in (and then subsequently forget it) at whatever time I took the test.

I will say that Baylor/Penn/JHU seem to have pretty high step scores (our avg is 238), so it doesn't seem to be hurting us...I dunno how this compares to, say, Cornell/WashU/Harvard or something.

riverie · Mar 6, 2008

i, like generic, took it in the middle of third year after one year of rotations. my CBSE score was 228 and my step score is 245. definitely my biochemistry, mole bio and some physio (those dang graphs!) were very rusty after a year of not using them, but i took extra time while studying to get reacquainted. while studying, i frequently noted i was able to retain clinically-related factoids (eg path, pharm, micro) more easily because i had a framework of clinical experience to build upon. so there's advantages and drawbacks. in the end, it kinda depends on your learning style and how heavily weighted the exam is towards clinically-applicable factoids vs not-so-applicable ones. i don't think biochem and mole bio were as heavily emphasized on my exam as usmleworld would have had me believe.

on the other hand, had i really been studying hard during basic science and knew my sh** cold i would have rather gotten it over with early. as it was, knowing i wouldn't have to take it until third year kinda led me to slack off during years 1.5 and i only really forced myself to study intensely for the 6 weeks before the step. then again, i felt that basic science was really rushed for me and i didn't get a chance to really sit down and learn things well the first time round (or maybe i was just a slacker) so i was glad for the extra time to apply basic science principles to clinical scenarios and learn them that way.

some of the previous posters have a point though. if i had taken the step before clinics, i would have probably performed better on my first two rotations (esp. medicine.) i definitely felt that my basic science knowledge was not solidified enough to let me shine on medicine. but after the first three rotations that handicap kinda resolved itself. maybe because i could use the info i learned on medicine for surgery and peds or maybe my later rotations were less dependent on basic science knowledge. who knows.

basically it's a toss up. you will probably adapt to whichever way you choose and perform well either way. for me, if i had to take the step right after basic science, i would have studied more during basic science to make sure i was prepared. even so, i don't think basic science prepared me that well for the step, so it was going to have to be a lot of self study anyway -- and for me, it didn't really matter when that self study took place, i'd be deficient at something or other. actually, if i had to study intensely for 4-6 weeks right after 2 weeks straight of final exams, i'd shoot myself.

RunwayModel · Mar 7, 2008

generic said:
I'm also at BCM, and took it in the middle of 3rd year, after 1 year of clinicals.

Before we started rotations, my projected score was 225 (EBSE). When I took the real deal (after studying ~5 wks), I got a 251.

I think it doesn't much matter. You forget some things over those clinical rotation times, but then you pick up some test-taking/pimping/critical thinking skills. Also, most of the info you learn for Step 1 is acquired right before the test...whether that's right after your basic sciences or after some clinical experience.

For example, I took the test 6 weeks ago, and today on Neurology we were discussing levels of Methylmalonic Acid in Vit. B12 deficiency/near-deficiency states. I KNOW I knew this on the test, but I couldn't dredge up that pathway and all those cofactors and stuff today. So, I feel like I would have had to cram that stuff in (and then subsequently forget it) at whatever time I took the test.

I will say that Baylor/Penn/JHU seem to have pretty high step scores (our avg is 238), so it doesn't seem to be hurting us...I dunno how this compares to, say, Cornell/WashU/Harvard or something.

Baylor's Step 1 AVERAGE is 238?!?!?! That is amazing!!!

RunwayModel · Mar 7, 2008

riverie said:
i, like generic, took it in the middle of third year after one year of rotations. my CBSE score was 228 and my step score is 245. definitely my biochemistry, mole bio and some physio (those dang graphs!) were very rusty after a year of not using them, but i took extra time while studying to get reacquainted. while studying, i frequently noted i was able to retain clinically-related factoids (eg path, pharm, micro) more easily because i had a framework of clinical experience to build upon. so there's advantages and drawbacks. in the end, it kinda depends on your learning style and how heavily weighted the exam is towards clinically-applicable factoids vs not-so-applicable ones. i don't think biochem and mole bio were as heavily emphasized on my exam as usmleworld would have had me believe.

on the other hand, had i really been studying hard during basic science and knew my sh** cold i would have rather gotten it over with early. as it was, knowing i wouldn't have to take it until third year kinda led me to slack off during years 1.5 and i only really forced myself to study intensely for the 6 weeks before the step. then again, i felt that basic science was really rushed for me and i didn't get a chance to really sit down and learn things well the first time round (or maybe i was just a slacker) so i was glad for the extra time to apply basic science principles to clinical scenarios and learn them that way.

some of the previous posters have a point though. if i had taken the step before clinics, i would have probably performed better on my first two rotations (esp. medicine.) i definitely felt that my basic science knowledge was not solidified enough to let me shine on medicine. but after the first three rotations that handicap kinda resolved itself. maybe because i could use the info i learned on medicine for surgery and peds or maybe my later rotations were less dependent on basic science knowledge. who knows.

basically it's a toss up. you will probably adapt to whichever way you choose and perform well either way. for me, if i had to take the step right after basic science, i would have studied more during basic science to make sure i was prepared. even so, i don't think basic science prepared me that well for the step, so it was going to have to be a lot of self study anyway -- and for me, it didn't really matter when that self study took place, i'd be deficient at something or other. actually, if i had to study intensely for 4-6 weeks right after 2 weeks straight of final exams, i'd shoot myself.

Hey Riverie,

With the system at Baylor of having syllabus notes with videotaped lectures which you can playback at your own speed, and possibly not even go to class at all did you feel that was a huge advantage with respect to your preparation for boards. I guess in other words, did you feel that the curriculum and teaching at Baylor was very pertinent to covering what was on the boards?

The reason I ask is that the institutions mentioned: JHU, UPenn, and Baylor are very good schools with very good faculty hence possibly the higher board scores in addition to getting possibly some more time to study for boards.

One bad thing I think taking it right after MS-2 is that you have to begin your studying and start making connections long before your test date, but the problem is you're still learning new material at the same time!!! Unlike the schools that let you take it later, you've had the time to make those integrations between different subjects.

QuantumMechanic · Mar 7, 2008

RunwayModel said:
Baylor's Step 1 AVERAGE is 238?!?!?! That is amazing!!!

They are also one of the top schools in the country, some other schools of it caliber have similar averages. Its probably more a function of having bright minds than something inherently better about teaching.

I wonder how Baylor and UPenn students would do if they took Step 1 after they were done with basic sciences (these schools only spend about a year and a half on them). I don't think the averages would be changed very dramatically. However, the continuity of the education might be better since there's no 2 month break between basics and clinicals. Plus, (and this was the argument for it that I liked when I interviewed at Baylor) it gives you an even longer "4th year" since you get the time for Steps 1 and 2 and your 4th year clinicals. I doubt anyone can argue against having a longer 4th year, even if it means having to take steps 1 and 2, since 4th year is so much more flexible and student friendly.

Also, with the recent rumor that the Steps will be consolidated in the future into a test taken during 4th year, you wonder if these schools have the right idea. After all, once you are done with 3rd year required rotations, you theoretically should be able to take Step 2.

riverie · Mar 7, 2008

RunwayModel said:
I guess in other words, did you feel that the curriculum and teaching at Baylor was very pertinent to covering what was on the boards?

The reason I ask is that the institutions mentioned: JHU, UPenn, and Baylor are very good schools with very good faculty hence possibly the higher board scores in addition to getting possibly some more time to study for boards.

like the poster after you said, i think the high average at Baylor and other top schools speaks more to the caliber of the students rather than the quality of teaching. i can honestly say that with the exception of a handful of professors, the others were average or even pretty bad lecturers. also, students who make it to these schools tend to have already been high scorers in SAT, MCAT, college courses and so tend to generally be good test takers. i would say baylor does not particularly "teach to the boards" in basic science and i ended up having to learn a lot of stuff on my own during my step prep. i didn't really take advantage of the "MD-from-home" set up, as i preferred learning in a classroom setting and more importantly, seeing my friends daily.

tennisnr · May 27, 2008

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.

Blesbok · May 27, 2008

honestly, i think it would be to your disadvantage. boards cover a lot of obscure diseases that you would never see in 10 years of clinicals and an extra year away from learning them would just decrease info retention.

obiwan · May 27, 2008

does anyone know what the highest average step score is for a med school? stanford on their website said that theres was the highest in the country with 237 but apparantly BCM beats it now.

Step 1 after 3rd year?

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