Potential impact of P/F Step 1 on residency match

[920820]

Incoming medical student at a US MD school. There is a possibility that Step 1 will become P/F in the coming years as you know. The general consensus seems to be that making step 1 P/F will make it difficult for students from non-famous schools to match into top residencies. Personally, this is a major concern because I hope to match in my home city in the East coast, and many programs in this city are considered prestigious and difficult to match into. This school is in the Midwest and historically has matched students into programs in the Midwest and in California, which aren't my target locations.

That said I know psychiatry is more holistic in selecting applicants for residency positions. I also recognize that PDs at certain programs have begun to stratify competitive applicants based on step 1. How do PDs, especially in top residency programs, expect the process of selecting students into their program to change if step 1 is to become pass/fail?

---

Members don't see this ad.

 

[Monocles]

step 2 will become the new "make it or break it" exam

 

[splik]

I really don't think it is helpful to try to understand this, because in the unlikely event that step 1 does become pass/fail, there will be other significant changes to the residency process (which may occur even if the USMLE remains scored) including a likely cap on the number of programs applicants can apply to, a new national standardized and scored test that focuses on "soft" skills (e.g. ethics, professionalism), standardized MSPE, standardized LoRs, a multi-staged residency process etc all of these have been proposed as possible solutions to the problems.

also other proposed changes might be to give a quartile/quintile ranking rather than absolute score, or to combined step1 and 2 scores into a single score, rather than to make step 1 p/f. These things also take some time. The recommendations will be made some time next year, but there are multiple stakeholders (AAMC, NBME, ECFMG, FSMB, AMA etc) so it will be some years before any changes, which will likely be phased in, would be made.

Regardless, the most competitive programs in psychiatry, do not place as heavy an emphasis on step 1 scores, as the next tier, because they can afford to be selective. you would be surprised to learn of the step 1 scores of some of the residents at the most competitive programs. Psychiatry does have a more holistic selection process than most other specialties, and programs vary widely in how much emphasis they put on scores. Instead of thinking about hypotheticals, I would encourage you to perform the best you can in medical school (e.g. honoring your clerkships), demonstrate your commitment to a career in psychiatry, and showing your interests/skills in some other areas (e.g. research, teaching/education, policy, advocacy, leadership, community service). Seeking out a mentor (or several), and not necessarily confined to your medical school, to guide you will also be invaluable. You also need to accept that you might not be able to match where you want, despite your best efforts.

 

[MacDonaldTriad]

I hope you are right splik. If this does happen, it will make failing step one more fatal. Failing by a point is different than failing by 40 points, but we will not be able to see that if this happens. Another change would be that we would stop having discussions about taking or not taking step two any more.

 

[NickNaylor]

Agree with @splik's final point, which is that I do not think step 1 is as important in psychiatry as it is in other specialties. At my institution, for example, step 1 has essentially zero impact on your final ranking. The program does use a cut-off to screen applications for the interview, but the cut-off is quite low (somewhere in the 180s-190s). After that initial screening, step scores have zero input into our process.

I'm sure some programs place some importance on it, but my impression is that they are relatively few and far between.

 

[Ironspy]

Seriously no one knows what will happen in the future and this is totally out of your control. Each program and pd is different and will approach things differently if this happens. No one here has a crystal ball. Take a deep breath and focus on the things you can control like knowledge and clinical skills.

 

[MacDonaldTriad]

Almost all LORs are glowing, and there is very poor standardization of Dean's letters. Final adjectives are all over the place and we have had many debates about how meaningless PSs are. USLME step-I may not be the end all for psychiatry, but it is the only true yard stick that crosses all schools equally. I would agree that extra curriculars, research and a compelling story would mean much more, but most of these are modal and help when they help but that is a small minority.