USMLE Pass/Fail Comment Period.. Official Recommendations and Here is your chance to give feedback to USMLE

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
This is how our board exams are. Matching is mostly dependent on class rank, GPA, externship performance, teachability, and personality.

I think pharmacy residency works much the same way too. No standardized tool in residency selection.

Those in medicine pushing for P/F do not know how lucky they are to have scored Steps until they are gone imho.

Members don't see this ad.
 
it’s more of the medical schools fault for having silly administration and dumb teachers at many places. Each school should be teaching toward a similar curriculum not what each instructor wants to teach. If you make step pass fail it just gives medical schools less motivation to teach what needs to be taught. There would likely be more left field teaching if the exam went pass fail. Don’t just think med schools will “fix” themselves.

I find it funny the same people who complain about their schools curriculum sucking want the exam to be PF. How does making it PF fix your schools curriculum???? More than likely they will just suck more.



TBH there should be MORE standardized tests across the board that PDs could use to quantify applicants. The shelves for each specific field should be reported to PDs, as should step 1 and 2. So at least if you butcher one you can redeem yourself. Add in a specific MCQ test for YOUR specialty and a video interview like EM does.

It’s sickening that the elite schools are pushing their agenda and people with their heavy hearts for those who they believe are less fortunate life actually buy into their game. The game that only benefits the elite not the poor URM from Chicago.
 
  • Like
Reactions: 6 users
Members don't see this ad :)
No One taught you how to use a stethoscope, take a history, deliver bad news, do an abdominal exam in your first two years? Really?

Said this many times. as an option, make STEP1 an optional entrance exam along with MCAT. Then 3 month hardcore pure intro to clinical training, history taking, etc and humanism 8 hrs a day. then clinical years.
 
  • Like
Reactions: 3 users
Said this many times. as an option, make STEP1 an optional entrance exam along with MCAT. Then 3 month hardcore pure intro to clinical training, history taking, etc and humanism 8 hrs a day. then clinical years.
Why would medical schools want to make less money?

I agree it would work. I basically taught myself for Step 1 using UFAPS anyway (as most of us did) while neglecting classes, but it'll never happen.
 
  • Like
Reactions: 2 users
Why would medical schools want to make less money?

I agree it would work. I basically taught myself for Step 1 using UFAPS anyway (as most of us did) while neglecting classes, but it'll never happen.

The only way it will happen is if lawmakers push laws making it so doctor salaries plummet, and they necessarily will have to change medical education to be cheaper so they can attract more to the profession.
 
  • Like
Reactions: 1 users
So how will making it PF fix anything?
It won't directly. But by removing the carrot of 'specialize in anything with good enough boards' that DO's schools like to dangle, I would bet the apps will go down significantly. That will in turn force them to either close down the weak schools, or they will have to step up their game and provide the kind of resources residencies want to see or actually open up specialty residencies themselves. Long term, pass fail is good, just like the merger. Short term its pain tho.
 
  • Like
Reactions: 1 users
It won't directly. But by removing the carrot of 'specialize in anything with good enough boards' that DO's schools like to dangle, I would bet the apps will go down significantly. That will in turn force them to either close down the weak schools, or they will have to step up their game and provide the kind of resources residencies want to see or actually open up specialty residencies themselves. Long term, pass fail is good, just like the merger. Short term its pain tho.
Not sure if I can jump on the PF step so DO schools close down wagon. Doesn’t fix the problem of a hard requirement of some sort of standard across the board for residency and the MCAT taking the biggest effect on residency placement. Should MCAT be pass fail also?

Do we want the MCAT being the determining factor of who gets to be what type of doctor sort of how MBA is the GRE or whatever they MBA test is they use I can’t remember the name of.
 
  • Like
Reactions: 1 user
I think P/F Step 1 would be good if:
1. They also make Step 2 P/F
2. There was some other way of stratifying applicants that doesn't rely on school prestige.

But, neither of those were addressed in the report so :thumbdown:
 
It won't directly. But by removing the carrot of 'specialize in anything with good enough boards' that DO's schools like to dangle, I would bet the apps will go down significantly. That will in turn force them to either close down the weak schools, or they will have to step up their game and provide the kind of resources residencies want to see or actually open up specialty residencies themselves. Long term, pass fail is good, just like the merger. Short term its pain tho.

Weak DO schools won't be impacted by USMLE step 1 P/F. in fact, it would be the opposite, they would say: take the COMLEX only, because it has a score and people can see how competitive you are based on that.
 
We all should publicly comment for a specialty entrance exam that would be weighted decently. For as im an IM resident so for IM after step 2 people would have to take an IM exam. Same for peds and whatever else. This is if they want to PF step two. Be judged by what you can do with what you are going into
 
Members don't see this ad :)
We all should publicly comment for a specialty entrance exam that would be weighted decently. For as im an IM resident so for IM after step 2 people would have to take an IM exam. Same for peds and whatever else. This is if they want to PF step two. Be judged by what you can do with what you are going into

The problem I have with this is the same issue I have with Step 2 being the only scored test, you take it so close to applications that your entire app could be blown up right before you apply leaving you 100% SCREWED.
 
  • Like
Reactions: 2 users
The problem I have with this is the same issue I have with Step 2 being the only scored test, you take it so close to applications that your entire app could be blown up right before you apply leaving you 100% SCREWED.
Yeah I agree with that part. It could maybe be something they get in by rank list time to assist PDs with rank order but again we agree that a PF step effs people for interviews and for knowing what they can do if step 2 is still gradeded. Funny part is al of our mundane ideas are more than NBME has come up with so far lmao
 
We all should publicly comment
Unfortunately I'm just not convinced that they really care about our comments. They clearly only care about the articles being written by students at T10 schools.
 
  • Like
  • Sad
Reactions: 2 users
Unfortunately I'm just not convinced that they really care about our comments. They clearly only care about the articles being written by students at T10 schools.
All them schools padding their pockets
 
No One taught you how to use a stethoscope, take a history, deliver bad news, do an abdominal exam in your first two years? Really?
While i get what youre getting at here goro. This was maybe 5% max of my in school time (thank god it wasnt longer im not advocating for that), and the majority of what i learned was from bates online videos. A lot of the in class time spent on this was just supervised peer practice. Which im totally fine with and think it was the right way to do it, but it was definitely not worth 160k (and dont get me wrong i genuinely enjoyed most of my patient care profs). I could have a driveway full of teslas with that $$
 
  • Like
Reactions: 5 users
While i get what youre getting at here goro. This was maybe 5% max of my in school time (thank god it wasnt longer im not advocating for that), and the majority of what i learned was from bates online videos. A lot of the in class time spent on this was just supervised peer practice. Which im totally fine with and think it was the right way to do it, but it was definitely not worth 160k (and dont get me wrong i genuinely enjoyed most of my patient care profs). I could have a driveway full of teslas with that $$
You're lucky. These foundational skills were taught by peer learners at my program which just pissed me off. I received better clinical skills training (no joke) at my $5,000/year community college's paramedic program than I did the $65k/year medical school.

Medical schools are a colossal waste of time talent and resources as they stand today.
 
  • Like
  • Wow
Reactions: 10 users
You're lucky. These foundational skills were taught by peer learners at my program which just pissed me off. I received better clinical skills training (no joke) at my $5,000/year community college's paramedic program than I did the $65k/year medical school.

Medical schools are a colossal waste of time talent and resources as they stand today.
DO schools blow in general but our clinical skills class was top notch. Depends a lot by school. Also don’t let the midlevel lobby hear you admit this they’ll take it and run with it
 
  • Like
  • Haha
Reactions: 4 users
The problem I have with this is the same issue I have with Step 2 being the only scored test, you take it so close to applications that your entire app could be blown up right before you apply leaving you 100% SCREWED.
I am fairly certain that if Step 1 goes pass fail, step 2 will as well. And Comlex will copy whatever Step does in a year or two at most. So I don't believe your scenario will actually play out. I definitely see this as a long term gain for us.

IMO each specialty would probably come up with some other standardized shelf to replace step. And I think that is closer to how it should be.
 
  • Like
Reactions: 1 user
I am fairly certain that if Step 1 goes pass fail, step 2 will as well. And Comlex will copy whatever Step does in a year or two at most. So I don't believe your scenario will actually play out. I definitely see this as a long term gain for us.

IMO each specialty would probably come up with some other standardized shelf to replace step. And I think that is closer to how it should be.

Right now making Step 2 P/F is not really in the discussion so that is a false assumption. As to the standardized shelf thing that still doesn't answer ANY of the concerns I mention. It would be taken right before applications and lots of people would get ROYALLY shafted by having this app tailored to a field and then getting to the test and bombing it because up to that point there were zero measuring sticks to warn them they would do so and might need to make a contingency plan. Not to mention the NBME will likely deliver these tests which will just be one more test students have to pay for.

Quite frankly I find your opinion on this rather vague. You say things like "how it should be" and "it will be a benefit long term" but then don't really say what that means, why it will be so or what that looks like and have yet to address the many glaring issues with a P/F exam and why those cons are somehow better than the current status quo.

The current model isn't perfect, but Step 1 being P/F isn't the answer.
 
  • Like
Reactions: 4 users
For 700$ we could have a 1:1 in person exam with a NBME examiner OR a supervised group exam. We could have teamwork situations, situation in which we explain basic science concept in a teach me back way, all video recorded and available to residency directors. Sure, it would be slightly more subjective, but if there are NBME certified examiner that travel and take the exams, there would be some standard and you could be put in a percentile with everyone that had the same examiner.
 
For 700$ we could have a 1:1 in person exam with a NBME examiner OR a supervised group exam. We could have teamwork situations, situation in which we explain basic science concept in a teach me back way, all video recorded and available to residency directors. Sure, it would be slightly more subjective, but if there are NBME certified examiner that travel and take the exams, there would be some standard and you could be put in a percentile with everyone that had the same examiner.

how is that better than leaving Step 1 just the way it currently is?

IMHO, unless the NBME intentionally wants to benefit some particular groups at the expense of everyone else, they seem to forget the phrase, "First, do no harm" :caution:
 
how is that better than leaving Step 1 just the way it currently is?

IMHO, unless the NBME intentionally wants to benefit some particular groups at the expense of everyone else, they seem to forget the phrase, "First, do no harm" :caution:

It's better as it assesses your knowledge, interpersonal skills and it also gives you a chance to show what you know outside of checking 1/5 boxes. A report by a trained examiner would be much more useful than 3 digits.
 
So here's my question for you. What do the MDs have that we don't? Not including name recognition for places like Harvard, etc.

Just casually reading this but one big thing the MD schools have that DO programs don't have is solid clinical sites. I think that's where DO students really get screwed over. And honestly, if they don't have strong clinical sites and affiliations with good hospital systems, these schools need to either drop their class sizes or stop making satellite campuses.
 
  • Like
Reactions: 1 users
Just casually reading this but one big thing the MD schools have that DO programs don't have is solid clinical sites. I think that's where DO students really get screwed over. And honestly, if they don't have strong clinical sites and affiliations with good hospital systems, these schools need to either drop their class sizes or stop making satellite campuses.
Research. Connections. A good governing body. Rotation sites. Residency programs.

Honestly once I’m done with residency considering the chip from DO school is still on my shoulder I wouldn’t mind helping students speak out against DO schools. Most people stop caring but mine wasted enough of my time for a lethal life sentence of bashing from me
 
  • Like
Reactions: 4 users
Research. Connections. A good governing body. Rotation sites. Residency programs.

Honestly once I’m done with residency considering the chip from DO school is still on my shoulder I wouldn’t mind helping students speak out against DO schools. Most people stop caring but mine wasted enough of my time for a lethal life sentence of bashing from me

Same, except instead of the school (I actually really enjoy most aspects of my school) it will be directed at the NBOME and AOA.
 
  • Like
Reactions: 1 users
Same, except instead of the school (I actually really enjoy most aspects of my school) it will be directed at the NBOME and AOA.
Same with mine but it wasn’t enough for 50k. A good do school is still usually Lulz vs an average MD school

Just wait till you get letters in the mail begging you to get AOA cert lol. It’s so pathetic they have nothing to offer
 
  • Like
Reactions: 1 user
Same with mine but it wasn’t enough for 50k. A good do school is still usually Lulz vs an average MD school

Just wait till you get letters in the mail begging you to get AOA cert lol. It’s so pathetic they have nothing to offer

Yeah for 50k it's pretty absurd and it seems to be the standard across the board.
 
  • Like
Reactions: 1 user
It won't directly. But by removing the carrot of 'specialize in anything with good enough boards' that DO's schools like to dangle, I would bet the apps will go down significantly. That will in turn force them to either close down the weak schools, or they will have to step up their game and provide the kind of resources residencies want to see or actually open up specialty residencies themselves. Long term, pass fail is good, just like the merger. Short term its pain tho.

I don't know if that is what will truly happen. If anything, this will allow DO schools to more openly vouch for their students to pursue primary care all the more now that getting into upper-tier specialties especially at good places has become much harder. While the number of applicants may go down somewhat, the appeal of wanting to be a doctor will still be strong, and it is for this reason that I think DO schools will still be self-sufficient in the long run.
 
  • Like
Reactions: 1 user
Would test prep companies or founders of outside resources also speak out against this? I feel like the incentive to invest in these would drop if Step became p/f
 
Would test prep companies or founders of outside resources also speak out against this? I feel like the incentive to invest in these would drop if Step became p/f

I know Dr. Fischer already started speaking out about it.
 
  • Like
Reactions: 1 user
Yeah for 50k it's pretty absurd and it seems to be the standard across the board.

My experience is a bit different. The further I get in residency and the more exposure I have to a mid-tier MD school, the more I realize how little the differences really were between my school and a lot of MD schools. I also paid much less than $50k/yr. To be fair though, I went to one clinical site for my core rotations, and that site had numerous DO residency programs, which are all now ACGME accredited. Not everyone at my school had the same experience.

Generally speaking rotation sites are the issue at DO schools though. Residencies are sometimes an issue. Mine had plenty of residencies in its OPTI (obviously a big chunk in primary care, but also all specialties), but a lot of the new schools just bought membership into pre-existing OPTIs, and just didn't open up a single residency program.
 
  • Like
Reactions: 4 users
If each school was forced to have its own OPTI with enough slots for every student that would fix a lot of problems with many DO schools.
 
  • Like
Reactions: 3 users
I have given USMLE step 1 exam passed with 199 score in second attempt. I know I have a very poor score in step 1. Is there any possibility to get residency?? i am an img. i havegreen card
 
I have given USMLE step 1 exam passed with 199 score in second attempt. I know I have a very poor score in step 1. Is there any possibility to get residency?? i am an img. i havegreen card
How did you end up here?
You’re in the DO forum on a post about making step pass/fail
 
  • Like
Reactions: 2 users
Pass fail would be great for this person lol
P/F would be the death blow to IMG's in most circumstances.

After reading through this thread I realized I never fully enunciated some of the things that I think would change for the better if P/F. I think P/F would force the DO schools to be more like the MD's. Our schools get away with a lot because 'high scores open doors.' You take that away from them and we lose most of our superstars which in turn would make DO a whole lot less appealing to premeds because lets face it, people want to believe if they work hard they have a chance at anything. That wouldn't be true in a P/F scenario with the way most DO schools are set up. And once the apps drop, the DO schools have to actually convince premeds that the 'DO difference' is not just getting screwed in the match. They would have to make their programs actually match what program directors want.

Some differences I would anticipate is that it would force DO schools to open more home programs, unless they wanted to lose half their class. I don't think you can find 10k medical students a year interested in FM. I also think this would force them to have research facilities and faculty that the majority of DO don't have right now for the same reasons. This would increase the importance of rotations and aways. Showing teachability and aptitude for a subject would become much more important. Similar to the Podiatrist who posted at the end of the first page, GPA and rank would need to make a comeback for the few DO schools that don't do it. They would also have to really increase their investment in their students. I don't think the current 'screw em' attitude would result in 98% placement in a scenario where Step was P/F. They would actually need to be helpful if they wanted all their students to have a residency.

I don't think any of this would happen overnight, but I bet it would be faster than you think. DO schools couldn't be a 400+ student program with basically no residency's for home programs. They wouldn't fill without Step or the pool would become so dilute that half wouldn't pass like the Caribbean. I think DO schools have a very vested interest in trying to differentiate themselves from the Caribbean so I imagine most would step up or be closed.
 
Last edited:
  • Like
Reactions: 1 users
P/F would be the death blow to IMG's in most circumstances.

After reading through this thread I realized I never fully enunciated some of the things that I think would change for the better if P/F. I think P/F would force the DO schools to be more like the MD's. Our schools get away with a lot because 'high scores open doors.' You take that away from them and we lose most of our superstars which in turn would make DO a whole lot less appealing to premeds because lets face it, people want to believe if they work hard they have a chance at anything. That wouldn't be true in a P/F scenario with the way most DO schools are set up. And once the apps drop, the DO schools have to actually convince premeds that the 'DO difference' is not just getting screwed in the match. They would have to make their programs actually match what program directors want.

Some differences I would anticipate is that it would force DO schools to open more home programs, unless they wanted to lose half their class. I don't think you can find 10k medical students a year interested in FM. I also think this would force them to have research facilities and faculty that the majority of DO don't have right now for the same reasons. This would increase the importance of rotations and aways. Showing teachability and aptitude for a subject would become much more important. Similar to the Podiatrist who posted at the end of the first page, GPA and rank would need to make a comeback for the few DO schools that don't do it. They would also have to really increase their investment in their students. I don't think the current 'screw em' attitude would result in 98% placement in a scenario where Step was P/F. They would actually need to be helpful if they wanted all their students to have a residency.

I don't think any of this would happen overnight, but I bet it would be faster than you think. DO schools couldn't be a 400+ student program with basically no residency's for home programs. They wouldn't fill without Step or the pool would become so dilute that half wouldn't pass like the Caribbean. I think DO schools have a very vested interest in trying to differentiate themselves from the Caribbean so I imagine most would step up or be closed.

that or just simply say NO to P/F . Why giving up the revenue of 400+ student class??? :)
 
that or just simply say NO to P/F . Why giving up the revenue of 400+ student class??? :)
400+ student classes shouldn't be a thing in medical school. Anywhere. Especially when your school has only a couple small residencies associated with it. These programs are leeches and very greedy without regard to students. And as they say, pigs get fat and hogs get slaughtered. DO schools are getting pretty hoggy.
 
  • Like
Reactions: 1 users
400+ student classes shouldn't be a thing in medical school. Anywhere. Especially when your school has only a couple small residencies associated with it. These programs are leeches and very greedy without regard to students. And as they say, pigs get fat and hogs get slaughtered. DO schools are getting pretty hoggy.
Schools with 400+ classes usually have separate campuses. But I see what you mean though
 
Last edited:
  • Like
Reactions: 1 user
P/F would be the death blow to IMG's in most circumstances.

After reading through this thread I realized I never fully enunciated some of the things that I think would change for the better if P/F. I think P/F would force the DO schools to be more like the MD's. Our schools get away with a lot because 'high scores open doors.' You take that away from them and we lose most of our superstars which in turn would make DO a whole lot less appealing to premeds because lets face it, people want to believe if they work hard they have a chance at anything. That wouldn't be true in a P/F scenario with the way most DO schools are set up. And once the apps drop, the DO schools have to actually convince premeds that the 'DO difference' is not just getting screwed in the match. They would have to make their programs actually match what program directors want.

Some differences I would anticipate is that it would force DO schools to open more home programs, unless they wanted to lose half their class. I don't think you can find 10k medical students a year interested in FM. I also think this would force them to have research facilities and faculty that the majority of DO don't have right now for the same reasons. This would increase the importance of rotations and aways. Showing teachability and aptitude for a subject would become much more important. Similar to the Podiatrist who posted at the end of the first page, GPA and rank would need to make a comeback for the few DO schools that don't do it. They would also have to really increase their investment in their students. I don't think the current 'screw em' attitude would result in 98% placement in a scenario where Step was P/F. They would actually need to be helpful if they wanted all their students to have a residency.

I don't think any of this would happen overnight, but I bet it would be faster than you think. DO schools couldn't be a 400+ student program with basically no residency's for home programs. They wouldn't fill without Step or the pool would become so dilute that half wouldn't pass like the Caribbean. I think DO schools have a very vested interest in trying to differentiate themselves from the Caribbean so I imagine most would step up or be closed.
It would be cool if any of that happened. But this assumes that administrators who’ve never really done anything for their student bodies are all of a sudden going to do WAY more for their students than ever before. Opening programs and getting research cost time, money, and effort. The current people in charge have neither the ability or interest to do any of this. The likely outcome would be that our match rates plummet and our attrition in turn sky rockets bc we only want our best hitting third year.

Even if all the stuff you said happened and we genuinely did just started producing DO students who were better in a more clinically oriented way, its not like MD schools wouldn’t be doing the same thing. So at best we’d be right back to our current state of being screwed in the match because of our initials when everything else is equal. Likely we’d be worse off because we don’t have that objective number to prove ourselves superior to our MD counterparts on some metric.

How would we get interviews for auditions anyway? We currently get screened for them by board scores. We could be very talented clinically but if we can’t get the audition we’ll never prove it to anyone who matters.
 
  • Like
Reactions: 1 users
It would be cool if any of that happened. But this assumes that administrators who’ve never really done anything for their student bodies are all of a sudden going to do WAY more for their students than ever before. Opening programs and getting research cost time, money, and effort. The current people in charge have neither the ability or interest to do any of this. The likely outcome would be that our match rates plummet and our attrition in turn sky rockets bc we only want our best hitting third year.

Even if all the stuff you said happened and we genuinely did just started producing DO students who were better in a more clinically oriented way, its not like MD schools wouldn’t be doing the same thing. So at best we’d be right back to our current state of being screwed in the match because of our initials when everything else is equal. Likely we’d be worse off because we don’t have that objective number to prove ourselves superior to our MD counterparts on some metric.

How would we get interviews for auditions anyway? We currently get screened for them by board scores. We could be very talented clinically but if we can’t get the audition we’ll never prove it to anyone who matters.
They would need to produce home programs to solve the audition issue. In my opinion, admittedly a thought exercise, the DO schools would respond to increasing attrition by actually establishing their own programs and increasing the quality of education. I think they would and that would made the MD/DO thing mute. However, it is also pretty easy to argue that they would become the carribbean without much fight. I definately can see a large amount of administrators who are fine with that route based on laziness and apathy. However, I don't think AOA/COCA is fine with becoming the caribbean, and thats why I think it would go the other way. They are still approving more schools, but the leash is definitely tightening and the fees going up. They want the gravy train to continue, not stagnant and start dying like Caribbean is right now.
 
Last edited:
  • Like
Reactions: 1 user
Schools with 400+ classes usually have separate campuses. But I see what you meam though
My school has close to 400 they have a separate campus but literally share faculty and stream lectures.

I almost never had questions but the couple times I sent an email or tried to talk to faculty about something they either never replied or where dismissive I can imagine it’s gotten ten times worse w the addition of a new campus and barely any new faculty.
Gotta keep the $$ rollin
 
Last edited:
  • Wow
Reactions: 1 user
With streaming lectures... at some point, the first 2 basic science years can practically be online only. Some nurse practitioner programs practically online programs. The students attend online lectures for one year and the next year arrange their own rotation/preceptorships with local physicians. They only attend the actual campus for graduation and orientation. The students can live in South Florida and complete the program based out of Wisconsin. With the way medical education is going, why not accept 2000 students and have them do pre-recorded lectures, take online tests, and arrange their own rotations...
 
why not accept 2000 students and have them do pre-recorded lectures, take online tests, and arrange their own rotations...

Because there's not enough spots for 2000 students to do rotations when the time comes.
 
With streaming lectures... at some point, the first 2 basic science years can practically be online only. Some nurse practitioner programs practically online programs. The students attend online lectures for one year and the next year arrange their own rotation/preceptorships with local physicians. They only attend the actual campus for graduation and orientation. The students can live in South Florida and complete the program based out of Wisconsin. With the way medical education is going, why not accept 2000 students and have them do pre-recorded lectures, take online tests, and arrange their own rotations...
One of the specific reasons I did not attend NP school was the arranging your own rotations. If the quality of rotations is questionable now, do that and they will become way worse. Np rotations are generally just shadowing of another NP, I don't know any decent physician or midlevel who thinks those are good rotations.

If NPs do something that we do not, thats generally a sign that it is much worse.
 
Top