2018: Step 2 CS...make it stop

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valleyrekt

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The attempt in 2016 to end Step 2 CS attacked the NBME because this fake acting and typing exam in front of fake acting civilians in a fake, made-up, contrived scenario was ridiculously too inconvenient and expensive (it still is, now more so than before) and also because it allegedly didn't fail enough students. The point that they should have focused more on is that there is no proof whatsoever that this exam actually improves patient care and patient safety...and that the NBME is simply using this to rob students blind. All of the arguments supporting this fake acting and typing exam are made by the people who are making millions off of having it in place. It should be a crime to use this fake acting and typing exam to derail the careers of students with regards to obtaining residency...never giving any explanation to the student what went wrong with the exam other than showing "*" marks estimating their CIS, ICE, SEP performances on an "objective" report. Especially with regards to the CIS component, this fake acting and typing exam is far from objective. Putting the future careers of medical students on the line in front of civilians being paid $15/hour acting out fake cases that are just "so realistic to the actual encounter of working with a patient" and assuring us that these standardized patients won't make any mistakes or biased assessments in their grading of the student...give me a break. Medical students are being played for fools. There is such a lack of transparency with the grading of this fake acting and typing exam, it honestly makes me ill.

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What a novel idea. Never heard this argument before.
 
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I don't think you'll find a single med student who disagrees with you

Yeah and they're just words. The test isn't going anywhere just like the nfl isn't going anywhere over cte. Both are real gripes but money talks and all that bs walks.
 
You'll take it and like it.
-NBME
 
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Seriously, somebody, anybody, please do something... unbelievable.
I seem to recall a story about some cantankerous young Harvard kids, being on the forefront of medical education and all, who dared take on the NBME. It went something like this...

Med students: Step 2 CS is pointless, everyone passes it, it's just highway robbery...
NBME: Hmm maybe you're right, not enough people are failing CS.
Med students: Exactly that's what we're say--wait, what

And now, thanks to them, 1 out of every 10 med students fails CS. The end.
 
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I seem to recall a story about some cantankerous young Harvard kids, being on the forefront of medical education and all, who dared take on the NBME. It went something like this...

Med students: Step 2 CS is pointless, everyone passes it, it's just highway robbery...
NBME: Hmm maybe you're right, not enough people are failing CS.
Med students: Exactly that's what we're say--wait, what

And now, thanks to them, 1 out of every 10 med students fails CS. The end.
That is exactly my point though, they approached it completely wrong. That is what this very thread is about, refer back to my first point in this thread.
 
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I think there wouldn't be so much objection to it if it was cheaper. I'd like to see what the breakdown is for the $1200 price. How much to standardized patient, to prometric, to the physician graders, etc.
 
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Honestly, I think you're fighting for the wrong thing. There isn't a single medical student that likes this exam or finds it useful. Theoretically all residencies can reject CS/not care about, but a lot more are starting to require that they have a Pass score in before ranking you. It isn't going anywhere so trying to get rid of it just won't ever happen and can be met with even worse outcomes like failing more people (like the Harvard students wonderfully did for us with their petition and website).

What would be a good cause is focus on getting more testing centers available with more dates. Or even try to see if scoring can be done slightly quicker so that students can retake if they fail.

Here is the NBME's response that is basically sticking a middle finger to all medical students:
The NBME, along with its collaborators in USMLE (the Federation of State Medical Boards and the Educational Commission for Foreign Medical Graduates), is committed to the assessment of clinical skills as part of the licensing examination sequence. In fact, a major recommendation from the Committee to Evaluate the USMLE program (CEUP) states: "CEUP recommends that the assessment of clinical skills remain a component of USMLE, but that USMLE consider ways to further enhance the testing methods currently used, in order to address additional skills important to medical practice. It is also recommended that the administrative challenges and costs to examinees associated with related testing formats be given substantial weight in the consideration of future changes."

This recommendation, among others, was approved by all three organizations that govern the USMLE program. The clinical skills examination is here to stay!

Source: www.nbme.org/students/Urban-Legends/index.html
 
Honestly, I think you're fighting for the wrong thing. There isn't a single medical student that likes this exam or finds it useful. Theoretically all residencies can reject CS/not care about, but a lot more are starting to require that they have a Pass score in before ranking you. It isn't going anywhere so trying to get rid of it just won't ever happen and can be met with even worse outcomes like failing more people (like the Harvard students wonderfully did for us with their petition and website).

What would be a good cause is focus on getting more testing centers available with more dates. Or even try to see if scoring can be done slightly quicker so that students can retake if they fail.

Here is the NBME's response that is basically sticking a middle finger to all medical students:


Source: www.nbme.org/students/Urban-Legends/index.html
Getting more testing centers/dates and report the result in 3 wks like step1/CK would probably ease some of the frustrations that med students have with this exam. It's crazy for someone to not being able to start intern year because of that exam...
 
Specialty boards...do they involve SP encounters?

I'm pretty sure anesthesia boards include SP encounters. Other boards that have an oral component may as well.

I get that people hate CS. I hated it too. But to be completely honest, there's probably a much higher likelihood of a candidate error than a standardized patient error/bias. I get that it really sucks to have failed the test and it means more money and more stress and potentially having to SOAP. I can't imagine that feeling. But take this as an opportunity to improve yourself and how you interact with patients. Maybe practice with a classmate and have them critique how you did.
 
I'm pretty sure anesthesia boards include SP encounters. Other boards that have an oral component may as well.

I get that people hate CS. I hated it too. But to be completely honest, there's probably a much higher likelihood of a candidate error than a standardized patient error/bias. I get that it really sucks to have failed the test and it means more money and more stress and potentially having to SOAP. I can't imagine that feeling. But take this as an opportunity to improve yourself and how you interact with patients. Maybe practice with a classmate and have them critique how you did.

SPs and these contrived scenarios should not have this much power over a medical student's career. Yes, if I failed, I'd take it in stride, like I always do. That's the fault of the medical student, we are so willing to do anything, like let an algorithm determine our future job, no one gives us a second thought. No other group of intelligent people are this submissive.

Every medical school in the US already has a comprehensive 4th year OSCE. Step 2 CS is a scam and needs to be abolished. The only reason it hasn't is because MS4s who take it and pass can't be bothered to make change for the next generation. We need unity.
 
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@Anti-PD1

I agree with you 100%... A lot things in our medical system need to change. Someone who is going to do a fellowship in GI, cardio, AI, ID etc... does not need to spend 3 years in IM... Make it that these people do 2-year IM only.
 
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@Anti-PD1

I agree with you 100%... A lot things in our medical system need to change. Someone who is going to do a fellowship in GI, cardio, AI, ID etc... does not need to spend 3 years in IM... Make it that these people do 2-year IM only.

Follow the Neurology model...1 year prelim IM only!
 
Just goes to show our profession is more money based now a days than evidence based now a days. A real disgusting example of everything wrong with medicine these days
 
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Why not rally PDs instead of the NBME to not care/reject CS scores? Why are PDs even looking at it? It's not a graduation requirement is it?
 
Why not rally PDs instead of the NBME to not care/reject CS scores? Why are PDs even looking at it? It's not a graduation requirement is it?

LOL You need to pass step 1 and step 2 CK/CS in order to take step 3. Why would a PD not look at whether you passed CS or not? They would be more than happy to create another Step exam if it meant finding a way to weed out more medical students. They care about their situation first and foremost, they don't give a crap about our situation.
 
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LOL You need to pass step 1 and step 2 CK/CS in order to take step 3. Why would a PD not look at whether you passed CS or not? They would be more than happy to create another Step exam if it meant finding a way to weed out more medical students. They care about their situation first and foremost, they don't give a crap about our situation.

I kind of realize that it's becoming more of a checkbox thing the further we're into our training. Instead of measuring 1st, 2nd, 3rd, or 4th quartile gpa, it's more about have you passed this thing on first try.
 
LOL You need to pass step 1 and step 2 CK/CS in order to take step 3. Why would a PD not look at whether you passed CS or not? They would be more than happy to create another Step exam if it meant finding a way to weed out more medical students. They care about their situation first and foremost, they don't give a crap about our situation.
The requirement to take step3 is to graduate from med school... My school does not require CS for graduation. You need to pass CS to get a training license in virtually all US states.

FSMB | Step 3 FAQ
 
I think there wouldn't be so much objection to it if it was cheaper. I'd like to see what the breakdown is for the $1200 price. How much to standardized patient, to prometric, to the physician graders, etc.
There's also the fact that your career is basically wrecked if you fail
 
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SPs and these contrived scenarios should not have this much power over a medical student's career. Yes, if I failed, I'd take it in stride, like I always do. That's the fault of the medical student, we are so willing to do anything, like let an algorithm determine our future job, no one gives us a second thought. No other group of intelligent people are this submissive.

Every medical school in the US already has a comprehensive 4th year OSCE. Step 2 CS is a scam and needs to be abolished. The only reason it hasn't is because MS4s who take it and pass can't be bothered to make change for the next generation. We need unity.
I fully support any initiative to abolish this exam but I worry it's going to take more than most of us are willing to risk. Turns out burying someone 200k in debt works as a super effective deterrent for dissension.
 
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The requirement to take step3 is to graduate from med school... My school does not require CS for graduation. You need to pass CS to get a training license in virtually all US states.

FSMB | Step 3 FAQ

Wasn't mentioning about graduation, this can vary amongst schools. You still need to pass step I and both parts of step II to take step III. This still holds true.

I kind of realize that it's becoming more of a checkbox thing the further we're into our training. Instead of measuring 1st, 2nd, 3rd, or 4th quartile gpa, it's more about have you passed this thing on first try.

Yeah. It more of a did you pass thing. If it was between a person that passed and didn't pass, the PD would rank the person who passed higher the first time.
 
The field of medicine doesn't give a **** about its students or trainees. The sooner you accept this, the more content you'll be.
 
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The field of medicine doesn't give a **** about its students or trainees. The sooner you accept this, the more content you'll be.

Hence why other fields are encroaching on our turf. Dont even get me started about EM online interviews.
 
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SPs and these contrived scenarios should not have this much power over a medical student's career. Yes, if I failed, I'd take it in stride, like I always do. That's the fault of the medical student, we are so willing to do anything, like let an algorithm determine our future job, no one gives us a second thought. No other group of intelligent people are this submissive.

Every medical school in the US already has a comprehensive 4th year OSCE. Step 2 CS is a scam and needs to be abolished. The only reason it hasn't is because MS4s who take it and pass can't be bothered to make change for the next generation. We need unity.

I prefer to be more of a realist. You're never going to unite all MS4's because for the vast majority of students, this is an easy but expensive pass which is currently a required checkbox to take Step 3 and get your license. Pretty sure the only way things will change is if licensing boards stop requiring CS.

Yeah in an ideal world, NBME would listen to students and this exam wouldn't exist. But it does, and it's unlikely to go anywhere. It's not that people "can't be bothered." It's that people would just prefer to fork over the money and pass the test so they can get into residency rather than risk it all for something that's unlikely to change anyway. You may call it submissive, but I say I have plenty of other things I can focus my time and energy towards changing that will actually change. You've seen the results of countless petitions in the past -- all it's gotten people is that now more people fail. They don't care about what the students think.

Do you have any suggestions for how people can enact this change?

The requirement to take step3 is to graduate from med school... My school does not require CS for graduation. You need to pass CS to get a training license in virtually all US states.

FSMB | Step 3 FAQ

You need to have passed Step 1, 2 CK and 2CS before you can sit for Step 3.
 
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There's also the fact that your career is basically wrecked if you fail

That's true for any Step exam I would say. Unless you mean in terms of the turn-around time for the test. That does need to be shortened also.
 
That's true for any Step exam I would say. Unless you mean in terms of the turn-around time for the test. That does need to be shortened also.
Given how arbitrary this one is and that it now has the highest failure rate of any exam, it's kind of a nightmare
 
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Yeah the NBME responded real well the last time its precious Step 2 CS exam was threatened by the student body. Spoilers: they just screwed the students even harder

WeLGeXn.jpg
 
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Do you have any suggestions for how people can enact this change?

The only people who have a chance of changing this are the medical schools. They have deep pockets, and are politically connected. They could argue that it does not discriminate well, interferes with medical school training, and seriously adversely impacts students if they fail.

I guess the other option is a class action lawsuit by the people who failed. Discovery would force the NBME to release the videos of the failed tests. If those videos were reviewed and demonstrated bias / vagueness / etc, the entire exam might collapse (or the NBME would double down and simply rebuild the exam).
 
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The only people who have a chance of changing this are the medical schools. They have deep pockets, and are politically connected. They could argue that it does not discriminate well, interferes with medical school training, and seriously adversely impacts students if they fail.

I guess the other option is a class action lawsuit by the people who failed. Discovery would force the NBME to release the videos of the failed tests. If those videos were reviewed and demonstrated bias / vagueness / etc, the entire exam might collapse (or the NBME would double down and simply rebuild the exam).
Bingo...

I can't believe there has not been a lawsuit against the NBME yet for CS...

If anyone does (other people might join), and there will be a bigger momentum to get rid of that pest...
 
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I volunteer to fail CS and start the lawsuit!
 
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Bingo...

I can't believe there has not been a lawsuit against the NBME yet for CS...

If anyone does (other people might join), and there will be a bigger momentum to get rid of that pest...

This would be very, very hard to prove. You would need to prove that the grading is truly arbitrary, which it probably isn't The better plan is to get the US MD schools to push back against the NBME.
 
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The only people who have a chance of changing this are the medical schools. They have deep pockets, and are politically connected. They could argue that it does not discriminate well, interferes with medical school training, and seriously adversely impacts students if they fail.

I guess the other option is a class action lawsuit by the people who failed. Discovery would force the NBME to release the videos of the failed tests. If those videos were reviewed and demonstrated bias / vagueness / etc, the entire exam might collapse (or the NBME would double down and simply rebuild the exam).
Would that work? Usually, when a few people take on a large organization with tons of money and resources in court, it turns into an attrition battle where the larger entity just stalls until the weaker party runs out of money for court costs. Best case scenario: they get a small pittance in the form of a settlement and nothing really changes. I don't see any reason why students suing the NBME would turn out any different.
 
The only people who have a chance of changing this are the medical schools. They have deep pockets, and are politically connected. They could argue that it does not discriminate well, interferes with medical school training, and seriously adversely impacts students if they fail.

I guess the other option is a class action lawsuit by the people who failed. Discovery would force the NBME to release the videos of the failed tests. If those videos were reviewed and demonstrated bias / vagueness / etc, the entire exam might collapse (or the NBME would double down and simply rebuild the exam).

There is already evidence of bias. I have found others but don’t remember where.

Detection of Biased Rating of Medical Students by Standardized Patients: Opportunity for Improvement


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This would be very, very hard to prove. You would need to prove that the grading is truly arbitrary, which it probably isn't The better plan is to get the US MD schools to push back against the NBME.
We all know that the schools are not going to push back against them because they don't really care...
 
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I had one of the CS SPs admit that they have difficulty remembering where they are in the script towards the end of the day. I was his last student and he was a tad sarcastic during the encounter. We met in the elevator on the way down.

So how’s that to say that they’re not the most reliable in their checkboxes for the CIS portion. It’s the least objective and if a student doesn’t get all their touchy-feely points or a SP feels like they didn’t feel validated or thought a student should have taken notes or spent more time in the room. Those are very subjective and change with every SP. Or if you get newer SPs, how specific are their instructions? If they are early 20’s and have absolutely NO medical background, how are they to know that you asking one question, a certain answer implies the answer to another? And when you have 3-4 of these young SP’s their lack of knowledge results in a failure.

No matter how much you research about the process, it’s almost a “nothing to see here, ignore the man behind the curtain.” You can’t see the hiring criteria or their training process or if there’s a vetting process for new SP’s. It can’t be this hugely competitive job. Who wants to be in a hospital gown being poked and prodded all day long?


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The only people who have a chance of changing this are the medical schools. They have deep pockets, and are politically connected. They could argue that it does not discriminate well, interferes with medical school training, and seriously adversely impacts students if they fail.

I guess the other option is a class action lawsuit by the people who failed. Discovery would force the NBME to release the videos of the failed tests. If those videos were reviewed and demonstrated bias / vagueness / etc, the entire exam might collapse (or the NBME would double down and simply rebuild the exam).

Then maybe us non-Hahvad med students (ok HMS too) should bring this issue to our student senates and demand the administration take action, all on the same day. It can be like V for Vendetta with less actual dynamite. Organize via FB whatever. It could be called White Coats to End CS (WC2ECS?)

I'm on my senate, the kind of crap students complain about and get their way with, Step 2 CS is a worthy target.
 
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Yeah they should have real patients that swear at you, threaten you, actually hit you, vomit and piss on you and then ask for a turkey sandwich and a note for work.
 
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I had one of the CS SPs admit that they have difficulty remembering where they are in the script towards the end of the day. I was his last student and he was a tad sarcastic during the encounter. We met in the elevator on the way down.

So how’s that to say that they’re not the most reliable in their checkboxes for the CIS portion. It’s the least objective and if a student doesn’t get all their touchy-feely points or a SP feels like they didn’t feel validated or thought a student should have taken notes or spent more time in the room. Those are very subjective and change with every SP. Or if you get newer SPs, how specific are their instructions? If they are early 20’s and have absolutely NO medical background, how are they to know that you asking one question, a certain answer implies the answer to another? And when you have 3-4 of these young SP’s their lack of knowledge results in a failure.

No matter how much you research about the process, it’s almost a “nothing to see here, ignore the man behind the curtain.” You can’t see the hiring criteria or their training process or if there’s a vetting process for new SP’s. It can’t be this hugely competitive job. Who wants to be in a hospital gown being poked and prodded all day long?


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If this is so, it would effect everyone on their last station. I agree with APD and think it’s not likely that this test is that subjective. It’s more or less that it’s a stupid test that would fail someone who tries to go into it thinking they can reason through things vs. having a plug and chug strategy. The key to this exam I feel is to keep things simple, don’t try to complicate things by fixating in details.
 
Then maybe us non-Hahvad med students (ok HMS too) should bring this issue to our student senates and demand the administration take action, all on the same day. It can be like V for Vendetta with less actual dynamite. Organize via FB whatever. It could be called White Coats to End CS (WC2ECS?)

I'm on my senate, the kind of crap students complain about and get their way with, Step 2 CS is a worthy target.

I'm game if NP is game.






* = Natalie Portman
 
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Yeah they should have real patients that swear at you, threaten you, actually hit you, vomit and piss on you and then ask for a turkey sandwich and a note for work.
Better than one who can rob you of a career you have been working on for 4 years and eliminate your chances of participating in the match.
 
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