MD Are students at top-10 schools essentially guaranteed 250+ on step 1 if they work super hard?

[sliceofbread136]

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Have you taken Step I yet, FF? Because if not, you're simply blowing smoke out of your ass.

You haven't taken it either...

 

[Goro]

I teach med students who do take it, and I know them.

I'm signed up to take Step I later this year. COMLEX I I've already taken 2x.

You haven't taken it either...

 

[mwsapphire]

I teach med students who do take it, and I know them.

I'm signed up to take Step I later this year. COMLEX I I've already taken 2x.

...wut.

 

[ActinicKeratosis]

Took it got 250+ and had average MCAT but above average preclinical med school grades.


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[Frogger27]

Took it got 250+ and had average MCAT but above average preclinical med school grades.


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So what's your take on the thread? Hard work?

 

[Aonyx]

I think it depends on a lot of factors. Being intelligent and memorizing obscene amounts of information are prerequisites to doing well. Being a good test taker is what benefited me the most. I got a 31 on my best MCAT and around 3.6 undergrad GPA. I ended up with a 4.0 GPA for the first two years at my DO school and a 260+ on both step 1 and 2. I think the key for me was figuring out what the heck the question was testing me on. Every question has a concept that is being tested. Figuring out what it is enables you to figure out what answer choices can be eliminated immediately. From that, having a good knowledge base can get you to the right answer. I certainly don't think that a 250 or 260+ is attainable by "anyone" if they just put in the work and aren't lazy. I had a friend who studied as much or more as I did and struggled to break 200. It takes more than just work and intelligence. You really have to develop a solid test taking strategy and apply it on test day.

I also don't think that any standardized test is a good predictor of whether or not you will be a good clinician. It certainly helps if you have a good knowledge base, but there are many other important factors that aren't tested on standardized tests.

 

[AlteredScale]

...wut.

Faculty will take these board exams every year to get a feel for what is on it to direct their teaching. We have had faculty who have taken USMLE/COMLEX every year for 10-15 years.

 

[Astra]

Tl;dr: Work hard and smart, hope for the best.

 

[sharkbyte]

This is what I believe (others may disagree, but nothing will change my mind): MCAT is more of an IQ test, whereas Step 1 is primarily memorization. Now before you get your panties in a knot, obviously Step 1 requires a healthy amount of critical thinking and integration, however that is not the bottleneck. In MCAT, you could memorize every single fact in the book and still not get an elite score simply because you lacked the required reading comprehension / logic ability. In contrast, if you had only slightly above average IQ but somehow literally memorized every testable fact for boards, I believe it would be pretty straightforward to get a 265. It stands to reason that a test with a vastly greater amount of testable material would come down to memory. Case in point the prototypical foreign medical grad who gets a 260+ simply because they had the luxury of studying full time for a whole year. People love to say "Memorizing First Aid is not enough," but thats a heaping pile of bull-crap because, in reality, very, very, very few people have managed to *literally* memorize every single point in that book. And 99% of the time, those who say that they had Step 1 questions that weren't in FA are simply wrong and just missed that point in the sea of high-yield minutia. Again, you obviously need to understand the things that you're memorizing, but that doesn't change the fact that it's still much more information than the average person has the time or willpower to memorize. Like others have said, it's a test in which sacrifices pay dividends. Your fancy shmancy US news ranking won't save you if you don't sit your butt down and do the work. You can no longer rely on innate ability at this juncture...because, at the end of the day, people want the doctor who knows the most, not the one with the highest IQ. Encyclopedic knowledge beats IQ pretty much every time in medicine.

You have not taken the test and formally studied for it yet. You should not be talking as if you know anything about it. End of discussion.

 

[ActinicKeratosis]

So what's your take on the thread? Hard work?

Hard work is key. There is just a ton of material to know and unless you have a photographic memory there is no substitute for brute force studying. My school was all pass/fail for the first two years so beginning in the fall of second year I started focusing mostly on boards. Months of studying leads to a high score if you study effectively and don't burn out.


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[Panther_]

You get out of med school what you put into it. Work ethic counts.

What are your thoughts on students who performed poorly in CARS/Verbal Reasoning and their success in medical school during the first two years?

I've seen the weak correlation of CARS with Step 1 performance, but I am somewhat apprehensive about my ability to be academically successful in medical school based on continued poor performance (multiple MCAT's) on this section.

 

[speedyxx626]

What are your thoughts on students who performed poorly in CARS/Verbal Reasoning and their success in medical school during the first two years?

I've seen the weak correlation of CARS with Step 1 performance, but I am somewhat apprehensive about my ability to be academically successful in medical school based on continued poor performance (multiple MCAT's) on this section.

My verbal score on MCAT was a 6 the first time, and the second time around I scored a 9. One of my buddies had the same 2 scores on his verbal section and we both scored 250+ on Step 1. Pretty anecdotal, I know, but just saying that you shouldn't let performance on a previous exam dictate your future scores. Some say that better verbal scores correlate with overall performance in med school, or how well you'll be able to handle the material (due to "better comprehension skills"), but I hardly find that to be true (at least in my case). In fact, I know multiple people that scored >95 percentile on the reading section and have performed pretty poorly/average in med school. Study hard, study efficiently, and make sure you get a solid foundation from your first two years and it's definitely doable with decent reasoning skills.

 

[Panther_]

My verbal score on MCAT was a 6 the first time, and the second time around I scored a 9. One of my buddies had the same 2 scores on his verbal section and we both scored 250+ on Step 1. Pretty anecdotal, I know, but just saying that you shouldn't let performance on a previous exam dictate your future scores. Some say that better verbal scores correlate with overall performance in med school, or how well you'll be able to handle the material (due to "better comprehension skills"), but I hardly find that to be true (at least in my case). In fact, I know multiple people that scored >95 percentile on the reading section and have performed pretty poorly/average in med school. Study hard, study efficiently, and make sure you get a solid foundation from your first two years and it's definitely doable with decent reasoning skills.

Thanks for the encouragement! Although anecdotal, your post is definitely reassuring!

 

[Shams al Deen]

Everyone (most people) in med school are capable of getting a 250...however, most people are not willing to sacrifice what it takes to get that 250. Also, it's pretty insulting to tell people who get 230 or 240 that they are lazy...just because they don't put in the time to get the 250 doesn't mean they're lazy...it means they chose not to put the time in because they have other hobbies, commitments, etc...

IDK about this tbh. Everyone at my med school studies so hard and always seem on top of all the material. Yet the overwhelming majority (75%+) simply don't hit 250. They are putting in the hours, so many hours. They are aiming for 250. Very few people in med school are willingly saying "hey I'm gonna go out and do my 'hobby' 3x/week, because I don't care if I get 250+, my 'hobby' is more important". Most people in med school generally aren't wired that way.

@1almond how many almonds would you say is the perfect amount?

 

[Goro]

What are your thoughts on students who performed poorly in CARS/Verbal Reasoning and their success in medical school during the first two years?

I've seen the weak correlation of CARS with Step 1 performance, but I am somewhat apprehensive about my ability to be academically successful in medical school based on continued poor performance (multiple MCAT's) on this section.

The CARS/VR sections are perverse.

I have yet to see any convincing data that MCAT subsections in and of themselves are good predictors of anything.

 

[speedyxx626]

The CARS/VR sections are perverse.

I have yet to see any convincing data that MCAT subsections in and of themselves are good predictors of anything.

Here's a paper written by someone I know. Agrees with your statement above that grades in the first two years have the best correlation with step 1 score.

A Predictive Model for USMLE Step 1 Scores

 

[cellsaver]

You haven't taken it either...

I teach med students who do take it, and I know them.
I'm signed up to take Step I later this year. COMLEX I I've already taken 2x.

Goro, the comment by sliceofbread136 made me wince. I apologize for their rudeness. I can take it pretty well, but when someone does it to an admin who is here just to help aspiring physicians, it just really sux.

 

[ridethecliche]

Congrats gaiz! You fed the tr0lll0l0l0l0l.

Most kids bust their ass through medical school, so if your average score is a 236 at Yale, chances are 90% of the kids there were giving it their all and the average ended up being far shy of your desired 250-260.

Yale's a weird school to pick for an example due to their curriculum though.

 

[1almond]

Congrats gaiz! You fed the tr0lll0l0l0l0l.

not a troll. I don't know why anyone considers this an unreasonable question, given that about half of you think I'm an idiot because the answer is "obviously yes, if you work hard enough," and the other half of you think I'm an idiot because the answer is "obviously no." When people are so divided on the answer, and so confident about their different answers, it's not really fair to claim that the question is a bad one.

 

[cbrons]

Obviously not

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[dempty]

Here's a paper written by someone I know. Agrees with your statement above that grades in the first two years have the best correlation with step 1 score.

A Predictive Model for USMLE Step 1 Scores

I've seen this paper before. With respect to you or whoever wrote it, it's got a lot of methodological issues in it that open it up to falling very short of what they said their goal was.

 

[speedyxx626]

I've seen this paper before. With respect to you or whoever wrote it, it's got a lot of methodological issues in it that open it up to falling very short of what they said their goal was.

No, not my paper. Didn't really look through the whole thing, just thought I'd share.

 

[HatTricks01]

My verbal score on MCAT was a 6 the first time, and the second time around I scored a 9. One of my buddies had the same 2 scores on his verbal section and we both scored 250+ on Step 1. Pretty anecdotal, I know, but just saying that you shouldn't let performance on a previous exam dictate your future scores. Some say that better verbal scores correlate with overall performance in med school, or how well you'll be able to handle the material (due to "better comprehension skills"), but I hardly find that to be true (at least in my case). In fact, I know multiple people that scored >95 percentile on the reading section and have performed pretty poorly/average in med school. Study hard, study efficiently, and make sure you get a solid foundation from your first two years and it's definitely doable with decent reasoning skills.

Gonna add some more anecdotal evidence to this. For the life of me, I could never score above an 8 on the VR section of the MCAT. Took it twice and got an 8 both times. Also never scored above that on any of the 10+ practice tests I took either. (Had a mediocre performance on the verbal portion of the SATs as well if my memory serves me right.) Scored >250 on step 1 and have been scoring >90th percentile on most of my shelves. Give me an article on one man's take on contemporary art and I will, without a doubt, s**t the bed; give me a question with some clinical relevance and I'm your man.

 

[Affiche]

What are your thoughts on students who performed poorly in CARS/Verbal Reasoning and their success in medical school during the first two years?

I've seen the weak correlation of CARS with Step 1 performance, but I am somewhat apprehensive about my ability to be academically successful in medical school based on continued poor performance (multiple MCAT's) on this section.

I haven't taken Step yet, but I've found the bio section of the MCAT to be best predictor of success in preclinical (so far). My bio score was >95th percentile, my CARS was dog shyt, and I honor my courses with significantly less effort than a lot of my classmates (I still work pretty hard, though). I don't say this as a humble brag, but I had similar concerns last year, so thought I'd share.

 

[libertyyne]

Here's a paper written by someone I know. Agrees with your statement above that grades in the first two years have the best correlation with step 1 score.

A Predictive Model for USMLE Step 1 Scores

"There are several limitations to this study. First, the predictive model was developed from the experiences of one medical school and our overall sample size was small with a poor survey response rate. This may explain why other studies have been able to correlate MCAT scores to Step 1 scores while ours did not."

 

[speedyxx626]

"There are several limitations to this study. First, the predictive model was developed from the experiences of one medical school and our overall sample size was small with a poor survey response rate. This may explain why other studies have been able to correlate MCAT scores to Step 1 scores while ours did not."

Read above. I didn't read through the whole thing, just thought I'd share it.

 

[dempty]

"There are several limitations to this study. First, the predictive model was developed from the experiences of one medical school and our overall sample size was small with a poor survey response rate. This may explain why other studies have been able to correlate MCAT scores to Step 1 scores while ours did not."

I'm not even talking about their criticism of the paper. They have a lot of glaring issues with the paper and the ultimate product, from a statistical perspective. To be honest, the part you quoted is probably one of the smallest of their concerns.

 

[libertyyne]

I'm not even talking about their criticism of the paper. They have a lot of glaring issues with the paper and the ultimate product, from a statistical perspective. To be honest, the part you quoted is probably one of the smallest of their concerns.

I qouted it to show that even the authors listed it as an important limitation. I haven't delved deeper into the statistical issues with the paper it self because I read "self reported survey of students at one institution". That was enough of a red flag for me.

 

[Panther_]

I haven't taken Step yet, but I've found the bio section of the MCAT to be best predictor of success in preclinical (so far). My bio score was >95th percentile, my CARS was dog shyt, and I honor my courses with significantly less effort than a lot of my classmates (I still work pretty hard, though). I don't say this as a humble brag, but I had similar concerns last year, so thought I'd share.

That's good to hear that you are doing well in your coursework. It seems like the general consensus here is to work hard/do well during preclinical years and during dedicated step time. Obviously getting above a 250 is not guaranteed, but its good to know that there are med students in my position who have done well on step and who are doing well in med school in general.

 

[dempty]

I qouted it to show that even the authors listed it as an important limitation. I haven't delved deeper into the statistical issues with the paper it self because I read "self reported survey of students at one institution". That was enough of a red flag for me.

That isn't necessarily a red flag in itself,though. It definitely exacerbates the whole issue when you see they didn't execute in a bunch of areas. If they did some other things properly, the single-school problem might not be much of an issue or might be far less of an issue.

 

[libertyyne]

That isn't necessarily a red flag in itself,though. It definitely exacerbates the whole issue when you see they didn't execute in a bunch of areas. If they did some other things properly, the single-school problem might not be much of an issue or might be far less of an issue.

I suppose I personally finding surveying a convenience sample poor quality in the grand scheme of study designs. Considering people can lie, bias in response rates etc.

 

[dempty]

I suppose I personally finding surveying a convenience sample poor quality in the grand scheme of study designs. Considering people can lie, bias in response rates etc.

I agree with you absolutely. I just think there's a bit of limitations to a study like this. It would be hard to reliably get the study information from students. The easiest stuff to get with a high degree of fidelity would probably be NBME scores and the STEP 1 score sent to the school with the student ID, then the school can match up and add the GPA, MCAT, financial aid, and so on, but that would require some cooperation from the NBME. I would also argue that there are going to be problems in every study, but real world performance is what matters. In other words, if somehow this was the worst study ever, but they set out to build a predictive model for STEP1 scores, and the model performed well with external data and thorough vetting, then we probably won't care too much that the respondents lied or whatever. I think this isn't the most likely scenario, but similar issues arise in economics and soft fields like sociology. The assumptions are incredibly realistic and the model does poorly in reality, so we discredit it somewhat. When we have models that have bad assumptions but work well, we don't disregard them because there are theoretical issues.

For this paper, it seems they have the potential issue you mentioned with a ton of other stuff piled on top. They're taking steps in the right direction, but it seems they forgot their shoes, the map, their lunch, and sunblock.

By the way, I'd love to see a randomized controlled trial for STEP study methods. Nothing extreme, just using the standard resources everyone talks about. All groups use UWorld with some getting nothing additional, some getting FA, some getting pathoma, and a few combinations, of course. I would not sign up, though.

 

[ridethecliche]

not a troll. I don't know why anyone considers this an unreasonable question, given that about half of you think I'm an idiot because the answer is "obviously yes, if you work hard enough," and the other half of you think I'm an idiot because the answer is "obviously no." When people are so divided on the answer, and so confident about their different answers, it's not really fair to claim that the question is a bad one.

 

[libertyyne]

I agree with you absolutely. I just think there's a bit of limitations to a study like this. It would be hard to reliably get the study information from students. The easiest stuff to get with a high degree of fidelity would probably be NBME scores and the STEP 1 score sent to the school with the student ID, then the school can match up and add the GPA, MCAT, financial aid, and so on, but that would require some cooperation from the NBME. I would also argue that there are going to be problems in every study, but real world performance is what matters. In other words, if somehow this was the worst study ever, but they set out to build a predictive model for STEP1 scores, and the model performed well with external data and thorough vetting, then we probably won't care too much that the respondents lied or whatever. I think this isn't the most likely scenario, but similar issues arise in economics and soft fields like sociology. The assumptions are incredibly realistic and the model does poorly in reality, so we discredit it somewhat. When we have models that have bad assumptions but work well, we don't disregard them because there are theoretical issues.

For this paper, it seems they have the potential issue you mentioned with a ton of other stuff piled on top. They're taking steps in the right direction, but it seems they forgot their shoes, the map, their lunch, and sunblock.

By the way, I'd love to see a randomized controlled trial for STEP study methods. Nothing extreme, just using the standard resources everyone talks about. All groups use UWorld with some getting nothing additional, some getting FA, some getting pathoma, and a few combinations, of course. I would not sign up, though.

Not sure if it matters but here is a much better meta-analysis, although an older one on the question of mcat and USMLE performance.

http://www.internationalgme.org/Resources/Pubs/Donnon et al (2007) Acad Med.pdf

 

[intubesteak]

OP, and any other anxious/ambitious pre-M1's, here is what you do:

1. Start with the attitude that anybody can get a 250 is they work hard enough

2. If you don't end up with a 250 and you worked hard, go with the "250 is only attainable for people with the right constellation of intelligence/personality/whatever". Just don't get depressed on us.

3. If you do get a 250, don't be a douche about it

 

[failedatlife]

Show me the data on that one, or even a quote from a PD saying something remotely close to that. Not going to argue that name helps. But, most programs that are very competitive have Step score floors that will make it so the 225 will be looked over easily.

Can you show me data on your statement?

 

[Anicetus]

OP, and any other anxious/ambitious pre-M1's, here is what you do:

1. Start with the attitude that anybody can get a 250 is they work hard enough

2. If you don't end up with a 250 and you worked hard, go with the "250 is only attainable for people with the right constellation of intelligence/personality/whatever". Just don't get depressed on us.

3. If you do get a 250, don't be a douche about it

The only people who believe a 250 is attainable for any med student if they work hard enough are:

-Med students who have yet to take it.

- admins without an MD/DO who take it.

- people who got 250+ even if they went like hiking for 50% of their dedicated study period of 3 weeks, God himself wouldn't be able to convince this type of person that they are naturally bright.

- people who got under 250 who know they didn't give it their all.


Everyone else knows that scoring 85th percentile is not attainable simply from working/trying hard enough.

 

[intubesteak]

The only people who believe a 250 is attainable for any med student if they work hard enough are:

-Med students who have yet to take it.

- admins without an MD/DO who take it.

- people who got 250+ even if they went like hiking for 50% of their dedicated study period of 3 weeks, God himself wouldn't be able to convince this type of person that they are naturally bright.

- people who got under 250 who know they didn't give it their all.


Everyone else knows that scoring 85th percentile is not attainable simply from working/trying hard enough.

Don't underestimate the power of a positive attitude. Who cares if 250 is a pipe dream (in OPs case, its probably not. The dude is smart). If working towards a 250 keeps you going, then by all means you should believe that it is possible.

 

[Anicetus]

Don't underestimate the power of a positive attitude. Who cares if 250 is a pipe dream (in OPs case, its probably not. The dude is smart). If working towards a 250 keeps you going, then by all means you should believe that it is possible.

100% agree.

When people ask what the "goal score" is I don't even know what that means. Why people wouldn't put in 100% effort is beyond me and should have the theoretical goal of a 270.

Shed blood, sweat, and tears for it. This test can only be taken once so I don't know why someone would be lackadaisical during their dedicated time and even the time leading up to it.

Besides, as someone who only scored in the 230's I have no regrets from giving this test my hardest effort I've ever given. At the end of the day going through life with that score and no regrets is better than getting in the 230's after not giving it your all and always wondering how high that score really could've been.

 

[libertyyne]

The only people who believe a 250 is attainable for any med student if they work hard enough are:

-Med students who have yet to take it.

- admins without an MD/DO who take it.

- people who got 250+ even if they went like hiking for 50% of their dedicated study period of 3 weeks, God himself wouldn't be able to convince this type of person that they are naturally bright.

- people who got under 250 who know they didn't give it their all.


Everyone else knows that scoring 85th percentile is not attainable simply from working/trying hard enough.

so you are saying there is a chance.

 

[Anicetus]

so you are saying there is a chance.

Depends entirely on your brain.

 

[BraggingMyPeak]

Interesting trends of Step 1 vs. MCAT at various schools. Mayo clearly stands out as an outlier. Maybe more of a focus on individual study time?

 

[Shams al Deen]

Aren't the USNews step 1 scores BS?

 

[ivybme]

Things that stand out: Duke, Baylor, and Harvard incorporate their clinicals early on, and I believe it takes place before step occurs. Those three seem to be the most notable outliers aside from Mayo, which just has a unique curriculum altogether.

 

[DubbiDoctor]

No, not at all, this is approaching black hole dense levels of underestimating the USMLE.

Then there's me, who was a pretty solid applicant on paper (3.81, 35)

Sorry if you covered this previously, but with your stats (still comfortably above the MD median) why did you go DO and not MD? Do you regret it?

 

[Redpancreas]

No, but if they get that score and don’t screw up elsewhere, they’re guaranteed either the field of the choice or a top tier program in something like IM/Neuro/Gen Surg

 

[libertyyne]

Interesting trends of Step 1 vs. MCAT at various schools. Mayo clearly stands out as an outlier. Maybe more of a focus on individual study time?

Are the class MCAT medians reported for the same entering class as the Median step scores are reported?
Where was the step data obtained from?
Are you sure it is legit step data and not gamed?
are all of those medians or are some of them means?
Does it include people held back ?

 

[Oh_Gee]

Interesting trends of Step 1 vs. MCAT at various schools. Mayo clearly stands out as an outlier. Maybe more of a focus on individual study time?

where'd you get this from?

 

[Redpancreas]

Goro, the comment by sliceofbread136 made me wince. I apologize for their rudeness. I can take it pretty well, but when someone does it to an admin who is here just to help aspiring physicians, it just really sux.

Calm down. @sliceofbread136 ’s comment is actually quite reasonable. Goro is known for posting more than he knows and just parroting other’s advice sometimes in the wrong context. It’s not a stretch for medical students to remind him that’s he’s not taking USMLE Step 1 one time to determine the trajectory his life.

 

[Redpancreas]

Goro, the comment by sliceofbread136 made me wince. I apologize for their rudeness. I can take it pretty well, but when someone does it to an admin who is here just to help aspiring physicians, it just really sux.

Calm down. @sliceofbread136 ’s comment is actually quite reasonable. Goro is known for posting more than he knows and just parroting other’s advice sometimes in the wrong context. It’s not a stretch for medical students to remind him that’s he’s not taking USMLE Step 1 to determine his life.