Changes

[Dermpath]

Hey people, so since I'm about to take step 3 soon, I read the usmle page and they mentioned that there is now a change that will limit attempts to pass i guess each step to 6 times. Clearly I think it's a large # of attempts to pass these tests, but I'm wondering-what happens if someone cannot actually pass these tests? Do they simply get stuck with no license and no possibility to practice?

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[Shinken]

Do they simply get stuck with no license and no possibility to practice?

Yes.

 

[Dermpath]

Yes.

Wow that sucks. Seems kind of harsh no?

 

[LucidSplash]

Wow that sucks. Seems kind of harsh no?

Really? You think failing 6 opportunities (or I guess a total of 18) to just pass a set of exams which have numerous associated study-guides, question banks, and review courses means the bar was set too high? Would you want someone that was unable to pass the Steps to be your doctor?

 

[Dermpath]

Really? You think failing 6 opportunities (or I guess a total of 18) to just pass a set of exams which have numerous associated study-guides, question banks, and review courses means the bar was set too high? Would you want someone that was unable to pass the Steps to be your doctor?

I'm pretty sure that I mentioned that it was a large # of attempts, but I think it's harsh nevertheless. I think the steps do diddly squat to determine who will be a good doctor or a bad one. Except for those in IM/FM/Peds/OB, few people would be able to pass these exams without studying. You think rad oncs, rads, gas, GI's, etc. attendings would be able to pass these exams without serious study? Unlikely, even though they are in some of the most competitive specialties. 90% of those concepts are not something most doctors deal with on an everyday basis. Are you serious? I haven't seen a kid or touched a peds or OB subject since I took step 2. Most people never see these topics ever again after they are done with the rotations. Unless you are in Ob/Peds/FM, you would never touch these subjects again. So while I do think that 99.9% of people would pass these exams with a 6 time limit, I do think for the miniscule amount of those who can't, it sucks to waste 4 + years of medical education.

So whether I remember which antibiotic is associated with some dubious pediatric condition, or whether I remember which specific type of hemorrhage or placenta is more likely with this or that situation, becomes irrelevant for most of us, and it would suck to lose so many years of education based on this.

 

[LucidSplash]

I'm pretty sure that I mentioned that it was a large # of attempts, but I think it's harsh nevertheless. I think the steps do diddly squat to determine who will be a good doctor or a bad one. Except for those in IM/FM/Peds/OB, few people would be able to pass these exams without studying. You think rad oncs, rads, gas, GI's, etc. attendings would be able to pass these exams without serious study? Unlikely, even though they are in some of the most competitive specialties. 90% of those concepts are not something most doctors deal with on an everyday basis. Are you serious? I haven't seen a kid or touched a peds or OB subject since I took step 2. Most people never see these topics ever again after they are done with the rotations. Unless you are in Ob/Peds/FM, you would never touch these subjects again. So while I do think that 99.9% of people would pass these exams with a 6 time limit, I do think for the miniscule amount of those who can't, it sucks to waste 4 + years of medical education.

So whether I remember which antibiotic is associated with some dubious pediatric condition, or whether I remember which specific type of hemorrhage or placenta is more likely with this or that situation, becomes irrelevant for most of us, and it would suck to lose so many years of education based on this.

The point is, the line has to be drawn SOMEWHERE. If not with 6 attempts, where should it be? You haven't taken Step 3 yet but let me tell you, this is the easiest of the Steps and the lowest threshold of all. Yes you need to study and refresh, but even those of us not in a primary care field can pass it without too much studying. It is unlikely that someone with the study skills to do well enough on standardized tests to match into competitive field would have difficulty with Step 3 - that's a straw man argument. The pass limit on these exams is going to be aimed at those who struggle with Step I and Step II. I agree with your assertion that the Steps are not the ultimate test of the quality of a doctor (much like the MCAT is not the ultimate test of the quality of a medical student) but unless you are willing to do away with standardized testing entirely, there has to be some limit to what is the bare minimum of competency.

 

[Dermpath]

The point is, the line has to be drawn SOMEWHERE. If not with 6 attempts, where should it be? You haven't taken Step 3 yet but let me tell you, this is the easiest of the Steps and the lowest threshold of all. Yes you need to study and refresh, but even those of us not in a primary care field can pass it without too much studying. It is unlikely that someone with the study skills to do well enough on standardized tests to match into competitive field would have difficulty with Step 3 - that's a straw man argument. The pass limit on these exams is going to be aimed at those who struggle with Step I and Step II. I agree with your assertion that the Steps are not the ultimate test of the quality of a doctor (much like the MCAT is not the ultimate test of the quality of a medical student) but unless you are willing to do away with standardized testing entirely, there has to be some limit to what is the bare minimum of competency.

You are correct that I have not yet taken step 3 yet, although I hear that it's tough. I guess I'll see when I do take it. I was blessed to pass all steps thus far on my first attempt, but as someone who is not good at test taking, I gotta tell you that I find this policy harsh. I mean just imagine, for those of us who are not stellar test takers-could you imagine going through 5+ years of medication education and not being able to say pass step 3? Wow!

I think the MCAT is a bunch of pointlessness as well. I think all standarized testing is honestly. I guess I tend to go on the more compassionate side of things. Oh well.

 

[LucidSplash]

You are correct that I have not yet taken step 3 yet, although I hear that it's tough. I guess I'll see when I do take it. I was blessed to pass all steps thus far on my first attempt, but as someone who is not good at test taking, I gotta tell you that I find this policy harsh. I mean just imagine, for those of us who are not stellar test takers-could you imagine going through 5+ years of medication education and not being able to say pass step 3? Wow!

I think the MCAT is a bunch of pointlessness as well. I think all standarized testing is honestly. I guess I tend to go on the more compassionate side of things. Oh well.

As someone who is also not a great test taker, I still think there need to be bare minimums. If you want to do away with standardized testing that's fine, but please propose an alternative model for assessing whether an individual can handle the rigors of medical school (instead of the MCAT) or the ability to pass specialty boards (instead of the Steps).

This has nothing to do with being compassionate - regardless of how much effort/time someone puts into something, you shouldn't just get an automatic pass to the next level. You have to earn it. Should we stop testing in medical school too?

 

[Arcan57]

You are correct that I have not yet taken step 3 yet, although I hear that it's tough. I guess I'll see when I do take it. I was blessed to pass all steps thus far on my first attempt, but as someone who is not good at test taking, I gotta tell you that I find this policy harsh. I mean just imagine, for those of us who are not stellar test takers-could you imagine going through 5+ years of medication education and not being able to say pass step 3? Wow!

I think the MCAT is a bunch of pointlessness as well. I think all standarized testing is honestly. I guess I tend to go on the more compassionate side of things. Oh well.

Step III is not difficult. You don't have to be a stellar test taker to pass it. Depending on your field, you may have to commit more or less time studying the parts of medicine you don't see on a regular basis. While passing Step III isn't a guarantee of competence (see the numerous "why can't I be work as a PA threads"), it does represent some minimum level of general medical knowledge and I would not want a doctor that was unable to pass Step III in any way associated with my care.

Of note, judging by your user name, I'd be much more worried about the path boards as I've heard the level of esoterica tested there is significantly more ridiculous then Step III.

 

[Winged Scapula]

You are correct that I have not yet taken step 3 yet, although I hear that it's tough. I guess I'll see when I do take it.

From whom? Its by far the easiest of the exams (and I took it as a PGY-3 non-primary care resident and was still able to pass with minimal studying). The fact that over 97% of physicians taking it pass on the first try is testament to the fact that its pretty easy. I've never heard a physician state that the exam was tough.

 

[Dermpath]

As someone who is also not a great test taker, I still think there need to be bare minimums. If you want to do away with standardized testing that's fine, but please propose an alternative model for assessing whether an individual can handle the rigors of medical school (instead of the MCAT) or the ability to pass specialty boards (instead of the Steps).

This has nothing to do with being compassionate - regardless of how much effort/time someone puts into something, you shouldn't just get an automatic pass to the next level. You have to earn it. Should we stop testing in medical school too?

I think you bring up an interesting point about testing in medical school so I'll address that one first. I agree that a bare minimum should be expected, but there are elite medical schools, for example Harvard/Yale that take "optional tests" and their students are not required to take any test they don't want to. These curriculums have worked well given that students from these institutions do well on their steps and match well too. So I think that there is a possibility that testing in medical school should be reduced to some extent. Do we really learn about a person's ability to practice based on random test questions, and testing under extreme conditions (as in taking 7+ tests during a single week as we had to do in our med school). I dont think that makes sense necessarily. I think practice is a much more realistic setting of how good or bad someone is. I see the MCAT as a test to weed out people mostly who are not good at test taking, and the steps are instruments to weed out -again-people not good at test taking when it comes to competitive specialties.

So I think we could do just as well with less testing, and more practice. I do not have a perfect solution, but I think a major reform when it comes to medical education is important.

I think overall that we need a balance between academic rigors and compassion.

 

[Arcan57]

As someone who is also not a great test taker, I still think there need to be bare minimums. If you want to do away with standardized testing that's fine, but please propose an alternative model for assessing whether an individual can handle the rigors of medical school (instead of the MCAT) or the ability to pass specialty boards (instead of the Steps).

This has nothing to do with being compassionate - regardless of how much effort/time someone puts into something, you shouldn't just get an automatic pass to the next level. You have to earn it. Should we stop testing in medical school too?

I think the OP is completely ignoring that it's been consistently shown that almost everyone involved in the process wants more discrimination between students rather then less. Someone though it was ridiculous that med schools had letter grades, so they compressed everything into pass/fail. How long did that take to morph into the honors, high pass, pass, fail system that is a direct renaming of the A,B,C,F system?

 

[Dermpath]

Step III is not difficult. You don't have to be a stellar test taker to pass it. Depending on your field, you may have to commit more or less time studying the parts of medicine you don't see on a regular basis. While passing Step III isn't a guarantee of competence (see the numerous "why can't I be work as a PA threads"), it does represent some minimum level of general medical knowledge and I would not want a doctor that was unable to pass Step III in any way associated with my care.

Of note, judging by your user name, I'd be much more worried about the path boards as I've heard the level of esoterica tested there is significantly more ridiculous then Step III.

Ok, I have no clue if step 3 is difficult or not, I'm just going by what some people have told me, that's all. And if you scroll over to the test taking forums, you'll see a number of people who failed step 3 and thought it was tough, and Im sure they are not idiots. Oh and I'm not in path, but I can see why the confusion given my username.

 

[Dermpath]

From whom? Its by far the easiest of the exams (and I took it as a PGY-3 non-primary care resident and was still able to pass with minimal studying). The fact that over 97% of physicians taking it pass on the first try is testament to the fact that its pretty easy. I've never heard a physician state that the exam was tough.

Anecdotal statements. I don't know how hard/easy it is, this is simply what I've heard.

 

[Winged Scapula]

Anecdotal statements. I don't know how hard/easy it is, this is simply what I've heard.

Fair enough. But rather than listen to anecdotes, the fact that 97% pass on the first try should tell you its not that hard.

 

[DrAwsome]

As someone in one of the specialties you mentioned (rad onc), I have yet to find or hear of someone in my specialty that did not pass Step 3 on their first try. I'm sure its possible but my guess is its pretty rare.

I'm sure most people in rad-onc are good test takers, but as someone who will also be starting in rad-onc and came from Derm, I gotta tell you that I find a lot of these questions very esoteric, and I would consider myself pretty intelligent and a pretty darn good doc. If I don't do well, I don't think it would really be a testament to my skill level as a doc, just a significant removal from the subject matter that I will never use again. No, I do not remember what the exact management is for pyloric stenosis or whatever, and also not the best test taker as the OP has talked about, I find it scary that if I took it and failed enough times, all my work would vanish. I see OP's point to some extent.

I also wonder why this new change?

 

[Arcan57]

Ok, I have no clue if step 3 is difficult or not, I'm just going by what some people have told me, that's all. And if you scroll over to the test taking forums, you'll see a number of people who failed step 3 and thought it was tough, and Im sure they are not idiots. Oh and I'm not in path, but I can see why the confusion given my username.

If I fail a test, my perception is that it's difficult. That doesn't mean my perception is reality. My guess is that most of the Step III failures are FMGs who trained in a different healthcare system for med school and didn't put in enough prep time to learn the differences. I'm sure there are also a smattering of people who did no prep and are taking the test post-call, otherwise there's not really a good excuse for failing.

Harvard can get away with basically anything they want in terms of testing because the entrance requirements are ridiculous. If other schools were as difficult to get into, then lack of rigorous testing would probably be the norm. Fortunately, for most of us, the entrance requirements are a little less stringent in general but we have to prove ourselves more during med school.

 

[Dermpath]

If I fail a test, my perception is that it's difficult. That doesn't mean my perception is reality. My guess is that most of the Step III failures are FMGs who trained in a different healthcare system for med school and didn't put in enough prep time to learn the differences. I'm sure there are also a smattering of people who did no prep and are taking the test post-call, otherwise there's not really a good excuse for failing.

Harvard can get away with basically anything they want in terms of testing because the entrance requirements are ridiculous. If other schools were as difficult to get into, then lack of rigorous testing would probably be the norm. Fortunately, for most of us, the entrance requirements are a little less stringent in general but we have to prove ourselves more during med school.

Perhaps you are correct on your first statement. I certainly hope so.

 

[Arcan57]

I'm sure most people in rad-onc are good test takers, but as someone who will also be starting in rad-onc and came from Derm, I gotta tell you that I find a lot of these questions very esoteric, and I would consider myself pretty intelligent and a pretty darn good doc. If I don't do well, I don't think it would really be a testament to my skill level as a doc, just a significant removal from the subject matter that I will never use again. No, I do not remember what the exact management is for pyloric stenosis or whatever, and also not the best test taker as the OP has talked about, I find it scary that if I took it and failed enough times, all my work would vanish. I see OP's point to some extent.

I also wonder why this new change?

You matched in derm and switched to rad-onc? Claiming to be a bad-test taker is one of the bigger strawmen I've seen on this forum. It's not like Step III is detailed. They may want you to know that pyloric stenosis is a thing, but they're going to want you to get a surgical consult. They're not going to make you differentiate between who needs a pyloroplasty and who's managed conservatively.

 

[DrAwsome]

You matched in derm and switched to rad-onc? Claiming to be a bad-test taker is one of the bigger strawmen I've seen on this forum. It's not like Step III is detailed. They may want you to know that pyloric stenosis is a thing, but they're going to want you to get a surgical consult. They're not going to make you differentiate between who needs a pyloroplasty and who's managed conservatively.

Yes, going from derm ---> rad onc and I'm very much happy with the decision. Long story, don't really want to re-hash things.

Pyloric stenosis is simply an example. My point is that test taking is not easy for everyone for different reasons, and it's scary to think that it could all go to heck in a minute if someone did not pass, that's all. And given all the dubious questions, it's not unreasonable that some people would not pass. Let's hope for a good outcome for me on step 3!!

 

[Arcan57]

Yes, going from derm ---> rad onc and I'm very much happy with the decision. Long story, don't really want to re-hash things.

Pyloric stenosis is simply an example. My point is that test taking is not easy for everyone for different reasons, and it's scary to think that it could all go to heck in a minute if someone did not pass, that's all. And given all the dubious questions, it's not unreasonable that some people would not pass. Let's hope for a good outcome for me on step 3!!

Wasn't looking for a rehash of life-story, just noting that both of your specialties are noted for the high board scores required to match into them. Therefore it's extraordinarily unlikely you're a bad test taker (unless your mom was head of the dermatology department and your dad was head of the rad-onc department). I am starting to feel like you're trolling though. So well played.

 

[DrAwsome]

Wasn't looking for a rehash of life-story, just noting that both of your specialties are noted for the high board scores required to match into them. Therefore it's extraordinarily unlikely you're a bad test taker (unless your mom was head of the dermatology department and your dad was head of the rad-onc department). I am starting to feel like you're trolling though. So well played.

I am not "trolling" and while I am aware that both specialties are known for high board scores, not everyone has outlandishly high scores for one. Second, I did not start the thread, I was simply stating that OP has a point. I took a significantly longer amount of time to study for the steps than most people (I can guarantee you that) and while I did relatively well on them, I likely would not have had I not put in the significant effort I did given my difficulties with testing, which are numerous. I pray and hope that I will do well on step 3, but I can see how these tests are problematic for some people.

 

[Top Gun]

Wow that sucks. Seems kind of harsh no?

Ummm....no. Most people who take the Steps pass on the first attempt. If you can't get it right after 6 attempts, then you're probably not meant to be a practicing physician. This is especially true for Step 3 which is, by far, the easiest of the Steps.

 

[sanityonleave]

Ummm....no. Most people who take the Steps pass on the first attempt. If you can't get it right after 6 attempts, then you're probably not meant to be a practicing physician. This is especially true for Step 3 which is, by far, the easiest of the Steps.

This.

Individuals may have a greater or lesser ability to do well on the standardized tests (a lot of us are never going to turn in earth-shattering scores on any test), but the fact is that they intentionally set a bare minimum fund of knowledge and ability to apply that knowledge. Anyone who cannot pass them should not be a physician, period.

 

[Smurfette]

Remember that most states have a maximum number of passing attempts for the USMLE steps in order to secure a license. So if you are trying to get a license in a "3 attempts" state, the 6 attempts allowed by the USMLE are still more than generous considering if you take 5 attempts to pass, you still can't be licensed in that state. May seem harsh, but the states' rules in general are FAR harsher than the NBME's regarding USMLE attempts.

This is a theme that will follow you throughout your career: most boards only allow you a certain number of attempts to become board certified. For my field, IIRC, it's five attempts in five years. And you have to pass all the Steps to sit for the boards, etc.

 

[Buzz Me]

Step 3 is not hard to pass. I'm by no means the smartest guy around...but I passed it comfortably early on during my PGY-2 year, and my only studying was skimming First Aid for Step 3 (for the material) and doing the practice cases at the end during a long three-day weekend.

 

[Dermpath]

Remember that most states have a maximum number of passing attempts for the USMLE steps in order to secure a license. So if you are trying to get a license in a "3 attempts" state, the 6 attempts allowed by the USMLE are still more than generous considering if you take 5 attempts to pass, you still can't be licensed in that state. May seem harsh, but the states' rules in general are FAR harsher than the NBME's regarding USMLE attempts.

This is a theme that will follow you throughout your career: most boards only allow you a certain number of attempts to become board certified. For my field, IIRC, it's five attempts in five years. And you have to pass all the Steps to sit for the boards, etc.

I agree that it's a significant # of times to attempt, and I don't think that it should take that many times to pass. I guess I'm just thinking of the few people who may not pass and may have their whole career ruined I guess. Some people take step 3 towards the middle/end of residency and it would suck to end up with no career after all that work, even if it means it's just a very small handful of people that this happens to. And definitely I did see that most states have a much more strict rule when it comes to attempts for licensing. Thinking outloud I guess!

 

[Top Gun]

I agree that it's a significant # of times to attempt, and I don't think that it should take that many times to pass. I guess I'm just thinking of the few people who may not pass and may have their whole career ruined I guess. Some people take step 3 towards the middle/end of residency and it would suck to end up with no career after all that work, even if it means it's just a very small handful of people that this happens to. And definitely I did see that most states have a much more strict rule when it comes to attempts for licensing. Thinking outloud I guess!

It may suck for all those people to have their career ruined, but it would be far worse to allow incompetent physicians to go out and harm patients. You have to set the bar for competency somewhere. That's the whole purpose of the USMLE. Do you really want a physician who required 6 attempts in to pass the licensing exam to be caring for you and your family?

 

[45408]

You are correct that I have not yet taken step 3 yet, although I hear that it's tough. I guess I'll see when I do take it. I was blessed to pass all steps thus far on my first attempt, but as someone who is not good at test taking, I gotta tell you that I find this policy harsh.

It's not. I studied for 7-8 days, maybe 4-5 hours/day at the most, and I scored the same as I had on the other two steps, which I studied much harder for.