Class of 2023 Step 1 Scores Possibly may be converted to P/F on Residency Application per USMLE town hall

[M&L]

Yea I'm in the same boat, was reviewing a lot of biochem this past month since that's not my forte, but now I think I might switch over to reviewing year 1 msk and neuro. This is definitely something I'm gonna keep following tho bc it really affects how I'm gonna spend my time next year during our M2 blocks

Exactly . What do you guys cover over M2 year?

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[NotAProgDirector]

I think this thread, and others like it, confirm my original thoughts. When medical schools said that making S1 P/F was going to make things much better because students would focus on learning rather than grinding for steps, I said "No, I expect they will just find something else to obsess about"

There is no way to make this change without it being "unfair" to someone.

The problem isn't really S1 mania. It's medical student application mania. Making S1 P/F will just push the craziness eslewhere.

 

[Premed2295]

Wait , could you please explain to me real quick what’s that about ? I missed the whole thing apparently . (Short test and offsite thing )

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forums.studentdoctor.net

here is a thread on that ****show

 

[Lawpy]

I think this thread, and others like it, confirm my original thoughts. When medical schools said that making S1 P/F was going to make things much better because students would focus on learning rather than grinding for steps, I said "No, I expect they will just find something else to obsess about"

There is no way to make this change without it being "unfair" to someone.

The problem isn't really S1 mania. It's medical student application mania. Making S1 P/F will just push the craziness eslewhere.

Where does the craziness get pushed if Step 2 also goes P/F?

 

[pinkowl250]

Exactly . What do you guys cover over M2 year?

Path + pharm, mostly. We're systems based so we go through anatomy + physio for everything during M1, and then drugs and bugs during M2

 

[gamerEMdoc]

Where does the craziness get pushed if Step 2 also goes P/F?

Less craziness in the preclinical years and then way more craziness when it comes to SLOE season. For EM anyways. Who knows how other fields will decide on their applicants.

 

[Lawpy]

Less craziness in the preclinical years and then way more craziness when it comes to SLOE season. For EM anyways. Who knows how other fields will decide on their applicants.

Could you explain more? Is it like competing intensely for aways to find the attendings who are known to give good SLOEs?

 

[M&L]

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forums.studentdoctor.net

here is a thread on that ****show

Just read this . This is crazy ... all of this . What a “great” time to be a medical student . Hahaha

 

[M&L]

Path + pharm, mostly. We're systems based so we go through anatomy + physio for everything during M1, and then drugs and bugs during M2

Ok . We are “blocks” based- we have heart/lung/kidney module, then reproductive/endocrine and then brains/behavior in the spring of M2. We already covered GI, skin/muscles/bones and general mechanism of disease during M2. Pathology, micro and pharm are spread through the modules (so GI micro during GI, etc).

 

[slowthai]

Where does the craziness get pushed if Step 2 also goes P/F?

Research and away rotations.

 

[M&L]

Research and away rotations.

Well this will create a very unfair advantage to research heavy schools . Also this puts ppl who cannot do away rotations at horrible positions . Jesus . This is such a mess .

 

[slowthai]

Well this will create a very unfair advantage to research heavy schools . Also this puts ppl who cannot do away rotations at horrible positions . Jesus . This is such a mess .

The lack of research issue can be circumvented by doing research years, which has its own issues. Depending on the field, you may or may not have any choice about doing an away rotation. It's either you do it, or choose another field. Another possibility that's been discussed on the forum is field-specific exams or using clinical NBME exam scores.

 

[M&L]

The lack of research issue can be circumvented by doing research years, which has its own issues. Depending on the field, you may or may not have any choice about doing an away rotation. It's either you do it, or choose another field. Another possibility that's been discussed on the forum is field-specific exams or using clinical NBME exam scores.

You are forgetting about single parents and other ppl who are tied geographically . Are they supposed to give up on the dreams of becoming surgeons or ER docs, or dermatologists just because someone suddenly decided to change all the exams to p/f? It is easy when you are a young single 20-something year old , but when you have life , obligations , etc , things are harder . I think this is very unfair . I am personally pissed . Also not everyone can Financially afford taking a Year off for research .

 

[ExcitatorySynapse]

I wish this decision was made/implemented earlier or later. It isn’t fair for people who take step 1 after MS3 to be reduced to P/F and have them competing with people with scores. It’s also not right to make people who take it after MS2 to have to gun for the score when PDs will stop using it as heavily. Implement it summer 2022, or in 2021.
As an MD/PhD student, I don’t want to spend time pushing for a high score that will not reflect positively on me but can reflect negatively (if it’s presented in the same format that it was marked).

 

[naijacardriodoc]

So does this affect class of 2022 bc some schools take step 1 after third year? and some schools created that option bc of covid too....

 

[DPTinthemaking15]

People are saying that they could make it a match violation. But I guess that depends on the NRMP. The NBME would have to ensure that the NRMP puts this policy into place. The question is, how enforceable is it? Programs violate match rules all the time with no repercussions.

@NotAProgDirector @gamerEMdoc

What do you guys think?

That makes perfect sense. Myself and a classmate just talked about this. I am a "play by the rules" type of person, but when it comes to anything that decides the next 30-40 years of my life, I dont really feel bad if I handed someone a CV with my step score on it.

And to be quite honest I am unfamiliar with anything beyond step 1. Do DO students normally take Step 2 CK? If $o, doe$ thi$ mean I have to take an extra exam for the $ake of it. FYI: This is all hypothetical if this were to occur.

 

[M&L]

So does this affect class of 2022 bc some schools take step 1 after third year? and some schools created that option bc of covid too....

good question... i guess it depends on how they put it. If they tie it to the year of application for residency (2023) then - no. Like, if they say that tests starting january 2022 are pass fail, so whoever applied to residencies after that will be automatically converted to p/f, than class of 2022 wont be influenced... unless the person takes a year off for some reason, and graduates with class of 2023.

I keep thinking - we (MD students) are so stressed out... I cannot even imagine how much IMGs are panicking...

 

[texan2016]

In theory couldn’t the residency program directors be like “this is stupid” and have ERAS open their digital portal 6 months early and store the transcripts for students until they apply ?

 

[Lawpy]

In theory couldn’t the residency program directors be like “this is stupid” and have ERAS open their digital portal 6 months early and store the transcripts for students until they apply ?

idk if they even care though

 

[ciestar]

Well this will create a very unfair advantage to research heavy schools . Also this puts ppl who cannot do away rotations at horrible positions . Jesus . This is such a mess .

Now imagine if your school has no home programs.

 

[ciestar]

You are forgetting about single parents and other ppl who are tied geographically . Are they supposed to give up on the dreams of becoming surgeons or ER docs, or dermatologists just because someone suddenly decided to change all the exams to p/f? It is easy when you are a young single 20-something year old , but when you have life , obligations , etc , things are harder . I think this is very unfair . I am personally pissed . Also not everyone can Financially afford taking a Year off for research .

Aways are essentially a requirement for EM (SLOEs). Aways are also basically a requirement for super competitive specialties as well. That isn’t new.

I think most people doing research years do get a stipend for it.

Is it fair for people with certain circumstances? No, it isn’t. There are a lot of unfair things about medicine though.

 

[NotAProgDirector]

In theory couldn’t the residency program directors be like “this is stupid” and have ERAS open their digital portal 6 months early and store the transcripts for students until they apply ?

ERAS is owned by the AAMC. They don't do what we ask.

What we need to do is 1) build our own application system so we have control, and 2) create specialty specific exams so we have control.

 

[FutureSurgical]

Class of 2024 knew the new rules before they even applied to schools. That’s the only fair way imo.

To be fair we only found this out in February during our app cycle. C/o 2025 has the biggest advantage in terms of knowing how to apply with it being P/F

 

[RadOncMD]

To be fair we only found this out in February during our app cycle. C/o 2025 has the biggest advantage in terms of knowing how to apply with it being P/F

Noted. At this point the timeline is all over the place. Hard to keep up with all of it.

 

[slowthai]

You are forgetting about single parents and other ppl who are tied geographically . Are they supposed to give up on the dreams of becoming surgeons or ER docs, or dermatologists just because someone suddenly decided to change all the exams to p/f? It is easy when you are a young single 20-something year old , but when you have life , obligations , etc , things are harder . I think this is very unfair . I am personally pissed . Also not everyone can Financially afford taking a Year off for research .

Even now, depending on the applicant's research output (or lack thereof) and the specialty, a research year and away rotations may be required for a successful match. For example, neurosurgery requires multiple away rotations. What is someone to do if they're unable to do them? The only choice left on the table is to choose a different field. This is really an issue with the system. I think aways and research years are extreme requirements for these hyper-competitive fields, but it is what it is. There is just a mismatch between the amount of people that want these fields and the number of spots available.

 

[slowthai]

That makes perfect sense. Myself and a classmate just talked about this. I am a "play by the rules" type of person, but when it comes to anything that decides the next 30-40 years of my life, I dont really feel bad if I handed someone a CV with my step score on it.

And to be quite honest I am unfamiliar with anything beyond step 1. Do DO students normally take Step 2 CK? If $o, doe$ thi$ mean I have to take an extra exam for the $ake of it. FYI: This is all hypothetical if this were to occur.

100,000%. I am the exact same way. I will break any and every rule (short of the law) for the sake of my dreams. This is within reason, of course. Specifically, I will do it for something unjust like the erasure of my score.

And no, DO students usually don't take CK, as far as I know. This could totally make it worse. The NBME doesn't currently require step 1 to take CK, but PDs might explicitly or implicitly require it. Implicitly because they might be thinking, this DO student doesn't have a passed step 1; could they even pass? We all know it's a harder exam to do well on. It's unfair, but I think it's a real possibility.

 

[calivianya]

To be fair we only found this out in February during our app cycle. C/o 2025 has the biggest advantage in terms of knowing how to apply with it being P/F

I’ve been thinking that NBME should have given a three-year warning and not a two-year warning just for this reason.

If I had found out in February of my app cycle year that step 1 was going pass/fail, I would have absolutely lost my mind because that is mind-bogglingly unfair to have such a major piece of information withheld when you’re making decisions about where or even when to apply, and what kind of ECs you need on your application when you do.

It’s not like you can change your entire primary app in February and have it make a difference.

I am really feeling for people that are c/o 2024, and 2023 if the info in this thread comes to fruition - you guys got shafted big time. These changes should have taken place no earlier than 2023 if they were insisting on releasing the info in 2020.

 

[slowthai]

To be fair we only found this out in February during our app cycle. C/o 2025 has the biggest advantage in terms of knowing how to apply with it being P/F

I agree. What they should really do is make it P/F for the incoming class of 25, no retroactive crap. This would be the most fair. They would have known the game coming in and masters/PhDs wouldn't get screwed. These people would be competing against the incoming class with the advantage of having a score, but the population of masters and PhDs is so small relative to the rest of applicants.

 

[Matthew9Thirtyfive]

I’ve been thinking that NBME should have given a three-year warning and not a two-year warning just for this reason.

If I had found out in February of my app cycle year that step 1 was going pass/fail, I would have absolutely lost my mind because that is mind-bogglingly unfair to have such a major piece of information withheld when you’re making decisions about where or even when to apply, and what kind of ECs you need on your application when you do.

It’s not like you can change your entire primary app in February and have it make a difference.

I am really feeling for people that are c/o 2024, and 2023 if the info in this thread comes to fruition - you guys got shafted big time. These changes should have taken place no earlier than 2023 if they were insisting on releasing the info in 2020.

Eh. If you were competitive for the top schools you would be applying there anyway most likely. And if you weren’t, then step 1 going p/f doesn’t change that so I don’t really see how the app process would change (for most people). Which school you ultimately matriculate to might change, but in feb you still have months to decide. Also Harvard doesn’t even put out acceptances until March.

 

[Matthew9Thirtyfive]

I agree. What they should really do is make it P/F for the incoming class of 25, no retroactive crap. This would be the most fair. They would have known the game coming in and masters/PhDs wouldn't get screwed. These people would be competing against the incoming class with the advantage of having a score, but the population of masters and PhDs is so small relative to the rest of applicants.

The MD/PhDs I know who started with us will be c/o 2026, so you’d have to go all the way out to c/o 2027. They’re not going to announce something 7 years in advance lol.

 

[slowthai]

The MD/PhDs I know who started with us will be c/o 2026, so you’d have to go all the way out to c/o 2027. They’re not going to announce something 7 years in advance lol.

I forgot about your school. I should have included those that have already started medical school haha. P/F should only apply to the class of 2025 that are applying to med school currently or are about to apply.

 

[Matthew9Thirtyfive]

I forgot about your school. I should have included those that have already started medical school haha. P/F should only apply to the class of 2025 that are applying to med school currently or are about to apply.

Yeah I mean it’s just that the easier thing is to just report it as p/f for our class so that’s probably what they’re going to do lol.

 

[calivianya]

Eh. If you were competitive for the top schools you would be applying there anyway most likely. And if you weren’t, then step 1 going p/f doesn’t change that so I don’t really see how the app process would change (for most people). Which school you ultimately matriculate to might change, but in feb you still have months to decide. Also Harvard doesn’t even put out acceptances until March.

It really depends on what part of your app isn’t competitive. If you have the grades and the MCAT, but just lack the fluff and don’t want to spend the time to get it, p/f step 1 changes things a lot.

For example, I forget my AMCAS GPAs but my degrees were at 3.27, 3.86, and 3.86, and my MCAT was 515, but my letters didn’t get in until September and I had no research, minimal volunteering, and 12 total hours of shadowing. I managed to pull three MD interviews anyway but I got feedback from those interviews that I just didn’t have enough “stuff” - one told me just to get some primary care shadowing and reapply when I asked for feedback because my application was otherwise good for their school.

 

[RadOncMD]

I just wrote the longest most professional email of my life to [email protected]
you should all do the same if you don't like this policy change.

Just wrote mine as well.

I’m all for speculation but I feel like we really just need to voice our collective and personal concerns to them. Whether or not they listen is another story.

 

[altblue]

Eh. If you were competitive for the top schools you would be applying there anyway most likely. And if you weren’t, then step 1 going p/f doesn’t change that so I don’t really see how the app process would change (for most people). Which school you ultimately matriculate to might change, but in feb you still have months to decide. Also Harvard doesn’t even put out acceptances until March.

There's also the situation where you withdraw from a higher ranked program because it's not the best fit, and you feel attending a lower tier school won't hurt you as much because of a scored Step 1 to prove yourself. I didn't get interest from a top tier school by any means because I didn't take the MCAT seriously, but a USC/OSU/BU level program would definitely set me up for a successful match better than my current program. There's a lot of reasons why I chose the school I did, and I don't regret it, but access to pertinent information would have made my decision more informed.

 

[Matthew9Thirtyfive]

There's also the situation where you withdraw from a higher ranked program because it's not the best fit, and you feel attending a lower tier school won't hurt you as much because of a scored Step 1 to prove yourself. I didn't get interest from a top tier school by any means because I didn't take the MCAT seriously, but a USC/OSU/BU level program would definitely set me up for a successful match better than my current program. There's a lot of reasons why I chose the school I did, and I don't regret it, but access to pertinent information would have made my decision more informed.

That’s a good point.

 

[Matthew9Thirtyfive]

It really depends on what part of your app isn’t competitive. If you have the grades and the MCAT, but just lack the fluff and don’t want to spend the time to get it, p/f step 1 changes things a lot.

For example, I forget my AMCAS GPAs but my degrees were at 3.27, 3.86, and 3.86, and my MCAT was 515, but my letters didn’t get in until September and I had no research, minimal volunteering, and 12 total hours of shadowing. I managed to pull three MD interviews anyway but I got feedback from those interviews that I just didn’t have enough “stuff” - one told me just to get some primary care shadowing and reapply when I asked for feedback because my application was otherwise good for their school.

Fair enough.

 

[fldoctorgirl]

So does this affect class of 2022 bc some schools take step 1 after third year? and some schools created that option bc of covid too....

No, it shouldn't. Anyone who's c/o 2022 will be applying to residency in 2021, and they said scores will not be P/F until January 2022 at the earliest. This would only affect people who are currently class of 2022, and then decide to take a research year or do a fellowship or whatever, which would mean they join c/o 2023. Anyone graduating in 2022 will be unaffected, whether they took research years or took Step in M2 or M3.

 

[7331poas]

No, it shouldn't. Anyone who's c/o 2022 will be applying to residency in 2021, and they said scores will not be P/F until January 2022 at the earliest. This would only affect people who are currently class of 2022, and then decide to take a research year or do a fellowship or whatever, which would mean they join c/o 2023. Anyone graduating in 2022 will be unaffected, whether they took research years or took Step in M2 or M3.

Man, i hope residencies wont be internally transitioning to P/F to get ready for the next cycle though.

 

[fldoctorgirl]

Man, i hope residencies wont be internally transitioning to P/F to get ready for the next cycle though.

I doubt it, I think they'd want to use scores as long as they possibly could. I mean, I could maybe see them starting to look at Step 2 and/or other portions of the application a bit more, but I doubt they'd convert you to P/F. @NotAProgDirector might have better thoughts.

 

[Lucca]

I wish this decision was made/implemented earlier or later. It isn’t fair for people who take step 1 after MS3 to be reduced to P/F and have them competing with people with scores. It’s also not right to make people who take it after MS2 to have to gun for the score when PDs will stop using it as heavily. Implement it summer 2022, or in 2021.
As an MD/PhD student, I don’t want to spend time pushing for a high score that will not reflect positively on me but can reflect negatively (if it’s presented in the same format that it was marked).

Im personally not super worried about us on the MD/PhD path. Just like 10 years ago the cardinal advice from MSTP directors was "just pass" and that worked out fine, until step averages started skyrocketing and MSTP students started going unmatched because they didnt invest as much time into Step 1 as their MD classmates. Regardless of when in the immediate future this is implemented, if you havent yet taken Step 1 I think we will be essentially "resetting" to 10 years ago. The MD/PhD pool is so small and the timeline for ERAS so far for those in M1/M2 right now that a score other than P will most likely be utterly meaningless when the entire MD applicant pool is applying with P/F.

And like I said elsewhere: if the residency program you are applying to is judging an MD/PhD applicant primarily on Step 1 score in a P/F world and not research potential, that doesn't exactly inspire confidence in that program's ability to nurture physician scientists does it.

 

[Lucca]

Do we know for sure Step 1 will be p/f for class of 2024? My school said since they announced the date 'the earliest it will be pass fail', it probably won't be 2024 since thats just in the 'earliest' scenario.

It is 2020. No one knows anything for sure.

 

[ExcitatorySynapse]

Im personally not super worried about us on the MD/PhD path. Just like 10 years ago the cardinal advice from MSTP directors was "just pass" and that worked out fine, until step averages started skyrocketing and MSTP students started going unmatched because they didnt invest as much time into Step 1 as their MD classmates. Regardless of when in the immediate future this is implemented, if you havent yet taken Step 1 I think we will be essentially "resetting" to 10 years ago. The MD/PhD pool is so small and the timeline for ERAS so far for those in M1/M2 right now that a score other than P will most likely be utterly meaningless when the entire MD applicant pool is applying with P/F.

And like I said elsewhere: if the residency program you are applying to is judging an MD/PhD applicant primarily on Step 1 score in a P/F world and not research potential, that doesn't exactly inspire confidence in that program's ability to nurture physician scientists does it.

That’s honestly a good point. I don’t think a # will have any impact for PSTPs when the world goes P/F, but if an applicant wants to go into a competitive specialty in a clinical only residency (say ortho), I could see PDs looking at it. But ERAS 2025 will definitely be a different ballgame.

 

[Premed2295]

Just wrote mine as well.

I’m all for speculation but I feel like we really just need to voice our collective and personal concerns to them. Whether or not they listen is another story.

Hey, worth our best shot. They reversed on the no experimental questions thing didnt they?

 

[ace_inhibitor111]

Hey, worth our best shot. They reversed on the no experimental questions thing didnt they?

That and cancelling Step 2CS. Even though the NBME makes a lot of questionable decisions I have hope they are able to be reasoned with.

 

[efle]

A few thoughts

1) I am glad the USMLE is planning to go this route. Much, much more fair than the alternative (forcing someone with only Pass to compete with 250+ scores at competitive programs). This has seemed like the lesser evil since the beginning imo.

2) Like prog director and like Dr Carmody has been saying forever, what we really need are some damn application caps. Step 1 mania was a symptom of overapplication. I am really, really bummed about the lack of serious discussion about capping, especially for this upcoming Coronavirus cycle when people will be applying to many more programs and able to attend far more interviews. The individual specialty societies have recognized the problem and are downright pleading with applicants in their guidelines to apply to very few programs. But there is zero enforcement mechanism and so now the cycle is becoming a prisoner's dilemma.

I think it'll lead to a tragedy of the commons where interviews are all soaked up by a minority of superstars, and leave the Average Joe with fewer interviews and a lot of (justifiable) anxiety. I say justified because I do think the SOAP rate is going to spike up. The match is only theoretically zero-sum after the SOAP has occurred; it's completely possible for a ton of applicants and programs to fall of their rank lists in the main Match round due to an inappropriate distribution of interviews.

3) I think the crowd of people who turned down a big-name medical school for a scholarship elsewhere are few and far between. I know they're well represented on SDN, but in reality, only 20% of people even get accepted to more than 1 medical school. Only a tiny subset of them are going to have one option much higher ranked, while the other offers them scholarship, and while the big name refuses to price-match or gives less need-based aid. I recognize that the situation could really suck for these individuals in the class of 2023-24 but we can't make these global decisions based on how it affects a fringe group of superstars. The vast majority of med students are at their 1 option (or 1 of several similar options) and do not deserve to have their Pass compared against scores.

 

[peachrings]

A few thoughts

1) I am glad the USMLE is planning to go this route. Much, much more fair than the alternative (forcing someone with only Pass to compete with 250+ scores at competitive programs). This has seemed like the lesser evil since the beginning imo.

2) Like prog director and like Dr Carmody has been saying forever, what we really need are some damn application caps. Step 1 mania was a symptom of overapplication. I am really, really bummed about the lack of serious discussion about capping, especially for this upcoming Coronavirus cycle when people will be applying to many more programs and able to attend far more interviews. The individual specialty societies have recognized the problem and are downright pleading with applicants in their guidelines to apply to very few programs. But there is zero enforcement mechanism and so now the cycle is becoming a prisoner's dilemma.

I think it'll lead to a tragedy of the commons where interviews are all soaked up by a minority of superstars, and leave the Average Joe with fewer interviews and a lot of (justifiable) anxiety. I say justified because I do think the SOAP rate is going to spike up. The match is only theoretically zero-sum after the SOAP has occurred; it's completely possible for a ton of applicants and programs to fall of their rank lists in the main Match round due to an inappropriate distribution of interviews.

3) I think the crowd of people who turned down a big-name medical school for a scholarship elsewhere are few and far between. I know they're well represented on SDN, but in reality, only 20% of people even get accepted to more than 1 medical school. Only a tiny subset of them are going to have one option much higher ranked, while the other offers them scholarship, and while the big name refuses to price-match or gives less need-based aid. I recognize that the situation could really suck for these individuals in the class of 2023-24 but we can't make these global decisions based on how it affects a fringe group of superstars. The vast majority of med students are at their 1 option (or 1 of several similar options) and do not deserve to have their Pass compared against scores.

We can all agree that a. P competing against 250+ and b. getting a 250+ converted to a P are both negatives. I find it hard to gauge which is worse, so we should really be looking at how many people are affected negatively under each decision. If a majority of people already have a score, it doesn't make sense to nullify that score. The lesser evil is implementing P/F for c/o 2024, as they will enter medical school knowing Step 1 is P/F and act accordingly.

 

[efle]

We can all agree that a. P competing against 250+ and b. getting a 250+ converted to a P are both negatives. I find it hard to gauge which is worse, so we should really be looking at how many people are affected negatively under each decision. If a majority of people already have a score, it doesn't make sense to nullify that score. The lesser evil is implementing P/F for c/o 2024, as they will enter medical school knowing Step 1 is P/F and act accordingly.

Really, in a veil of ignorance scenario you'd treat those as equally unjust? If I didn't know which boat I'd be in and I wanted a surgical specialty, I'd be getting rid of Scenario A for sure. In B you will be on even ground, worst case is that you wasted a bunch of time flashcarding. In A your worst case is to be extremely disadvantaged and at greater risk of SOAPing

 

[slowthai]

One thing I've been wondering about is the resolving power of step 2. Apparently it's an easier and lower quality exam. With everyone gunning hard for it now, how good of a culling tool will it be? I feel like 260 will become the new 240.

 

[efle]

One thing I've been wondering about is the resolving power of step 2. Apparently it's an easier and lower quality exam. With everyone gunning hard for it now, how good of a culling tool will it be? I feel like 260 will become the new 240.

Yeah, it's going to imminently be pass/fail, I don't see how it can escape any of the same issues plaguing Step 1. But for the few years of interim, I bet people will try and piece together some kind of zanki alternative for CK and then it'll be a race to see who can start CK studying the soonest. Probably gonna see lots of people trying to memorize UpToDate flowcharts in MS1 before they've even studied the diseases being managed at all. Gonna be a real weird time to be a med student.