I think it does include presentations. If you look at anesthesia for example, charting outcomes says ~450 people have >5 “publications” (they make that mistake there at well) even though that is half the cohort applying and the median is 4.5. If you go to the interactive one and check only 2018, 2017 cohort it adds up to 450 as well. Otherwise, there’s no way that many anesthesia applicants have that many actual pubs. Residencyexplorer showed at most 5% had >5 actual pubs even at places like Stanford.
Class of 2023 Step 1 Scores Possibly may be converted to P/F on Residency Application per USMLE town hall
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I think it does include presentations. If you look at anesthesia for example, charting outcomes says ~450 people have >5 “publications” (they make that mistake there at well) even though that is half the cohort applying and the median is 4.5. If you go to the interactive one and check only 2018, 2017 cohort it adds up to 450 as well. Otherwise, there’s no way that many anesthesia applicants have that many actual pubs. Residencyexplorer showed at most 5% had >5 actual pubs even at places like Stanford.
Right, and no one will know how that dynamic changes once step goes P/F. If 10 people enter medical school interested in ortho, 3 of them get 240s and the rest get 210s, then only 3-4 people are going to apply ortho (and do sub-Is). After step goes P/F, there is no reason why 8-9 people wouldn't apply ortho since there is no way to know if you are a good applicant until match day. You might argue that sub-Is will decide who is a good applicant, but we all already know that most LORs are positive and paint applicants in positive light.
I think if that happens they need to reorganize clerkships so that there is more time for elective rotations early in the year. I question the concept of core rotations as is, why make a student suffer through OB/GYN or Neuro if they have no interest in it and make them compete for a grade? It just breeds animosity for other specialties IMO.
I mean if acting internships were done earlier, students would know how competitive they are in terms of LORs, clerkship grades, etc. before they apply and can make switch if need be.
Depends, what percent of ortho sub-I's offer generally positive reviews of an applicant. That is the problem here. If I am from a trash tier school with a publication or two, then I do an "early elective" in ortho and I get postive reviews, what does that mean for me? Should I enter the match for ortho? Even better, some of the people on this site also want application caps. So do I use all of my 10 applications on ortho? Should I lower my chance of matching and throw in 3 gen surg applications?
For 2018 and 250+, 58% of applicants had 5+ "publications", and 27% with 11+. For 230s, 58% have 5+ and 37% have 11+. This is consistent with counting all publications, abstracts, presentations, with a right skewed distribution. It also seems that 230s applicants probably self select because they have a lot of research.
I'd say very clearly yes (I assume you mean 3-4 positive sub-Is, which is the norm). Ortho places a lot less emphasis on prestige of medical school than say derm. Away rotations/LORs are the most important part of the application after step scores.
Yes, and what I am saying is that the number of people who are going to get 3-4 positive Sub-I's is going to skyrocket after step goes P/F simply due to there being more applicants. Meanwhile, the number of positions is going to stay the same.
this is wayyyy to handwavey. Just because "MD/PhD students have always been fine" doesn't mean we shouldn't actively resist a change that is going to make our lives a lot harder. You even said yourself that "MSTP student started going unmatched once step scores skyrocketed" so it's not like we can trust the establishment to take care of us once this change starts the step 2 arms race.
The hard truth is that 3rd year, which is already very stressful for MD/PhD students, is now going to become (1) even more important to residencies and (2) way more competitive and stressful. Sure we'll have an extra degree but not all of us are going to be applying into PSTPs that will care.
There are several cohorts of MSTP students who sacrificed months/years of their life preparing for a test that they were told would play a massive part in determining their future. Now they're going to emerge from their PhD labs, have their scores wiped away, and be thrown into the fiery hell of M3.
Allowing these students to retain their Step 1 scores would at least buffer the increase in Step 2 averages and the increased emphasis put on clinical rotation grades.
Yeah, but there's also the limited number of spots for rotators to consider. I imagine we'll start seeing people reserve spots at least a year in advance just because there will be an overload of applicants. This will mainly be because no one will be self-selecting out of pursuing the field anymore. The match is going to be even more chaotic than it is now. I wouldn't be surprised if we started seeing sub-30% match rates.
Yeah there are limited rotation spots, but not that limited. Every year there are spots at small community programs that are unfilled.
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I'm wondering when this golden age of pass/fail was? I graduated from medical school in the early 1990's, over 25 years ago. My exams were definitely scored. USMLE replaced the NBME part 1 and 2, and those appeared to be scored also. And, yes, scores meant something and were part of the application process to residency back then also.
Whether this change is good or bad is still an open question.
From speaking with faculty in multiple departments, apparently in the 80s and 90s, your ability to be various kinds of surgeon didnt hinge primarily on your boards. As recently as the mid 2000s, an average score was inside the IQR for Ortho. I think youd probably have to experience the current climate or take a couple of the newer practice USMLE forms to really understand why your era was golden in comparison to what's going on now.
Was competition for derm/neurosurg spots in the 80s anything like competition today? Including high levels of self selection? My suspicion is that it was not.
I don't know which specialties were the hottest in those years, but the competition might have been similar, since the overall match rate has been totally flat.
Match rate doesn't capture people who dropped out of the running due to step scores...
is there any evidence to show MSTP students do worse on rotations than their MD peers? There is no doubt about the added stress of jumping back in after 3-5 years of preclin knowledge attrition, but that will exist regardless of the step scoring system. In light of that do md/PhD students actually do worse?
a quick search found this paper from Vandy which showed no significant difference:
Effectiveness of a clinical intervention for MD/PhD students re-entering medical school - PubMed
These data suggest that the CPP intervention was successful in preparing MD/PhD students for the core clerkship year. Such a clinical intervention can be an effective preparation for MD/PhD students returning to medical school.
pubmed.ncbi.nlm.nih.gov
And at our institution I know there is no difference at least from internal knowledge.
clerkship grading has its problems but I’m skeptical that its imperfections include unfairly disadvantaging MD/PhDs
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have the number of people applying into these specialties declined relative to the increase in number of medical students per residency slot in these specialties? Answer that question and you will answer whether or not “dropping out due to step” really matters or not.
my guess is No, it doesn’t matter because people interested in NSG etc with “less competitive” scores are now ALSO applying to multiple fields simultaneously and applying to more programs to ensure that they match rather than choosing to not apply at all; after all, if it’s your dream and you can have a safety parachute, why just give up on your dream entirely? Surely, some will, but I doubt it’s enough to invalidate a flat match rate.
I disagree. If I have a low step score or I come from a low ranked med school, I am not going to go on 4 nsg sub-I's in futility and potentially tank my gen surg application
You have to consider that back then the consequences of not matching weren't as severe. Debt was minimal and those that didn't match probably could have kept trying for the same specialty with decent success. Step 1 scores are really just a symptom of how tense the situation is today. Step 2CK, clinical grades, research/publication creep, away rotation creep are going to be bigger issues now that it's pass/fail for the Class of 2023.
I like how doing mindless chart reviews is more important than the first half of med school now.
Great work
Great work
i thought having a home program is key for these specialties. i guess without a home program, it's clinical grades, aways and getting lucky in finding the right attending for research and connections?
The way to fix that is revert to graded preclinicals but no one wants that because P/F preclinicals = chill
can we just cap the number of apps to stop the insanity?
Thank God all of these people will do a bunch of pointless research to show they really deserve to do Ortho before going to private practice where most people desire, and do, end up. Honestly med student level research is straight cancer to the process more than a few weak-minded students so worried about having to do some extra Anki cards for step 1. Instead of making everyone now have to do research essentially perhaps they should have fixed their own issues with regards to board exams.
It's my opinion that an argument against doing extra preclinical work to get a good residency is no different than someone doing pointless research projects to get a good residency. One just happens to help top schools where daddy can just drop a BS project on their desk. Hmmmm.
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It’s unclear who this helps. Students at Harvard already self-cap themselves at half the average number of applications for every specialty, while students at low-tier schools or with low scores are the ones applying everywhere because they need the extra boost. Furthermore, students don’t really know where they are competitive at or what’s a good fit. They will likely just apply to the same programs recommended by reddit or programs in desirable cities, while lesser known programs get a precipitous drop in the number of quality applicants.
it's interesting how there's an accepted way to evaluate undergraduate work, i.e. by science GPA, for med school but for med school to residency it's become contentious all around, including preclinical grades
perhaps part of it is that 90%+ of a US medical school class is smart and hard-working - you don't have many people who don't take tests well but repeatedly get drunk the weekend before an exam. a lot of the variation in preclinical grades can be attributed to weddings, background, family issues/commitments, illness, being traditional/young with few distractions etc. rather than from memorizing ability alone
basically the only way to discriminate between students in an objective way in the preclinical years is by seeing not just who has the most sponge-like long-term memory but also the greatest fortitude, and freedom from commitment, to grind for hours on end. doesn't seem like the best way to choose future subspecialist surgeons
it's a tough situation all around though, so it's difficult to see a solution.
is there any evidence to show MSTP students do worse on rotations than their MD peers? There is no doubt about the added stress of jumping back in after 3-5 years of preclin knowledge attrition, but that will exist regardless of the step scoring system. In light of that do md/PhD students actually do worse?
a quick search found this paper from Vandy which showed no significant difference:
Effectiveness of a clinical intervention for MD/PhD students re-entering medical school - PubMed
These data suggest that the CPP intervention was successful in preparing MD/PhD students for the core clerkship year. Such a clinical intervention can be an effective preparation for MD/PhD students returning to medical school.
And at our institution I know there is no difference at least from internal knowledge.
clerkship grading has its problems but I’m skeptical that its imperfections include unfairly disadvantaging MD/PhDs
I would say there is definitely a disadvantage for MD/PhDs coming back from their PhDs. If they did not have enough time to study to recover their clinical knowledge prior to returning to MS3, they face uphill climbs in terms of poor performance on shelf exams, and poor clinical evaluations due to perceived lack of knowledge. I speak from personal experience and from that of my peers.
Regarding this pass/fail on step1 for MD/PhDs, it seems there will always be a group that will be unhappy with this proposed change. One solution is just to focus on your Step2 score
Research heavy schools have always had an advantage , even in the step one climate you can’t get a seat at the table without some research , and the better the research the more we’ll known your mentors the higher up the food chain you get a seat. And frankly step score at these t20 schools was not the driving factor of matching .
away rotations have also been a defacto requirement for competitive specialties. I think this is not as huge a shift from the current paradigm . Instead of step 1 doing the filtering it will be step 2 .
Dorian deck for lyfe. Good enough to get honors on most shelves. Probably going to be sufficient to crack 260 on step 2
Hard disagree. Core rotations are amazing at seeing the a good breadth of medicine and surgery , the different styles of practice and gives a good knowledge base for general practice and even specialized practice . Teaches you how to deal with different patient populations , and how different specialties think. Plus it shows that you are adaptable .
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In 2005, the mean S1 score for ortho was 230, with a mean overall of 218
Now, the ortho mean is 248 with an overall mean of 228.
I agree the overall mean in ortho has gone up.
So has the interest in ortho. When I was a medical student, only the "meatheads" wanted to go into ortho, and it wasn't anywhere near as well compensated as it is now. Same with Derm and rads. Nephrology was the hot field in IM that everyone who was smart wanted to go into. Things change.
There was nothing to study for S1 back in the day. You just took it and hoped for the best. No dedicated. No Zanki. Just a number 2 pencil in a huge conference center with 1000's of other people. No choice of day either.
No duty hours. Worked 8 weeks in a row without a day off. Post call days until 8PM. Golden age. Right.
Every generation thinks the earlier generation had it easier. Every generation thinks the current/next generation has it easier also. The circle of life.
There are whole threads on this idea. It's not so simple. Lots of people will be hurt by a cap, unless it somehow is paired with very clear information about what programs you're actually competitive for.
There's already specialty recommendations that tried to limit the number of aways. These turn out to be useless since they aren't enforced but they serve as a first step in the transition to application caps imo.
Yeah, the V2 deck contains Dorian, so I'm really looking forward to hopefully molly wopping step 2 with it
All of those things are luck. At my school getting a particular rotation site determines whether you get honors in many of the subjects. Why should that exclude me from matching? Aways are misleading, everyone gets positive letters.
Research connections are also BS, since it's the top schools with nsg home programs that are producing nsg research.
What's the percentage of people that match into neurosurgery at home or where they rotated? If it's similar to ortho, which I believe is around 60%, then I'd argue that your performance at your home sub-i's/aways holds more weight than letters because you're a known commodity wherever you rotated.
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Sure, but to continue my argument, after step is pass fail then more people will be rotating in general with a static number of positions. This will lead to a big problem with match rates (in my estimation)
Yeah, this is basically what I said earlier in the thread about people not self-selecting out anymore.
You aren't wrong but you are missing the point here. Several posters in this thread are just straight gaslighting and aren't even remotely trying to make a cogent point so of course they aren't going to do anything but condescendingly pat you on the head and tell you it's fine cause big academic daddy knows best.
Look at the national averages and the specialty IQRs. In the mid 2000s, an average score was at the lower whisker, you wouldn't be an outlier matching into surgical fields at all. Fast forward to now, and the average score is a dozen points below the start of surgical IQRs. When you look on Tableau, being average now puts you in the bottom few percentage of applicants with only a ~50-70% success rate depending on specialty. It's a completely different recipe for success in today's world.
Your generation absolutely had it harder in a lot of ways that we are now shielded from, especially regarding duty hours. But the emphasis on Step 1 for ambitious medical students in 2020 is above and beyond anything prior generations experienced academically. I'm actually surprised that you haven't seen it yourself as someone immersed in the world of residency applications for years. Faculty have been everywhere from bewildered to annoyed about Step 1 mania, but they've all recognized it happening, and our residency advising has started factoring it in much more.
Edit: A verbatim exchange with one of our advisors here:
"Don't you think it would be really risky to pick a specialty like Ophtho or Derm in MS3 Spring?"
"I wouldn't be worried. You have a good step score."
I sincerely doubt that's how it worked in 1995.
Regarding the advising at your school, the conversation would go much differently at my school (mid-low tier). We would be told to consider a research year even with a good Step 1. If anything, I think Step 1 mania helped students from top-tier schools more on average than those at lower schools, despite talk of Step 1 being an equalizer. People tend to forget that top schools have higher Step 1 averages, barring a few exceptions.
Okay, and the advising in the future will be, "oh I see you have mostly honors on your rotations, you probably need a research year anyway".
There's only been 10+ threads about this for 2 years with pages and pages and pages of discussion in addition to twitter, med journalism, reddit threads, and academic literature about it but ok
I don't really care either way. JUST LET US KNOW SO WE CAN ADJUST ACCORDINGLY
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