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

[ExcitatorySynapse]

we’ll get a score yes. But the argument here is that they would mask our transcripts summer of 2022 when we apply for residency. USMLE is still unsure of that

United States Medical Licensing Examination

The United States Medical Licensing Examination (USMLE) assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease.

www.usmle.org

I just want to know whether masking will happen at all. I don't know of any schools that do step after MS1, so presumably c/o 2024 will take it, at the earliest in summer 2022? If they cut off right around then, maybe c/o 2024 and everyone after will get P/F while we MD/PhD schmucks will have to apply with out scores.

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[7331poas]

I just want to know whether masking will happen at all. I don't know of any schools that do step after MS1, so presumably c/o 2024 will take it, at the earliest in summer 2022? If they cut off right around then, maybe c/o 2024 and everyone after will get P/F while we MD/PhD schmucks will have to apply with out scores.

Duke maybe?

 

[Lucca]

Some of the responses here really emphasize how out of touch SDN is with the real world. Literally 100% of medical students put their entire being into studying for Step 1 and <100% of them get an amazing score on it. The amount I studied and dedicated to Step 1 was orders of magnitude greater than the amount I have ever studied for anything else ever, and I got an average score - which probably has something to do with the fact that during the pre-clinical years, I was a fairly average medical student. I know many people who went to truly preposterous lengths and got scores in the 200s-210s. I also know many people who went to equally preposterous lengths and got obscenely high scores.

very much this. once again, it's also worth that the standard error of your Step 1 score as measured on your exam day is fairly broad. Probably gets even broader towards the right tail end where ur rly competing on the basis of luck on exam day and cold-recall of obscure facts.

 

[Matthew9Thirtyfive]

According to my schools admin:

NBME released a statement to admin confirming that Step 1 will not change to pass/fail until 2022 at the earliest. This means our class (2023) will still have numerical scores.

Again, unless your school takes step in third year. If the change is in Jan or feb of 2022, there are a bunch of class of 2023 students who will be taking a pass/fail test. They have to deal with that somehow.

 

[CJhooper123]

Again, unless your school takes step in third year. If the change is in Jan or feb of 2022, there are a bunch of class of 2023 students who will be taking a pass/fail test. They have to deal with that somehow.

Has there been any confirmation that Step will actually change to P/F in January 2022? My understanding was that would be the “earliest date” they would make a change. I feel like it’s entirely possible the test won’t be P/F until later in 2022.

 

[Matthew9Thirtyfive]

Has there been any confirmation that Step will actually change to P/F in January 2022? My understanding was that would be the “earliest date” they would make a change. I feel like it’s entirely possible the test won’t be P/F until later in 2022.

No one knows. They’re just saying no earlier than Jan 2022. It could be 2023 or 2024 for all we know.

 

[blastokine]

What happens to those of us who take it in 3rd year potentially after they make it pass fail? We’ll be taking it with c/o 2024 students mostly but applying to match with c/o 2023 students.

I know what you're saying. They should honestly give you guys the option to make it scored because you're class of 23. All I can really say is they should do this and they should do that, but I'm not a money hungry NBME employee.

I was under the impression that since a good amount of C/O 2023 students are going to be taking Step1 after it becomes P/F (during their 3rd year) that IS why USMLE is considering masking all scores from C/O 2023. To provide an equal playing field, i.e so residency programs aren’t getting 3 digit scores and P/F results from people applying in the same class.

 

[Matthew9Thirtyfive]

I was under the impression that since a good amount of C/O 2023 students are going to be taking Step1 after it becomes P/F (during their 3rd year) that IS why USMLE is considering masking all scores from C/O 2023. To provide an equal playing field, i.e so residency programs aren’t getting 3 digit scores and P/F results from people applying in the same class.

I assume that’s the reason as well. I’m sure they’re probably considering how much outrage and backlash it will cause and if there is another way to do it.

 

[blastokine]

I assume that’s the reason as well. I’m sure they’re probably considering how much outrage and backlash it will cause and if there is another way to do it.

True. I go to a small state school so our Step scores are supposed to hopefully distinguish us from applicants from “top” tier schools. Idk how I feel about the situation. Personally I like to chill and I know my quality of life will vastly improve if our scores are masked. But as of now I got to proceed as if we’re going to get a 3 digit score.

 

[Matthew9Thirtyfive]

True. I go to a small state school so our Step scores are supposed to hopefully distinguish us from applicants from “top” tier schools. Idk how I feel about the situation. Personally I like to chill and I know my quality of life will vastly improve if our scores are masked. But as of now I got to proceed as if we’re going to get a 3 digit score.

Yeah I think I would benefit from a pass/fail step but I’m not sure how I feel about it. I do like the idea of being able to chill a bit, but I know that even if it is masked I would still do a heavy dedicated because of my incredible fear of failure.

 

[Striatum14]

So wait, we would get numerical scores but can't use them in residency apps? That sounds incredibly stupid. What's the point of giving out 3 digit scores then?

 

[Premed2295]

Yeah now they will only have the prestige of their schools and inflated Step 2 scores because they take 1 and 2 at the same time.
Trust me that small number of applicants would be alright.

I was under the impression that since a good amount of C/O 2023 students are going to be taking Step1 after it becomes P/F (during their 3rd year) that IS why USMLE is considering masking all scores from C/O 2023. To provide an equal playing field, i.e so residency programs aren’t getting 3 digit scores and P/F results from people applying in the same class.

 

[Premed2295]

Anyway, were we not supposed to get an update by this past week? Could the reddit user have been wrong?

 

[slowthai]

Anyway, were we not supposed to get an update by this past week? Could the reddit user have been wrong?

That non-answer was the "update" lol. Just irritating.

 

[Striatum14]

There are a lot of unknowns here:
-Will step 1 100% be p/f in 2022?
-Will our scores definitely be masked for residency apps?
-Will residency directors have a way of obtaining our scores even if they are masked?

Until I know the answers to these questions, I'm inclined to continue treating step 1 as a scored, high-stakes exam.

 

[aldol16]

I've been out of the loop - anybody hear anything about the masking vs not masking yet? Seems incredibly stupid to me to mask. That doesn't really benefit those who have to take Step 1 P/F because they have to perform well on Step 2 CK regardless and only penalizes people who already studied hard for Step 1 and achieved a good score.

 

[Matthew9Thirtyfive]

I've been out of the loop - anybody hear anything about the masking vs not masking yet? Seems incredibly stupid to me to mask. That doesn't really benefit those who have to take Step 1 P/F because they have to perform well on Step 2 CK regardless and only penalizes people who already studied hard for Step 1 and achieved a good score.

I mean it benefits the people who would have to take it p/f. When residency app time comes around, if you have someone with a 250 and someone who would have gotten a 250 but has a P, that is naturally going to not look as good because there’s no way to know if that was a 210 P or a 250 P. So that person with a P is going to be looked at not as high as a 250 most likely.

 

[ArdorAyurveda]

Agree with the notion that a 250 on Step 1 looks better to most PDs of competitive programs in specialties with a low # of residency spots available (Derm, Plastics, etc.) than a Step 1 with just a Pass.

However, if we accept the fact that Step 1 scores do no not predict someone’s success as a physician, does it not follow that Step 1 scores should not be used to select applicants for the most competitive specialties?

Furthermore, if we assume that medicine is meritocratic (hint: it’s not), then shouldn’t PDs select candidates on the merit of the candidates’ performances on away rotations?

Step 1 has become the Beelzebub of medical education due to inertia. The sooner we change Step 1 to Pass/Fail, the sooner PDs can adapt to finding some other more valid metric of ranking applicants for their oh-so-coveted ophthamaology residency slots.

People often ask the rhetorical question “If PDs don’t use Step 1 to eliminate applicants, what will they use?”. A fair question, but we don’t need an answer to a hypothetical question in order to make necessary changes right now.

In other words, PDs will cross that bridge when they get there.

It is clear to me that P/F Step 1 will improve the culture of medical education in the long-term because students will re-prioritize their time to align with more important things like personal wellness rather than getting the highest possible score on Step 1.

People say PDs will use Step 2 instead. This claim is based on the tendency of medical students to obsess over numbers and percentiles. Anxious personalities will find something to worry about.

 

[aldol16]

I mean it benefits the people who would have to take it p/f. When residency app time comes around, if you have someone with a 250 and someone who would have gotten a 250 but has a P, that is naturally going to not look as good because there’s no way to know if that was a 210 P or a 250 P. So that person with a P is going to be looked at not as high as a 250 most likely.

Good point. I'm not one who has studied ethics extensively but I generally don't think that someone's preferences should be weighted much at all if their benefit is only directly tied to someone else's harm. Like if you preferred to have a nice view from your back porch but the only way to do that is to bulldoze the house behind you, your preferences shouldn't be weighted at all. Those who take Step 1 P/F aren't really given a choice to take it scored and so no matter what happens, they know that they need to do well on CK.

 

[aldol16]

However, if we accept the fact that Step 1 scores do no not predict someone’s success as a physician, does it not follow that Step 1 scores should not be used to select applicants for the most competitive specialties?

Furthermore, if we assume that medicine is meritocratic (hint: it’s not), then shouldn’t PDs select candidates on the merit of the candidates’ performances on away rotations?

In the most competitive specialties, they already do. Step 1 is important insofar as you need to either 1) not get screened out or 2) get screened out but have someone make a call for you so that they review your app. Away rotations are consistently rated by PDs as one of the most important factors in selecting residents. It's no coincidence that aways are required for the most competitive specialties.

People often ask the rhetorical question “If PDs don’t use Step 1 to eliminate applicants, what will they use?”. A fair question, but we don’t need an answer to a hypothetical question in order to make necessary changes right now.

We do need an answer now (Well, I don't because I don't have any skin in this game but MS1s should). We need an answer because what if the alternative is worse? PDs have said that they will increasingly emphasize Step 2 CK once Step 1 goes P/F. Maybe Step 2 CK will also go P/F in the future. But for the time being, it's still scored. This really makes it incredibly high stress. Because in the past, what has happened if you scored low on Step 1 but wanted to go into a competitive specialty? You could take a research year and try to network to get your foot in the door, study hard for CK and redeem yourself by knocking it out of the park, or you can decide to go into something else entirely. You've now essentially eliminated the last two options. Step 2 CK will be the deciding exam and once you get your score, you'll have what, 2-3 months before ERAS is due? I suppose you could try to craft an application for another specialty but you'd be working under incredible time pressure.

 

[Matthew9Thirtyfive]

Good point. I'm not one who has studied ethics extensively but I generally don't think that someone's preferences should be weighted much at all if their benefit is only directly tied to someone else's harm. Like if you preferred to have a nice view from your back porch but the only way to do that is to bulldoze the house behind you, your preferences shouldn't be weighted at all. Those who take Step 1 P/F aren't really given a choice to take it scored and so no matter what happens, they know that they need to do well on CK.

If the point is equity, then the only two choices are to push it back so no one in c/o 2023 takes a p/f exam or to mask all their scores. Preference is really irrelevant except for what the majority prefers from those two choices.

 

[aldol16]

If the point is equity, then the only two choices are to push it back so no one in c/o 2023 takes a p/f exam or to mask all their scores. Preference is really irrelevant except for what the majority prefers from those two choices.

Mask just the c/o 2023 or everybody's score? I'm talking about the proposed masking of everybody's score.

 

[Matthew9Thirtyfive]

Mask just the c/o 2023 or everybody's score? I'm talking about the proposed masking of everybody's score.

C/o 2023 and beyond. Alternatively, make the effective date after anyone from c/o 2023 would have taken it and have everyone from c/o 2024 and beyond masked.

 

[frozencubes]

incoming m1 here, should i still use anki for studying? Was it effective in general to keep info intact throughout the block or should i stick to writing notes and watching videos?

 

[aldol16]

C/o 2023 and beyond. Alternatively, make the effective date after anyone from c/o 2023 would have taken it and have everyone from c/o 2024 and beyond masked.

I mean, there's no difference between masking and P/F at that point. If you mask everyone from c/o 2023 and beyond. There's no point in showing them their scores if they can't use it or report it to programs anyway. It would just be a tease.

 

[Matthew9Thirtyfive]

I mean, there's no difference between masking and P/F at that point. If you mask everyone from c/o 2023 and beyond. There's no point in showing them their scores if they can't use it or report it to programs anyway. It would just be a tease.

Yeah sorry, what I meant was if you’re going to do it for all of 2023, then mask for the whole class and straight p/f beyond. Alternatively you can make the p/f date after everyone from 2023 takes it and mask any of the people from 2024 who took it at that point and then make it straight p/f from that point on.

 

[Osminog]

Why can't the NBME make up its mind about retroactive P/F for the class of 2023? It’s been four months since the original P/F announcement.

 

[Matthew9Thirtyfive]

incoming m1 here, should i still use anki for studying? Was it effective in general to keep info intact throughout the block or should i stick to writing notes and watching videos?

Yes, it is very effective whether you’re using it for step or classes in general. Also keep in mind that step is not suddenly going to be something you can just cram for once it’s p/f. A lot of people study really hard for it and still score average.

 

[Medical_studies]

I'm probably just not understanding something here. But if they wanted to mask the scores, why not instead just (for the c/o 2023 only) rank a P from those 20 schools that have post-clinical step 1 testing above any scored result from any other applicant. Then the rest of the students can still have a competitive step 1 score between each other with no detriment to those who took step after the third year. Pd's could just look at a P as more favorable than a score for 2023. I would rather have that than I get a P and every other test taker gets a P as well.

We decide which school to attend by alot of factors and commit to spending 100's of thousands of dollars pursuing this. At the very last minute hearing that your step 1 is going to be a P instead of a score is a little bit of a surprise. Especially after USMLE made an official announcement that pass/fail would not go into effect before 2022.

It seems like it would be more palatable to just concede the top residencies to students from those 20 schools. That allows any student the possibility to match atleast somewhere if they study enough, have no red flags, etc.

 

[aldol16]

Yeah sorry, what I meant was if you’re going to do it for all of 2023, then mask for the whole class and straight p/f beyond. Alternatively you can make the p/f date after everyone from 2023 takes it and mask any of the people from 2024 who took it at that point and then make it straight p/f from that point on.

But how is that equitable for the people who took it scored, expecting it to be scored for ERAS, and now have to do well on Step 2 CK as well instead of delaying that until after ERAS?

At least if you have a P/F Step 1 for some and scored for others, PDs can look at Step 2 CK for those who have P/F Step 1.

 

[CJhooper123]

Why can't the NBME make up its mind about retroactive P/F for the class of 2023? It’s been four months since the original P/F announcement.

I feel like they don't even have an exact date for when P/F will be implemented. All they said was that it would be switched s/p January 2022 at the earliest. That could be 2023, 2024, etc. It's very possible that everyone from c/o 2023 will get a 3-digit score and they wouldn't consider masking scores.

 

[Lawpy]

Yes, it is very effective whether you’re using it for step or classes in general. Also keep in mind that step is not suddenly going to be something you can just cram for once it’s p/f. A lot of people study really hard for it and still score average.

Average is still pass though?

 

[Matthew9Thirtyfive]

But how is that equitable for the people who took it scored, expecting it to be scored for ERAS, and now have to do well on Step 2 CK as well instead of delaying that until after ERAS?

At least if you have a P/F Step 1 for some and scored for others, PDs can look at Step 2 CK for those who have P/F Step 1.

I think you misread. The second option would be to make the p/f date after all of c/o 2023 takes it. People in c/o 2024 who happened to take it by then would have it masked, but that would be a small number I think. So all of class of 2023 would have a scored exam, and all of 2024 would know going into it that it would be p/f.

 

[Matthew9Thirtyfive]

Average is still pass though?

If you’re studying hard for months and are scoring average, how do you think you’ll do if you don’t put time into it?

 

[aldol16]

I think you misread. The second option would be to make the p/f date after all of c/o 2023 takes it. People in c/o 2024 who happened to take it by then would have it masked, but that would be a small number I think. So all of class of 2023 would have a scored exam, and all of 2024 would know going into it that it would be p/f.

Let's speak in terms of entering class because it gets convoluted when you talk about graduating class. The class of 2023 the way you mean it, as I interpret it, is entering class of 2019. Class of 2024 would then be entering class of 2020, who will enter in the fall. While the entering class of 2020 would have entered knowing it was pass/fail, there are many people graduating in 2024 - not a small number I think - who would have taken it scored. This includes anyone from prior years who took a research year, pursued another degree (PhD being the longest), or took a leave of absence for any other reason. This is why I think even 2022 or 2023 is too early to be going P/F without large disruptions.

 

[Lawpy]

If you’re studying hard for months and are scoring average, how do you think you’ll do if you don’t put time into it?

I think studying to pass in preclinicals is good enough to pass the Steps.

 

[Matthew9Thirtyfive]

Let's speak in terms of entering class because it gets convoluted when you talk about graduating class. The class of 2023 the way you mean it, as I interpret it, is entering class of 2019. Class of 2024 would then be entering class of 2020, who will enter in the fall. While the entering class of 2020 would have entered knowing it was pass/fail, there are many people graduating in 2024 - not a small number I think - who would have taken it scored. This includes anyone from prior years who took a research year, pursued another degree (PhD being the longest), or took a leave of absence for any other reason. This is why I think even 2022 or 2023 is too early to be going P/F without large disruptions.

I mean if they’re going to do it they aren’t going to wait 6 or 7 years to do it. If you’re willing to make it so that several hundred people have a P while the rest have a score, why are you not okay with only a much smaller number of people having a P instead of a score?

If they absolutely have to do this in 2022 for some reason, making it so the entering class of 2019 has a score and just saying up front that everyone entering in 2020 and beyond will have a P is probably the fairest way.

 

[Matthew9Thirtyfive]

I think studying to pass in preclinicals is good enough to pass the Steps.

Yo there’s a lot of **** from the beginning of this year I forgot already. Without some kind of dedicated, I’m not going to just magically remember that **** on test day.

 

[Lawpy]

Yo there’s a lot of **** from the beginning of this year I forgot already. Without some kind of dedicated, I’m not going to just magically remember that **** on test day.

Anki review? Going full UFAPS is overkill imo.

Also good point about dedicated. I'm not sure how P/F Step would change it.

 

[aldol16]

I mean if they’re going to do it they aren’t going to wait 6 or 7 years to do it. If you’re willing to make it so that several hundred people have a P while the rest have a score, why are you not okay with only a much smaller number of people having a P instead of a score?

If they absolutely have to do this in 2022 for some reason, making it so the entering class of 2019 has a score and just saying up front that everyone entering in 2020 and beyond will have a P is probably the fairest way.

Another reason why this was such a terrible idea made worse by rushing things. And because you're ignoring the fact that the effect isn't just on Step 1. I'm okay with people who already studied for Step 1 and got scores continuing to have their scores because they worked hard for it. Everyone else who has P/F Step 1 will just not study hard for Step 1 and study hard for Step 2. They'll have Step 2 scores to show for it. So PDs can still filter applicants by score - they can apply a Step 1 screen and a Step 2 screen. The person with a P/F Step 1 isn't having that compared with a 250 Step 1 in isolation. The person with a P/F Step 1 will have a Step 2 score. Maybe that's 260 (in line with Step 2 being 10 points higher than Step 1 on average). Obviously Step 2 isn't directly comparable to Step 1 but it's a start. It's not the Pass compared to 250 as you implied.

 

[Matthew9Thirtyfive]

Anki review? Going full UFAPS is overkill imo.

Also good point about dedicated. I'm not sure how P/F Step would change it.

I know for me, I’ll still be doing one just because I have an intense fear of not studying enough and failing lol.

 

[Matthew9Thirtyfive]

Another reason why this was such a terrible idea made worse by rushing things. And because you're ignoring the fact that the effect isn't just on Step 1. I'm okay with people who already studied for Step 1 and got scores continuing to have their scores because they worked hard for it. Everyone else who has P/F Step 1 will just not study hard for Step 1 and study hard for Step 2. They'll have Step 2 scores to show for it. So PDs can still filter applicants by score - they can apply a Step 1 screen and a Step 2 screen. The person with a P/F Step 1 isn't having that compared with a 250 Step 1 in isolation. The person with a P/F Step 1 will have a Step 2 score. Maybe that's 260 (in line with Step 2 being 10 points higher than Step 1 on average). Obviously Step 2 isn't directly comparable to Step 1 but it's a start. It's not the Pass compared to 250 as you implied.

Yeah I mean I just think they way they are doing it is terrible all around. I’m just trying to think of the least worst way they could do it with how they’ve put it out there.

Would PDs look at a 260 2CK as implying around a 250 step 1? If they would then it’s not as bad as a P versus a 250. But I still think that just psychologically it won’t be looked at as equivalent.

 

[aldol16]

Would PDs look at a 260 2CK as implying around a 250 step 1? If they would then it’s not as bad as a P versus a 250. But I still think that just psychologically it won’t be looked at as equivalent.

Yeah, I'm thinking about how they could implement this in the fairest way possible too. I have no skin in this game so I like to think that I can be objective. Whether that's really true or not - idk.

I think it's hard to have any sort of equivalency but my argument is that PDs are already familiar with looking at CK in the context of Step 1. Those who score poorly on Step 1 often take CK before ERAS is due to help make up for that poorer Step 1. So PDs presumably have a sense of what sort of score on CK would be viewed as a great score relative to Step 1 scores.

But even if it didn't, it still provides a way for PDs to screen applicants in a fair manner. It just requires an additional step of filtering by CK score in addition to Step 1. So they would filter by Step 1 for those who have it. Then they'd add to this set the applications of those who meet a Step 2 CK screen. This combined pool would be the ones they can read in detail.

This approach would allow those who scored well on Step 1 to delay CK after ERAS and not take away their hard-earned efforts. It would allow those who scored poorly on Step 1 to take Step 2 CK early and make up for it (as they always have). And it would allow those who have no choice but to take Step 2 CK to also be evaluated based on their single "high-stakes" exam. Everybody has one high-stakes exam except for those who choose to take both. It's hard to see who "loses" in that scenario - it appears Pareto efficient. You can't improve the position of those who take Step 1 P/F without harming someone else, i.e. everybody who took it scored.

 

[Lawpy]

I know for me, I’ll still be doing one just because I have an intense fear of not studying enough and failing lol.

That's the best approach. Another recent thread involved someone failing CS and not being able to retake it because covid cancellations. P/F can't be taken lightly but the standard approach to 250+ is overkill.

 

[ArdorAyurveda]

@jkdoctor @aldol16

I concede that I was wrong about how potentially important Step 2 will be once Step 1 goes P/F.

 

[aldol16]

I concede that I was wrong about how potentially important Step 2 will be once Step 1 goes P/F.

Yep, https://www.nejm.org/doi/full/10.1056/NEJMp2006148?query=featured_home

What a ****show this is.

 

[Striatum14]

Just found this webinar from April 2020 on r/step1 (need to register to view)

https://register.gotowebinar.com/recording/recordingView?webinarKey=7645394036531736844&registrantEmail=spearpoosb%40yahoo.com

At 13:40 the guy talking (apparently president of the Federation of State Medical Boards) says they won't be retroactively masking scores. I wonder if they have changed their view on this since then...

 

[Medical_studies]

When so much money is involved in tuition for all of this, I really hope they will stick to their official announcements and this recording and not have a pass/fail score for anyone before 2022. There is no difference between masking and a pass/fail score. There will be ways to give students who test after the benefit of the doubt. For example, start masking jan 1 2022 for 2024 match applicants only and move to pass/fail in 2023

 

[Premed2295]

Agree. Students decide how to sacrifice their time and money weighing all factors. It isnt fair to change the game halfway through. Everyone who will be getting "masked" should know that before commiting.

 

[BibFortuna]

Perfect breakdown of everything from this video a few months back when the change was first announced. Someone should email this video to the NBME. Honestly so many things that people fail to consider that are mentioned in this video. Long but super important and worth the watch