Curious about step 1 score

[Bevo]

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A friend failed step 1 by a point

But I was wondering which is worse. Failing by a point and getting the opportunity to re-take the exam and show a stronger score on the 2nd try.

Or

Just passing by a point and living with that score.

 

[Vince]

I'd say failing by a point is better......

just do a whole heck of a lot better on the 2nd try

 

[docmartin]

I'd say failing by a point is better......

just do a whole heck of a lot better on the 2nd try

I agree with Vince. 😀

 

[Idiopathic]

Seconded here

With an increased score, you can at least claim that you were sick on test day the first time.

 

[Cristagali]

Well he HAS to retake it so now he knows what the exam is like so he can tailor his studies to increase his scores. However, some programs, state NO FAILED attempts for applicants, others allow one retake. so in the end, as long as he passes this time, he should be ok. good luck.

 

[Stinger86]

Fail by a point and retake, no doubt. It's rough that once you pass a Step exam, you're branded with that score forever.

 

[Blade28]

Fail, study hard, ace the test the second time around.

Barely pass with a 182 or 183, and you're going to have a VERY difficult time matching into even semi-competitive residencies.

 

[neilc]

totally disagree. it is better to pass the first time. i mean, you are expected to do better the second time! so, comparing somebody who passed the first time with somebody who failed then did better...my money would be on the applicant that can get through it without a practice run. everbody goes into this exam expecting/attmepting to pass, so those that achieve this goal on the first try are in a league above those that don't get through for whatever reason. if you gave everyone that got a crappy score a second chance, they would likely raise the score significantly as well...

if you were in charge of hiring somebody, wouldn't you do pick the person that could get the job done the first time???

 

[Idiopathic]

I might be inclined to pick the one who could learn from his mistakes and do an excellent job the second time rather than someone who did a marginal job the first time.

 

[BellKicker]

I have to go with Neil (partly, at least)

For AMGs: Better to fail first and then pass with a good score.

For IMGs: Better to pass the first time. Some people take months off to study for step 1, in which case a good score isn't really that impressive. In fact, some programs won't even consider an IMGs application if he/she didn't pass in the first attempt.

 

[neilc]

I might be inclined to pick the one who could learn from his mistakes and do an excellent job the second time rather than someone who did a marginal job the first time.

well, i doubt this would be the thinking of the program director...marginal on the first time is still a pass. and, if you gave everyone that did marginal the first time the opportunity to also increase their score, many of those on the low end of pass would also do excellent the second time around. it seems crazy to me to look over someone who did the job the first time, in favor of somebody who needed a second chance.

additionally, if a program does screen applications based on score, you can be pretty sure that they will also screen out any failures. it seems counter-intuitive to have this automatic screen on scores, yet not exclude anyone that fails.

i do agree with bell kicker that it may be slightly different for AMG's. but, for us internationals, you had better pass first try and do as well as you can. i would think a fail would really limit you on what programs will even look at you.

 

[WatchingWaiting]

Step I isn't the MCAT. Failing it is a major black mark on an application, will screw up your third year schedule, may very well get you placed on academic probation at your school. Competitive residencies are not going to care about improvement: they're going to to dump you and move on to the next candidate. Even non-competitive programs will have concern that you failed it the first time, whereas a barely passing score will not necessarily be noticed or scrutinized much at less competitive programs.

Also, I think the assumption that a student who is around a 180 on the first attempt it somehow going to get a big improvement on a retake is deeply flawed. Given that you won't find out for a month or two until after you've started your clinical rotations, you are not exactly going to have a lot of time to study and get the score up, not to mention you will probably not be in a very self-confident mindset either.

 

[woowoo]

I know of an 2nd yr. ortho resident who failed the step twice, which held him back a year, but at the same time he used the extra 6 months that he had to do some research and strongly improve his residency application. he did well the third time around, but most importantly showed that he was willing to work hard and do anything that it took to succeed. He is in a really good program in the southeast. Granted most of your top tier programs will shred your application right away once they see that you have failed even once, but I am convinced that there are some PD's who will look positively at your overcoming past failures.

 

[Smurfette]

I remember once that at my school, the administration told us that the majority of people who fail step I failed it by less than 8-10 points. However, most people who re-take it only improve their score by maybe 10-15 points---meaning most re-takers still barely pass it in the end. There are exceptions to this, of course (people who were sick and so forth), but it is rare for someone who fails it the first time to break 200 on the re-take.

I think either way---failing and re-taking vs passing by a point the first time---will make it tougher for you when applying to programs, so they are probably viewed similarly by programs if they do not specify "first-time passing score" as a requirement. That being said, many other factors contribute to residency application other than board scores, so if your only "bad mark" per se is your board score, don't get too hung up over it---95% will match into a residency program!

 

[Firion451]

This discussion came up in my school right before we took Step 1. I said that I would rather fail than pass by 1 point...and then got lambasted by classmates who said that it is always better to pass and the only people who say they would rather fail are people who EXPECT to do really well in the first place (and therefore the failure would be a statistical anomaly).

Now having gone through both Step 1 and 2 CK (also took CS, but waiting for score) I have to agree with Smurfette. Either scenario sucks. There are two important factors to consider:

1. According to the USMLE website, US allopathic med students' pass rate for Step I was 90% on the 1st try and only 62% on subsequent tries. So your probability of failure more than TRIPLES if you have failed it once. It's even worse for 2 CK...94% passed 1st try but only 64% passed as repeaters. That's a 6% risk elevating to a 36% risk!

2. Even if you do pass as a repeater, it is highly unlikely that you will get a great score on the retry. The standard error of measurement for last year's step 1 was 6 points on the 3 digit scale, and the mean was 218. If you failed by 1 point your score was 181. So you have only a 0.5% chance of increasing your score by 3 standard errors (18 points). Even if you managed to achieve this, it would only raise your score to 199--still 19 points below the mean!

In short, unless there is a highly unusual reason why you failed (i.e. didn't study, major illness, death in family, etc.), there's very little reason to believe you're going to get the kind of score that will impress a program director on your retake anyway...so I would say it's better to pass on the 1st try.

 

[outgolfing26]

I know of an 2nd yr. ortho resident who failed the step twice, which held him back a year, but at the same time he used the extra 6 months that he had to do some research and strongly improve his residency application. he did well the third time around, but most importantly showed that he was willing to work hard and do anything that it took to succeed.

just a question....if you failed twice, then finally pass...how much of a chance will if you have if you want to go into family med or internal med?....has anyone out there experienced this before?....thanks for your thoughts.

 

[fourthyearmed]

A friend failed step 1 by a point

But I was wondering which is worse. Failing by a point and getting the opportunity to re-take the exam and show a stronger score on the 2nd try.

Or

Just passing by a point and living with that score.

OK, how many of you who said fail and retake have actually taken the test? I personally would rather jump off a bridge than take that test again. Studying for it was the worst, most stressful 5 weeks of my life not to mention the stress of taking the 8 hour test. Failing that test is really a black mark on your record. You'll always be known by your classmates as one of the people who failed the boards even if it was just one point (they may not know that). The majority of people I know who failed were smart people who just didn't apply themselves but what does it say about them that they didn't study enough to pass the first time? To me it says they won't work hard as a resident either. Programs see failing the test as a red flag. I don't know if they find out your first score or if they just know you failed. Step 1 is nothing like the MCAT - it's not a take and retake to get the highest score. It's a pass/fail test in essence, it's just the higher you score the better.

 

[UnderDoc]

1. According to the USMLE website, US allopathic med students' pass rate for Step I was 90% on the 1st try and only 62% on subsequent tries. So your probability of failure more than TRIPLES if you have failed it once. It's even worse for 2 CK...94% passed 1st try but only 64% passed as repeaters. That's a 6% risk elevating to a 36% risk!

While I agree that it's better to pass on the first attempt, Firion's logic is a bit askew here. Since it can be safely assumed that 100% of re-takers failed on their first attempt, a 36% fail-rate on the re-take is not too bad (ie, almost 2/3 went from failure to passing). Therefore, your risk of failure cannot be "elevated" as Firion asserts. In fact, statistically it's gone from 100% failure rate to 36% failure rate.

2. Even if you do pass as a repeater, it is highly unlikely that you will get a great score on the retry. The standard error of measurement for last year's step 1 was 6 points on the 3 digit scale, and the mean was 218. If you failed by 1 point your score was 181. So you have only a 0.5% chance of increasing your score by 3 standard errors (18 points). Even if you managed to achieve this, it would only raise your score to 199--still 19 points below the mean!

Again, there are some logical gaps here. If students were to retake the exam without studying then it might be safe to assume, as Firion does, that it would be only mere chance (error) that would contribute to a score sufficiently high enough to pass. However, I'll bet that most people who fail their boards, regardless of the circumstances, invest some extra study time in an attempt to assure that it doesn't happen again. The fact that 74% people pass on the second go-round proves this point. Were this not the case you would expect only a very small minority of re-takers to pass - generally those with borderline scores who benefit from error in the testing instrument to lift them beyond the passing threshold.

 

[Firion451]

Thanks for this reply, UnderDoc. I am always looking for ways to hone my statistics skills. Let me just reiterate that before I took Step 1, I used to believe that it was better to fail and retake. I had no fear of actually failing, and neither has anyone that I have ever heard make that statement. Now that I'm older and wiser (i.e. passed Step 1 and 2 CK), I believe it is foolish for anyone to say it is better to fail. In fact, those who truly fear failing usually pray they pass on the first try regardless of their score. Anyway, on to the stats blog...

While I agree that it's better to pass on the first attempt, Firion's logic is a bit askew here. Since it can be safely assumed that 100% of re-takers failed on their first attempt, a 36% fail-rate on the re-take is not too bad (ie, almost 2/3 went from failure to passing). Therefore, your risk of failure cannot be "elevated" as Firion asserts. In fact, statistically it's gone from 100% failure rate to 36% failure rate.

Point taken, but your point of view differs in that you are looking from the perspective of having already failed and assigning a p value of failure as 1.00. If I bet on red in 00 roulette my p value for "failure" is 0.55 whether I win or lose. Now it is impossible to mathematically predict a failure rate for Step 1, but it is experimentally 10%, or 0.1, for 1st time takers. Now as repeater, that experimental failure rate goes to 0.36...and that is DESPITE extra studying efforts and time off. So I believe that your logic is faulty because the actual change in p value for failure is +0.26 (increased a priori failure risk) as opposed to -0.64 as you propose.

Again, there are some logical gaps here. If students were to retake the exam without studying then it might be safe to assume, as Firion does, that it would be only mere chance (error) that would contribute to a score sufficiently high enough to pass. However, I'll bet that most people who fail their boards, regardless of the circumstances, invest some extra study time in an attempt to assure that it doesn't happen again. The fact that 74% people pass on the second go-round proves this point. Were this not the case you would expect only a very small minority of re-takers to pass - generally those with borderline scores who benefit from error in the testing instrument to lift them beyond the passing threshold.

Because of how the OP worded the question, we are assuming the tester failed by 1 point, or got a 181. If this hypothetical tester retested without studying or using any other method to enhance his/her knowledge, the expected pass rate would be slightly less than 50% (the mean would be centered at 181 with a SD of 6 according the NBME statistics). Without knowing the mean scores of the retakers, I don't know if the 74% 2nd try pass rate is statistically significant, but I will assume that it is. EVEN SO, there is absolutely no evidence that a retaker who passes will get a monster score or even has a good chance of beating the mean.

The second part of my post was to speak to whiners (such as I once was) who specifically say they would rather fail in order to have a shot at a monster score on their second try. One's score on Step 1 is a function of how well the preclinical years have "sunk in" and of how well a candidate takes tests in general, and both of these factors are very hard to change in the short term. Additionally, the vast majority of "failers" ARE within 1 SEM of passing, so it is not only possible but PROBABLE that many of the second try passes are due to chance alone and not due to a further accumulation of knowledge.

 

[felicia2001uk]

what is the significance of new change in score..182 to 185? 240 and above last year was 99 th percentile...what is it in 2007?

 

[lord_jeebus]

what is the significance of new change in score..182 to 185? 240 and above last year was 99 th percentile...what is it in 2007?

The 2 digit score is not a percentile.

99th percentile was probably in the 260's.

 

[goldensnow]

The 2 digit score is not a percentile.

99th percentile was probably in the 260's.

then what does the 2 digit score mean?
while u r at it, can u say anything about 3 digit and 2 digit , i don;t get their meaning at all.is 3 digit percentage u make on ur test , example 260 out of 400. or what?

 

[VincentAdultman]

then what does the 2 digit score mean?
while u r at it, can u say anything about 3 digit and 2 digit , i don;t get their meaning at all.is 3 digit percentage u make on ur test , example 260 out of 400. or what?

🙄

The two digit score is set with 75 as passing. Some programs require it to interpret the exam, or some crap. Pretty sure this explanation comes with the results.

Oh...and the correct answer is 1 point above pass>>>>>>>fail by one point.