Does step 1 school average matter? What percentage of step 1 individual performance is dependent on the school?

[stevec90]

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Hello, I have always considered a particular school’s step 1 average to be a factor to be considered in choosing a medical school to attend. However, I have recently come to believe that any curriculum at a US medical school would be on par in quality.
Based on your experiences, what portion of a person’s performance on Step 1 is dependent upon a school’s education, given that the schools I am considering all fall in the same “tier” of schools in the US? What percentage is based on the individual “will to succeed”? Thank you for any insights.

 

[GoSpursGo]

Moving to pre-med.

The percentage depends on the individual. Plenty of outstanding students score well at low tier schools. Plenty of sub par students do poorly at top tier schools.

 

[EdgeTrimmer]

May be it depends on how good they are at taking standardized tests. If you got good MCAT score it's more likely you will get good USMLE scores (provided you didn't slack off 🙂 )

 

[AnatomyGrey12]

All of it is on you as the student.

 

[getdown]

Unless the school is sitting there taking the test, it's all on you.

 

[deleted903608]

Copy-pasting something I wrote about this on a thread asking the same question a couple months back:

At a recent meeting regarding Step 1 prep, my school's dean told us: "Yes, our school's Step 1 is above national average. No, that does not necessarily mean we are better at teaching to the boards than others. It might just mean we are better at picking students to accept who score well on exams."

In other words, I agree with my dean that a school's average step scores are not much of a reflection of how well they prepare students for the exam (though that may well be one of many factors). I wouldn't consider it a major factor in selecting a school. Most of your step score is on you.

 

[Lucca]

I don’t think u should care at all what the reported step average is.

I will say this though: how does the school support you before and during step prep? Is the school P/F? Do you need to worry about preclin grades for ranking or not? Does everyone at the school take it on the same timeline or does the school give you more flexibility in when you decide to take it? How much time can students ask for dedicated studying / how much do ppl typically take? Does the school (or do the students) subsidize or provide any prep materials? Finally, and I know no one wants to talk about this, consider to some extent what the match list looks like at that school. Are there people getting to where you want to be on a regular basis? If you want to match a very competitive field like derm, for example, it will probably matter more to you that School A actually has a home Derm Department, a history of consistently matching its own students to that department as well as others, than whether or not the reported Step 1 average is 5 points lower than School B. Or, if you want to match a field that highly valued research then it will be more important that the school makes it financially feasible and easy for you to do that research or take extra time to do it. If you’ve already well differentiated your career aspirations and know you are not interested in anything uber competitive then you REALLY shouldn’t care about average Step.

In other words, I’d worry less about “what is the average value of this number?” and more about “will this school provide an environment where someone like me is likely to succeed and meet my goals?”

 

[efle]

Entirely dependent on the students. We had a jump of 11-14 points over just 1-2 years here, the curriculum and MCAT/GPA averages stayed exactly the same. What changed was that the students started abandoning the curriculum in favor of boards resources en masse. If you start your B&B/Anki/UFAPS early and substitute it for your school courses, you'll end up with the same preclinical experience wherever you are*

*exception for graded/ranked preclinical schools where you'd have to still care about the curriculum

 

[Dr. Rick Sanchez]

I would also add to this that nearly half of all matriculants had a single acceptance, so there is no consideration of any outside factors.

for those with more than one acceptance, costs, financial aid, location, and a host of other factors are more important considerations. This is especially true as it is quite likely STEP will become pass/fail in a few years

Why do you feel it is quite likely STEP will be P/F in a few years?

 

[efle]

Why do you feel it is quite likely STEP will be P/F in a few years?

Give this a listen at 2x if you want a thorough and interesting overview



from:

The Sheriff of Sodium

Salty about medical education

thesheriffofsodium.com

 

[stevec90]

I just want to take a moment to say that I appreciate all of the comments and contributions made on this topic! Thank you!

 

[Dr. Rick Sanchez]

Because it is being actively considered and formally discussed by the AMA, AAMC, ECFMG, FSMB, and NBME under an umbrella InCUS
Should the USMLE be pass/fail?

The Invitational Conference on USMLE Scoring (InCUS) recently brought together more than 60 students, residents, program directors, deans, and members of the public to discuss underlying problems and identify possible solutions.

The two-day event was convened by five leading medical groups: the AAMC, the American Medical Association, the Educational Commission for Foreign Medical Graduates, and the two groups that oversee the USMLE, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).

Using brainstorming activities, reams of reading materials, and extensive discussion, the group explored ideas to improve the process that a five-member InCUS planning committee then distilled into preliminary recommendations. Throughout the in-depth process, participants recognized that much more than USMLE scoring needs to change.

I completely agree that there is an incredible overemphasis on STEP 1 scores without the validity/translation into residency performances to back it up. I think the opportunity cost for students is great, but the score has become so important that students' behavior is justifiable. Although I know there must be better metrics we can use and I am excited to see the ball rolling, as an incoming medical student, I am just worried about the transitional period and more specifically how residencies will unpredictably react/replace the void left behind.

This somehow reminds me of the transitional period going on right now with MD admissions without MAR and its unpredictability (more waitlists, more silence, presumably more WL action?, more importance of letters of intent?).

 

[AnatomyGrey12]

Although I know there must be better metrics we can use and I am excited to see the ball rolling, as an incoming medical student, I am just worried about the transitional period and more specifically how residencies will unpredictably react/replace the void left behind.

This is the big catch, that no one has a good plan for how to move forward. It’s all squawking about how “something must change!” Without any actual plan for how to go about it in a reasonable way. There are some serious cons to changing the test P/F that would impact just about every medical student outside of the ones at elite schools, but no one seems to want to offer any viable solutions to mitigate these effects.

This is the big debate. And for the record, I don’t really like the way things are either but until we know we have an actual solution, and not just swapping one massive problem for another, then things shouldn’t change. Honestly most people don’t really expect it to change to P/F anytime soon, even the ones that want it to.

 

[efle]

This is the big catch, that no one has a good plan for how to move forward. It’s all squawking about how “something must change!” Without any actual plan for how to go about it in a reasonable way. There are some serious cons to changing the test P/F that would impact just about every medical student outside of the ones at elite schools, but no one seems to want to offer any viable solutions to mitigate these effects.

This is the big debate. And for the record, I don’t really like the way things are either but until we know we have an actual solution, and not just swapping one massive problem for another, then things shouldn’t change. Honestly most people don’t really expect it to change to P/F anytime soon, even the ones that want it to.

I think the stance is more like, "the system from the year 2000 was better than this." Nobody gave a hoot about your step score, and yet somehow the competitive residencies still managed to fill themselves with qualified applicants. No doubt it would suck for DO and IMG students because they lose their main mechanism for overcoming stereotype. But for Joe Schmoe the USMD student who wants to match Ortho, it'll just be the same game as before with good grades and letters and research and auditions, but sans the months of drilling useless flashcard minutia into his brain during M1-M2.

 

[Dr. Rick Sanchez]

This is the big catch, that no one has a good plan for how to move forward. It’s all squawking about how “something must change!” Without any actual plan for how to go about it in a reasonable way. There are some serious cons to changing the test P/F that would impact just about every medical student outside of the ones at elite schools, but no one seems to want to offer any viable solutions to mitigate these effects.

This is the big debate. And for the record, I don’t really like the way things are either but until we know we have an actual solution, and not just swapping one massive problem for another, then things shouldn’t change. Honestly most people don’t really expect it to change to P/F anytime soon, even the ones that want it to.

Yeah I agree the effects will be most profound at DO/IMG, but also at mid/low tier medical schools. I think the default retaliation from residency programs would be to "play it safe" and pick mostly from top tiers without STEP score considerations. I assume this already goes on to a large extent, but it might be magnified. As a future applicant, I don't want to be guessing what residencies would replace the void with, rather I would want to have better metrics in place when transitioning to P/F. It's a lot to ask for, but I think just going P/F without supplementing "something else" for residencies to use might shift importance to other factors that result in a similar dilemma.

 

[efle]

Yeah I agree the effects will be most profound at DO/IMG, but also at mid/low tier medical schools. I think the default retaliation from residency programs would be to "play it safe" and pick mostly from top tiers without STEP score considerations. I assume this already goes on to a large extent, but it might be magnified. As a future applicant, I don't want to be guessing what residencies would replace the void with, rather I would want to have better metrics in place when transitioning to P/F. It's a lot to ask for, but I think just going P/F without supplementing "something else" for residencies to use might shift importance to other factors that result in a similar dilemma.

The fear of "tiers" taking over is totally lacking in data as far as I've ever seen. Here are the percentages of matched applicants from the "Top 40 NIH Funded":

All Specialties as Reference: 32%
Derm: 48%
Ortho: 32% (no difference!)
ENT: 30% (lower!)
Plastic: 40%
Neurosurg: 44%

So depending on the specialty, we're talking about either no "top tier" over-representation at all (ENT, Ortho) or very minor skew of only 1/10th or so of the pool.

Being scared of a Pass/Fail switch as a DO or IMG makes complete sense. Being scared of a Pass/Fail switch because you're at your mid tier state school does not.

 

[Ho0v-man]

It’s mostly on the student. Things your school can do is have fewer mandatory things, like anatomy prosection/shorter anatomy curriculum overall instead of spending most of preclinical in lab; no mandatory lectures; meaningful breaks between M1 and M2, etc.

The more time your school takes up with worthless professionalism courses, mandatory lectures about how poor people don’t have health insurance (duh), mandatory community service, growing unknown microorganisms on multiple agars on the weekend, or going into a physiology lab to graph out stuff no one understands, the more downward pressure is placed on your personal step score ceiling.

TLDR; pick the school that leaves you alone the most

 

[Prehealth1011]

Mandatory attendance: Yes or No?

That's the only question that matters.

 

[Dr. Rick Sanchez]

Mandatory attendance: Yes or No?

That's the only question that matters.

Haha this is a no from me... traditional lectures definitely need a makeover to become relevant in today's digitized society. I personally enjoy lectures, but in my interviewing experience, less than 20% students (being generous) attend lectures when given the option. It just isn't efficient if podcasted, when you could be maximizing studying for STEP 1. However, I assume a lot of money considerations are complicating moving away from traditional lectures.

 

[Dr. Rick Sanchez]

The fear of "tiers" taking over is totally lacking in data as far as I've ever seen. Here are the percentages of matched applicants from the "Top 40 NIH Funded":

All Specialties as Reference: 32%
Derm: 48%
Ortho: 32% (no difference!)
ENT: 30% (lower!)
Plastic: 40%
Neurosurg: 44%

So depending on the specialty, we're talking about either no "top tier" over-representation at all (ENT, Ortho) or very minor skew of only 1/10th or so of the pool.

Being scared of a Pass/Fail switch as a DO or IMG makes complete sense. Being scared of a Pass/Fail switch because you're at your mid tier state school does not.

This was actually very interesting, 32% matched from "top 40" was not what I would expect. Thanks for sharing it. However, I am concerned this would change if STEP 1 scores were not considered when choosing applicants. Thinking like a residency director, I would accept a "top 40" applicant with better confidence (overemphasizing prestige) when compared to another applicant given both passed STEP 1. There's only so much more emphasis you can redirect to letters of rec, extracurriculars, etc. This is just my premed opinion and I would love to hear other opinions.

 

[Angus Avagadro]

This is the big catch, that no one has a good plan for how to move forward. It’s all squawking about how “something must change!” Without any actual plan for how to go about it in a reasonable way. There are some serious cons to changing the test P/F that would impact just about every medical student outside of the ones at elite schools, but no one seems to want to offer any viable solutions to mitigate these effects.

This is the big debate. And for the record, I don’t really like the way things are either but until we know we have an actual solution, and not just swapping one massive problem for another, then things shouldn’t change. Honestly most people don’t really expect it to change to P/F anytime soon, even the ones that want it to.

I could not agree more. With many more applicants on the horizon, how will residencies, or med schools for that matter, evaluate all that apply to their program? They cannot evaluate every application. A better subjective process needs to be developed first before Step goes to pass fail.

 

[Goro]

Hello, I have always considered a particular school’s step 1 average to be a factor to be considered in choosing a medical school to attend. However, I have recently come to believe that any curriculum at a US medical school would be on par in quality.
Based on your experiences, what portion of a person’s performance on Step 1 is dependent upon a school’s education, given that the schools I am considering all fall in the same “tier” of schools in the US? What percentage is based on the individual “will to succeed”? Thank you for any insights.

100% on you.

 

[deleted688779]

Entirely dependent on the students. We had a jump of 11-14 points over just 1-2 years here, the curriculum and MCAT/GPA averages stayed exactly the same. What changed was that the students started abandoning the curriculum in favor of boards resources en masse. If you start your B&B/Anki/UFAPS early and substitute it for your school courses, you'll end up with the same preclinical experience wherever you are*

*exception for graded/ranked preclinical schools where you'd have to still care about the curriculum

Do you think doing that affects one’s performance during clinical years? I’m all for substituting regular curriculum with STEP practice, just wondering about the possible draw backs.

 

[efle]

Do you think doing that affects one’s performance during clinical years? I’m all for substituting regular curriculum with STEP practice, just wondering about the possible draw backs.

I'm in an unranked pass/fail curriculum so it doesn't matter even if it did. I passed all my school's exams on the first try despite ditching the curriculum entirely.

 

[clinicallabguy]

Ya. Agree mostly with above. The most important component of the curriculum with respect to USMLE step 1 is that it does not interfere with your ability to formulate your study plan and learn the high yield topics. Nonmandatory lectures are definitely a good thing. Low amount of required busy work. I'm sure every medical school has variability in quality of their course material from course to course. For step 1, determine how much protected time exists between the end of coursework in year 2 and the beginning of clinical rotations in year 3. More time is better (up to a point). After about 6-8 weeks, you may start to go a bit crazy and burn out, but everybody is different.

 

[AnatomyGrey12]

But for Joe Schmoe the USMD student who wants to match Ortho, it'll just be the same game as before with good grades and letters and research and auditions, but sans the months of drilling useless flashcard minutia into his brain during M1-M2.

Do you truly believe Joe Schmoe from UMKC/LSU/UTSA matches HCORP if Step goes to P/F? Honest question. I don't give a crap about X% of students going into specific specialties. I'm a DO and my ability to match the field I want doesn't change if it goes P/F either, but my ability to match to the level I am hoping to match completely disappears and this would happen to everyone at non-elite schools. To say this wouldn't affect Joe Schmoe USMD student at a non-elite school is willful ignorance at this point.

Until an actual solution is proffered, change for the sake of change is a terrible idea.

A better subjective process needs to be developed first before Step goes to pass fail.

This is all I ask. Develop a path forward first, instead of just blowing up the current path and hoping that a new one, a high quality one that doesn't make things worse, miraculously appears.

Do you think doing that affects one’s performance during clinical years? I’m all for substituting regular curriculum with STEP practice, just wondering about the possible draw backs.

Contrary to what some people will argue, the people who do better on Step are generally the stronger students during the clinical years as well, obviously there are exceptions but good students tend to always be good students.

 

[efle]

Do you truly believe Joe Schmoe from UMKC/LSU/UTSA matches HCORP if Step goes to P/F? Honest question. I don't give a crap about X% of students going into specific specialties. I'm a DO and my ability to match the field I want doesn't change if it goes P/F either, but my ability to match to the level I am hoping to match completely disappears and this would happen to everyone at non-elite schools. To say this wouldn't affect Joe Schmoe USMD student at a non-elite school is willful ignorance at this point.

Until an actual solution is proffered, change for the sake of change is a terrible idea.



This is all I ask. Develop a path forward first, instead of just blowing up the current path and hoping that a new one, a high quality one that doesn't make things worse, miraculously appears.



Contrary to what some people will argue, the people who do better on Step are generally the stronger students during the clinical years as well, obviously there are exceptions but good students tend to always be good students.

Yeah I do actually think the elitism bias at the best residencies is also overhyped. Pull up a roster for something with a big N like JHH IM. Theres more than enough top 20 applicants in these big fields to fill their class every year. But yet they have dozens of matches from everywhere else. If Joe Schmoe fails to match Big 4, and tells himself it's because he went to U of State or Mid Tier Private SOM, hes just protecting his ego

 

[Lawpy]

Yeah I do actually think the elitism bias at the best residencies is also overhyped. Pull up a roster for something with a big N like JHH IM. Theres more than enough top 20 applicants in these big fields to fill their class every year. But yet they have dozens of matches from everywhere else. If Joe Schmoe fails to match Big 4, and tells himself it's because he went to U of State or Mid Tier Private SOM, hes just protecting his ego

something is off in the IM forums because the Big 4 is difficult to match into without having the school name to back you up. the people somehow matching to JHH IM without a top school background must have had something like connections at that program and unusually high productive research on top of everything else strong to get there. that's rare though

 

[AnatomyGrey12]

Yeah I do actually think the elitism bias at the best residencies is also overhyped. Pull up a roster for something with a big N like JHH IM. Theres more than enough top 20 applicants in these big fields to fill their class every year. But yet they have dozens of matches from everywhere else. If Joe Schmoe fails to match Big 4, and tells himself it's because he went to U of State or Mid Tier Private SOM, hes just protecting his ego

Lmao. Right, and I'm the only one of the two of us whose perspective is skewed.

 

[efle]

Lmao. Right, and I'm the only one of the two of us whose perspective is skewed.

Copied from JHH IM intern roster for this year:

Harvard
U Penn
Kentucky
Miami
Drexel
Northwestern
Harvard
Maryland
Miami
Temple
UT Houston
Alabama
Wash U St. Louis
VA Commonwealth
Arizona
Vanderbilt
SLU
South Carolina
Harvard
U Conn
Harvard
Wash U St. Louis
Baylor
Baylor
Hopkins
Yale
Texas A&M
Case Western
Kentucky
Alabama
Einstein
South Carolina
Mississippi
U Penn
Hopkins
Minnesota
Jefferson
Yale
Alabama
GWU
LSU
Tennessee
Hopkins
UNC
Hopkins
Alabama
VA Commonwealth
U Penn
Illinois

You're barking up the wrong tree dude, unless you can read that list and tell me with a straight face that Joe Midtier State is being excluded despite making up 60% of the class.

 

[Med Ed]

Do you think doing that affects one’s performance during clinical years? I’m all for substituting regular curriculum with STEP practice, just wondering about the possible draw backs.

Can't speak for other institutions, but the number complaints from our faculty about lack of student preparedness for the clinics has steadily trended upwards. We don't know if the increased emphasis on Step 1 is causative, but there is a clear temporal association.

 

[Dr. Rick Sanchez]

Can't speak for other institutions, but the number complaints from our faculty about lack of student preparedness for the clinics has steadily trended upwards. We don't know if the increased emphasis on Step 1 is causative, but there is a clear temporal association.

Do you think the trend of moving STEP 1 to third year after rotations would alleviate this? Schools claim STEP scores have increased by moving STEP farther back (more clinical skills represented on the test), but now I am thinking they just want students to better prepare for clinics and cannot stop them for focusing more on STEP without moving it.

 

[efle]

Do you think the trend of moving STEP 1 to third year after rotations would alleviate this? Schools claim STEP scores have increased by moving STEP farther back (more clinical skills represented on the test), but now I am thinking they just want students to better prepare for clinics and cannot stop them for focusing more on STEP without moving it.

The talk about clinical experiences helping you recognize and answer vignettes is bunk. It's all the shelf studying that helps. There's enough overlap between Step1 and Step2/shelves that doing thousands of additional UWorld Step 2 questions and practice NBMEs nets you some points on test day.

 

[AnatomyGrey12]

You're barking up the wrong tree dude, unless you can read that list and tell me with a straight face that Joe Midtier State is being excluded despite making up 60% of the class.

All I’m saying bro is if you make Step 1 P/F Joe Midtier State has a much higher chance he doesn’t match JHH IM.

There absolutely has to be a way to objectively compare candidates that is standardized between every medical student. Come up with a solution that works first, and only then change Step to P/F. No one is saying it’s perfect, or even a good way to compare people, but it’s what we have and it’s something everyone is familiar with. Until we know we have something better, change for the sake of change will cause more problems than it will fix.

 

[Ho0v-man]

Copied from JHH IM intern roster for this year:

Harvard
U Penn
Kentucky
Miami
Drexel
Northwestern
Harvard
Maryland
Miami
Temple
UT Houston
Alabama
Wash U St. Louis
VA Commonwealth
Arizona
Vanderbilt
SLU
South Carolina
Harvard
U Conn
Harvard
Wash U St. Louis
Baylor
Baylor
Hopkins
Yale
Texas A&M
Case Western
Kentucky
Alabama
Einstein
South Carolina
Mississippi
U Penn
Hopkins
Minnesota
Jefferson
Yale
Alabama
GWU
LSU
Tennessee
Hopkins
UNC
Hopkins
Alabama
VA Commonwealth
U Penn
Illinois

You're barking up the wrong tree dude, unless you can read that list and tell me with a straight face that Joe Midtier State is being excluded despite making up 60% of the class.

I think the argument is that without metrics like a quantitative exam to outperform those with superior pedigree, those students couldn’t match there. Who knows if that’s the case though? It’s not like step scores get posted on the “our residents” pages.

I also think that if you go to a tippy-top program but get a 225 on step 1, you likely won’t be applying to derm. This is why top schools aren’t heavily over-represented in competitive fields. Currently there’s something in place that prevents this from happening. Derm ain’t for me, but let’s not pretend that the vast majority of medical students wouldn’t at least consider it if the average step score weren’t so insane.

 

[efle]

All I’m saying bro is if you make Step 1 P/F Joe Midtier State has a much higher chance he doesn’t match JHH IM.

There absolutely has to be a way to objectively compare candidates that is standardized between every medical student. Come up with a solution that works first, and only then change Step to P/F. No one is saying it’s perfect, or even a good way to compare people, but it’s what we have and it’s something everyone is familiar with. Until we know we have something better, change for the sake of change will cause more problems than it will fix.

I think the argument is that without metrics like a quantitative exam to outperform those with superior pedigree, those students couldn’t match there. Who knows if that’s the case though? It’s not like step scores get posted on the “our residents” pages.

I also think that if you go to a tippy-top program but get a 225 on step 1, you likely won’t be applying to derm. This is why top schools aren’t heavily over-represented in competitive fields. Currently there’s something in place that prevents this from happening. Derm ain’t for me, but let’s not pretend that the vast majority of medical students wouldn’t at least consider it if the average step score weren’t so insane.

And I'm of the position that there are more than enough 250+ applicants from big-name medical schools to fill all the slots, if that's what they wanted. Instead they take people from all over because they don't actually harbor this elitism/favoritism that everyone seems so scared of. If scores went pass/fail tomorrow, I still think their roster would be a big mix like it is now.

Gotta remember the absolute numbers. Derm has a 250 median, sure, but only a few hundred applicants. There were ~1000 IM applicants with a 250+ last year. Another 1000 between Anesthesia, EM, GenSurg, and Neuro. The vast majority of people who have high scores still choose other things. All the competitive fields have little to no elitism bias because only a few of the high-scoring folks at each school are interested in that specialty, and that's true whether we're talking about the cohorts at U State or Top 20.

 

[Ho0v-man]

And I'm of the position that there are more than enough 250+ applicants from big-name medical schools to fill all the slots, if that's what they wanted. Instead they take people from all over because they don't actually harbor this elitism/favoritism that everyone seems so scared of. If scores went pass/fail tomorrow, I still think their roster would be a big mix like it is now.

Gotta remember the absolute numbers. Derm has a 250 median, sure, but only a few hundred applicants. There were ~1000 IM applicants with a 250+ last year. Another 1000 between Anesthesia, EM, GenSurg, and Neuro. The vast majority of people who have high scores still choose other things. All the competitive fields have little to no elitism bias because only a few of the high-scoring folks at each school are interested in that specialty, and that's true whether we're talking about the cohorts at U State or Top 20.

I’m only able to find 2018 match data, but there were only about 880 people that applied to IM that year in that range. When selected for US seniors that number is just over 500. There’s like what ~2,000 grads from the top 20 schools. Those schools have about 915 IM spots between (if research tracks are included.). So there’s really not enough 250+ applicants to IM to fill the top programs at all, definitely not with USMDs. Most of the folks there are probably there bc of their school name. And of course I’m just guessing as much as anyone else on this last bit, but I’m willing to be that the folks from the bolds in your previous post outperformed the rest on boards and other metrics like research.

There were 547 USMDs who applied to the other fields you mentioned.

 

[efle]

I’m only able to find 2018 match data, but there were only about 880 people that applied to IM that year in that range. When selected for US seniors that number is just over 500. There’s like what ~2,000 grads from the top 20 schools. Those schools have about 915 IM spots between (if research tracks are included.). So there’s really not enough 250+ applicants to IM to fill the top programs at all, definitely not with USMDs. Most of the folks there are probably there bc of their school name. And of course I’m just guessing as much as anyone else on this last bit, but I’m willing to be that the folks from the bolds in your previous post outperformed the rest on boards and other metrics like research.

There were 547 USMDs who applied to the other fields you mentioned.

Right, obviously not all top 20 med schools can fill their associated IM residencies with top 20 graduates. The residencies are cohorts of several dozens and the schools graduate only a small fraction of that many IM applicants each year. But there's a handful (Big 4) I do think could set that criteria if they wanted to, and when you look at their rosters, that's not how they behave at all. Again, I have to ask how anyone can say people land at the top (or not) based largely off their school name, when the Osler roster is majority public and mid-tier private schools.

Add in the other noncompetitive specialties I left out and the point stands. The fraction of 250+ people choosing not to go for derm or a surgical sub-specialty outnumber the fraction that does. We attribute way too much of people's decisions to step score. Don't get me wrong, someone with their heart set on a surgical subspecialty should be very upset and worried if they hit a 230. But the notion that receiving a good score suddenly makes everyone interested in skin, eyes or bones isn't borne out! It's an urban myth just like the idea of these specialties drawing disproportionately from the top med schools.

 

[Ho0v-man]

Right, obviously not all top 20 med schools can fill their associated IM residencies with top 20 graduates. The residencies are cohorts of several dozens and the schools graduate only a small fraction of that many IM applicants each year. But there's a handful (Big 4) I do think could set that criteria if they wanted to, and when you look at their rosters, that's not how they behave at all. Again, I have to ask how anyone can say people land at the top (or not) based largely off their school name, when the Osler roster is majority public and mid-tier private schools.

If anything, this exercise has proven that even that would be difficult. The top 4 programs are about 160-200 spots to fill from about 500 of the 250+ applicants. The only way this becomes feasible is if 100% of the high scoring IM applicants come from top 20 schools which is just definitely not the case. So even though you’ve moved the goal post, it’s still a very impractical assertion.

Add in the other noncompetitive specialties I left out and the point stands. The fraction of 250+ people choosing not to go for derm or a surgical sub-specialty outnumber the fraction that does. We attribute way too much of people's decisions to step score. Don't get me wrong, someone with their heart set on a surgical subspecialty should be very upset and worried if they hit a 230. But the notion that receiving a good score suddenly makes everyone interested in skin, eyes or bones isn't borne out! It's an urban myth just like the idea of these specialties drawing disproportionately from the top med schools.

I agree with the bolded. I’m not into surgery at all and think derm is gross. But I know a lot of people going into IM bc they have no shot numbers wise at those fields. Maybe that’s why my view differs from yours.

But I believe that if anything looking at the numbers has proven the point that if you receive a 230-240 from a top school you’ll still match very well into a top IM program. There’s simply not enough insane step 1 scores from IM applicants from these schools to justify their school prestige not playing a role in their match level.

Who’s to say what they would have selected if they scored higher? Or maybe they didn’t care about scoring higher because they wanted IM and knew it would play out like this. No one really knows. But it is apparent that a significant portion of the top 20 IM applicants would still struggle to match or fail to match derm or a surgical sub due to step score. Take away that barrier, and those fields are on the table. Right now it’s easy to say they were never interested. They don’t stand a chance anyway.

 

[efle]

If anything, this exercise has proven that even that would be difficult. The top 4 programs are about 160-200 spots to fill from about 500 of the 250+ applicants. The only way this becomes feasible is if 100% of the high scoring IM applicants come from top 20 schools which is just definitely not the case. So even though you’ve moved the goal post, it’s still a very impractical assertion.



I agree with the bolded. I’m not into surgery at all and think derm is gross. But I know a lot of people going into IM bc they have no shot numbers wise at those fields. Maybe that’s why my view differs from yours.

But I believe that if anything looking at the numbers has proven the point that if you receive a 230-240 from a top school you’ll still match very well into a top IM program. There’s simply not enough insane step 1 scores from IM applicants from these schools to justify their school prestige not playing a role in their match level.

Who’s to say what they would have selected if they scored higher? Or maybe they didn’t care about scoring higher because they wanted IM and knew it would play out like this. No one really knows. But it is apparent that a significant portion of the top 20 IM applicants would still struggle to match or fail to match derm or a surgical sub due to step score. Take away that barrier, and those fields are on the table. Right now it’s easy to say they were never interested. They don’t stand a chance anyway.

That's very fair, but I suppose I've also been stating it wrong for other specialties too. A "250 specialty" like Derm or Ortho also isn't all 250+ scoring. Really it's only about half to give that as the median that people target. So the fact that there's 500 instead of 1000 people with those numbers applying IM still dwarfs the 200 instead of 400 going Derm. In the same vein a place like JHH obviously doesn't have a hard screen at 250+ for everyone, but their median is certainly high.

And considering the median step scores at most t20 schools are in the 240s now, I absolutely still do think JHH could afford to draw much, much more than half their class from the big names. They just choose not to.

Good point about the chicken and the egg. Can't know if someone's specialty was really their top choice. But if there's about 3000 people awarded a 250+ per year and only about 200 of them apply derm, that's at least a little heartening that the appeal of $kin is limited to ~5%. Before looking up any of these numbers I would've guessed it was a much larger proportion

 

[Ho0v-man]

That's very fair, but I suppose I've also been stating it wrong for other specialties too. A "250 specialty" like Derm or Ortho also isn't all 250+ scoring. Really it's only about half to give that as the median that people target. So the fact that there's 500 instead of 1000 people with those numbers applying IM still dwarfs the 200 instead of 400 going Derm. In the same vein a place like JHH obviously doesn't have a hard screen at 250+ for everyone, but their median is certainly high.

And considering the median step scores at most t20 schools are in the 240s now, I absolutely still do think JHH could afford to draw much, much more than half their class from the big names. They just choose not to.

Good point about the chicken and the egg. Can't know if someone's specialty was really their top choice. But if there's about 3000 people awarded a 250+ per year and only about 200 of them apply derm, that's at least a little heartening that the appeal of $kin is limited to ~5%. Before looking up any of these numbers I would've guessed it was a much larger proportion

Excellent points. My personal argument is that it’s very likely those from mid/low tier schools use their step scores and research profile to transcend into those higher tier programs. Taking away step 1, in my opinion, would make it less likely those students could do that. Similarly, while fields like ortho and derm do certainly have people that score in 230s-240s, there’s no way to know if those applicants were the ones from high tier programs or not.

Our differing opinions on the matter likely stem from being at very opposite ends of the prestige spectrum lol.

I agree that not everyone wants $kin and bone$ regardless of their ability to obtain them. But I’ve seen interest in those fields miraculously vanish after boards. If I were to guess, your view is likely skewed because a low score is much less of a barrier for you. Similarly, my view is likely skewed because a high score is expected to be considered average for mid tier training. I respect your opinion even though I disagree. Ultimately the truth is probably somewhere between.