Does this mean STEP 1 is likely going to be pass/fail as soon as this year?

[ConfusedAboutEverything]

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They said they are planning on enacting pass/fail STEP 1 as soon as the winter of '19-'20

But they are just recommendations, is this going to happen? What could stop it?

 

[Lucca]

There are like 3 rly long threads about this over on the Allo board.

The bottom line is that a set of recommendations has been made after this InCUS conference but no final decisions have been made. If any changes are made, the current advertised timeline is to implement them by 2020. *one* of those recommendations is Step 1 going P/F. There are other recommendations in the document, several of which don’t touch Step 1 scoring.

We will know more in the autumn after the public comment period ends.

 

[Lucca]

Let me add just one other comment. The bottom line is to applicants is this does not matter. Unless for some reason that you would consider NOT applying to medical school because of this, which I cant imagine anyone is considering, you will go forward and take the STEP when it happens.

Depending on when/if anything happens, it will impact how people choose medical schools in April, for better or worse. Applicants should still be informed.

 

[993444]

Depending on when/if anything happens, it will impact how people choose medical schools in April, for better or worse. Applicants should still be informed.

What I've heard on the street is that this will make it much more difficult for students from lower ranking MD schools to land top residencies. Because scoring high on STEP 1 is one of their biggest opportunities to stand out. Program directors use STEP 1 to sort through applications and if that is no longer an option, they'll choose to sort through the stack by using the applicant's med school rank.

 

[Lucca]

What I've heard on the street is that this will make it much more difficult for students from lower ranking MD schools to land top residencies. Because scoring high on STEP 1 is one of their biggest opportunities to stand out. Program directors use STEP 1 to sort through applications and if that is no longer an option, they'll choose to sort through the stack by using the applicant's med school rank.

Yah I don’t believe that it will be as drastic as ppl say and also I’m skeptical any change to the exam will happen in isolation from the rest of GmE precisely because PDs are already hyper aware of the weight step 1 currently has in resident selection.

Anyways I don’t want this to become yet again another rehash of the discussions already had on Allo.

 

[993444]

Yah I don’t believe that it will be as drastic as ppl say and also I’m skeptical any change to the exam will happen in isolation from the rest of GmE precisely because PDs are already hyper aware of the weight step 1 currently has in resident selection.

Anyways I don’t want this to become yet again another rehash of the discussions already had on Allo.

I feel like it’s important to talk about this though because of it’s huge impact.

And I know there are multiple discussions going on. But I feel like in this case it’s ok because it gives out more exposure to the topic for the people who just glance on this site.

 

[Goro]

What I've heard on the street is that this will make it much more difficult for students from lower ranking MD schools to land top residencies. Because scoring high on STEP 1 is one of their biggest opportunities to stand out. Program directors use STEP 1 to sort through applications and if that is no longer an option, they'll choose to sort through the stack by using the applicant's med school rank.

You are forgetting that med schools are often feeders to residencies. So if enough, say Albany grads have gone to Dartmouth IM, then don't think that some unknown from JHU will be taken over the Albany kid.

Kids from newer schools might be handicapped as you fear, but you know what? This happened already, and you can see it by the match list of a very new school for its first coups of graduating classes.

If P/F goes forward as thought, it will be up to medical students to network more and to do aways/auditions.

I'm unconvinced that when you are a known quantity, that a PD and his/her staff will say "Trex rotated with us and did a great job, but they only went to [XSOM]. Joe/Jane here on this CV, who is only a name on a piece of paper, went to Yale... Let's take them!"

 

[993444]

You are forgetting that med schools are often feeders to residencies. So if enough, say Albany grads have gone to Dartmouth IM, then don't think that some unknown from JHU will be taken over the Albany kid.

Kids from newer schools might be handicapped as you fear, but you know what? This happened already, and you can see it by the match list of a very new school for its first coups of graduating classes.

If P/F goes forward as thought, it will be up to medical students to network more and to do aways/auditions.

I'm unconvinced that when you are a known quantity, that a PD and his/her staff will say "Trex rotated with us and did a great job, but they only went to [XSOM]. Joe/Jane here on this CV, who is only a name on a piece of paper, went to Yale... Let's take them!"

Thank you Goro 🙂 You really know how to make a man feel good about himself!

I always knew you were a softie inside 😉

 

[Angus Avagadro]

You are forgetting that med schools are often feeders to residencies. So if enough, say Albany grads have gone to Dartmouth IM, then don't think that some unknown from JHU will be taken over the Albany kid.

Kids from newer schools might be handicapped as you fear, but you know what? This happened already, and you can see it by the match list of a very new school for its first coups of graduating classes.

If P/F goes forward as thought, it will be up to medical students to network more and to do aways/auditions.

I'm unconvinced that when you are a known quantity, that a PD and his/her staff will say "Trex rotated with us and did a great job, but they only went to [XSOM]. Joe/Jane here on this CV, who is only a name on a piece of paper, went to Yale... Let's take them!"

I dont mean to ***in the punch bowl here, but I have seen my former residency do just that. If anyone from the Ivys applied, they tripped over themselves to get them. Two real dip sticks are emblazoned in my brain. One from JHU and another from UCSF. I'm not saying that's the rule, but it happens occasionally

 

[Moko]

This change will likely benefit those from higher ranked schools. To oversimplify the decision-making process, let's say PDs currently base their decisions on five factors: school prestige, Step I/II score, clinical grades, LORs, and research productivity. By removing Step I/II as a differentiating factor between applicants, school prestige will most likely increase in importance on a relative basis (along with the other remaining criteria). This will likely also place much more emphasis on the clinical grades and away rotations, both of which can be highly subjective and dependent on luck.

Bottom line is that personal performance will still matter, but those from lower ranked schools will have one less avenue to prove themselves. Still, I doubt that this is enough to warrant panic, and people should not be deciding on where to go solely based on school prestige. Just my thoughts

 

[993444]

This change will likely benefit those from higher ranked schools. To oversimplify the decision-making process, let's say PDs currently base their decisions on five factors: school prestige, Step I/II score, clinical grades, LORs, and research productivity. By removing Step I/II as a differentiating factor between applicants, school prestige will most likely increase in importance on a relative basis (along with the other remaining criteria). This will likely also place much more emphasis on the clinical grades and away rotations, both of which can be highly subjective and dependent on luck.

Bottom line is that personal performance will still matter, but those from lower ranked schools will have one less avenue to prove themselves. Still, I doubt that this is enough to warrant panic, and people should not be deciding on where to go solely based on school prestige. Just my thoughts

I just wanna go to med school to help poor people in underserved areas struggling with terminal illnesses. Hopefully this change in STEP scoring won’t affect my opportunities to do that.

 

[Moko]

I just wanna go to med school to help poor people in underserved areas struggling with terminal illnesses. Hopefully this change in STEP scoring won’t affect my opportunities to do that.

It won't

 

[CyrilFiggis]

You're already seeing the residency application process start to change in certain specialties. If you look at the match survey data for programs like EM, PDs are using away rotations and the SLOEs from those with as much weight and sometimes more than STEP 1 scores to look at applicants. Some top programs will still use scores to filter their applicant pool, but they are finding objective peer review to be more helpful than a one day score or puffy, superficial letters from a random doctor. Also, in general for all programs, the NRMP data shows that candidate familiarity has a huge impact. And other programs like Ortho are adopting the SVI as part of the application. The process 5-10 years from now will not be the same as it is today in many of these specialties.

I disregard the the whole, "top ranked program" BS. Guess what, there are only a handful of them in each specialty and the majority of physicians did not go to one. If you match into the specialty you want, you'll become exactly the doctor you're supposed to be.

 

[Dr panda]

I disregard the the whole, "top ranked program" BS. Guess what, there are only a handful of them in each specialty and the majority of physicians did not go to one. If you match into the specialty you want, you'll become exactly the doctor you're supposed to be.

I think people who are afraid are those who want to get into top specialties (ortho, derm, etc), and step 1 score is how they get there, if the test will be pass/fail then those specialities will be out of the reach for students from non top 20 schools, at least that is how I understand it, might be wrong.

 

[AnatomyGrey12]

They said they are planning on enacting pass/fail STEP 1 as soon as the winter of '19-'20

No if you look at the exact verbiage there really isn't anything decided. Far from it actually.

What I've heard on the street is that this will make it much more difficult for students from lower ranking MD schools to land top residencies. Because scoring high on STEP 1 is one of their biggest opportunities to stand out. Program directors use STEP 1 to sort through applications and if that is no longer an option, they'll choose to sort through the stack by using the applicant's med school rank.

It will.

then don't think that some unknown from JHU will be taken over the Albany kid.

We already see this happen.

Yah I don’t believe that it will be as drastic as ppl say

Right. 🙄

 

[ChymeofPassion]

Can't imagine why pre-meds would worry that they will no longer be able to test their way into everything and may have to use some semblance of social skills and networking to stand out.

 

[chemdoctor]

Wouldn’t this be awesome?

 

[Lucca]

I think people who are afraid are those who want to get into top specialties (ortho, derm, etc), and step 1 score is how they get there, if the test will be pass/fail then those specialities will be out of the reach for students from non top 20 schools, at least that is how I understand it, might be wrong.

I feel those people, I really do and there’s little doubt in my mind that there would be a steeper battle for the most competitive residency slots for most applicants if step 1 were made p/f and nothing else changed. But that’s a pretty radical scenario. Many things in between could happen and, again, I’m very doubtful a change to the exam would be made without further changes elsewhere in the pipeline even if it means PDs creating idiosyncratic evaluation mechanisms as has been done in EM recently. Furthermore, I think it’s just fallacious to assume everyone at top med schools literally only cares about matching ortho or derm, or top whatever residency in their specialty. Look at any top med school match list. Higher proportion of pedigreed matches compared to other schools? Yes. Are a plurality at the home program which is probably itself pedigreed to some extent? Also yes. Are they matching the most raw number of students in the most competitive specialties (ortho, derm, plastics, etc)? Nope. Will the top places that have historically drawn from many medical schools outside the top tier of the US news rankings stop taking those grads altogether just because they lost their favorite number? I’m doubtful but I recognize my skepticism is in the minority here.

I also recognize I’m nowhere near qualified enough to have any meaningful opinion on the matter. Just stating what I think based on general principles of selection processes.

 

[Dr panda]

Look at any top med school match list. Are they matching the most raw number of students in the most competitive specialties (ortho, derm, plastics, etc)? Nope.

Well, I think this is partially due to step 1 score, if you are from Harvard and have a subpar 200, then Derm/ortho will be hard to match. Not everyone who score top 10% on step 1 is ivy graduate. However, if scores will be eliminated, then the school name will do its job like it happens in law/mba industry.
(yes, I know that I first need to get into medical school before worrying about those things but I am just curious)

 

[993444]

Can someone explain what SLOE means and it’s effects? From what I’ve read online it seems like the residency equivalent of a committee letter.

 

[Lucca]

Well, I think this is partially due to step 1 score, if you are from Harvard and have a subpar 200, then Derm/ortho will be hard to match. Not everyone who score top 10% on step 1 is ivy graduate. However, if scores will be eliminated, then the school name will do its job like it happens in law/mba industry.

I think this is a poor way of thinking about it because it assumes that everyone’s goal is to match ortho/seem and it just isn’t. I actually have very little doubt that every single student at HMS or any other institution where almost everyone is 3.8+/516+ coming out of UG could score above national average if they really wanted to make that their goal. People who want to get into competitive specialties will make that their goal from day 1 and med students being med students will do what they perceive they have to do to achieve their goals. Indeed, the average at a lot of these schools is around 240. Why people match what they do is not a trivial thing to suss out, especially from no data other than where they end up matching. That’s not to say people don’t fall short of their ambitions and have to recalibrate, just that we shouldn’t consider matching Ortho/Derm a generic Good for all med students. For example, I could care less.

 

[Dr panda]

I think this is a poor way of thinking about it because it assumes that everyone’s goal is to match ortho/seem and it just isn’t. I actually have very little doubt that every single student at HMS or any other institution where almost everyone is 3.8+/516+ coming out of UG could score above national average if they really wanted to make that their goal. People who want to get into competitive specialties will make that their goal from day 1 and med students being med students will do what they perceive they have to do to achieve their goals. Indeed, the average at a lot of these schools is around 240. Why people match what they do is not a trivial thing to suss out, especially from no data other than where they end up matching. That’s not to say people don’t fall short of their ambitions and have to recalibrate, just that we shouldn’t consider matching Ortho/Derm a generic Good for all med students. For example, I could care less.

I understand your point and it seems rational; may be its just my premed vibe because like every single premed in my podunk state daydreams about ortho and speaks about it as they are already working there.

 

[Lucca]

I understand your point and it seems rational; may be its just my premed vibe because like every single premed in my podunk state daydreams about ortho and speaks about it as they are already working there.

They googled the salary and average hours worked. Which, to be fair, isn’t that far removed from how some medical students seem to choose their specialty.

 

[CyrilFiggis]

Can someone explain what SLOE means and it’s effects? From what I’ve read online it seems like the residency equivalent of a committee letter.

Standardized Letter of Eval. You can consider it a committee letter, but it is on objective evaluation of a student's performance during a 4th year clinical elective, currently only in EM. It contains a stratified numerical ranking of an applicant (Top 10%, Top 1/3, Middle 1/3, Bottom 1/3) based on specific criteria (clinical decision making, teamwork, communication, etc), how they did overall, where they would fall on that programs match list as well as a written more subjective area highlighting the applicants personality and other traits that are worth mentioning.

It gives programs a better understanding of an applicant. If you rotate at the Cook County ED and get a SLOE saying you were a Top 1/3 student and they would rank you in their Top 1/3 and discuss positive aspects of your professionalism, etc etc another program will see that and say "Ok this student succeeded at a large urban county hospital and they would be happy to have him in their program. Maybe his 220 STEP 1 score doesn't fully encompass his ability. If you get 1-2 more SLOEs showing the same from other programs, that truly shows your qualification in the specialty and programs will perk up at your application. It also weeds out those who can't cut it.

As a 4th year currently on aways, I love it. I get to audition with programs and make a direct impression that not only influences them, but will hopefully influence other programs.

 

[993444]

Standardized Letter of Eval. You can consider it a committee letter, but it is on objective evaluation of a student's performance during a 4th year clinical elective, currently only in EM. It contains a stratified numerical ranking of an applicant (Top 10%, Top 1/3, Middle 1/3, Bottom 1/3) based on specific criteria (clinical decision making, teamwork, communication, etc), how they did overall, where they would fall on that programs match list as well as a written more subjective area highlighting the applicants personality and other traits that are worth mentioning.

It gives programs a better understanding of an applicant. If you rotate at the Cook County ED and get a SLOE saying you were a Top 1/3 student and they would rank you in their Top 1/3 and discuss positive aspects of your professionalism, etc etc another program will see that and say "Ok this student succeeded at a large urban county hospital and they would be happy to have him in their program. Maybe his 220 STEP 1 score doesn't fully encompass his ability. If you get 1-2 more SLOEs showing the same from other programs, that truly shows your qualification in the specialty and programs will perk up at your application. It also weeds out those who can't cut it.

As a 4th year currently on aways, I love it. I get to audition with programs and make a direct impression that not only influences them, but will hopefully influence other programs.

So do you get multiple SLOE's from different programs? Also, do med students get to read their LORs?

 

[CyrilFiggis]

So do you get multiple SLOE's from different programs? Also, do med students get to read their LORs?

You get one SLOE from each program. You need at least 2 for your residency application. Some applicants, like myself choose to get three.

No, you waive the right to see your SLOE. But you typically have a mid-clerkship and/or end of clerkship review and a final grade which will sort of tell you where you stand.

 

[Lucca]

Standardized Letter of Eval. You can consider it a committee letter, but it is on objective evaluation of a student's performance during a 4th year clinical elective, currently only in EM. It contains a stratified numerical ranking of an applicant (Top 10%, Top 1/3, Middle 1/3, Bottom 1/3) based on specific criteria (clinical decision making, teamwork, communication, etc), how they did overall, where they would fall on that programs match list as well as a written more subjective area highlighting the applicants personality and other traits that are worth mentioning.

It gives programs a better understanding of an applicant. If you rotate at the Cook County ED and get a SLOE saying you were a Top 1/3 student and they would rank you in their Top 1/3 and discuss positive aspects of your professionalism, etc etc another program will see that and say "Ok this student succeeded at a large urban county hospital and they would be happy to have him in their program. Maybe his 220 STEP 1 score doesn't fully encompass his ability. If you get 1-2 more SLOEs showing the same from other programs, that truly shows your qualification in the specialty and programs will perk up at your application. It also weeds out those who can't cut it.

As a 4th year currently on aways, I love it. I get to audition with programs and make a direct impression that not only influences them, but will hopefully influence other programs.

What’s interesting about the implementation of SLOEs to me is that ED program directors are now something of outliers in no longer rating step 1 as the most important factor for their consideration pre-interview in the 2018 NRMP PD survey. It’s now the 4th highest rated element of the application. In other similarly competitive specialties (indeed in most) Step 1 usually comes out on top.

In your opinion, is there anything stopping something like specialty specific SLOEs from being implemented in every specialty? Are there downsides to knowing this is the most important element?

 

[Med Ed]

In your opinion, is there anything stopping something like specialty specific SLOEs from being implemented in every specialty? Are there downsides to knowing this is the most important element?

There are no barriers to broader adoption of this approach. The major recognized downside of a SLOE is that it concentrates a disproportionate amount of power in the hands of 2-3 individuals, who basically serve as a gateway to the country club.

 

[Lucca]

There are no barriers to broader adoption of this approach. The major recognized downside of a SLOE is that it concentrates a disproportionate amount of power in the hands of 2-3 individuals, who basically serve as a gateway to the country club.

What about having abbreviated SLOEs for every clerkship available and more detailed SLOEs for the students specialty of interest? Surely a detailed, multidimensional history of someone’s performance is more useful than a one dimensional number that measures performance on a single day

 

[Med Ed]

What about having abbreviated SLOEs for every clerkship available and more detailed SLOEs for the students specialty of interest? Surely a detailed, multidimensional history of someone’s performance is more useful than a one dimensional number that measures performance on a single day

The former is the MSPE, the latter is LORs from physicians in the specialty of interest.

 

[CyrilFiggis]

In your opinion, is there anything stopping something like specialty specific SLOEs from being implemented in every specialty? Are there downsides to knowing this is the most important element?

I will say for SLOEs, it just moves the goalposts. You have to start competing for away rotations to get your SLOEs. I don't have the best stats and I had to apply to 15+ aways just to get 2. Ironically, to apply for aways, many programs want your STEP 1 score. That being said, you only need one away and it doesn't matter the program.

 

[AnatomyGrey12]

Can't imagine why pre-meds would worry that they will no longer be able to test their way into everything and may have to use some semblance of social skills and networking to stand out.

So you want the MCAT to play a heavy role in how someone's medical career turns out?

Wouldn’t this be awesome?

No.

What about having abbreviated SLOEs for every clerkship available and more detailed SLOEs for the students specialty of interest? Surely a detailed, multidimensional history of someone’s performance is more useful than a one dimensional number that measures performance on a single day

This is the MSPE and already exists. Part of the problem of "USMLE mania" as people call it is that medical students are exceptionally neurotic and place way more emphasis than they should on it. The end of your quote is honestly pretty rare. It's rare PD's take Step score in a vacuum, if they did then how do people at my DO school match Plastics, IR, Derm, etc, with only slightly above average scores? Part of the problem of "USMLE mania" as people call it is that medical students are exceptionally neurotic and place way more emphasis than they should on it., however making the test won't actually change anything. They will simply move that neuroticism on to the next big thing whether that be Step 2, SLOEs, Specialty specific entrance exams, etc. In essence nothing will change.

 

[ciestar]

So you want the MCAT to play a heavy role in how someone's medical career turns out?


No.


This is the MSPE and already exists. Part of the problem of "USMLE mania" as people call it is that medical students are exceptionally neurotic and place way more emphasis than they should on it. The end of your quote is honestly pretty rare. It's rare PD's take Step score in a vacuum, if they did then how do people at my DO school match Plastics, IR, Derm, etc, with only slightly above average scores? Part of the problem of "USMLE mania" as people call it is that medical students are exceptionally neurotic and place way more emphasis than they should on it., however making the test won't actually change anything. They will simply move that neuroticism on to the next big thing whether that be Step 2, SLOEs, Specialty specific entrance exams, etc. In essence nothing will change.

They do. Which is why when you don’t do well you feel worthless. (That, and another user ive since put on ignore told me I’d be a bad doctor because of my step 1 score).

Thankfully, I had at ~35-40 percentile improvement on step 2

 

[Lucca]

So you want the MCAT to play a heavy role in how someone's medical career turns out?


No.


This is the MSPE and already exists. Part of the problem of "USMLE mania" as people call it is that medical students are exceptionally neurotic and place way more emphasis than they should on it. The end of your quote is honestly pretty rare. It's rare PD's take Step score in a vacuum, if they did then how do people at my DO school match Plastics, IR, Derm, etc, with only slightly above average scores? Part of the problem of "USMLE mania" as people call it is that medical students are exceptionally neurotic and place way more emphasis than they should on it., however making the test won't actually change anything. They will simply move that neuroticism on to the next big thing whether that be Step 2, SLOEs, Specialty specific entrance exams, etc. In essence nothing will change.

Kicking the weight down to Step 2 seems like moving the goalposts to me, the other options not so much rather like actually changing the game thats being played. I am more concerned that people be incentivized to pour their energy into activities which may actually be meaningful in the long-run of a medical career.

 

[ChymeofPassion]

So you want the MCAT to play a heavy role in how someone's medical career turns out?

What?

 

[Med Ed]

Kicking the weight down to Step 2 seems like moving the goalposts to me,

Which of the following exams should receive more weight in the resident selection process?

Exam 1 assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning.

Exam 2 assesses an examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine under supervision.

 

[efle]

Step score is consistently rated the highest importance factor in the PD surveys and from speaking to faculty involved in resident selection here, the #1 way to ruin your odds of matching a competitive specialty is a score that will be below their filter. Nobody would even read the rest if you fall too far short.

Pushing it to step 2 is just going to make people kill themselves with flashcarding while they're on the wards, instead of when they're only responsible for a couple hours of lecture/small group daily. And having already done all the step 1 Uworld prep and most of Step 2, it's really not substantially different. For the most part the same people will get high scores for the same reasons.

 

[Med Ed]

Step score is consistently rated the highest importance factor in the PD surveys

Step 1 is the most cited factor in choosing who to interview, but other factors have higher ratings. In fact, of the top 13 shown below, Step 1's average rating is tied for #9.

and from speaking to faculty involved in resident selection here, the #1 way to ruin your odds of matching a competitive specialty is a score that will be below their filter. Nobody would even read the rest if you fall too far short.

This gets at two things. One is overapplication, which has driven filtering and established a positive feedback loop for Step neuroticism.

The other is the entire reason that this has become the current national conversation in medical education: increasing proportions of students are pursuing Step success at the expense of other necessary elements of their training. You're right, you'll get filtered out if you don't hit a program's magic number. But you likewise won't be successful if you can't do much of anything other than choose A-E. So the challenge becomes finding a way to more appropriately weight different parts of the residency application.

If you go to national meetings and talk to people in student affairs and academic affairs you will very quickly realize what a profound mess this has become.

 

[ConfusedAboutEverything]

Standardized Letter of Eval. You can consider it a committee letter, but it is on objective evaluation of a student's performance during a 4th year clinical elective, currently only in EM. It contains a stratified numerical ranking of an applicant (Top 10%, Top 1/3, Middle 1/3, Bottom 1/3) based on specific criteria (clinical decision making, teamwork, communication, etc), how they did overall, where they would fall on that programs match list as well as a written more subjective area highlighting the applicants personality and other traits that are worth mentioning.

It gives programs a better understanding of an applicant. If you rotate at the Cook County ED and get a SLOE saying you were a Top 1/3 student and they would rank you in their Top 1/3 and discuss positive aspects of your professionalism, etc etc another program will see that and say "Ok this student succeeded at a large urban county hospital and they would be happy to have him in their program. Maybe his 220 STEP 1 score doesn't fully encompass his ability. If you get 1-2 more SLOEs showing the same from other programs, that truly shows your qualification in the specialty and programs will perk up at your application. It also weeds out those who can't cut it.

As a 4th year currently on aways, I love it. I get to audition with programs and make a direct impression that not only influences them, but will hopefully influence other programs.

Let's say you get an SLOE for EM, but you ended up choosing to apply to IM. Will IM PD's see the SLOE?

Also: let's say you apply to mostly EM, but some IM programs, do IM PD's see the SLOE?

Let's say you reapply after failing to match EM first year, but you reapply to IM/FM the following year, will they see the EM SLOE?

 

[CyrilFiggis]

Let's say you get an SLOE for EM, but you ended up choosing to apply to IM. Will IM PD's see the SLOE?

Also: let's say you apply to mostly EM, but some IM programs, do IM PD's see the SLOE?

Let's say you reapply after failing to match EM first year, but you reapply to IM/FM the following year, will they see the EM SLOE?

Your SDN handle is remarkably accurate.

At this point in your career don't worry about any of this. Also, most of what you're talking about should not or would not happen. There's honestly too much to unpack and it's not worth it.

 

[ChymeofPassion]

In all honesty, making career advancement into something as subjective as “whether people like you” often only ends up privileging straight white men. I’m not trying to turn this into a political debate so please forgive me if that’s what it looks like, but I just want to point out that networking very heavily depends on mentors being able to identify with you and support you, and given that practicing doctors are still 70% male and mostly white, it could lead to them advocating primarily for students who look like them.

There’s a great article in the NYT about the law firm Paul Weiss, which is a pretty prestigious NYC firm. Their most recent partner class of 12 was all white, with 11 of them being white men. Even though the firm employs women and minority associates, they were not given the same opportunities for mentorship and career advancement, leading to them not being able to work on the sort of cases that really showcase talent and allow associates to be promoted to partner. I’d rly hate to see what would happen in medicine if we removed one of the major objective measures of performance (Step 1) and replaced it with more subjectivity, such as how much your research mentors/attending physicians like you.

See article here: Elite Law Firm’s All-White Partner Class Stirs Debate on Diversity

While I appreciate the sentiment and acknowledge that implicit bias is a real thing that can be very harmful, especially among older generations, in a short future, there will likely be more female doctors than men. Your points may still be applicable for PoC though, although with the number of diversity initiatives in academia it may be less pronounced than you think.

 

[efle]

In all honesty, making career advancement into something as subjective as “whether people like you” often only ends up privileging straight white men. I’m not trying to turn this into a political debate so please forgive me if that’s what it looks like, but I just want to point out that networking very heavily depends on mentors being able to identify with you and support you, and given that practicing doctors are still 70% male and mostly white, it could lead to them advocating primarily for students who look like them.

There’s a great article in the NYT about the law firm Paul Weiss, which is a pretty prestigious NYC firm. Their most recent partner class of 12 was all white, with 11 of them being white men. Even though the firm employs women and minority associates, they were not given the same opportunities for mentorship and career advancement, leading to them not being able to work on the sort of cases that really showcase talent and allow associates to be promoted to partner. I’d rly hate to see what would happen in medicine if we removed one of the major objective measures of performance (Step 1) and replaced it with more subjectivity, such as how much your research mentors/attending physicians like you.

See article here: Elite Law Firm’s All-White Partner Class Stirs Debate on Diversity

But doesn't this argument fall apart when the groups at risk of being undervalued, tend to perform significantly worse on the Step/MCAT/SAT/whatever? Seems detrimental to make it central in that case.

Step 1 is the most cited factor in choosing who to interview, but other factors have higher ratings. In fact, of the top 13 shown below, Step 1's average rating is tied for #9.

View attachment 272156



This gets at two things. One is overapplication, which has driven filtering and established a positive feedback loop for Step neuroticism.

The other is the entire reason that this has become the current national conversation in medical education: increasing proportions of students are pursuing Step success at the expense of other necessary elements of their training. You're right, you'll get filtered out if you don't hit a program's magic number. But you likewise won't be successful if you can't do much of anything other than choose A-E. So the challenge becomes finding a way to more appropriately weight different parts of the residency application.

If you go to national meetings and talk to people in student affairs and academic affairs you will very quickly realize what a profound mess this has become.

Thanks for the correction

I've been seeing the profound mess directly from my peers. People taking gap years to essentially study part-time for the exam for 12 months, people doing 200,000 - 500,000 flashcards in lieu of their school curriculum, people getting a score back that falls slightly shy of their target and being devastated about it for months afterwards.

I sure hope you can convince the USMLE board to at least switch this monster to quartiles/quintiles

 

[The Knife & Gun Club]

In all honesty, making career advancement into something as subjective as “whether people like you” often only ends up privileging straight white men. I’m not trying to turn this into a political debate so please forgive me if that’s what it looks like, but I just want to point out that networking very heavily depends on mentors being able to identify with you and support you, and given that practicing doctors are still 70% male and mostly white, it could lead to them advocating primarily for students who look like them.

There’s a great article in the NYT about the law firm Paul Weiss, which is a pretty prestigious NYC firm. Their most recent partner class of 12 was all white, with 11 of them being white men. Even though the firm employs women and minority associates, they were not given the same opportunities for mentorship and career advancement, leading to them not being able to work on the sort of cases that really showcase talent and allow associates to be promoted to partner. I’d rly hate to see what would happen in medicine if we removed one of the major objective measures of performance (Step 1) and replaced it with more subjectivity, such as how much your research mentors/attending physicians like you.

See article here: Elite Law Firm’s All-White Partner Class Stirs Debate on Diversity

Ok so lemme clear some stuff up about the SLOE and how it relates here. The SLOE is actually an attempt to prevent exactly the thing you are describing.

First: how is a sloe written? It is not an LOR. After every ED shift, your attending fills out an eval card. It includes as objective as is possible information about the shift (scale 1-5 in terms of patient presentations, procedural skills, knowledge, work ethic) and a brief 1-2 sentence comment. These evals are averaged over the rotation to generate your sloe. At some places standardized patient encounters or NBME exams are included as well. This creates as fair of a SLOE as is reasonably possible.

Obviously subconscious bias is possible. But the SLOE aims to avoid the “old boys club” effect of traditional LORs by using a concrete pre-determined ruberic and averaging performance across many evaluators.

 

[efle]

And just to give premeds lurking this thread an idea of how rapidly the score drift is accelerating:

A few years back in 2015-2016, a new NBME practice exam was released: NBME 18. It was widely considered to be the most difficult practice exam by a wide margin, and getting ~90% (180 out of 200 questions) was equated to a 260 (96th percentile).

Fast forward to 2019, and while NBME 18 is still in use, it's now considered the easiest practice exam by a wide margin, and getting the same ~90% correct is equated to a 248 (80th percentile).

So buckle up, the knowledge and study effort that used to put you way up in the top end of the curve, is now a touch below average for competitive specialties. And this happened in 3 years!!!

 

[The Knife & Gun Club]

Thanks for giving me the rundown! But aren’t SLOEs currently only used in EM for the most part? Are there other specialties looking to employ this type of letter, especially if step 1 grading does change?

As of now the sloe is only deployed fully in EM. Ortho has a sloe that’s also well used but not universally required.

However many schools now use a template similar to the sloe for all their clinical evaluations, making 3rd year transcripts able to better resist the effects of a handful of old white dudes controlling students futures.

 

[907914]

other than choose A-E

Wait, wait, wait......MCAT was only A-D. Are you telling me that come time for Step exams I will have to deal with a fifth choice?!?! That is a deal breaker. Time to drop the premed track.

 

[ciestar]

Wait, wait, wait......MCAT was only A-D. Are you telling me that come time for Step exams I will have to deal with a fifth choice?!?! That is a deal breaker. Time to drop the premed track.

Sometimes more

 

[The Knife & Gun Club]

Wait, wait, wait......MCAT was only A-D. Are you telling me that come time for Step exams I will have to deal with a fifth choice?!?! That is a deal breaker. Time to drop the premed track.

There are some questions on step where you choose A-J. 10 choices.

 

[907914]

Sometimes more

There are some questions on step where you choose A-J. 10 choices.

 

[993444]

Step 1 is the most cited factor in choosing who to interview, but other factors have higher ratings. In fact, of the top 13 shown below, Step 1's average rating is tied for #9.

View attachment 272156



This gets at two things. One is overapplication, which has driven filtering and established a positive feedback loop for Step neuroticism.

The other is the entire reason that this has become the current national conversation in medical education: increasing proportions of students are pursuing Step success at the expense of other necessary elements of their training. You're right, you'll get filtered out if you don't hit a program's magic number. But you likewise won't be successful if you can't do much of anything other than choose A-E. So the challenge becomes finding a way to more appropriately weight different parts of the residency application.

If you go to national meetings and talk to people in student affairs and academic affairs you will very quickly realize what a profound mess this has become.

65% cited "Evidence of professionalism and ethics" as a factor. What's going on with the other 35%? 😵 You'd think that all residency programs would consider that to be important....