MD & DO EVMS MD critique of NBME

[AnatomyGrey12]

And how is knowing biochem, anatomy or immonology not clinically relevant? Couldn't it help you rule out diagnosis? For instance, knowing that the liver is on the right side and that the spleen is on the Left side of the body, would help you rule out spleen(whatever) in a patient presenting with RUQ pain.

Wut? How far along are you in your medical training?

I also find it hard to believe that 235 isn't statistically different than a 250

It’s not.

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[NotYou20]

Although I am getting the critique about step 1, it's improved a lot when I took it last year. My peers who also took it last year might disagree, but there were a lot of clinically relevant questions on my step 1 exam. Studying and doing well on step 1 gave me a solid foundation for clinicals and helped me understand the pathology and pathophysiology of diseases and drugs much better than someone who did not study as much for it.
I still use lot of the knowledge that I gained from studying for the system based questions on cardiology, GI, neurology, hematology, etc on my rotations. What should be changed is decrease the amount of biochemistry, immunology, gross anatomy (rote memorization portion of it, clinically relevant anatomy should be emphasized) and more emphasis should be placed on system based knowledge.

Strongly agree

 

[whoknows2012]

Sir, you'd take subjectivety over objectivity?? You'd prefer having a third party company asses your ability rather than step 1??


I also find it hard to believe that 235 isn't statistically different than a 250. I guess stats can't measure effort nor dedication...

What year in your schooling are you? Have you taken any of the steps yet? The way you explain your understanding of how a 235 and 250 are not statistically different shows at least some lack of understanding of how statistics work.

In any event how are you proclaiming this has anything to do with high score jealousy? I already explained from my perspective I actually scored very well but I’m taking an objective view here.

When you’re a resident and eventually an attending you’ll see how useless know the Krebs cycle is. Testing it on step 1 is fair given that Its taught during first and 2nd yr but it clinical utility is limited. Using the example of where the liver and spleen are is quite simplistic. And anatomy is very important for surgical specialties so I don’t think anybody is in favor of that’s not being taught or tested. The above poster spefically said “clinically relevant anatomy.” I think knowing where certain organs are which is something you might learn in middle school biology is not the best way to make your case.

 

[Trollest]

My year of schooling doesnt preclude me from having an opinion. Some of my points are still valid.

Most of the P/F step 1'ers do though, notice how they don't want to get rid of the test; Rather, they want to be seen/taken in the same light as someone who made a 270.

And using that logic, I could tell you that knowing physics or organic chemistry is kind of useless for the MCAT as well.

In any event how are you proclaiming this has anything to do with high score jealousy? I already explained from my perspective I actually scored very well but I’m taking an objective view here I think knowing where certain organs are which is something you might learn in middle school biology is not the best way to make your case.

 

[whoknows2012]

My year of schooling doesnt preclude me from having an opinion. Some of my points are still valid.

Most of the P/F step 1'ers do though, notice how they don't want to get rid of the test; Rather, they want to be seen/taken in the same light as someone who made a 270.

And using that logic, I could tell you that knowing physics or organic chemistry is kind of useless for the MCAT as well.

Yes your year of schooling absolutely impacts your credibility on this issue. If you are a 1st year and haven’t even taken it or studied for it yet it’s vastly different than if you are a 4th year or already in training/practice. Ie @aProgDirector views on the issue while I disagree with some of them deserve more credibility than mine due to experience and knowledge of the issue.

You have to acknowledge it’s possible you’re not very informed on the issues being discussed. You are accusing other posters of having score jealousy and have written some pretty suspicious comments in the thread that at least to myself and some other posters made us question your year of training because of how you’re coming across. Not trying to sound condescending but this is an important issue and healthy substantive debate is important

And please help me understand how you have come to believe that the step 1 p/f’ers here have high score jealousy? Given the make up of sdn it wouldn’t surprise me if these exact posters are quite intelligent and have high scores themselves?

 

[Trollest]

"First, I completely disagree with the MD but I wanted to know what SND thought of his points? Are they valid?"

First sentence of this thread, I am clearly trying to learn here. I just happen to disagree with your points. There is nothing wrong with that. I changed my stance on a couple of issue throughout the thread. I admit that I might know as much as you do; however, I have values and core principles that, I am afraid, are immutable. I value hard work, no amount of studies is going to change that. I respect anyone who score in the 250!! I respect them.

Tell me though, is the kreb cycle useless to an endocrinologist???
Is immunology usseless to an oncologist?
Or wouldn't a pathologist benefit from knowing every minutia of gross anotomy????

Yes your year of schooling absolutely impacts your credibility on this issue. If you are a 1st year and haven’t even taken it or studied for it yet it’s vastly different than if you are a 4th year or already in training/practice. Ie @aProgDirector views on the issue while I disagree with some of them deserve more credibility than mine due to experience and knowledge of the issue.

You have to acknowledge it’s possible you’re not very informed on the issues being discussed. You are accusing other posters of having score jealousy and have written some pretty suspicious comments in the thread that at least to myself and some other posters made us question your year of training because of how you’re coming across. Not trying to sound condescending but this is an important issue and healthy substantive debate is important

 

[whoknows2012]

"First, I completely disagree with the MD but I wanted to know what SND thought of his points? Are they valid?"

First sentence of this thread, I am clearly trying to learn here. I just happen to disagree with your points. There is nothing wrong with that. I change my stance on a couple of issue throughout the thread. I admit that I might know as much as you do; however, I have values and core principles that, I am afraid, are immutable.

Tell me though, is the kreb cycle useless to an endocrinologist???
Is immunology usseless to an oncologist?
Or wouldn't a pathologist benefit from knowing every minutia of gross anotomy????

If you think my problem is that you disagree with me than you have misunderstood my posts.

To answer your questions yes the Krebs cycle is completely irrelevant to endocrinologists.

As far as immunology and pathology of course they’re important subjects. I’m not saying they shouldn’t be tested where did you get that from? Having pass fail step 1 doesn’t preclude an individual from knowing these topics.

 

[Trollest]

Way too many doors would be closed by having/making step 1 P/F, IMG, DOs, superstars from low unranked schools, such a suggestion is evil in itself.

I have yet to hear your response to the PD though because you are coming off as if you are more for "experimenting" new stuff than improving the system. If anything they should keep Step 1 grading scheme and make it more clinical.

To answer your questions yes the Krebs cycle is completely irrelevant to endocrinologists.

As far as immunology and pathology of course they’re important subjects. I’m not saying they shouldn’t be tested where did you get that from? Having pass fail step 1 doesn’t preclude an individual from knowing these topics.

 

[AnatomyGrey12]

My year of schooling doesnt preclude me from having an opinion.

Not having an opinion no, but it does give your opinion far less weight. Especially in light of the comment below.

Tell me though, is the kreb cycle useless to an endocrinologist???
Is immunology usseless to an oncologist?
Or wouldn't a pathologist benefit from knowing every minutia of gross anotomy????

You need to stop with this argument. It shows how little you actually understand. I say this as someone who disagrees with making the test P/F.

 

[operaman]

Sir, you'd take subjectivety over objectivity?? You'd prefer having a third party company asses your ability rather than step 1??


I also find it hard to believe that 235 isn't statistically different than a 250. I guess stats can't measure effort nor dedication...

Yes.

Plus step one is already run by a third party company. Having one more that scores a behavioral interview wouldn’t bother me a bit. It’s so widely used and effective in the business world that I wish we had it in medicine too! There are some papers showing how powerful this is in residency interviews but programs that have done entirely structured interviews in person have been penalized by applicants who don’t rank them as highly. Doing the structured interview by phone let’s the programs do a little more of selling themselves rather than putting everyone through a grueling interview during the few precious hours they have them.

The step 1 scaling differences are straight out of the nbme publications. Two scores must differ by more than 16 points to be statistically significant.

You are correct that stats don’t measure effort or dedications. It just tells us how likely it is that two scores represent a true difference between test takers or whether that difference is a result of scaling and the random distribution of questions given.

 

[Trollest]

I am confused?? How does the part quoted have anything to do with making step 1 P/F?? We were discussing irrelevant content on the exam.

You need to stop with this argument. It shows how little you actually understand. I say this as someone who disagrees with making the test P/F.

 

[whoknows2012]

Way too many doors would be closed by having/making step 1 P/F, IMG, DOs, superstars from low unranked schools, such a suggestion is evil in itself.

I have yet to hear your response to the PD though because you are coming off as if you are more for "experimenting" new stuff than improving the system. If anything they should keep Step 1 grading scheme and make it more clinical.

I’m for an evidence based test or evaluation that has predictive ability. Step 2 has that. Step 1 does not. I’m not for experimenting at all. I’ve said over and over again that this needs to be studied more. It can and has been done before. Though there were some flaws the medicine and surgery studies about duty hours are great recent examples. It is absolutely a reasonable stance that we should be using an evidence based assessment to evaluate prospective applicants.

 

[whoknows2012]

Way too many doors would be closed by having/making step 1 P/F, IMG, DOs, superstars from low unranked schools, such a suggestion is evil in itself.

I have yet to hear your response to the PD though because you are coming off as if you are more for "experimenting" new stuff than improving the system. If anything they should keep Step 1 grading scheme and make it more clinical.

Also making step 1 p/f is an evil suggestion? You’re coming out of left field with your arguments. Your point that it could bias low tier med school students DO’s etc is fair but my response to that would be id only support something that was across the board fair.

 

[MSTP18]

Or wouldn't a pathologist benefit from knowing every minutia of gross anotomy????

Only 6 months in to residency but so far I vote not really. I can think of things I’m not taught in med school that would be far more useful (eg a mandatory pathology and lab medicine rotation so that non pathologists have a better understanding of how all our stuff works)

Also, OP’s name literally has “troll” in it

 

[NotAProgDirector]

Just replying to the idea about a specialty specific exam. I’ve thought about this a lot and I keep coming to the conclusion that it would be a lot better for a number of reasons:

I think specialty specific exams, either with scored or P/F USMLE, is certainly something to think about. In fact, perhaps the "best" way to move this idea forward is to create the specialty specific exam first. If everyone applying to IM took some IM specific exam, IM programs might start weighing USMLE less and this new exam more, and then ultimately making USMLE P/F would be no big deal. But then the specialty exam becomes another "high stakes choke point". I guess you could allow people to take it multiple times (like the MCAT), but then that raises the problem of getting a 60th percentile score, and then retaking and getting a 40th percentile score -- but I guess that's the student's problem and programs can do whatever they want with multiple scores. It would certainly increase costs to students, who now would need to take yet another exam (and perhaps encourage schools to create yet more "dedicated study time").

You could even have the surgical exam include knot tying, etc (although this would probably make the exam even more expensive). Each field could decide what content they wanted to cover.

1) renewed investment in their medical education by students rather than attempting to hack a high stakes exam.

Sure, although then students will "hack" the specialty exams.

2) an exam that is potentially better at comparing applicants than the POS that is step one where a 250 and a 235 are not significantly different. We instinctively think those are scores are entirely different leagues but the Nbme data says the difference does not reach the threshold of statistical significance.

I think this depends upon your definition of "statistical significance". If you use the research publication cutoff of p=0.05, then perhaps (I haven't looked at the numbers myself). But I don't need 95% certainty -- I'm fine with much less. And I'm usually not comparing just two applicants -- I think that students who score 250 in general have better knowledge (as measured on an MCQ test) than those with a 235.

3) incoming interns/residents with better field- relevant knowledge. Imagine a world where students put the same effort into studying what we want them to know rather than a lot of basic science stuff that - while important foundationally - May largely comprise material that is less relevant.

I think this is the best of your arguments. Those fields that want lots of basic science can test for it.

I’d like to see the usmle continue to report detailed scores to students and their schools. The one issue I can see with field specific exams is the delay in taking doesn’t allow much time to prepare backup plans. Giving people and their schools scaled data would help someone in the 10th percentile nationally realize that it may be risky applying only to a highly competitive field. Having national comparative data would help schools properly advise their students.

This is a real potential problem. Score a 198 on S1, and you're basically not going to be a neurosurgeon. Make S1 and 2 P/F, and you might be deep into your 4th year until you score poorly on the NS specific exam, and then it's much harder to change paths.

I think residency programs could also adopt other objective screening methods. There has been some flirtation with telephone based behavioral question screens that are scores by an independent company and the scores given to programs. This is pretty standard in corporate interviews and in the HR literature has proven highly predictive of job performance. Add something like that to field specific exam and you’ve got some powerful objective data.

Be careful what you wish for. The AAMC is testing a standardized video interview. So far, only ED is using it. 3 video recorded questions all 5 minutes long (or something like that), each scored on a 1 to 5 scale with a total score of 3 to 15. Plenty of posts here on SDN of people having AOA, straight honors, 260+ steps, and then a 6 on their SVI. Any high stakes eval at the end of your educational path could completely derail your application.

Why not something like how EM uses SLOEs only we do it for every field? That way we can have evidence that a student can function appropriately in the environment of that specialty choice.

We've tried in IM. Some IM department letters are helpful. Most are not.

 

[Trollest]

This!! I doesnt matter how much we refute these facts, but anyone who score more than you by even 1 point; Knows a thing that you do not.

And people want the best of the best; It's called capitalism guys. The P/F system is communist to its core!

But I don't need 95% certainty -- I'm fine with much less. And I'm usually not comparing just two applicants -- I think that students who score 250 in general have better knowledge (as measured on an MCQ test) than those with a 235.
\.

 

[afib123]

I think specialty specific exams, either with scored or P/F USMLE, is certainly something to think about. In fact, perhaps the "best" way to move this idea forward is to create the specialty specific exam first. If everyone applying to IM took some IM specific exam, IM programs might start weighing USMLE less and this new exam more, and then ultimately making USMLE P/F would be no big deal. But then the specialty exam becomes another "high stakes choke point". I guess you could allow people to take it multiple times (like the MCAT), but then that raises the problem of getting a 60th percentile score, and then retaking and getting a 40th percentile score -- but I guess that's the student's problem and programs can do whatever they want with multiple scores. It would certainly increase costs to students, who now would need to take yet another exam (and perhaps encourage schools to create yet more "dedicated study time").

You could even have the surgical exam include knot tying, etc (although this would probably make the exam even more expensive). Each field could decide what content they wanted to cover.



Sure, although then students will "hack" the specialty exams.



I think this depends upon your definition of "statistical significance". If you use the research publication cutoff of p=0.05, then perhaps (I haven't looked at the numbers myself). But I don't need 95% certainty -- I'm fine with much less. And I'm usually not comparing just two applicants -- I think that students who score 250 in general have better knowledge (as measured on an MCQ test) than those with a 235.



I think this is the best of your arguments. Those fields that want lots of basic science can test for it.



This is a real potential problem. Score a 198 on S1, and you're basically not going to be a neurosurgeon. Make S1 and 2 P/F, and you might be deep into your 4th year until you score poorly on the NS specific exam, and then it's much harder to change paths.



Be careful what you wish for. The AAMC is testing a standardized video interview. So far, only ED is using it. 3 video recorded questions all 5 minutes long (or something like that), each scored on a 1 to 5 scale with a total score of 3 to 15. Plenty of posts here on SDN of people having AOA, straight honors, 260+ steps, and then a 6 on their SVI. Any high stakes eval at the end of your educational path could completely derail your application.



We've tried in IM. Some IM department letters are helpful. Most are not.

Thanks for adding your experience to the discussion. Ultimately, for me it comes down to exams being the relatively most objective form of evaluation of mainly hard work and some intelligence. The way the curriculum is set up, the timing of step 1 makes it the most viable test in terms of practicality. Any of these speciality specific tests need to be taken earlier than later for them to have any value practically or most students wouldn't be able to lock into a speciality until right before interviews, which I would definitely not like.
Continually improving Step 1 to make it a more clinically relevant exam and rehauling the curriculum the first 2 years would be my solution.
If the argument for speciality exams is so that students will be more prepared in their speciality of choice (if the speciality exam is to evaluate their skills then this argument won't apply), but I am assuming there should plenty of time (theoretically available) for 4th year students to master their skills in their speciality before intern year. But from my conversations with 4th year students, most of them use this time to take a lighter schedule than really master their skills in their speciality of choice.

 

[Trollest]

Well, I am far from a troll but thanks for noting that. I just like the name

Also, OP’s name literally has “troll” in it

 

[Trollest]

This!! The only way that would ever work is if medical school is 10 years long!

Any of these speciality specific tests need to be taken earlier than later for them to have any value practically or most students wouldn't be able to lock into a speciality until right before interviews, which I would definitely not like. .

I agree as well

Continually improving Step 1 to make it a more clinically relevant exam and rehauling the curriculum the first 2 years would be my solution..

 

[AnatomyGrey12]

but anyone who score more than you by even 1 point; Knows a thing that you do not.

That’s....... not how that works....

 

[Treebeard]

Personally, I'm in the minority that actually agrees with what the NBME guy said...

I know for a fact that if you took away the pressure of step 1, my classmates would not respond by suddenly volunteering all of their time at free clinics, taking deep dives into pathophysiology, or running in depth basic science research projects. They would sleep in, party, and watch netflix.

EDIT: BTW, I would also certainly waste a lot of time in that situation. Not suggesting I am better than anyone else.

 

[aprilfools]

Personally, I'm in the minority that actually agrees with what the NBME guy said...

I know for a fact that if you took away the pressure of step 1, my classmates would not respond by suddenly volunteering all of their time at free clinics, taking deep dives into pathophysiology, or running in depth basic science research projects. They would sleep in, party, and watch netflix.

I don't think you or he are 100% wrong. I think a good number of people will spend more time doing what you described. But to think ALL students will spend ALL of their new "free time" doing that is foolish.

Furthermore, and the real problem with his statement, is that his suggestion implies that to be in medicine, 100% of your life must revolve around medicine, which is totally ridiculous, and is probably one of, if not the main reason that the rate of depression, suicide, etc is so much higher in medical trainees than in the general population. His statement propagates an unhealthy and dangerous ideal of medical training that the whole system has been actively trying to move away from: that a work-life balance is not necessary or possible for physicians.

 

[bananafish94]

Wow. I had to actually read the paper to verify that this wasn't a joke. I've never understood that animosity that some people harbor towards younger generations. Not to mention that this style of writing should not be acceptable in an academic paper.

I disagree with comments that Step 1 should be abolished or transitioned to pass/fail - Step 1 and Step 2 CK, for their faults, are by and large fair exams that do provide one of the only ways to meaningfully stratify applicants. Eliminating them or making them pass/fail would only serve to make the application process more subjective than it already is. I say this as someone who only did a bit above average on Step 1.

As for Step 2 CS, I'd be happy to see it go. If someone can get through medical school interviews, two years of clinical rotations without any weird red flags, and residency interviews successfully, I think it's fair to say that that's a fairly sensitive test for identifying any gross deficiencies in interpersonal communication/empathy/etc. However, I haven't actually looked at the data and I'm willing to revise my opinion if there is evidence to support its use. A) Is there any evidence that Step 2 CS actually accomplishes its objectives? B) Is there any good reason for why Step 2 CS needs to be as expensive as it is? C) Is there any good reason for why it is only offered in five cities, disproportionately affecting students who have to fly a long distance?

 

[whoknows2012]

Personally, I'm in the minority that actually agrees with what the NBME guy said...

I know for a fact that if you took away the pressure of step 1, my classmates would not respond by suddenly volunteering all of their time at free clinics, taking deep dives into pathophysiology, or running in depth basic science research projects. They would sleep in, party, and watch netflix.

You clearly think very highly of your peers. That’s kinda sad to be honest

In medicine there’s a lot more to living then devoting every waking hour to the field. Having a good work life balance throughout medical school training and practice protects against burnout and makes you a happier person overall.

 

[Trollest]

Isn't happiness in a way related to someone self-efficacy or self-esteem? I remember reading something about it on the MCAT. For instance, if you are self-esteem is solely based on academic; the theory posits, that you'd be happier by devoting every waking hour to the field of medicine.

I am just trying to point out that happiness is subjective.

 

[whoknows2012]

Isn't happiness in a way related to someone self-efficacy or self-esteem? I remember reading something about it on the MCAT. For instance, if you are self-esteem is solely based on academic; the theory posits, that you'd be happier by devoting every waking hour to the field of medicine.

I am just trying to point out that happiness is subjective.

I almost can’t even respond to this because you’re so contrarian with every point that is brought up.

Happiness is subjective you are correct. However, the way medicine is practiced these days with way more bureaucracy, among other unpleasant intrusions into practice that are non clinical, it is imperative that you are happy to not burn out. If you somehow believe that is achieved by devoting every waking hour, well then you’re in for a rude awakening. This is even true in medical school, In which constant studying and lack of good balance can easily lead to depression and burn out.

 

[Cognovi]

:troll:

 

[Dr.Bruh]

Fair point, but I still don't agree with the MD. So much is at stake!


I beg to differ; preclinical year do play a significant role on one's ability to doctor. Who is the better anesthesiologist? The guy who understand every aspect of pharm, biochem, cardio or the guy who just passed step1?

You can learn on the job for sure; but if we ever proceed in that direction what would be the difference between PA, CRNA and doctors? Isn't understand and applying what you know what step 1 is all about?

The idea that preclinical years “play a significant role in ones ability to doctor” is laughable and so cringy. It’s negligible at best.

 

[Mr.S]

I always felt that using the USMLE scores to stratify applicants was not the intent and spirit of the exam. It is simply a exam used for LICENSING. IT really shouldnt even be used by schools for promotion. It has simply morphed into something totally different from it's initial goal.

For those of you who say *well how will we stratify applicants?" Ill tell you how! Use the deans letter. Read comments about applicants. Interview. Choosing an applicant because of high scores on usmle will make you choose the wrong person more often than not.

 

[libertyyne]

I always felt that using the USMLE scores to stratify applicants was not the intent and spirit of the exam. It is simply a exam used for LICENSING. IT really shouldnt even be used by schools for promotion. It has simply morphed into something totally different from it's initial goal.

For those of you who say *well how will we stratify applicants?" Ill tell you how! Use the deans letter. Read comments about applicants. Interview. Choosing an applicant because of high scores on usmle will make you choose the wrong person more often than not.

reading through 10K applications to evaluate some subjective language sounds like my personal nightmare. Doesnt seem like a very practical way to cull down applicants to something manageable. Scores, grades, research productivity turns 1k into 50 applicants and then just a precursory read through for red flags should be workable.

 

[Mr.S]

reading through 10K applications to evaluate some subjective language sounds like my personal nightmare. Doesnt seem like a very practical way to cull down applicants to something manageable. Scores, grades, research productivity turns 1k into 50 applicants and then just a precursory read through for red flags should be workable.

I doubt highly resdiency programs get 10K applications dude. That is more that what medical school get to get iinto medical school. I bet the avg residency gets about 500-1000 applications

 

[libertyyne]

I doubt highly resdiency programs get 10K applications dude. That is more that what medical school get to get iinto medical school. I bet the avg residency gets about 500-1000 applications

im obviously exagerating for the purpose of making the point. But do you seriously think reading through 1000 subjective evaluations is a good use of time and a good way to stratify applicants? There are an incredible number of biases that crop up even in the same person as they get hungry or tired or depending on their mood. Seems like a serious way to put an incredible amount of effort into the process without actually objectively making it better.

Plus in a world where board exams still exisit and there is a correlation between step and board failure rates it is not surprising PDs want to minimize board failure risk by selecting for the best step scores they can get.

 

[Wordead]

I always felt that using the USMLE scores to stratify applicants was not the intent and spirit of the exam. It is simply a exam used for LICENSING. IT really shouldnt even be used by schools for promotion. It has simply morphed into something totally different from it's initial goal.

For those of you who say *well how will we stratify applicants?" Ill tell you how! Use the deans letter. Read comments about applicants. Interview. Choosing an applicant because of high scores on usmle will make you choose the wrong person more often than not.

I did app reviews for my program this year and let me tell you - it is ****ing impossible to figure out how a student did even at their own school much less compare it to another school. The wording is so vague and always positive that the lowest ranked person in a class who failed everything twice is still described as a good candidate.

Look, Step 1 isn't perfect and it's not a great gauge of who will be a good doctor. But it's a good barometer of whether or not you have the drive and work ethic to get **** done. Everyone knows how important this test is. Nothing else in your first 2 years matters nearly as much. So did you prepare yourself adequately?

 

[Giovanotto]

Anyone with more than 2 brain cells would argue that your ability to consistently outperform your colleagues (i.e. class grades) trumps your performance on one exam. However, because each medical school has its own formulate, it's impossible to compare students from one school to the other. Possible solution? Have every school administer NBME exams for each block (on top of school exams if a school wishes....). This would make school more stressful, but it's probably a better system overall. Plus, the NBME will still get to make money, hooray!

 

[Mr.S]

im obviously exagerating for the purpose of making the point. But do you seriously think reading through 1000 subjective evaluations is a good use of time and a good way to stratify applicants? There are an incredible number of biases that crop up even in the same person as they get hungry or tired or depending on their mood. Seems like a serious way to put an incredible amount of effort into the process without actually objectively making it better.
View attachment 246804


Plus in a world where board exams still exisit and there is a correlation between step and board failure rates it is not surprising PDs want to minimize board failure risk by selecting for the best step scores they can get.

I get what you are saying. I really do. And I get the board failure rate and all. But literally everybody passes specialty board exams if they want to. SO that is a non issue.

Wny would you want to base your selection on a standardized test score. Seems short sighted. I would want to read personal statements and see narrative evaluations.
If you dont read narrative evals you may miss something like "he works harder than anyone in the universe" and its backed up by concrete examples. I would want that person on my team. I dont care what his step score was as long as it was passing.

 

[libertyyne]

I get what you are saying. I really do. And I get the board failure rate and all. But literally everybody passes specialty board exams if they want to. SO that is a non issue.

Wny would you want to base your selection on a standardized test score. Seems short sighted. I would want to read personal statements and see narrative evaluations.
If you dont read narrative evals you may miss something like "he works harder than anyone in the universe" and its backed up by concrete examples. I would want that person on my team. I dont care what his step score was as long as it was passing.

Nothing is literally stopping PDs from doing that.Yet they continue to use floors on step 1 to perform indepth applicant analysis. Board failures are obviously stressful for PDs considering they might have to hold someone back, or kick someone out.

The problem with the narrative assessment is that you could be the hardest working person in the world and if you are evaluated with someone who doesnt care, they are going to give you meh reviews anyway. There is an incredible amount of subjectivity in both the creation of the document and the analysis by PD. might as well create a lottery system for interviews because it would be just as productive.

 

[MSTP18]

Choosing an applicant because of high scores on usmle will make you choose the wrong person more often than not.

Is there any data to back that up?

 

[Mr.S]

Is there any data to back that up?

https://www.ajog.org/article/S0002-9378(17)32811-9/pdf

 

[Trollest]

lol, thats an opinion.

https://www.ajog.org/article/S0002-9378(17)32811-9/pdf

 

[libertyyne]

https://www.ajog.org/article/S0002-9378(17)32811-9/pdf

Thanks for the clarification, I didnt realize low step score candidates had a monopoly on the human aspect of medicine and that a step score of 245 and above immediately disqualifies physicians from having said qualities.

Also, not sure why the presence of step 1 being graded is stopping a PD from ignoring it completely?

 

[NotAProgDirector]

But literally everybody passes specialty board exams if they want to.

This is simply not true.

Wny would you want to base your selection on a standardized test score. Seems short sighted. I would want to read personal statements and see narrative evaluations.
If you dont read narrative evals you may miss something like "he works harder than anyone in the universe" and its backed up by concrete examples. I would want that person on my team. I dont care what his step score was as long as it was passing.

Literally all dean's letters say something like this. And every LOR says the person is in the top 5% of everyone they have ever worked with.

https://www.ajog.org/article/S0002-9378(17)32811-9/pdf

Your definition of data and mine differ.

 

[Mr.S]

Thanks for the clarification, I didnt realize low step score candidates had a monopoly on the human aspect of medicine and that a step score of 245 and above immediately disqualifies physicians from having said qualities.

Also, not sure why the presence of step 1 being graded is stopping a PD from ignoring it completely?

You answered your own question as to why you need to read narratives(most importantly). Look at clinical evals etc etc etc.

 

[Mr.S]

This is simply not true.



Literally all dean's letters say something like this. And every LOR says the person is in the top 5% of everyone they have ever worked with.



Your definition of data and mine differ.

take it easy!

 

[Mr.S]

This is simply not true.



Literally all dean's letters say something like this. And every LOR says the person is in the top 5% of everyone they have ever worked with.



Your definition of data and mine differ.

http://www.sbccp.org.br/arquivos/LG2015-04/lary.24860.pdf

 

[libertyyne]

You answered your own question as to why you need to read narratives(most importantly). Look at clinical evals etc etc etc.

or displays the error-prone nature and capriciousness of the process that you are proposing.

 

[AnatomyGrey12]

https://www.ajog.org/article/S0002-9378(17)32811-9/pdf

Did you legit just cite an opinion piece?

http://www.sbccp.org.br/arquivos/LG2015-04/lary.24860.pdf

I suggest you read the conclusion to that before you start readying the horses for that victory lap you are planning....

 

[Mr.S]

Did you legit just cite an opinion piece?



I suggest you read the conclusion to that before you start readying the horses for that victory lap you are planning....

Opinion of someone who has many publications and books written.
I did read the conclusion.

 

[Mr.S]

This is simply not true.



Literally all dean's letters say something like this. And every LOR says the person is in the top 5% of everyone they have ever worked with.



Your definition of data and mine differ.

My deans letter didn't say all great things.
Nowadays it's pretty much required to be boarded. So the test is geared towards passing everyone within reason . Anesthesia has 80% pass on orals. WHich is quite low. BUt 80 perecent is a decent number of people. And the ones who dont pass, don't really take it seriously.

 

[Raryn]

"First, I completely disagree with the MD but I wanted to know what SND thought of his points? Are they valid?"

First sentence of this thread, I am clearly trying to learn here. I just happen to disagree with your points. There is nothing wrong with that. I changed my stance on a couple of issue throughout the thread. I admit that I might know as much as you do; however, I have values and core principles that, I am afraid, are immutable. I value hard work, no amount of studies is going to change that. I respect anyone who score in the 250!! I respect them.

Tell me though, is the kreb cycle useless to an endocrinologist???
Is immunology usseless to an oncologist?
Or wouldn't a pathologist benefit from knowing every minutia of gross anotomy????

Speaking as a practicing endocrinologist... Yes.

 

[Raney Schauer]

What I saw was "These kids today and their Netflix..." which is tantamount to "Old man shouts at cloud". The baby-boomer-retiring-driven shortage of doctors by 202x can't come soon enough.