Factoring P/F Step 1 Changes Into Med School Selection

[Black Suede]

---

Members do not see this ad.

Hi everyone, I would like to pose a question and hopefully start a discussion about how the Step 1 change to a P/F format should be taken into account when selecting a med school this cycle.

Personally, up until this change, I have been weighing the financial cost of attendance as a significant factor in choosing a medical school (in addition to curriculum, student support, and student culture), but am now wondering if this the cost of attendance is less of a factor now due to the change in Step 1. It seems that matching into a competitive residency spot is going to much more dependent on school rank/rep, LORs, and publications now (with the last two factors often tying into the first).

I guess what I'm trying to get at, is do you all think that paying more to attend a higher ranked/better rep school is going to be moreso mandatory now in order to improve odds of matching into desired residency programs? Or do you all think the rank/rep of a med school will still not be that important when applying for residency spots?

Thanks in advance for your thoughts and perspectives! 😀

 

[langwang3]

I've talked to a few residency directors (ortho and derm) at top programs (Harvard,UCSF) about this change and they all said Step2 scores will replace Step1 importance, and med school ranking will not become any more or less important. Therefore I think cost of attending med school should still be a crucial factor for all applicants, and given the changes, another important factor should be how well students do on Step2 and how will the curriculum change to accommodate more step2 study time.

 

[Moko]

Step II will essentially be the new Step I. And once Step II becomes P/F too, residencies will expect applicants to have completed Step III and be board certified prior to starting residency.

 

[Black Suede]

I've talked to a few residency directors (ortho and derm) at top programs (Harvard,UCSF) about this change and they all said Step2 scores will replace Step1 importance, and med school ranking will not become any more or less important. Therefore I think cost of attending med school should still be a crucial factor for all applicants, and given the changes, another important factor should be how well students do on Step2 and how will the curriculum change to accommodate more step2 study time.

Step II will essentially be the new Step I. And once Step II becomes P/F too, residencies will expect applicants to have completed Step III and be board certified prior to starting residency.

I've heard this from a few other people as well, but how will this be if most residency interviews are done before Step 2 CK? Or am I mistaken in this?

Also, I hadn't even thought about schools needing to change the curriculum to allow for more Step 2 study time, so thank you for mentioning this @langwang3 !

 

[langwang3]

I've heard this from a few other people as well, but how will this be if most residency interviews are done before Step 2 CK? Or am I mistaken in this?

Also, I hadn't even thought about schools needing to change the curriculum to allow for more Step 2 study time, so thank you for mentioning this @langwang3 !

Yeah, as of now Step2ck scores are not required before applying. By the time current med school applicants will apply to residency, the residency application requirements will change to require step2 scores before interviews. Here are average step 2 scores by med school (as of about a year ago) if you're interested:

 

[Black Suede]

Yeah, as of now Step2ck scores are not required before applying. By the time current med school applicants will apply to residency, the residency application requirements will change to require step2 scores before interviews. Here are average step 2 scores by med school (as of about a year ago) if you're interested: ]

Wow this data is great, thanks @langwang3 ! What's still bothering me though, is the fact that a vast majority of the listed schools have very similar Step 2 scores in the 240-250 range, which doesn't make choosing between them based on the factor any easier. Also, did USMLE state somewhere that residency requirements will change to include Step 2 before interviews, or is this an assumption based on something else?

 

[Black Suede]

Also this poll data is really interesting. With a 50/50 split so far, is anyone else willing to share their thoughts on why they voted the way they did?

 

[langwang3]

Wow this data is great, thanks @langwang3 ! What's still bothering me though, is the fact that a vast majority of the listed schools have very similar Step 2 scores in the 240-250 range, which doesn't make choosing between them based on the factor any easier. Also, did USMLE state somewhere that residency requirements will change to include Step 2 before interviews, or is this an assumption based on something else?

it's an assumption based on talking to PDs, but I think its a safe assumption

 

[Black Suede]

it's an assumption based on talking to PDs, but I think its a safe assumption

After checking out some other threads, I think you're absolutely right. Makes the fact that most of the Step 2 CK scores are in a narrow range for most schools cause me to think that rank/rep will factor in some way after all 🤔

 

[langwang3]

After checking out some other threads, I think you're absolutely right. Makes the fact that most of the Step 2 CK scores are in a narrow range for most schools cause me to think that rank/rep will factor in some way after all 🤔

The average step2 scores are similar between schools from the data I posted, but that doesn't say anything about the range of individual scores, unless you're looking at some other data. I think it makes more sense to conclude that the ranking of school does not really matter that much when it comes to performing well on Step2, as its an individual test. You can differentiate yourself as an individual applicant by performing well on step2, even if you go to a lower-ranked school, just the same way that has been the case with step1. This is the distribution of individual step2ck scores (pg 2-3), and there is quite a bit of variance there.

 

[Saturday’s Child]

Is there anything important to be learned from a school like Ohio State having a significantly higher step 2 average (251) than a place like Hopkins (244)? Why would this be the case? Is this entirely an indication of clinical training strength or?

 

[KnightDoc]

Is there anything important to be learned from a school like Ohio State having a significantly higher step 2 average (251) than a place like Hopkins (244)? Why would this be the case? Is this entirely an indication of clinical training strength or?

Or maybe the people at Hopkins not worrying as much about it because, after all, they go to Hopkins and the emphasis has been on Step 1 as opposed to Step 2?

 

[deleted804295]

I'm going to get a 273 step II easy peasy.

I'll speak it into existence

 

[DrOngoGablogian]

Or maybe the people at Hopkins not worrying as much about it because, after all, they go to Hopkins and the emphasis has been on Step 1 as opposed to Step 2?

Look at the step 1s. The answer given above probably best articulates it. The margin between averages school to school says nothing about the averages student to student. Step 1 averages were fairly close between schools too.

 

[Black Suede]

@langwang3 I see what you're saying. Based on that logic, it seems that things will mostly stay the same just as Step 2 CK taking the place of Step 1 as the emphasized metric, but it would still be up to the individual student's performance.

However that does lead me to another question: Do you all think there is a possibility that the caliber of the clinical sites students are able to rotate at will be considered in addition to Step 2 CK as well? Just curious.

 

[Black Suede]

Also it looks like the poll is starting to lean in favor of higher ranked schools. Anyone care to elaborate? I'm wondering if that opinion is because of the Step 1 change or if you guys already felt that way before.

 

[AnatomyGrey12]

Is there anything important to be learned from a school like Ohio State having a significantly higher step 2 average (251) than a place like Hopkins (244)? Why would this be the case? Is this entirely an indication of clinical training strength or?

Ok so there are some basics you pre-meds need to understand about Step 2:

First, the current averages published by schools are fairly meaningless, as a lot of people intentionally don't take Step 2 until after applying to residency and a lot of programs used to not care whether it was a high score or not. You could apply to residency with a 250 Step 1, then roll a 240 on Step 2 and not have it hurt you.

Second, the scale is different. The average Step 1 score nationally last year was a 231, and the national Step 2 was a 242. 11 points higher. So you can increase your numerical score from Step 1 to Step 2 AND STILL drop in percentile. 260 on Step 2 is roughly a 250 on Step 1.

Third, the R value between Step 1 and Step 2 scores is 0.55. The best predictor of a high Step 2 is a high Step 1. You simply can't get a P on Step 1 and then expect to roll a 260 on Step 2.

Fourth, one big difference from Step 1 to Step 2 is that studying for clinical shelves is a lot more similar to studying for Step 2 than studying class material was for Step 1. People frequently use UWorld to study for their 3rd year shelf exams. This meaning that it was less dedicated time you had to take to get a decent (around average) score, and you would likely supersede your Step 1 score numerically.

Fifth, Step 2 has the same problems as Step 1 with regards to psychometrics and its ability to discern between two candidates. This means that a P/F Step 2 is probably ultimately going to happen as well.

Just thought I'd give you guys some perspective as to what Step 2 numbers mean. The difference between a 251 v. 244 on Step 2 is essentially meaningless. The Hopkins students probably don't really study hard for Step 2 honestly, as they probably didn't take it until residency apps and interviews were behind them. Once this P/F thing gets going I guarantee you that you'll see either massive increases in average score at schools, or the NBME will start yanking the average down to fit the same bell curve as Step 1 used to. I fully expect residency programs to require a Step 2 score to be on your application before you can apply to residency.

 

[Black Suede]

@AnatomyGrey12 A few of your points are new info for me. With all that you said in mind and the issues with using Step 2 as an accurate way to compare students, do you think PDs will still use it that way though? I mean Step 1 is not accurate way to compare students, but residency programs seem to have been using it that way for some time now. As right as you are, I'm just wondering if programs faced with hundreds of not thousands of residency applications aren't still going to use it as a way to weed out filter students.

 

[Black Suede]

Bringing things back into perspective a little guys. Whether you think Step scores are an important metric or not, I would really like to get more insight into your thoughts on if higher ranked schools are worth the extra cost, and if so why? Especially if you don't think Step scores are that important, because I'm aware that there are a lot of other factors that play into getting a residency spot.

 

[langwang3]

Bringing things back into perspective a little guys. Whether you think Step scores are an important metric or not, I would really like to get more insight into your thoughts on if higher ranked schools are worth the extra cost, and if so why? Especially if you don't think Step scores are that important, because I'm aware that there are a lot of other factors that play into getting a residency spot.

The relevant question here is will residency PDs use Step2 scores just the same way they had used Step1 scores in making admissions decisions, despite the fact that both tests are flawed. And from everyone I've spoken to, the answer seems to be yes, which makes me conclude that all the other factors, including med school reputation, will have the same importance after the change to P/F Step1 as they did before. So I'm not saying you should not go to a high-ranked school, but rather the change to P/F step1 should not really affect the importance of cost of attendance in your decision-making. At least, that's how I'm planning on going about things

 

[zinrath]

The better-ranked schools generally have more connections and it is easier to do research and get pubs. Based on just what I've seen on interviews, rich schools lead to rich opportunities outside of just Step. I don't know what the new metric will be, but I will feel a lot more secure at schools where 98% of their students have historically gotten their first choice of residency spots.

 

[AnatomyGrey12]

do you think PDs will still use it that way though?

100% yes. It will become the new Step 1.

 

[Pluto98]

@Jalby Your thoughts?

 

[Black Suede]

The better-ranked schools generally have more connections and it is easier to do research and get pubs. Based on just what I've seen on interviews, rich schools lead to rich opportunities outside of just Step. I don't know what the new metric will be, but I will feel a lot more secure at schools where 98% of their students have historically gotten their first choice of residency spots.

Very well said. This is a very good point. Would you say that a T25 school is therefore worth the extra cost over the general state school? No pressure, just curious. It's starting to seem to me, with or without the change to Step, that the greater number of opportunities is where the greater cost of higher ranked schools comes from, and those opportunities may play a much bigger role in matching than some would like to admit.

 

[AnatomyGrey12]

Very well said. This is a very good point. Would you say that a T25 school is therefore worth the extra cost over the general state school? No pressure, just curious. It's starting to seem to me, with or without the change to Step, that the greater number of opportunities is where the greater cost of higher ranked schools comes from, and those opportunities may play a much bigger role in matching than some would like to admit.

You are correct.

 

[Saturday’s Child]

Very well said. This is a very good point. Would you say that a T25 school is therefore worth the extra cost over the general state school?

Worth it to who? The more I think about it, this issue is getting a bit blown out of proportion. How few people even have an option to choose between multiple med schools? Out of those, how many are choosing between a T20 and a “podunk” state school? How many of those are trying to match into a competitive specialty? How many of those are trying to match at an “elite” residency for that specialty?

Regardless, the math is not very hard to do if you’re trying to decide if Harvard will set you up better for an orthopedic residency at Hospital for Special Surgery than [insert low-ranked state school].

 

[Moko]

I will feel a lot more secure at schools where 98% of their students have historically gotten their first choice of residency spots.

One caveat to this is that this statistic only takes into account the programs ranked by a student. It may not represent a student's true first choice. As an example:
- At the start of the application cycle for residency, let's say that we have two students who both want to match at MGH or BWH. Their next choices are the main hospitals for JHU, NYU, and so on down the list according to USNWR rankings.
- Student A has a stellar application and received interviews at MGH, BWH, JHH, etc. Student B on the other hand has a mediocre application (still categorized as "excellent" on the MSPE) and received interviews at Columbia NYP (USNWR rank 11) and other programs down the list.
- When compiling their rank list, student A ranks MGH as their first choice, BWH as their second, etc, while student B ranks NYP as their first choice among the programs they interviewed at.
- Student A ends up matching at NYU (#4 on their rank list), while student B ends up matching at NYP (#1 on their rank list, but really their 11th choice).

Looking at this 'first choice' statistic, it would seem that student B came out ahead, even though from their perspective they ended up at a less desirable program than student A. So despite many schools having 90%+ 'first choice' matches, it may partly be a function of their students not getting interviews at the most competitive programs. As with any statistic, it needs to be interpreted with caution and the appropriate context.

like to get more insight into your thoughts on if higher ranked schools are worth the extra cost, and if so why?

The answer to this will depend very much on a person's career goals, geographic preferences, cost differences, financial circumstances (and aversion to debt), ego, etc. and whether we're comparing two T5 schools; T5 vs T20; or T5. vs T100, and so on. Without knowing your goals, preferences and options, it's unlikely that you will get a meaningful answer. Just my thoughts

 

[Engrailed]

One caveat to this is that this statistic only takes into account the programs ranked by a student. It may not represent a student's true first choice. As an example:
- At the start of the application cycle for residency, let's say that we have two students who both want to match at MGH or BWH. Their next choices are the main hospitals for JHU, NYU, and so on down the list according to USNWR rankings.
- Student A has a stellar application and received interviews at MGH, BWH, JHH, etc. Student B on the other hand has a mediocre application (still categorized as "excellent" on the MSPE) and received interviews at Columbia NYP (USNWR rank 11) and other programs down the list.
- When compiling their rank list, student A ranks MGH as their first choice, BWH as their second, etc, while student B ranks NYP as their first choice among the programs they interviewed at.
- Student A ends up matching at NYU (#4 on their rank list), while student B ends up matching at NYP (#1 on their rank list, but really their 11th choice).

Looking at this 'first choice' statistic, it would seem that student B came out ahead, even though from their perspective they ended up at a less desirable program than student A. So despite many schools having 90%+ 'first choice' matches, it may partly be a function of their students not getting interviews at the most competitive programs. As with any statistic, it needs to be interpreted with caution and the appropriate context.


The answer to this will depend very much on a person's career goals, geographic preferences, cost differences, financial circumstances (and aversion to debt), ego, etc. and whether we're comparing two T5 schools; T5 vs T20; or T5. vs T100, and so on. Without knowing your goals, preferences and options, it's unlikely that you will get a meaningful answer. Just my thoughts

I wasn’t expecting to find this explanation on this thread (Step 1 PF). I’ve always wondered how so many schools can boast how 95-9Xth percent of their students match into their 1st choice-seemed like a statistical impossibility when residency positions are limited? This was insightful.

 

[A Ryan Seacrest Type]

Whether brand name is worth the cost depends on the name, the cost and your aspirations. If you’re fine being a community internal medicine doctor in Iowa, then by all means go to the cheaper school. If you’re trying to match plastic surgery at Harvard, then school name 100% matters. However, it also depends on the cost you’re willing to take on. You might want to do ortho but is it worth attending a top20 over a top 40 if it will cost you $100k more, it all depends on how strong of a student you can be. If you are a super star, there is a chance you can land a MGH residency, but realize a top med school student with less stellar stats than you can possibly get chosen over you. The reality is that top schools brand name help “mediocre” med students get great residencies to a certain extent, and this is true now and will continue to be true when step goes pass/fail.

 

[longhaul3]

Is there anything important to be learned from a school like Ohio State having a significantly higher step 2 average (251) than a place like Hopkins (244)? Why would this be the case? Is this entirely an indication of clinical training strength or?

Because Step 2 doesn't matter, especially the higher up the pecking order you go. CK is not really an indicator of clinical training. It's a standardized exam just like Step 1, there are probably 3k+ UWorld questions, and you study for it the same as any other exam. Yes, it tests the material you are supposed to learn on the wards, but at the end of the day you study for it at a desk from reference materials, not on rounds. So no, it's not really dependent on the strength of your rotations.

@langwang3 I see what you're saying. Based on that logic, it seems that things will mostly stay the same just as Step 2 CK taking the place of Step 1 as the emphasized metric, but it would still be up to the individual student's performance.

However that does lead me to another question: Do you all think there is a possibility that the caliber of the clinical sites students are able to rotate at will be considered in addition to Step 2 CK as well? Just curious.

Do you mean considered as an independent factor in the residency application process? Like student X did his clerkships at UCSF, while student Y did hers at UCSD, therefore student X is superior in this regard? Definitely not.

Very well said. This is a very good point. Would you say that a T25 school is therefore worth the extra cost over the general state school? No pressure, just curious. It's starting to seem to me, with or without the change to Step, that the greater number of opportunities is where the greater cost of higher ranked schools comes from, and those opportunities may play a much bigger role in matching than some would like to admit.

If you're interested in a competitive specialty or want to be the department chair at an academic center, my answer is yes. Obviously people match in every specialty from ever tier of school every year, but you only get one bite at the apple, so you might as well prepare yourself as best you can.

I believe that the scored CK era will be very short-lived, and in a few years it will be all about research in the most competitive specialties, without much emphasis on anything else. It's already gotten there in some, where above a certain Step 1 score there's no real difference. And when it comes to research opportunities, it does make a big difference to be at one of the top X NIH-funded institutions, etc.

 

[star.buck]

I've heard this from a few other people as well, but how will this be if most residency interviews are done before Step 2 CK? Or am I mistaken in this?

Also, I hadn't even thought about schools needing to change the curriculum to allow for more Step 2 study time, so thank you for mentioning this @langwang3 !

Current MS4, most people take CK between year 3 and 4, specifically for the purpose of having the grade in prior to interviews and even before the app is live. This will likely become crucial with the new step 1 change.

Also an interesting trend I’ve seen, those that classically do well on Step 1 (usually good at memorizing and regurgitating) seem to struggle a little with CK (clinical analysis/big picture).

I’m personally VERY glad I missed this change - and wish those who have to go through it the best of luck.

 

[Black Suede]

Worth it to who? The more I think about it, this issue is getting a bit blown out of proportion. How few people even have an option to choose between multiple med schools? Out of those, how many are choosing between a T20 and a “podunk” state school? How many of those are trying to match into a competitive specialty? How many of those are trying to match at an “elite” residency for that specialty?

Regardless, the math is not very hard to do if you’re trying to decide if Harvard will set you up better for an orthopedic residency at Hospital for Special Surgery than [insert low-ranked state school].

The answer to this will depend very much on a person's career goals, geographic preferences, cost differences, financial circumstances (and aversion to debt), ego, etc. and whether we're comparing two T5 schools; T5 vs T20; or T5. vs T100, and so on. Without knowing your goals, preferences and options, it's unlikely that you will get a meaningful answer. Just my thoughts

Whether brand name is worth the cost depends on the name, the cost and your aspirations. If you’re fine being a community internal medicine doctor in Iowa, then by all means go to the cheaper school. If you’re trying to match plastic surgery at Harvard, then school name 100% matters. However, it also depends on the cost you’re willing to take on. You might want to do ortho but is it worth attending a top20 over a top 40 if it will cost you $100k more, it all depends on how strong of a student you can be.

If you're interested in a competitive specialty or want to be the department chair at an academic center, my answer is yes. Obviously people match in every specialty from ever tier of school every year, but you only get one bite at the apple, so you might as well prepare yourself as best you can.

Thank you all for your really insightful responses! I'm relatively new to SDN, so I was a little hesitant about sharing my specific situation/goals off the bat, but I feel much more comfortable sharing more now.

I asked the question because I am in an odd position where I am looking at having to choose between a private T25 with a COA of ~$90k/yr (per their website) and my state school that is ranked in the 80s (per U.S. News) and had a COA of ~$50k/yr. I'm up for possible merit scholarships at both, but this is not guaranteed and I have received any aid estimates from either yet. At this point, I'm not 100% sold on any specialty, but I know that I like to work with my hands and all the ones I have a genuine interest in at this point are considered competitive (particularly Ophthalmology). I don't necessarily care about matching into a big name residency, but I would like to match into a residency that is above average for the specialty and will offer solid training in the "bread and butter" aspects as well as newer innovative techniques and treatments. Also, I enjoy teaching others, but I wouldn't say it's a goal of mine to serve in a big academic role somewhere either.

With all that being said, I don't like the idea of having more debt than I can handle, but I also don't like the idea of possible messing up my chances to do what I really want to do, before I even know for sure what that is, because I chose the wrong school.

I would really love to hear your thoughts on the situation, and similar situations that others may be in, given this more specific info.

Thanks guys, you're all really awesome for sharing your thoughts on this! 😊

 

[hellanutella]

Is there anything important to be learned from a school like Ohio State having a significantly higher step 2 average (251) than a place like Hopkins (244)? Why would this be the case? Is this entirely an indication of clinical training strength or?

An additional variable is that Hopkins allows their students to take Step 2 after ERAS (residency app) submission – and I've even had multiple classmates take it post-match. Most other schools typically have earlier deadlines, thus more incentive to score highly. However, I expect this more relaxed CK policy will soon be a thing of the past with P/F Step1.

Also for that chart linked in Reddit – those numbers are for the class of 2018. Since then, the admin revamped the Step 1 advising process (and a cultural shift of more aggressive Step 1 prep swept Hopkins). My cohort had a 245 average and Med20 rolled in either at 250 or 249 (don't remember the exact value but it was crazy high). However, it was not uncommon to see people digging into UWorld during MS1. Step 1 fever was not a healthy phenomenon, but I don't think shifting emphasis to CK will temper the test-prep culture.