MD & DO Guess what? Field specific exams may be closer than we thought

[slowthai]

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My gf is an ortho resident and her department has already joined gen surg, plastic, nsg, ENT, Uro, and ophtho to start creating a "surgical entrance exam". Interesting how surgeons have already started designing their test.

I'm gonna need decks of orthobullets, Handbook of Fractures, Pocket Pimped, everything high yield ortho immediately.

Listen, I know I've made some enemies on here but please. If you're a nerd, just nerd it up real quick and I'll put in a good word with the program director of whatever specialty you want. I've got pull. Yeah, it's like that

 

[Goro]

Coming soon: Sketchy Ortho!

 

[OrthoTraumaMD]

I'm gonna need decks of orthobullets, Handbook of Fractures, Pocket Pimped, everything high yield ortho immediately.

Listen, I know I've made some enemies on here but please. If you're a nerd, just nerd it up real quick and I'll put in a good word with the program director of whatever specialty you want. I've got pull. Yeah, it's like that

Only going to make the ridiculous sub-sub-specialization worse. Pretty soon we will have surgeons who operate only on the left leg.

 

[Matthew9Thirtyfive]

Only going to make the ridiculous sub-sub-specialization worse. Pretty soon we will have surgeons who operate only on the left leg.

Although based on data that might not be a bad thing.

 

[libertyyne]

I predicted this as an outcome! I think this is the right way to go in a world where step 1 , 2 become pass fail.

 

[The Knife & Gun Club]

EM already sort of has this with the shelf and the SAEM standardized exam.

2/3 of my EM auditions used the exam as a major component of the SLOE, which in EM carries more weight than your step score.

 

[slowthai]

I predicted this as an outcome! I think this is the right way to go in a world where step 1 , 2 become pass fail.

I remember @operaman talking about this a few years back, and I was totally in favor. It only makes sense from where I stand. Only downside is that it'll cost more. And, I guess, for the people that are undecided/decide late, it might be tougher to prepare for it unless they take research years or something.

I also think they should maybe have non-cat internships for those pursuing these fields. Would be a great way to supercharge your knowledge before you take it while proving yourself if you do it between third and fourth year.

 

[Ho0v-man]

Makes a lot more sense than the current setup. Derm is kinda low yield for step 1 and they’ve got the highest scores lol. Similar story for the surgical subs.

On the other hand it runs into the same problem as step 2 scores though in that you likely won’t know you’re competitive for a field until super late since I’m assuming you’d take these exams after rotating in said field. Not an issue for the third year core fields though.

Also, say this was implemented today. How would one study for this? I’ve no clue. I’ve been through step 1 uworld and most of step 2 and I doubt I can put 50 optho questions together from the two for example.

once third party resources catch up, it’ll be the same madness. Everyone will be doing their ortho anki deck from the beginning of first year and just skating through med school. And it’ll really suck if you want to switch from ortho to rads for example bc you just haven’t been crushing the rads deck and stand no chance now.

So basically five years out from this the same super scorers will be gobbling up the competitive fields that they do now. The plus side being they’ll actually focus on stuff specific to their interests throughout medical school. The negatives being disincentivization of learning anything beyond the bare minimum of any other field and having less opportunity to change your mind about the field you went into med school to learn.

 

[slowthai]

Makes a lot more sense than the current setup. Derm is kinda low yield for step 1 and they’ve got the highest scores lol. Similar story for the surgical subs.

On the other hand it runs into the same problem as step 2 scores though in that you likely won’t know you’re competitive for a field until super late since I’m assuming you’d take these exams after rotating in said field. Not an issue for the third year core fields though.

Also, say this was implemented today. How would one study for this? I’ve no clue. I’ve been through step 1 uworld and most of step 2 and I doubt I can put 50 optho questions together from the two for example.

once third party resources catch up, it’ll be the same madness. Everyone will be doing their ortho anki deck from the beginning of first year and just skating through med school. And it’ll really suck if you want to switch from ortho to rads for example bc you just haven’t been crushing the rads deck and stand no chance now.

So basically five years out from this the same super scorers will be gobbling up the competitive fields that they do now. The plus side being they’ll actually focus on stuff specific to their interests throughout medical school. The negatives being disincentivization of learning anything beyond the bare minimum of any other field and having less opportunity to change your mind about the field you went into med school to learn.

Like I said, that's where the research/non-cat years come in. Just means taking extra time and compounding loans. It's unfortunate, but if you want a field bad enough, you'll obviously do whatever it takes. If you're willing to settle, then that's fine too. It's about what the individual wants at the end of the day.

 

[Mad Jack]

EM already sort of has this with the shelf and the SAEM standardized exam.

2/3 of my EM auditions used the exam as a major component of the SLOE, which in EM carries more weight than your step score.

At this point why is EM even in the regular match, as its entrance process is becoming vastly different from the rest of the match

 

[Dantrolene FC]

Pretty soon you’ll have to be board certified before you can even apply for residency.

 

[Chelsea FC]

Wonder how much money they will cost. The cost of these exams is crazy and adding more really sucks for students who are trying to manage the debt as best as we can.

 

[kb1900]

This is so dumb imo - we continue to pretend that these exams are useful in selecting successful residents when in reality most med students are teachable so all you’re selecting for at a certain point is who can tolerate and afford the most *** to appease their dream specialty.

Let’s not forget that we literally have to pay thousands for Qbank on top of qbank and dozens of practice tests. And if you want to go into certain fields you better be willing to publish 10x, take a research year with a minimal stipend, and do $10,000 worth of aways across the country


You can add on every test you want - most people probably score at or around the same percentile range across every shelf and step in medical school. What value are these exams adding? If the issue is too many apps and not enough screening....then why not limit number of apps allowed.


I can’t wait until tutoring for the Ortho “specialty exam” becomes more profitable than 5 years of residency /s Even mcat/usmle tutoring can get to $200-300/hr x 30 hours a week. In fact I bet a huge motivating factor for these exams is literally the $ to be made off med student loan dollars going toward exam prep material. Everyone wants a piece of the US education debt pie/bubble

 

[CyrilFiggis]

There’s already the Surgery Shelf. It’s dumb to create another.

At this point why is EM even in the regular match, as its entrance process is becoming vastly different from the rest of the match

The SLOE is the only difference. I did 3 EM rotations and never took the SAEM or shelf exam. We did have SVI, but they ditched it. Honestly, more specialties should adopt away requirements. Quantitative peer evaluation protects PDs from interviewing douchy applicants who are only good test takers and protects students (well, used to) who may struggle on boards, but are otherwise clinically competent.

 

[Dantrolene FC]

There’s already the Surgery Shelf. It’s dumb to create another.



The SLOE is the only difference. I did 3 EM rotations and never took the SAEM or shelf exam. We did have SVI, but they ditched it. Honestly, more specialties should adopt away requirements. Quantitative peer evaluation protects PDs from interviewing douchy applicants who are only good test takers and protects students (well, used to) who may struggle on boards, but are otherwise clinically competent.

It also gives an advantage to people with money who can afford aways. I didn’t do any aways in anesthesia because I wanted to save the money. The process is already expensive enough as it is.

 

[CherryRedDracul]

Just what we need: MORE $tandardized exams.

 

[ace_inhibitor111]

My gf is an ortho resident and her department has already joined gen surg, plastic, nsg, ENT, Uro, and ophtho to start creating a "surgical entrance exam". Interesting how surgeons have already started designing their test.

They should have a mental manipulation component like in the DAT, and maybe a fine motor skills portion as well. Would help applicants decide if they’re a good fit for surgery also.

 

[ace_inhibitor111]

@ace_inhibitor111 You can figure out if you are a good fit for surgery through rotations. Most programs don't care about students' surgical skills because that could be learned from thousands of hours of practice. Those programs who do care, have students tie knots/suture at residency interviews (which doesn't require extra $$)

I’m specifically talking about exams though. If you’re going to have a surgery specific exam, might as well have other components that are not multiple choice.

For the sake of argument though, you don’t actually have “thousands of hours” to learn every procedure you need to as a subspecialty surgeon. Your autonomy is limited in the OR and some residents don’t do full cases until 3rd or 4th year. If you mess up a lot, you’re attending will give you less autonomy. Being able to pick up motor procedures quickly and under pressure is super beneficial. Doesn’t mean that’s others can’t be a surgeon, but it certainly makes their lives much harder.

 

[Gilakend]

I opened this saying "please don't let this be ortho" and lo and behold

 

[DokterMom]

I can see one "surgery" aptitude exam but not five different Ortho, ENT, Plastics, Ophtho, Vascular-exams. But it would have to be taken early enough to allow 3rd years to react to their scores and adapt accordingly.

 

[slowthai]

I opened this saying "please don't let this be ortho" and lo and behold

It's always ortho. Gotta gun harder baby!

 

[slowthai]

I can see one "surgery" aptitude exam but not five different Ortho, ENT, Plastics, Ophtho, Vascular-exams. But it would have to be taken early enough to allow 3rd years to react to their scores and adapt accordingly.

If that's the case, they are totally wasting their time and should just demand that the schools release surgery shelf scores.

 

[AnatomyGrey12]

I’m a little confused as to what these tests would look like. I mean, we’re med students at the end of the day and so tests that go into any sort of depth into these fields is kind of defeating the purpose of med school and simply moving the point of specialization earlier.

A "better" option would be to just standardize the entire process with every school taking the same subject exams and then the same shelves for core rotations. Standardize grading and ranking across the country at every school. Make these scores available to programs. We are kidding ourselves if we think anyone will design a test that "determines who will be a good surgeon" or whatever. Someone who knows more of the Handbook of Fractures as a 3rd year doesn't mean they'll be a better orthopod, it just means they studied Handbook of Fractures earlier.

 

[Dantes]

I feel like the focus of Step 1 mania will just keep shifting targets as long as med school seats keep outpacing growth of residency spots, making the competitive specialties even more competitive.

 

[A Ryan Seacrest Type]

It does not make sense.

Programs didn’t expect us to have a ton of knowledge back when I was doing away rotations in urology. The expectation was to be teachable. They said, “we don’t expect you to know much. That is what residency is for.“

Med school is time to gain all the foundational knowledge you need. Uro residencies already do 6 months of uro in intern year now and you start taking the inservice exam as an intern. No need to push the specialization even earlier

Exactly such a dumb idea. And you have people here, like “oh look at me, I predicted this was gonna happen” congrats, you called a dumb idea...

 

[libertyyne]

Exactly such a dumb idea. And you have people here, like “oh look at me, I predicted this was gonna happen” congrats, you called a dumb idea...

thanks dude. What is your alternative? Status Quo of STEP2 becoming a screener? or school pedigree ?

 

[Lawpy]

Is anyone in favor of making Step exams aptitude tests like the MCAT?

 

[AnatomyGrey12]

Is anyone in favor of making Step exams aptitude tests like the MCAT?

No. I'm not sure how that shows who will be a good surgeon (derm, ophtho, IM, whatever specialty here) or not. The MCAT might be a "better" test but it still doesn't determine whether or not that 520 will be a better med student than the 511.

 

[libertyyne]

I’m a little confused as to what these tests would look like. I mean, we’re med students at the end of the day and so tests that go into any sort of depth into these fields is kind of defeating the purpose of med school and simply moving the point of specialization earlier.

A "better" option would be to just standardize the entire process with every school taking the same subject exams and then the same shelves for core rotations. Standardize grading and ranking across the country at every school. Make these scores available to programs. We are kidding ourselves if we think anyone will design a test that "determines who will be a good surgeon" or whatever. Someone who knows more of the Handbook of Fractures as a 3rd year doesn't mean they'll be a better orthopod, it just means they studied Handbook of Fractures earlier.

I agree that reverting to shelf exams would be less financially stressful. And probably a better move to incorporate current testing already into the screening process.

I do think that they could design subject specific shelves if they wanted, You do a home rotation and then you take the shelf, it only impacts a very small portion of students who are applying to these fields.

It is also completely possible to design a test about basic med student knowledge that a student should know for that required field , but is probably not tested enough or high yield enough for larger shelves or step

Basic exam findings, common pathology and treatment, physiology, and pertinent pharm That was taught, but was never really tested.



The exam in of itself accomplishes a few things
1. Interest , considering you need to be motivated enough to study and sit for the exam.
2. Baseline field specific competency.
3. Standardized comparative tool between two applicants where everything else provides no objective information about the difference.

This will realistically impact a small proportion of the medical school going population, not everyone is going for derm, ent, or optho. Those numbers are dwarfed by primary care specialties. This is really one of the logical outcomes of a world where there is more demand for specialty seats and limited number of seats. with no objective measure to quickly screen through candidates. Quite frankly the alternative is that of what the real world uses in terms of finding a job, which is a nightmare in comparison considering who you know and school pedigree are the first things asked.

As an aside can you imagine sitting through a 100 image exam that is nothing but skin rashes. Brutal.

 

[libertyyne]

Makes a lot more sense than the current setup. Derm is kinda low yield for step 1 and they’ve got the highest scores lol. Similar story for the surgical subs.

On the other hand it runs into the same problem as step 2 scores though in that you likely won’t know you’re competitive for a field until super late since I’m assuming you’d take these exams after rotating in said field. Not an issue for the third year core fields though.

Also, say this was implemented today. How would one study for this? I’ve no clue. I’ve been through step 1 uworld and most of step 2 and I doubt I can put 50 optho questions together from the two for example.

once third party resources catch up, it’ll be the same madness. Everyone will be doing their ortho anki deck from the beginning of first year and just skating through med school. And it’ll really suck if you want to switch from ortho to rads for example bc you just haven’t been crushing the rads deck and stand no chance now.

So basically five years out from this the same super scorers will be gobbling up the competitive fields that they do now. The plus side being they’ll actually focus on stuff specific to their interests throughout medical school. The negatives being disincentivization of learning anything beyond the bare minimum of any other field and having less opportunity to change your mind about the field you went into med school to learn.

I agree with your analysis . However,Clinical grades will still deter people from completely blowing off everything else.

I dont think the intent of the exam is to somewhat make these fields accessible to poor test performers. That could even be accomplished under the current climate of taking research years. I think its intent exactly is to seperate the high performers from the lower performers on the tests. Now it is obviously true that it is not necessary that the high performers will be better fits for their fields. But I dont know how anyone can find the best fit for a field and program out of all the applicants. Atleast a standardized test on face value seems meritocratic.

Also i feel like there has to be more than 50 ophtho questions .
I can think of 15 off the top of my head.

 

[A Ryan Seacrest Type]

thanks dude. What is your alternative? Status Quo of STEP2 becoming a screener? or school pedigree ?

Yo Im not doing this again with you cause you conveniently choose what you want to respond to or create your own interpretations of my arguments, so it’s pointless.

 

[Ho0v-man]

I agree with your analysis . However,Clinical grades will still deter people from completely blowing off everything else.

Pfft! My eyes have been opened this year to the reality that most people just find the easiest grader so they can do the bare minimum

I think AnatGrey really hit the nail on the head previously. If specialization to this degree was pushed there’d literally be no point in med school.

 

[slowthai]

Pfft! My eyes have been opened this year to the reality that most people just find the easiest grader so they can do the bare minimum

I think AnatGrey really hit the nail on the head previously. If specialization to this degree was pushed there’d literally be no point in med school.

I'd like to think of it more like "grade security" lol.
You still work hard, but you don't get screwed by a mindless evaluator that gives everyone straight passes. At least that's what I plan to do.

 

[NotAProgDirector]

A problem with using shelf exams is that IMG's and DO's do not take them. I guess we could start down the road of delivering them at Pearson centers like the USMLE and have all of them take them -- this brings a ton of new $$$ to the NBME which I am fully against.

 

[libertyyne]

Yo Im not doing this again with you cause you conveniently choose what you want to respond to or create your own interpretations of my arguments, so it’s pointless.

Why don’t you just give an alternative.

Also what does the second part even mean?
Everyone literally has to interpret your argument when you write something online. That’s literally how communication works .Especially if it unclear.

 

[deleted407021]

I don’t hate this idea.

 

[libertyyne]

Step 2, AOA status, clinical grades in relevant fields, personal statement, LORs, away rotation evals/“commitment to the field,” regional bias, school name

I don’t why everyone thinks the sky needs to fall because Step 1 is P/F. I disagree with the change, but those exact things I listed are what urology and ophthalmology have been using for years except swap Step 2 for Step 1.

If ophtho and uro can make decisions using those points, there is no reason ortho, neurosx, and ENT need extra information. IMO, anyone who needs more data points is either 1) panicking because they don’t adjust well with changes 2) using it as way to profit

The kind of test being described here is the inservice exam. It would be insane to ask med students to take the inservice exam. The expectations for interns on the inservice is low because programs know they will be learning throughout residency. Someone who does well on step 2 and throughout med school will be able to learn the medical knowledge for their field

I think when people talk about these changes they talk about how in all likelihood step 2ck will become pass fail as well, because the exact same reason step 1 became pass/fail apply to step 2 ck. The only reason step 2ck was not made p/f is because program directors would riot.

Everything else you listed is very subjective and is essentially incapable of easily filtering applicants.

AOA status- some schools dont participate, at others its a popularity contest.
Clincal grades are fairly non-standardized to where some schools dont even take shelves or to where those shelves account for 100% .

We take field specific tests right now in fields like obgyn, psych , even FM and peds. I am unsure why it would be extraordinarily onerous if people had to take one for smaller fields if they were doing rotations in them.

I am still not seeing any objective way to stratify applicants based on what you have said.

 

[A Ryan Seacrest Type]

Why don’t you just give an alternative.

Also what does the second part even mean?
Everyone literally has to interpret your argument when you write something online. That’s literally how communication works .Especially if it unclear.

Yeah except when your interpretation of what I’m saying completely undermines the point I’m trying to make, exacerbated by the fact you pick and choose what you want to respond to.

 

[libertyyne]

Yeah except when your interpretation of what I’m saying completely undermines the point I’m trying to make, exacerbated by the fact you pick and choose what you want to respond to. Again I don’t feel like going down this damn rabbit hole with you again. Alternative or not, I still think it’s a dumb idea.

Ok.
1.If your point is so unclear that it can be interpreted in a fashion to completely undermine it , perhaps the problem is with the way you are making the point and not the people interpreting the point.
2. when people dont respond to everypoint that literally means your point was made so poorly that people didnt even get that you were making a point.
Or alternatively they agree with that point .

Thanks tho. Its easy to call things dumb, its hard to actually come up with reasonable implementable ideas for problems. And considering you have proposed ZERO alternatives it is smarter than anything you have proposed by default.

 

[CidHighwind]

It's always ortho. Gotta gun harder baby!

It’s always funny how ortho adds all these hoops when those in leadership in ortho probably got in with 220s and were middle of their class

 

[slowthai]

It’s always funny how ortho adds all these hoops when those in leadership in ortho probably got in with 220s and were middle of their class

Man, it's actually been competitive for 30-40 years, so those guys are close to retirement if not already haha

 

[libertyyne]

Some of those things are subjective, but it is exactly what has been used forever. There is no way to make it completely objective. Programs make a grading sheet where faculty grade their interpretation of letters, etc out of 10 to make an objective score.

Some programs filter out students who don't H on surgery. In urology, H in surgery and Ob are the only things that have been shown to correlate with success as a uro resident. Surgical subspecialties are small fields, so having good letters is very important (most programs would prefer an average applicant who gets along with everyone versus a superstar weirdo). People who do well at a top med schools have a track record of doing well, so I don't think it's crazy to consider that (and I went to a state med school). Subjective factors are useful.

Step scores don't even correlate with resident success. It's only used to filter applicants. That's why top uro programs have a bunch of people who scored in the low 240s on Step and plenty of people with 255+ end up at mid to low tier programs. Programs know that once you reach a threshold step score subjective things will be what separates out the future leaders in the field. An applicant with 240 on Step 1 won't be struggling to build medical knowledge in residency.

There is no evidence that prestudying for residency will produce better resident outcomes, so adding tests would be a waste of money, time, and resources. Do you think that people who do well on Step 2Ck would do poorly on a field-specific pre-residency test? Likely not, so you would only filter out a tiny number of applicants and the programs would continue on looking at subjective stuff. Cost-benefit: Are the number of USMDs screened out by Step 2Cs worth the cost? Does a USMD failing CS the first time mean anything? Similarly, would adding a pre-residency test that only a few people who scored well on Step 2CK would do poorly on justify the costs?

Im not sure why you are ignoring that in a world where step 2ck is pass fail there is no doing well on it. there is just passing or failing it.

I never actually said that the current system was great. Step 1 , 2 tests are only correlated with ability to pass board exams . Doesnt take a large leap of faith to see that if someone is good at taking tests they are going to be good at taking other multiple choice tests.

I think you are underestimating the impact of going to pass fail is going to have on applications towards competitive specialties. If step 1 and 2 are pass fail, there will be more people applying DERM and other competitive specialties. Right now people would be saying they are all about derm and then after step 1 results came out they would suddenly become interested in FM.

Just to give an example my Neurosurgery interest group had 15 people that were extremely comitted to Neurosurgery, after Step 1 , there are only 5 that are planning on applying. The test culled people before they even applied. In a world where there is no test that does that these program directors are going to be innundated with more applications.

Given your example of Uro, do you think URO directors would be able to differentiate between a 195 and a 250 if step 1,2 was pass fail?

Now instead of the 200 applications the program is going to get 500 applications of people that would have been culled, do you honestly tell me they are going to sit down and evaluate each candidate before they extend interviews? Or read each LOR? I hope i get evaluated when you are in a good mood.

Its fine if you are advocating that higher weight be given to school pedigree. It doesnt seem meritocratic, and doesnt really mean that you will be attracting the hardest working highest achieving applicants in medical school, just the people who did well on the MCAT and had high UG GPAs.

And I am not saying you should be prestudying for residency. Rather the test should be designed for medical student level content that is really not high yield enough to be tested in major exams like step 1 or other clinical shelves.

 

[libertyyne]

I don't know why you are bringing up a world in which Step 2 CK is P/F. This thread isn't about what should be done if Step 2 is P/F. "What is your alternative? Status Quo of STEP2 becoming a screener? or school pedigree?" was your original comment. I don't think step 2 will be p/f because the USMLE would risk becoming irrelevant and be replaced by a different testing company. If they do change, it will not be for a while and that's something I'm not wasting time discussing until there is reason to. I'm commenting on whether pre-residency, specialty-specific tests are necessary at this time.

With Step 1 p/f, Step 2 will serve the same filtering purpose.

And I'm not advocating higher weight be put on pedigree. I think pedigree is given weight now, which is reasonable. Pedigree is only one part of the puzzle

I 100% believe step 2 will become pass fail over the next 5- 10years. So we can disagree. These programs are just looking towards preparing for eventuality of what is going to happen.
I can agree with you that they are not necessary in a world where step 2 is still graded.

 

[Goro]

Is anyone in favor of making Step exams aptitude tests like the MCAT?

Steps were meant to be competency exams and nothing more. Overworked PDs, faced with tons of apps, turned them into screening tools

 

[Lawpy]

Steps were meant to be competency exams and nothing more. Overworked PDs, faced with tons of apps, turned them into screening tools

Well then all Steps should be converted to pass/fail

 

[CherryRedDracul]

Steps were meant to be competency exams and nothing more. Overworked PDs, faced with tons of apps, turned them into screening tools

And taking a step (hehe) back, it's the Match that has led to the reliance on score-based screening tools. To be competitive to match, applicants are encouraged to interview at a multitude of places, and programs are incentivized to rank several people down the line to make sure they don't end up with an unfilled position.

Compare that to subspecialty fellowships, some of which do take the traditional approach: you send in an application to a program, the program offers you an interview, you interview, and then they call you back to let you know whether they will offer you a position or not. In this scenario, you may have to interview at far fewer programs (in my case, just one, and it was my #1), and programs have to interview far fewer candidates if they like the ones they interviewed. The downside is that if you have a number #1 in mind who hasn't offered you an interview, but another program offers you a spot (say a #3 or #4 program), then you're stuck in a tough spot because you're given a small amount of time to take the spot or leave it.

 

[Goro]

Well then all Steps should be converted to pass/fail

Tell that to the PDs!

 

[3characterslong]

Steps were meant to be competency exams and nothing more. Overworked PDs, faced with tons of apps, turned them into screening tools

I go to an MD school, so I don't really have to care, but do you actively hate your own DO students or something? Because you can kiss any chance of them matching Derm, ENT, or Ortho goodbye with this change. It's like you're deadset on advocating for the failure of your own students. It's unsightly.

 

[Goro]

I go to an MD school, so I don't really have to care, but do you actively hate your own DO students or something? Because you can kiss any chance of them matching Derm, ENT, or Ortho goodbye with this change. It's like you're deadset on advocating for the failure of your own students. It's unsightly.

How on earth did you get past CARS with such terrible reading comprehension??