Has Step I scoring changed?

[efle]

You probably mean well but, the difference you'd still come out with a positive advantage regardless. It's like listening to wall street about who caused the financial recession in 2008

I think it's more like hearing Warren Buffet talk about how broken the current wealth distribution is. If he thinks it needs fixing, he's more likely to be persuasive than Joe Plumber.

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[7331poas]

There's definitely some clinically useful stuff tested on Step 1, but the preclinical curriculums at most med schools and/or Step 2 CK are generally a lot more clinically relevant. "Teaching to the step" usually means teaching a bunch of esoteric basic science details that nobody really needs to know in a hospital.

A large portion of step 1 material isnt the esoteric G protein stuff you guys listed. Those are just referenced as strawman tactics.

The best preparation for step 2? Knowing your Step 1 content.

I personally am not interested in hearing from students from top 50 programs about why they want it to be pass/fail. They are the ones who will directly benefit from this change.

I think it's more like hearing Warren Buffet talk about how broken the current wealth distribution is. If he thinks it needs fixing, he's more likely to be persuasive than Joe Plumber.

No, because in this case mr buffet will also being the one who stands to gain the most.

 

[Thesimplelifeofamyloid]

I think it's more like hearing Warren Buffet talk about how broken the current wealth distribution is. If he thinks it needs fixing, he's more likely to be persuasive than Joe Plumber.

If you're truly serious about what you think, you should always state that disclosure before you state your opinion. Let the people decide whether that disclosure is significant.

 

[efle]

A large portion of step 1 material isnt the esoteric G protein stuff you guys listed. Those are just referenced as strawman tactics.

The best preparation for step 2? Knowing your Step 1 content.

I personally am not interested in hearing from students from top 50 programs about why they want it to be pass/fail. They are the ones who will directly benefit from this change.

I agree that isn't the largest portion. It's just a significant portion and by far the biggest area of difference from preclinical curriculum. If someone who threw themselves wholeheartedly into the lectures at HMS and someone who threw themselves into First Aid both took Step1, the latter would score a lot higher. But it would mostly be from the questions about biochem, immunology, details of pharma mechanisms, extraordinarily rare genetic conditions, and so on, not from the questions that doctors actually need to know to safely practice in the USA.

Like I said, I think losing the step score barrier to competitive specialties would hurt me more than help me, but if you want to dismiss me I can't stop you.

 

[Lawpy]

Like I said, I think losing the step score barrier to competitive specialties would hurt me more than help me

How?

 

[efle]

If you're truly serious about what you think, you should always state that disclosure before you state your opinion. Let the people decide whether that disclosure is significant.

Honestly, all the INCUS consideration would have a 3-5 year timeline for implementation, minimum. There is essentially zero chance that anything would change in time for my match. I have no personal skin in this game, at all. I'm just sharing what I hope can happen for posterity's sake.

 

[libertyyne]

Not all of it. Some of the Boards and Beyond topics contain some highly clinically relevant information.

Most of that stuff should be in your curriculum anyway.

You probably mean well but, the difference you'd still come out with a positive advantage regardless. It's like listening to wall street about who caused the financial recession in 2008

I dont go to a t-20 school but i have a step score in a similar range. I completely agree that something needs to be done to the current system, because it is not sustainable, and not very beneficial to anyone. The stupid test has a standard error of 8 points and a SD of 21. Is there really a difference between the person who hit 250 vs 243? or the person who hit 260 and 253? a good or bad test day can make completely change the trajectory of your career, and everything that comes with it. Insane.

 

[Lawpy]

*insert argument that Step 1 should be made an aptitude test like the MCAT with reduced standard errors*

 

[efle]

How?

Let's use Derm as an example, given the thread. Hopkins sent a whopping total of 3 people into derm last year. Other similar schools are similar in numbers. In terms of total representation, "top tier schools" are a tiny minority of the match for competitive specialties. There just aren't that many applicants coming from them.

By far the bigger factor is Step 1. Right now, you need to be in the top 10-15% to clear the average for specialties like this. Switching to Pass/Fail would have a huge impact on how many people could apply for it.

If I was to pick between switching my med school to Mizzou or my step score to 230, I'd protect the step score in a heartbeat. Yet here I am arguing against step 1 having this role. It's not a self-serving argument for me to make at all, but people accuse me of that every time it comes up.

 

[Thesimplelifeofamyloid]

Most of that stuff should be in your curriculum anyway.

I dont go to a t-20 school but i have a step score in a similar range. I completely agree that something needs to be done to the current system, because it is not sustainable, and not very beneficial to anyone. The stupid test has a standard error of 8 points and a SD of 21. Is there really a difference between the person who hit 250 vs 243? or the person who hit 260 and 253? a good or bad test day can make completely change the trajectory of your career, and everything that comes with it. Insane.

I agree something needs to be done but the answer is not making it P/F with no additional changes

 

[Thesimplelifeofamyloid]

Honestly, all the INCUS consideration would have a 3-5 year timeline for implementation, minimum. There is essentially zero chance that anything would change in time for my match. I have no personal skin in this game, at all. I'm just sharing what I hope can happen for posterity's sake.

You dodged the remark.

 

[Gurby]

*insert usual SDN argument spanning several pages why Step scores are necessary because matching*

/runs away

 

[efle]

You dodged the remark.

I've disclosed it in every thread where I state this opinion, I'm just not enough of a d-bag to wear it in my signature so that it's evident ahead of time. I do go to a school that would let me match Derm with a weaker score. I scored competitively for Derm anyways. I don't think any changes are coming in time to affect me.

And with all that openly disclosed, I absolutely think that we need to switch the Step 1 scoring. It's a licensing exam like the bar that was written to discriminate around the Pass threshold. It has no value for board pass rates after ~220+ and the authors of the test itself explicitly state that it isn't designed to be used in resident selection. It's forcing preclinical medical students to prioritize basic science flashcards over their professors' content, and it's a nonsensical reason for someone who wants to be a surgical specialist to lose access to their career. To bring up that blog one more time, at some point we might as well ask students to memorize digits of pi. I sympathize a lot with overwhelmed residency directors and DO/IMG students fighting to overcome unfair stereotypes. But I don't want to see the trend keep escalating for another decade.

 

[Lawpy]

Let's use Derm as an example, given the thread. Hopkins sent a whopping total of 3 people into derm last year. Other similar schools are similar in numbers. In terms of total representation, "top tier schools" are a tiny minority of the match for competitive specialties. There just aren't that many applicants coming from them.

By far the bigger factor is Step 1. Right now, you need to be in the top 10-15% to clear the average for specialties like this. Switching to Pass/Fail would have a huge impact on how many people could apply for it.

If I was to pick between switching my med school to Mizzou or my step score to 230, I'd protect the step score in a heartbeat. Yet here I am arguing against step 1 having this role. It's not a self-serving argument for me to make at all, but people accuse me of that every time it comes up.

So wait, the issue is the number of applicants applying to derm from top schools is low?

 

[Thesimplelifeofamyloid]

I've disclosed it in every thread where I state this opinion, I'm just not enough of a d-bag to wear it in my signature so that it's evident ahead of time. I do go to a school that would let me match Derm with a weaker score. I scored competitively for Derm anyways. I don't think any changes are coming in time to affect me.

And with all that openly disclosed, I absolutely think that we need to switch the Step 1 scoring. It's a licensing exam like the bar that was written to discriminate around the Pass threshold. It has no value for board pass rates after ~220+ and the authors of the test itself explicitly state that it isn't designed to be used in resident selection. It's forcing preclinical medical students to prioritize basic science flashcards over their professors' content, and it's a nonsensical reason for someone who wants to be a surgical specialist to lose access to their career. To bring up that blog one more time, at some point we might as well ask students to memorize digits of pi. I sympathize a lot with overwhelmed residency directors and DO/IMG students fighting to overcome unfair stereotypes. But I don't want to see the trend keep escalating for another decade.

You can make significant improvements with the scoring and the coverage without making it pass/fail, no questions asked. I've learned the most clinically relevant things from Boards and Beyond. Boards and step materials make the schools strive for better quality. Just because the experience at your school is positive doesn't mean that for everyone else.

 

[Lawpy]

I do go to a school that would let me match Derm with a weaker score. I scored competitively for Derm anyways.

If I was to pick between switching my med school to Mizzou or my step score to 230, I'd protect the step score in a heartbeat.

😕

 

[Ho0v-man]

I’ve only been in third year for a little over a month and have been pimped on some of the minutiae you guys are complaining about. Second messengers, biochem pathways, drug interactions, specific virulence factors, drug moa, etc. I was surprised to say the least.

Heck, a cardiologist came by to explain to the medicine residents why he picked a certain drug. His explanation started with arachidonic acid metabolism and he worked his way down pimping along the way.

I haven’t taken a shelf yet, but my experience doesn’t line up with what has been said in this thread thus far. I’ve gotten some good comments so far about this stuff. I guess attendings aren’t expecting third year med students to know all the causes of non gap metabolic acidosis or how to differentiate the different types of RTA but I can and I wouldn’t know this stuff if I just had to pass step 1 without the pressure to do well.

 

[Iz_FtB]

Grass is always greener.

There are rumblings of Canadian students wanting an objective measure added to their residency portfolio because the subjectivity leaves people unsure of their relative merits.

Step being p/f isn't going to make anyone's life easier. A 230-tier student is still going to compete against 260-tier students if applying into derm. Maybe for the few people scoring 230 who are research and clinical rockstars will benefit from a switch, but they aren't going to be many. The same people killing it on Step are going to find ways to kill it with any other cockamamie metric, and we're right back to where we started except with more subjectivity and less predictability.

Also, a strong Step I foundation makes learning on the wards easier. I can't imagine how anyone could say otherwise.

 

[efle]

You can make significant improvements with the scoring and the coverage without making it pass/fail, no questions asked. I've learned the most clinically relevant things from Boards and Beyond. Boards and step materials make the schools strive for better quality. Just because the experience at your school is positive doesn't mean that for everyone else.

Step 1 switching to tertiles wouldn't prevent you from listening to Dr. Ryan instead of your faculty. Learn the good, useful stuff however you want.

I’ve only been in third year for a little over a month and have been pimped on some of the minutiae you guys are complaining about. Second messengers, biochem pathways, drug interactions, specific virulence factors, drug moa, etc. I was surprised to say the least.

Heck, a cardiologist came by to explain to the medicine residents why he picked a certain drug. His explanation started with arachidonic acid metabolism and he worked his way down pimping along the way.

I haven’t taken a shelf yet, but my experience doesn’t line up with what has been said in this thread thus far. I’ve gotten some good comments so far about this stuff. I guess attendings aren’t expecting third year med students to know all the causes of non gap metabolic acidosis or how to differentiate the different types of RTA but I can and I wouldn’t know this stuff if I just had to pass step 1 without the pressure to do well.

I would be absolutely SHOCKED if I had an attending pimp me on the arachadonic acid metabolites pathways. All my pimping was stuff like "which antibiotics would you consider for this suspected source of sepsis."

 

[efle]

Also, a strong Step I foundation makes learning on the wards easier. I can't imagine how anyone could say otherwise.

Imagine a world where some of the best regarded medical schools in the country, send their students to the wards for many months or even a full year prior to taking Step 1....

 

[7331poas]

I've disclosed it in every thread where I state this opinion, I'm just not enough of a d-bag to wear it in my signature so that it's evident ahead of time. I do go to a school that would let me match Derm with a weaker score. I scored competitively for Derm anyways. I don't think any changes are coming in time to affect me.

And with all that openly disclosed, I absolutely think that we need to switch the Step 1 scoring. It's a licensing exam like the bar that was written to discriminate around the Pass threshold. It has no value for board pass rates after ~220+ and the authors of the test itself explicitly state that it isn't designed to be used in resident selection. It's forcing preclinical medical students to prioritize basic science flashcards over their professors' content, and it's a nonsensical reason for someone who wants to be a surgical specialist to lose access to their career. To bring up that blog one more time, at some point we might as well ask students to memorize digits of pi. I sympathize a lot with overwhelmed residency directors and DO/IMG students fighting to overcome unfair stereotypes. But I don't want to see the trend keep escalating for another decade.

You keep saying "DO/IMG" as if this change would not also drastically impact schools outside of the top 20. The top student at EVMS (for instance) deserves a fair shake at derm, especially considering he or she is probably a better student than the average student at Cornell.

But this change will undoubtedly prevent that student from entering dermatology.

A Harvard student with a pass and 5/7 honors will always beat out a EVMS student with 7/7 honors. And dont say LORs, because we all know the MGH faculty will look nicer than the glowing letters from EVMS (and wherever the student managed to get sub-Is)

 

[Iz_FtB]

Imagine a world where some of the best regarded medical schools in the country, send their students to the wards for many months or even a full year prior to taking Step 1....

Yeah, I'm at one of those schools and I spent my preclinical years studying for boards. What I said is correct. I have no idea what your point is.

 

[7331poas]

Imagine a world where some of the best regarded medical schools in the country, send their students to the wards for many months or even a full year prior to taking Step 1....

Students dont learn step 1 solely in dedicated. I also take step 1 after clerkship. I still matured zanki before starting clerkship

 

[ace_inhibitor111]

So I’m going to be a little biased since I scored 260+ on Step 1, but the difference in residency match rates for competitive specialties don’t actually differ that much between 250+ and 260+, or between 240+ and 250+ despite popular opinion. In ortho for example if I recall, 260+ would give you a 89% chance of matching, while 250+ it’s like 88%, and 240+ is 85%. Same thing for Derm and Neurosurg. Things don’t start dipping hard until the 220s or so, and let’s be honest there’s a big difference between a 220 scorer and a 250 scorer and it’s not just statistical noise or how much information you can Anki...

That said, I also disagree with efle that Step 1 tests useless minutae or random facts. I didn’t use Anki and there wasn’t a single question on my exam where I was “straining” to remember a fact from First Aid like I would on a bio exam. Most questions tested realllllly basic concepts just in a contrived way. Many of the “hard” vignettes were long and had multiple contradicting pieces of evidence that you had to prioritize and weigh. There were definitely a lot of distractors that punished you if you relied on pure recognition without thinking it through.

As for useless information, there is a ridiculous amount of overlap between Step 1 and Step 2/shelves. I mean there isn’t really an agreed upon source to study from for Step 2 except for UWorld, which is more of the same info just repackaged pretty much. People just rely on their knowledge from the first 2 years anyway plus random stuff on the wards (which isn’t really that much new info to be honest)

 

[efle]

You keep saying "DO/IMG" as if this change would not also drastically impact schools outside of the top 20. The top student at EVMS (for instance) deserves a fair shake at derm, especially considering he or she is probably a better student than the average student at Cornell.

But this change will undoubtedly prevent that student from entering dermatology.

A Harvard student with a pass and 5/7 honors will always beat out a EVMS student with 7/7 honors. And dont say LORs, because we all know the MGH faculty will look nicer than the glowing letters from EVMS (and wherever the student managed to get sub-Is)

See, that's what I don't buy. Look at the raw numbers. Hopkins sent 3 people into Ortho for example, out of ~1000 applicants. Also 3 into Derm out of ~650. 2 Optho, 3 ENT, 2 urology.

If you're looking to blame those few people from big names for your scramble, you're grasping at straws. It's an itty bitty negligible teeny weeny fraction of the competition. By far the more common scenario is someone being undoubtedly prevented from matching their surgical specialty of interest because they didn't memorize enough of the useless portions of First Aid.

 

[Lawpy]

See, that's what I don't buy. Look at the raw numbers. Hopkins sent 3 people into Ortho for example, out of ~1000 applicants. Also 3 into Derm out of ~650. 2 Optho, 3 ENT, 2 urology.

If you're looking to blame those few people from big names for your scramble, you're grasping at straws. It's an itty bitty negligible teeny weeny fraction of the competition. By far the more common scenario is someone being undoubtedly prevented from matching their surgical specialty of interest because they didn't memorize enough of the useless portions of First Aid.

But I thought you said there weren't too many applicants from top schools applying competitively?

 

[efle]

So I’m going to be a little biased since I scored 260+ on Step 1, but the difference in residency match rates for competitive specialties don’t actually differ that much between 250+ and 260+, or between 240+ and 250+ despite popular opinion. In ortho for example if I recall, 260+ would give you a 89% chance of matching, while 250+ it’s like 88%, and 240+ is 85%. Same thing for Derm and Neurosurg. Things don’t start dipping hard until the 220s or so, and let’s be honest there’s a big difference between a 220 scorer and a 250 scorer and it’s not just statistical noise or how much information you can Anki...

That said, I also disagree with efle that Step 1 tests useless minutae or random facts. I didn’t use Anki and there wasn’t a single question on my exam where I was “straining” to remember a fact from First Aid like I would on a bio exam. Most questions tested realllllly basic concepts just in a contrived way. Many of the “hard” vignettes were long and had multiple contradicting pieces of evidence that you had to prioritize and weigh. There were definitely a lot of distractors that punished you if you relied on pure recognition without thinking it through.

As for useless information, there is a ridiculous amount of overlap between Step 1 and Step 2/shelves. I mean most people don’t even have a source to study from for Step 2 except for UWorld, which is more of the same info just repackaged pretty much.

The drop off happens more like 230s when you look at the Tableau and you have to consider the numbers of people you're talking about. Most people with a score in the 220s that applied ortho matched, but that's a tiny fraction of a few dozen, and most of them probably only applied because they felt confident about matching at home or somewhere they did an away. There are doubtless many, many people who give up and don't even attempt to match surgical specialties any more because they score in the 220s or 230s and didn't feel they had that level of safety net.

Put it this way ace. If you took a well respected attending hospitalist at a major hospital, lets say an attending on the teaching service at MGH, do you really think they could take Step 1 tomorrow and score a 260+? Of course not. A huge component is details. Hell I had all the basic concepts understood at the end of preclinical and scored in the 210s on my first practice exam, then spent more than 2 months memorizing details out of First Aid and Uworld and climbed 40 points from doing so. You don't have to use Anki (I didn't either) but you do have to walk into the test with an encyclopedia's worth of factoids that our best mentors do not possess.

 

[efle]

Yeah, I'm at one of those schools and I spent my preclinical years studying for boards. What I said is correct. I have no idea what your point is.

Do you think your peers that didn't study for boards M1/M2, were unable to learn as well as you on the wards? Personally I think it's preposterous to say taking, and doing well on, the step 1 makes me a better student on the wards than my classmates who haven't taken it yet. I'm sure I found the shelf much more managable, but to pretend it makes me better able to learn actual patient care is too narcissistic even for me

 

[ace_inhibitor111]

The drop off happens more like 230s when you look at the Tableau and you have to consider the numbers of people you're talking about. Most people with a score in the 220s that applied ortho matched, but that's a tiny fraction of a few dozen, and most of them probably only applied because they felt confident about matching at home or somewhere they did an away. There are doubtless many, many people who give up and don't even attempt to match surgical specialties any more because they score in the 220s or 230s and didn't feel they had that level of safety net.

Put it this way ace. If you took a well respected attending hospitalist at a major hospital, lets say an attending on the teaching service at MGH, do you really think they could take Step 1 tomorrow and score a 260+? Of course not. A huge component is details. Hell I had all the basic concepts understood at the end of preclinical and scored in the 210s on my first practice exam, then spent more than 2 months memorizing details out of First Aid and Uworld and climbed 40 points from doing so. You don't have to use Anki (I didn't either) but you do have to walk into the test with an encyclopedia's worth of factoids that our best mentors do not possess.

Not to nitpick but I’d bet money they could take it tomorrow cold and get 240+ easy. Probably not 260, but I wouldn’t be able to get anywhere close to my past standardized scores either without brushing up.

One thing, if they ever change the scoring of Step 1, quintiles or quartiles make the most sense. Pass/Fail on an exam where 94% of test takers pass... well, I don’t that would be very useful

 

[Ho0v-man]

I would be absolutely SHOCKED if I had an attending pimp me on the arachadonic acid metabolites pathways. All my pimping was stuff like "which antibiotics would you consider for this suspected source of sepsis."

Oh trust me I was shook. I was glad it wasn’t happening to me bc the residents were totally not having a good time lol.


I got more of the bolded than probably anything, but that’s just softball stuff everyone knows.

Btw, I don’t totally disagree with you. I doubt I’m ever going to save anyone’s life bc I know that rRNA is made in the nucleolus, not the nucleus. Of course this excludes the 5srRNA made by RNA polymerase III which is mostly responsible for tRNA synthesis (hating myself as I type this). No doctor should ever care about that.

So I say the test should focus more on things that matter. That way the number reported meant a little more. Even in the basic sciences, there’s enough clinically relevant stuff to test on so no one ever has to care about nonsense like that. But to be fair, nothing quite that esoteric showed up on my step 1.

 

[PapaGuava]

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