MD Heard a rumor that Step 1 (and maybe Step 2 CK) may change from scores to P/F. Is that true?

[PreMedMissteps]

Heard a rumor that Step 1 (and maybe Step 2 CK) may change from scores to P/F. Is that true?

If so, why? Seems like this would make things more difficult for residency program directors of competitive programs.
And is it supposed to suggest that someone with a 205 should be viewed the same as someone with a 255?

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[7331poas]

bro there have been 20 threads on this.

 

[PreMedMissteps]

bro there have been 20 threads on this.

Lol, sorry. I’m in the premed forum so wasn’t aware. Now there’s 21! Will now search.

 

[Goro]

Heard a rumor that Step 1 (and maybe Step 2 CK) may change from scores to P/F. Is that true?

If so, why? Seems like this would make things more difficult for residency program directors of competitive programs.
And is it supposed to suggest that someone with a 205 should be viewed the same as someone with a 255?

Answer is yes.

Why? It will take the stress off of preclinical years.

It means that two different candidates will now be viewed either through the prism of Step 2, and/or the other humanistic stuff that PDs used to do before Step 1 mania made it the exam a screening tool:

• Auditions
• LORs
• research
• clinical grades/evals
• networking

BTW, there is no evidence that I know of that shows that Step I scores correlate to being a good doctor. The only thing it correlates to is the Medical Knowledge competency, which is but one of six required competencies for med students and residents. The other five are humanistic domains.

See in particular the wise Med Ed's comments in this thread:
Questions about the USMLE

 

[PreMedMissteps]

Answer is yes.

Why? It will take the stress off of preclinical years.

It means that two different candidates will now be viewed either through the prism of Step 2, and/or the other humanistic stuff that PDs used to do before Step 1 mania made it the exam a screening tool:

• Auditions
• LORs
• research
• clinical grades/evals
• networking

BTW, there is no evidence that I know of that shows that Step I scores correlate to being a good doctor. The only thing it correlates to is the Medical Knowledge competency, which is but one of six required competencies for med students and residents. The other five are humanistic domains.

See in particular the wise Med Ed's comments in this thread:
Questions about the USMLE

Thank you for your answer and for the link. Reading it now.
Dumb question.... your answer of “yes.” Is that saying that Step 1 will be pass/fail for next year? Or, yes, it’s being considered?

 

[Nurse2MD2018]

https://www.washingtonpost.com/news...ericas-future-doctors/?utm_term=.5dfec9cdff42
An awesome read on this topic.

 

[jhenj529]

Answer is yes.

Why? It will take the stress off of preclinical years.

It means that two different candidates will now be viewed either through the prism of Step 2, and/or the other humanistic stuff that PDs used to do before Step 1 mania made it the exam a screening tool:

• Auditions
• LORs
• research
• clinical grades/evals
• networking

BTW, there is no evidence that I know of that shows that Step I scores correlate to being a good doctor. The only thing it correlates to is the Medical Knowledge competency, which is but one of six required competencies for med students and residents. The other five are humanistic domains.

See in particular the wise Med Ed's comments in this thread:
Questions about the USMLE

This wouldn't change in a year and a half, right? I think this is a terrible idea. Make school prestige more important and other subjective markers. Also would crush DOs

 

[Goro]

Thank you for your answer and for the link. Reading it now.
Dumb question.... your answer of “yes.” Is that saying that Step 1 will be pass/fail for next year? Or, yes, it’s being considered?

that answer is to the title of your thread

 

[7331poas]

God damn this is the worst idea I have ever heard of. How the hell are students from low ranked school going to match competitive specialties?

Instead of a good step score, research years are now basically mandatory. I hope to God this doesn't go into effect until I am done.

 

[7331poas]

that answer is to the title of your thread

That doesn't answer his question. Do you know a time frame?

 

[ciestar]

That doesn't answer his question. Do you know a time frame?

Nobody knows until they meet to discuss it next month. It is all speculation at this point.

 

[jhenj529]

Nobody knows until they meet to discuss it next month. It is all speculation at this point.

Wouldn't it take 2-3 years to implement, like the old vs new MCAT?

 

[7331poas]

Wouldn't it take 2-3 years to implement, like the old vs new MCAT?

presumably they could literally just make the next test cycle P/F on a whim. our school does step 1 after clerkship, I feel a little pressured to move my date up to before clerkship just so I can get a score.

 

[jhenj529]

presumably they could literally just make the next test cycle P/F on a whim. our school does step 1 after clerkship, I feel a little pressured to move my date up to before clerkship just so I can get a score.

You think I'm screwed if I'm testing in a year and a half?

 

[7331poas]

You think I'm screwed if I'm testing in a year and a half?

idk. our dean is preaching how this is such a great thing for education; internally I am wondering why she hasnt thought through how such a change is screwing every student in the US other than the harvard/hopkins students.

 

[jhenj529]

idk. our dean is preaching how this is such a great thing for education; internally I am wondering why she hasnt thought through how such a change is screwing every student in the US other than the harvard/hopkins students.

I thought the meeting already happend? What's this talk about may?

 

[PreMedMissteps]

This wouldn't change in a year and a half, right? I think this is a terrible idea. Make school prestige more important and other subjective markers. Also would crush DOs

I agree. If the desire is for a competitive specialty or top ranked program, those students won’t consider a lower ranked med school. And since many aren’t entirely sure of their desired specialty until well-into med school, that would make attending a higher ranked med even more desirable. As it stands now, a strong student can happily attend whatever med school accepts him/her knowing that a top step score and strong school performance will get residency directors’ attention.
Why not then make the MCAT pass/fail then? Or is that next?

 

[ciestar]

Wouldn't it take 2-3 years to implement, like the old vs new MCAT?

Again, impossible to say.

 

[ciestar]

I thought the meeting already happend? What's this talk about may?

Different meeting. The March meeting was people (AMA included) that put in their recommendations that it be pass/fail.

 

[PreMedMissteps]

I’m assuming that some group doesn’t like that some residency directors (probably of top programs or very competitive specialties) may have been using Step 1 as the initial down-selecting. Want Derm or UCSF or MGH, then all with sub 235 are eliminated unless UIM. Or maybe: all with 250+ get an interview unless some other shortcoming(s).

 

[afib123]

This would be the worst idea. But, I got my 250+ score so I could care less. It is the future generations that are screwed and will be at the mercy of connections through family friends, social skills, and subjective grades between each medical school. Step 1 is the best exam there is out there to separate excellent students from good/average students the first 2 years. Then clinical grades will determine your clinical excellence. step 1 + 3rd year grades=best combo to evaluate students

Of course, medical schools professors will love this idea because students have to pay attention to their outdated (not all but a wide majority) lectures and take their personally made tests. But program directors are going to dislike it. People fail to realize, PD's use Step 1 because they like it not because they are forced. PD's are more than welcome to look at the extraneous crap but most of them know it's crap and don't consider it

 

[afib123]

presumably they could literally just make the next test cycle P/F on a whim. our school does step 1 after clerkship, I feel a little pressured to move my date up to before clerkship just so I can get a score.

You should.

 

[Lnsean]

Heard a rumor that Step 1 (and maybe Step 2 CK) may change from scores to P/F. Is that true?

If so, why? Seems like this would make things more difficult for residency program directors of competitive programs.
And is it supposed to suggest that someone with a 205 should be viewed the same as someone with a 255?

It will make it so that if your dad was friends with the PD, you would be a sure thing and no one would be able to criticize it. M3s will start being cute on rotations and bring in cookies, staying extra late, coming in at 3AM, and bringing in hand-made thank you cards.

 

[afib123]

It will make it so that if your dad was friends with the PD, you would be a sure thing and no one would be able to criticize it. M3s will start being cute on rotations and bring in cookies, staying extra late, coming in at 3AM, and bringing in hand-made thank you cards.

Oh yes.

 

[deleted600623]

Who votes on this? Like what committee? And who makes up this committee? Honestly this is the most millennial BS I’ve ever read.

 

[kb1900]

Would love to see an argument for why step 1 is better than step 2 in evaluating residency applicants

 

[wontonsoup]

What do you guys think about oral boards replacing STEP1? Assuming we could get over the logistical hurdles, at first glance oral boards with a scaled numerical score seem like the best of both worlds. Less cramming for testable minutiae and potentially more emphasis on clinical reasoning and communication. It would add more subjectivity to a system already full of complaints of arbitrariness, though.

 

[PreMedMissteps]

I’m wondering if some group believes that the most competitive specialties and programs are too populated with overly-represented groups?

If we look at the residents’ pics posted on top programs and competitive specialties, will we see too many ORMs who test very well?

And why is having a score for Step 1 “bad,” but it’s ok to have scores for MCAT and Step 2?

 

[Raney Schauer]

Answer is yes.

Why? It will take the stress off of preclinical years.

It means that two different candidates will now be viewed either through the prism of Step 2, and/or the other humanistic stuff that PDs used to do before Step 1 mania made it the exam a screening tool:

• Auditions
• LORs
• research
• clinical grades/evals
• networking

BTW, there is no evidence that I know of that shows that Step I scores correlate to being a good doctor. The only thing it correlates to is the Medical Knowledge competency, which is but one of six required competencies for med students and residents. The other five are humanistic domains.

See in particular the wise Med Ed's comments in this thread:
Questions about the USMLE

The hanging question therefore is "When"? Right now step scores still highly correlate to what specialties you'll get into.

 

[ciestar]

I’m wondering if some group believes that the most competitive specialties and programs are too populated with overly-represented groups?

If we look at the residents’ pics posted on top programs and competitive specialties, will we see too many ORMs who test very well?

And why is having a score for Step 1 “bad,” but it’s ok to have scores for MCAT and Step 2?

From what I’ve read, it is all about student well being. The exam average creeps up every year and med students put their identity into scoring well on the exam. Your world should not come crashing down if you don’t do great. I speak from experience. I shouldn’t have had to weigh dropping out of med school over it. Am I advocating it be P/F? Not necessarily.

Not everything is about race.

 

[studentdocftw]

A happy medium might be blinding PDs to Step 1 scores until after interview season. After interviews are complete, PDs get the scores and can use them how they want. This will allow people to get past the initial screen..which is probably the biggest gripe about the exam...but will give PDs who like the exam flexibility to include it in their rank algorithm.

 

[sloop]

Would love to see an argument for why step 1 is better than step 2 in evaluating residency applicants

Because essentially everyone has taken Step 1 by the time they apply for residency. A good portion of med students do not take Step 2 until some point in 4th year (the deadline for Step 2 or whether it is even required for graduation completely varies depending on the school).

One can argue about the applicability of Step 2 vs Step 1 content all they like but the truth is that a metric that can compare all applicants has a significant advantage over one that can compare only some of them.

 

[Goro]

The hanging question therefore is "When"? Right now step scores still highly correlate to what specialties you'll get into.

Aye, there's the rub.

 

[Goro]

That doesn't answer his question. Do you know a time frame?

No one does.

BTW, the angst about this subject reminds of the time when AAMC changed the MCAT.

You would have though it was going to be in Korean, the way people carried on!

 

[PickleRickelus]

I think I may have a solution. It is not perfect and I can guarantee that it is bound to tick off a lot of people, so here it goes.

Make step one the test it was intended to be: a competency-based exam that is simply pass-fail. Then that leaves the issue of how do you screen / rank applicants for residency programs. Well, introduce another test!

Now bear with me, this new test will be 4 hours max. It will be composed of four sections with 10 minute breaks in between.

The first section will be a rehash of CARS type passages that test your ability to read and synthesize information. I would like to see the passages pertaining to philosophy and ethics as they apply to advances in medicine and healthcare administration. If we are all going to be neurotic Med students, might as well focus our efforts on learning ethical/philosophical frameworks to confront issues like healthcare/resource utilization, advancements in technology such as gene editing, artificial intelligence, etc. These advances are poised to change the way we practice medicine in the future so we must be able to adapt. I suppose the best way to prepare for this section is to spend an hour a day reading an article from The New Yorker or BBC news.

The second section will simply be an IQ test. Not sure what kinds are available right now but put a team of psychologists in a room and I'm sure they can come up with something. At the top of my head, maybe include some logic games or puzzles.p

The third section will be an EQ test. Again, not sure how this will play out but maybe come up with some type of Casper like test to see how you would react when confronted with certain ethical dilemmas.

The fourth section will be specialty specific. For example, if you want to go into any type of surgery, this section could test you on anatomy, spatial orientation, being able to read CT/MRI scans and identify structures as being normal versus abnormal. This will largely depend on what program directors what see in their applicants. You could have the option to take another one as a back up specialty like IM/FM but the IM / FM program directors will not be able to see that you took the surgical one to control for bias.

Last and finally, this section will be optional on conducting an evaluation in another language. Nothing too crazy, it will just require you to possess high School level knowledge of a foreign language with an emphasis on medical terminology.

I suppose the best comparison would be to make it like applying to college. You have the ACT / SAT and a subject test in the thing you want to major in with a foreign language component thrown in.

Edit: typo on the number of sections

 

[ricksimmonsrafowens]

• Auditions
• LORs
• research
• clinical grades/evals
• networking

rip any student from outside top USMD applying to competitive specialties like neurosurg, plastics, etc... Research/networking and LORS are strongly dependent on the medical school of the student, not so much on the student themselves. Auditions can be very hit or miss experience depending on the away institution. I feel really really bad for future residency applicants with a Pass/Fail Step 1.

 

[ricksimmonsrafowens]

I think I may have a solution. It is not perfect and I can guarantee that it is bound to tick off a lot of people, so here it goes.

Make step one the test it was intended to be: a competency-based exam that is simply pass-fail. Then that leaves the issue of how do you screen / rank applicants for residency programs. Well, introduce another test!

Now bear with me, this new test will be 4 hours max. It will be composed of four sections with 10 minute breaks in between.

The first section will be a rehash of CARS type passages that test your ability to read and synthesize information. I would like to see the passages pertaining to philosophy and ethics as they apply to advances in medicine and healthcare administration. If we are all going to be neurotic Med students, might as well focus our efforts on learning ethical/philosophical frameworks to confront issues like healthcare/resource utilization, advancements in technology such as gene editing, artificial intelligence, etc. These advances are poised to change the way we practice medicine in the future so we must be able to adapt. I suppose the best way to prepare for this section is to spend an hour a day reading an article from The New Yorker or BBC news.

The second section will simply be an IQ test. Not sure what kinds are available right now but put a team of psychologists in a room and I'm sure they can come up with something. At the top of my head, maybe include some logic games or puzzles.p

The second section will be an EQ test. Again, not sure how this will play out but maybe come up with some type of Casper like test to see how you would react when confronted with certain ethical dilemmas.

The third section will be specialty specific. For example, if you want to go into any type of surgery, this section could test you on anatomy, spatial orientation, being able to read CT/MRI scans and identify structures as being normal versus abnormal. This will largely depend on what program directors what see in their applicants. You could have the option to take another one as a back up specialty like IM/FM but the IM / FM program directors will not be able to see that you took the surgical one to control for bias.

Last and finally, the last section will be on conducting an evaluation in another language. Nothing too crazy, it will just require you to possess high School level knowledge of a foreign language with an emphasis on medical terminology.

I suppose the best comparison would be to make it like applying to college. You have the ACT / SAT and a subject test in the thing you want to major in with a foreign language component thrown in.

lol

What level of training are you at?

 

[Sephirakra]

I think I may have a solution. It is not perfect and I can guarantee that it is bound to tick off a lot of people, so here it goes.

Make step one the test it was intended to be: a competency-based exam that is simply pass-fail. Then that leaves the issue of how do you screen / rank applicants for residency programs. Well, introduce another test!

Now bear with me, this new test will be 4 hours max. It will be composed of four sections with 10 minute breaks in between.

The first section will be a rehash of CARS type passages that test your ability to read and synthesize information. I would like to see the passages pertaining to philosophy and ethics as they apply to advances in medicine and healthcare administration. If we are all going to be neurotic Med students, might as well focus our efforts on learning ethical/philosophical frameworks to confront issues like healthcare/resource utilization, advancements in technology such as gene editing, artificial intelligence, etc. These advances are poised to change the way we practice medicine in the future so we must be able to adapt. I suppose the best way to prepare for this section is to spend an hour a day reading an article from The New Yorker or BBC news.

The second section will simply be an IQ test. Not sure what kinds are available right now but put a team of psychologists in a room and I'm sure they can come up with something. At the top of my head, maybe include some logic games or puzzles.p

The second section will be an EQ test. Again, not sure how this will play out but maybe come up with some type of Casper like test to see how you would react when confronted with certain ethical dilemmas.

The third section will be specialty specific. For example, if you want to go into any type of surgery, this section could test you on anatomy, spatial orientation, being able to read CT/MRI scans and identify structures as being normal versus abnormal. This will largely depend on what program directors what see in their applicants. You could have the option to take another one as a back up specialty like IM/FM but the IM / FM program directors will not be able to see that you took the surgical one to control for bias.

Last and finally, the last section will be on conducting an evaluation in another language. Nothing too crazy, it will just require you to possess high School level knowledge of a foreign language with an emphasis on medical terminology.

I suppose the best comparison would be to make it like applying to college. You have the ACT / SAT and a subject test in the thing you want to major in with a foreign language component thrown in.

I'm afraid you have five sections in your four-section test.

 

[PickleRickelus]

I'm afraid you have five sections in your four-section test.

Yes you are right, I meant to say the language section is optional so it should come out to four sections total lol

 

[PickleRickelus]

lol

What level of training are you at?

That bad huh?

 

[Little Green Mensch]

As someone from a newer medical school who matched into a surgical subspecialty, I have no doubt that my Step 1 score kept that option open to me.

Step 1 serves the same role as the MCAT: a standardized exam that allows direct comparison between applicants from schools with different curricula and grade schemes. Were I a program director, I would not want to give up the ability to quickly stratify the ever-increasing number of applicants.

High-stakes testing can be stressful, but most physicians will face far worse stressors. If you can't handle doing poorly on a test (granted, a test that has a huge impact on your career trajectory), how will you handle the bad outcomes that are an inevitable part of medicine?

 

[LebronManning]

I think I may have a solution. It is not perfect and I can guarantee that it is bound to tick off a lot of people, so here it goes.

Make step one the test it was intended to be: a competency-based exam that is simply pass-fail. Then that leaves the issue of how do you screen / rank applicants for residency programs. Well, introduce another test!

Now bear with me, this new test will be 4 hours max. It will be composed of four sections with 10 minute breaks in between.

The first section will be a rehash of CARS type passages that test your ability to read and synthesize information. I would like to see the passages pertaining to philosophy and ethics as they apply to advances in medicine and healthcare administration. If we are all going to be neurotic Med students, might as well focus our efforts on learning ethical/philosophical frameworks to confront issues like healthcare/resource utilization, advancements in technology such as gene editing, artificial intelligence, etc. These advances are poised to change the way we practice medicine in the future so we must be able to adapt. I suppose the best way to prepare for this section is to spend an hour a day reading an article from The New Yorker or BBC news.

The second section will simply be an IQ test. Not sure what kinds are available right now but put a team of psychologists in a room and I'm sure they can come up with something. At the top of my head, maybe include some logic games or puzzles.p

The third section will be an EQ test. Again, not sure how this will play out but maybe come up with some type of Casper like test to see how you would react when confronted with certain ethical dilemmas.

The fourth section will be specialty specific. For example, if you want to go into any type of surgery, this section could test you on anatomy, spatial orientation, being able to read CT/MRI scans and identify structures as being normal versus abnormal. This will largely depend on what program directors what see in their applicants. You could have the option to take another one as a back up specialty like IM/FM but the IM / FM program directors will not be able to see that you took the surgical one to control for bias.

Last and finally, this section will be optional on conducting an evaluation in another language. Nothing too crazy, it will just require you to possess high School level knowledge of a foreign language with an emphasis on medical terminology.

I suppose the best comparison would be to make it like applying to college. You have the ACT / SAT and a subject test in the thing you want to major in with a foreign language component thrown in.

Edit: typo on the number of sections

This is the worst thing I've read in 2019

 

[LebronManning]

This is literally the most ridiculous medicine related thing I've ever heard in my life. God the snowflakes are infiltrating medicine like no other these days.

Step 1 doesn't ruin anyone's life. US MD that scores poorly but still passes will easily match FM. That's what you get for being a poor test taker or just not very bright. Brighter people who work harder deserve nicer things (specialties they want). Thats just how life works.

This would absolutely annihilate students that are not at the top 40 schools matching into competitive specialties.

 

[Trollest]

So bad that I am going to keep my negatives thoughts to myself. Whoever made the original post has got to be kidding me. This is the reason why some of you shouldn't vote.

"A guy who is struggling on step 1 and somehow feels that he can perform better on another standardized test??" WTF, you can't make jokes like these.

This is the worst thing I've read in 2019

 

[kb1900]

Because essentially everyone has taken Step 1 by the time they apply for residency. A good portion of med students do not take Step 2 until some point in 4th year (the deadline for Step 2 or whether it is even required for graduation completely varies depending on the school).

One can argue about the applicability of Step 2 vs Step 1 content all they like but the truth is that a metric that can compare all applicants has a significant advantage over one that can compare only some of them.

Having everyone take step 2 earlier and putting less emphasis on step 1 seems far more reasonable than making step 1 pass fail.

 

[Goro]

rip any student from outside top USMD applying to competitive specialties like neurosurg, plastics, etc... Research/networking and LORS are strongly dependent on the medical school of the student, not so much on the student themselves. Auditions can be very hit or miss experience depending on the away institution. I feel really really bad for future residency applicants with a Pass/Fail Step 1.

Did this type of situation exist prior to Step I' s current incarnation?

The sky isnt falling.

 

[Nurse2MD2018]

Excuse my ignorance but how is this any different than schools moving towards P/F curriculum? I’ve heard some of these same arguments from students who attend institutions with graded preclinical years and an internal ranking system. I would like to think that admins are seeing systemic issues with the current step 1 process that students aren’t aware of, if they are aiming for such a drastic change. What were PDs doing to determine competitive candidates prior to having such a huge emphasis on Step 1? How were people matching into competitive specialties back then?

 

[Kuratz]

At some point PDs need an objective way to stratify applicants for interview invites. If Step 1 goes P/F it becomes a checkbox like Step 2CS, and an expensive one at that. The buck effectively gets kicked down a rung to the freaking MCAT which obviously plays a significant role in what tier of med school one can attend. I’d much rather be judged for my monumental effort on a sub-optimal exam in conjunction with, instead of only, the bull**** subjectiveness that is research output (I.e. most often useless noise), LORs (who you know), clinical evals, and tier of med school. They could easily change the exam to be more useful with clinical relevance but instead have gone down the rabbit hole of PhD mental-masturbation for score control that has lead to the situation we are in now.

On one hand I think med schools have an interest in de-emphasizing Step 1 in order to keep their lecturers relevant. I think most of my classmates had learned most of the requisite USMLE knowledge on their own and could just as easily done preclinical years on their own. On the other hand you have the USMLE that makes an absurd amount of money off of their exams and NBMEs. In both cases there are some people making lots of money. More than you reading this is likely to make. The dean at my med school makes 7 figures and the AAMC president makes 7 figures.

Medical school education has been consumed by greedy parasites who preach to us the importance of being selfless. I’m not sure what will happen with Step 1 but I’m pretty confident it will be in the administrators’ best financial interest. Post-secondary education, and especially medical education, is one of the biggest rackets in existence. Needs to be torn down then rebuilt from the ground up. Until then... get back to your Anki!

 

[ricksimmonsrafowens]

Did this type of situation exist prior to Step I' s current incarnation?

The sky isnt falling.

What do you mean by "current incarnation"?

and yes that type of situation did actually exist prior to residency applications becoming meritocratic thru the NRMP algorithm and numerical scoring of USMLE exams

 

[Trollest]

Not only that, I think the MOVE towards a quantified STEP 1 from a P/F system of the past was a result of the need to quantify application.

Like Step 1 had to be implemented for a reason.

What do you mean by "current incarnation"?

and yes that type of situation did actually exist prior to residency applications becoming meritocratic thru the NRMP algorithm and numerical scoring of USMLE exams