Just a few points to make. All of these are generalities, so please don't tell me about you or your friend who was the one exception to these. These apply to most students:
1. Step 1 is a measure of knowledge of the first 2 years of medicine, and tests clinically relevant knowledge. It's not esoteric garbage, it's the FOUNDATION OF MEDICINE. You can't argue that step 1 doesn't test important information. Sure no one cares about HLA Subtypes or lysosomal storage diseases, but these types of questions are few and far between.
2. Performance on Step 1 impacts performance during third year. High scorers tend to stand out on rounds and crush their shelf exams. Step 1 doesn't go out the window after test day. 90% is incredibly important and is what will help you do well during third year. Sure some not so great step scorers do well third year and a few 250+ kids struggle, but ON AVERAGE the 250+ kids outperform the 200-220 kids. Congrats if you got a 215 and are honoring everything. That doesn't mean the trend doesn't exist.
3. People who score well on step 1 generally score well on step 2. Putting the emphasis on Step 2 instead of Step 1 would do absolutely nothing. No one cares if maybe "it's more clinical". Most people with similar effort will not drop or gain percentiles from Step 1 to Step 2. The argument that step 2 is better than step 1 is ridiculous. Both exams can easily accomplish the same goal. No matter what metric you replace step 1 with, good students will continue to do better, there will always be a bell curve, you can't escape that.
4. Generally speaking, the top 10 to 20 to X% of Step 1 scorers tend to make better residents than low scorers. Even aprogramdirector said this. Please don't get offended... No one is saying that having a 210 makes you a bad doctor, what we are saying is that people with killer board scores, tend to be superstar residents much more often than those with poor scores. For the record, I'm not saying a 230 and a 240 are different or a 250 and 260 are different, no one has that resolution or detail. but when talking about 30-50 points on step 1, there will be noticeable differences.
Finally:
While these may be general trends, remember that you are an individual, not a trend line. I have met terrible students who get lucky on test day and score high and great students who have a bad day and score low. That doesn't mean that you can't be a good doctor.
But remember that for the vast majority of students their step one score will be a direct reflection of their work ethic and medical knowledge after 1/2 of medical school, and it's not a surprise that students who do well on this exam tend to do well on most other aspects of medical school and residency.
EDIT: And sure, you can't prove that Step 1 makes better residents in any study, but when countless faculty and program directors see the association, that's pretty hard to deny. Just do a rotation with general surgery residents and plastic/ENT/Ortho residents at the same regular hospital (not looking at Harvard Plastic vs Gen Surg, think mid-tier institutions). Another example: countless faculty have commented that their derm prelim interns are better than the IM prelim interns, which is shocking considering the difference in goals during that intern year. You will be absolutely blown away by the difference in resident quality overall.
