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

[VA Hopeful Dr]

Well how do you suggest they get through 500 apps for 2-3 spots? Its not perfect, but its the best thing we got. Why would you take someone who scores 220 over someone who scores 260? Its obvious the 220 had a poorer knowledge base. People should know how competitive things are and should keep that in mind when studying for step.

Lots of reasons.

That aside, as others have noted this won't change much unless CK also goes P/F. Then we'll just see GPA being emphasized. You'll have the problem then of PDs learning what schools grade more strictly compared to others and the students from those schools will be judged differently.

If we're trying to cut down on student stress with regards to step 1 scores, seems like the easiest thing would be to do something like score ranges. Instead of exact scores, maybe ranges like Less than 190 (or whatever passing grade is) then in increments of 20-30 and then >240 or so. You can still use it as a cut off and it fixes the issue where a 220 and a 230 aren't likely all that different in terms of performance.

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[deleted480308]

Well how do you suggest they get through 500 apps for 2-3 spots? Its not perfect, but its the best thing we got. Why would you take someone who scores 220 over someone who scores 260? Its obvious the 220 had a poorer knowledge base. People should know how competitive things are and should keep that in mind when studying for step.

The first part is the real issue, they just have to narrow the field

They just aren’t going to read that many, it’s not that a 230 is a better employee than 225.

 

[Trollest]

All thing being equal and standardized, a 230 "should be" a better employee than a 225. That's just fact.

The first part is the real issue, they just have to narrow the field

They just aren’t going to read that many, it’s not that a 230 is a better employee than 225.

 

[Chibucks15]

All thing being equal and standardized, a 230 "should be" a better employee than a 225. That's just fact.

and yet they aren't? I don't understand why 10 (or however many) more questions right on a multiple choice exam would in any way have an effect on your ability as an employee. It seems like a healthy chunk of med students have never been in the real world and don't understand that being an employee is 95% just working hard, being a decent person, and working well in a team, and has no correlation with perceived intelligence from a 3 digit score

 

[differentiating]

I don't envy future students if Step 1 is changed to P/F. I understand that Step 1 is an imperfect test - as is Step 2 - but I'd much rather have those objective measures of my relative performance balancing out the subjective mess that is clinical evaluations and grades than to have that alone determining my worth. Even at a top medical school, it'd worsen the dichotomy between those the med school endorses to succeed and those it doesn't care as much about.

 

[Goro]

Step 1 tests important concepts in medicine and pathophysiology and how we practice modern medicine... how is it not relevant to clinical competency?

C'mon Rick, stop depressing me

https://knowledgeplus.nejm.org/blog/exploring-acgme-core-competencies/
The six ACGME Core Competencies are as follows:

• Practice-Based Learning and Improvement
• Patient Care and Procedural Skills
• Systems-Based Practice
• Medical Knowledge
• Interpersonal and Communication Skills
• Professionalism

Step I only assesses for one of 1/6 critical domains.

 

[xALIAx]

Step 1 is a measure of how well someone can buckle down and independently work towards a goal, superimposed on testing ability. If you aren't happy with your Step 1 score, maybe you should have spent more time studying and less time backpacking on the EuroRail.

 

[xALIAx]

You also have to look at biases of the posters involved. A DO faculty member would likely be in favor of removing a test that his students statistically do poorly on.

 

[ciestar]

Oh lovely, what an assumption that because someone didn’t do as well on step 1 they didn’t study hard. Give me a break.

 

[xALIAx]

Ok, if you didn't do well on Step 1, you either did as your practice tests predicted (in which case, what did you expect? Should have postponed and studied more) or, you bombed on test day when it was time to perform and came up well short of your pre-test average. Both outcomes reflect poor decision making and / or ability to perform under pressure. If you were a PD and under pressure to not lose residents why would you not want an easily identifiable measure of this?

 

[Matthew9Thirtyfive]

Oh lovely, what an assumption that because someone didn’t do as well on step 1 they didn’t study hard. Give me a break.

It’s your own fault. You would have gotten a 260 if you had just studied more.

 

[Trollest]

Dude, I don't make the rules. It's the same reason why ANY ADCOM would pick someone with a 3.5 gpa over 3.4 GPA; assuming they both had the same MACt, LOR, volunteering experience, etc..

You can chant all you want but you are "unthoughtful idea" would jeopardize the future of an entire generation.

and yet they aren't? I don't understand why 10 (or however many) more questions right on a multiple choice exam would in any way have an effect on your ability as an employee. It seems like a healthy chunk of med students have never been in the real world and don't understand that being an employee is 95% just working hard, being a decent person, and working well in a team, and has no correlation with perceived intelligence from a 3 digit score

 

[xALIAx]

I never said that. the step 1 score is a measure of it, just like a ruler is used to measure but is not the ultimate authority on the length of an object. when you are sifting through 1000 applications for 50 interview spots that is what happens.

 

[Chibucks15]

Dude, I don't make the rules. It's the same reason why ANY ADCOM would pick someone with a 3.5 gpa over 3.4 GPA; assuming they both had the same MACt, LOR, volunteering experience, etc..

You can chant all you want but you are "unthoughtful idea" would jeopardize the future of an entire generation.

What? I was talking about you saying that a 230 is a better employee than a 225. Your response has literally 0 to do with what I said

I’m not advocating for P/F, just a change in the system somehow to make it more reflective of actually being a physician that decides your future instead of a multiple choice test

 

[Trollest]

Unless you both have a crystal ball we do have to rely on numbers. Everything else being equal, I would hire someone who made a 35 on his ACT over the guy who made a 34, 100x over..


As for the bolded, I am sorry and thanks for pointing that out to me.

I’m not advocating for P/F, just a change in the system somehow to make it more reflective of actually being a physician that decides your future instead of a multiple choice test

 

[Chibucks15]

Unless you both have a crystal ball we do have to rely on numbers. Everything else being equal, I would hire someone who made a 35 on his ACT over the guy who made a 34, 100x over..


As for the bolded, I am sorry and thanks for pointing that out to me.

I mean come on There’s no significant gap between those arbitrary numbers though. At that point you’re effectively even and it comes down to interview and if you’re a decent person to work with.

 

[7331poas]

just a change in the system somehow to make it more reflective of actually being a physician that decides your future instead of a multiple choice test

like what? How are you going to differentiate a thousand applications?

 

[Chibucks15]

like what? How are you going to differentiate a thousand applications?

I never said I had an ironclad idea about it haha this system just seems unsustainable long term with how fast 'basic' medical knowledge is expanding and how competitive everything is. I've always been a "fix the problem before it blows up" kinda guy

 

[Chibucks15]

Step 1 is a measure of how well someone can buckle down and independently work towards a goal, superimposed on testing ability. If you aren't happy with your Step 1 score, maybe you should have spent more time studying and less time backpacking on the EuroRail.

this is an outrageous take

 

[Goro]

You also have to look at biases of the posters involved. A DO faculty member would likely be in favor of removing a test that his students statistically do poorly on.

Ever hear the rule of thumb that a DO student has to work harder than an MD to get into a more competitive residency? Why would I be in favor of eliminating one objective measure that can help one of my grads??? There are only so many PDs who are OK with COMLEX Level I (oddly, more are OK with Level II, even in the uber-specialties)

I'm all in favor of less stress on medical students. But potentially making Step II more important just moves the goalposts, as pointed out numerous times above. The solution has to be global for Boards.

A thought just occurred to me (and this might be a bitter pill for many of you), but if the thinking of NBME is anything like NBOME, then they don't care not a bit about your career aspirations. They care only whether you are competent to practice Medicine.

 

[WedgeDawg]

What? I was talking about you saying that a 230 is a better employee than a 225. Your response has literally 0 to do with what I said

I’m not advocating for P/F, just a change in the system somehow to make it more reflective of actually being a physician that decides your future instead of a multiple choice test

Yeah, see actually it doesn’t, because while a single 3 digit score is reported to you, it is actually stated to be insignificantly different from a certain range of scores (usually 6-7 points on either side). So a 225 and 230 would essentially have no meaningful difference.

 

[Chibucks15]

Yeah, see actually it doesn’t, because while a single 3 digit score is reported to you, it is actually stated to be insignificantly different from a certain range of scores (usually 6-7 points on either side). So a 225 and 230 would essentially have no meaningful difference.

My point exactly

 

[TheRealCookieMonster]

There's also a lot of people who actually have obligations other than medical school. Families, actual human lives outside of step, etc. You work as hard as you can given the circumstances. Your mindset on other peoples work ethics and intelligence makes you sound pretty insufferable honestly. Some people do better in real life and not on a multiple choice test.

Not to undermine their values, but that's those people's choice. If someone has obligations outside of medicine. That's awesome, but they need to own it. You don't get points for having other priorities and it's a good thing. PDs and more importantly patients don't care about how much you love your kids or how often you get to the gym.
I'm all for new ideas, but venting about the step isn't new.
Would you rather take and IQ test and have to run a marathon?
The step works and is very practical. You won't find a "better solution" on SDN.

As if that multiple choice test and "real life" are somehow operating with different brain cells in a different universe. If someone has the power to charm people in person or come up with a good idea in a team, but not fully apply their base medical knowledge, intelligence, study habits on paper I'm sure PDs will take that into account.

It is often said that USMLE scores don't predict residency performance. My experience this is untrue, it's clearly not the only predictor, but in general residents with higher scores are better residents.

 

[vernhart]

like what? How are you going to differentiate a thousand applications?

Step 1 (of my master, super-creative bombastically titled plan-not to be confused with the standardized test): restrict # of applications so that you don't have to differentiate between a thousand applicants

 

[jazian]

I don't buy the argument that Step 1 shouldn't be used to select for residency. If that is the case, why do colleges use ACT/SAT to see who they admit? Why would someone who answers a few more multiple choice questions make a better college student? Why do medical schools use the MCAT to screen for who to interview/admit? 70% of the test is not applicable to stuff you learn in medical school but medical schools use it anyway.

Its because each of those tests are a good way to separate out applicants and see who has good critical thinking skills/reasoning and put in the work. Sure you might get unlucky and score a few points below what your skill level is but guess what, that is not gonna kill your career. If you're aiming for a competitive specialty and you're averaging 245's on practice tests and get a 238 on the actual test, you're still in the running if you can make up for it in other areas.

The advocates that want Step P/F most likely scored very poorly in the 210-220 range and thus are shut out of the very competitive specialties. That is how life works. There's 300 urology spots/400 ENT spots for god knows how many people are interested but don't apply because of Step scores and that is not necessarily a bad thing. Programs would be overwhelmed with applications if it is P/F with no way to screen applicants. There is always going to be competition and Step 1 is the measuring stick at the medical school level just like the MCAT is at the college level and ACT/SAT is at the high school level. I want to go to Stanford for medical school but my MCAT wasn't as high as their average so I didn't get an interview cause others did better than me and that is on me. I dedicated my life to Step 1 for 3 months and got the score I wanted so I can do what I want.

Don't blame the system, the rules haven't changed and it is that way because of limited resources/spots

 

[Chibucks15]

I

Not to undermine their values, but that's those people's choice. If someone has obligations outside of medicine. That's awesome, but they need to own it. You don't get points for having other priorities and it's a good thing. PDs and more importantly patients don't care about how much you love your kids or how often you get to the gym.
I'm all for new ideas, but venting about the step isn't new.
Would you rather take and IQ test and have to run a marathon?
The step works and is very practical. You won't find a "better solution" on SDN.

As if that multiple choice test and "real life" are somehow operating with different brain cells in a different universe. If someone has the power to charm people in person or come up with a good idea in a team, but not fully apply their base medical knowledge, intelligence, study habits on paper I'm sure PDs will take that into account.

if you took the context of that I was rebuffing the statement that if people don’t score 250 it’s because they we’re lazy and didn’t have the work ethic. I wasn’t looking for brownie points. Context is key.

But man your outlook of having a family and a life outside Medicine sounds pretty miserable. This is just a job after all

 

[Cheeni17]

I don't buy the argument that Step 1 shouldn't be used to select for residency. If that is the case, why do colleges use ACT/SAT to see who they admit? Why would someone who answers a few more multiple choice questions make a better college student? Why do medical schools use the MCAT to screen for who to interview/admit? 70% of the test is not applicable to stuff you learn in medical school but medical schools use it anyway.

Its because each of those tests are a good way to separate out applicants and see who has good critical thinking skills/reasoning and put in the work. Sure you might get unlucky and score a few points below what your skill level is but guess what, that is not gonna kill your career. If you're aiming for a competitive specialty and you're averaging 245's on practice tests and get a 238 on the actual test, you're still in the running if you can make up for it in other areas.

The advocates that want Step P/F most likely scored very poorly in the 210-220 range and thus are shut out of the very competitive specialties. That is how life works. There's 300 urology spots/400 ENT spots for god knows how many people are interested but don't apply because of Step scores and that is not necessarily a bad thing. Programs would be overwhelmed with applications if it is P/F with no way to screen applicants. There is always going to be competition and Step 1 is the measuring stick at the medical school level just like the MCAT is at the college level and ACT/SAT is at the high school level. I want to go to Stanford for medical school but my MCAT wasn't as high as their average so I didn't get an interview cause others did better than me and that is on me. I dedicated my life to Step 1 for 3 months and got the score I wanted so I can do what I want.

Don't blame the system, the rules haven't changed and it is that way because of limited resources/spots

This is 2019 America where the have nots try to change the rules to take from the haves and everyone gets a participation trophy

 

[Cheeni17]

It’s funny that the first test that people take that they realize the competition is as apt as they are they want it pass fail. Most people here probably scored top ACT SAT, top gpa in undergrad, good MCAT, and now that the field had thinned and they notice they are average they come and bicker that step should be PF.


Might I ask if those bickering would be here if SAT or MCAT were pass fail?

Everyone knows the people that want step PF probably bombed it relative to the specialty they want. If you don’t believe me look at this.

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The students in this study who did poorly want PF of course.

 

[TheRealCookieMonster]

Context is key.

Point taken.

 

[Chibucks15]

It’s funny that the first test that people take that they realize the competition is as apt as they are they want it pass fail. Most people here probably scored top ACT SAT, top gpa in undergrad, good MCAT, and now that the field had thinned and they notice they are average they come and bicker that step should be PF.


Might I ask if those bickering would be here if SAT or MCAT were pass fail?

Eh I was a reapplicant and went DO. I've failed plenty of times in my life. I personally just view becoming an anki robot as not a true indicator of being a physician. I'm not saying P/F lets just make the system better. I've worked on the other side of medicine, and there are more robot doctors who don't know how to work with people and talk to patients than there ever has been.

And that's a pretty lazy take with your last post. You can literally say that about anything. I'm tired of some of the millennial mindset too and I see it in plenty of my younger classmates. But when people are literally killing themselves over a 3 digit score, maybe it has moved past the "taking from the haves and participation trophy" BS and more into the "future physician livelihood" category. Congrats on your score, and I'm glad you're proud of it. But for every person on SDN there's 3 that are barely passing or not even close to where they want to be, and they are made to feel inferior and worthless. The system is at a tipping point as a whole, and memorizing countless flashcards is just the start

 

[Cheeni17]

Suicide is no laughing matter but changing step is the complete wrong target to paint red when it comes to suicide. As someone else said we are just moving the goal posts by making it PF. also most people consider residency more stress than boards.

We can’t just make everything easy because some people can’t handleit. What’s next putting a 40 hour cap on residencies and making step 2 PF also?

It takes a person with preexsistint mental illnesss to take their life during board season. STEP does not cause depression. STEP is not to blame

Medicine is hard. Not everyone should do it. If one can not handle STEP people’s lives should not be in their hands. End of story

 

[Chibucks15]

Suicide is no laughing matter but changing step is the complete wrong target to paint red when it comes to suicide. As someone else said we are just moving the goal posts by making it PF. also most people consider residency more stress than boards.

We can’t just make everything easy because some people can’t handleit. What’s next putting a 40 hour cap on residencies and making step 2 PF also?

It takes a person with preexsistint mental illnesss to take their life during board season. STEP does not cause depression. STEP is not to blame

Again I never said PF. Most people haven’t. We’re just more for altering the system so it’s sustainable. But obviously I’m in the minority of gunner SDN land so I’ll see myself out haha

 

[Oh_Gee]

Step 1 (of my master, super-creative bombastically titled plan-not to be confused with the standardized test): restrict # of applications so that you don't have to differentiate between a thousand applicants

would hurt ERAS's wallet. not going to happen

 

[965978]

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

It would actually be extremely easy. There is already a cutoff passing score so you just tell the applicant and residency program that they’ve passed and withhold the numerical score.

 

[965978]

Does anyone think how a P/F step system will change med school admission policies in terms of how MCAT scores are evaluated?

 

[Matthew9Thirtyfive]

Does anyone think how a P/F step system will change med school admission policies in terms of how MCAT scores are evaluated?

My school already essentially treats the MCAT as p/f. Your score is blocked out in your application if it is 500 or above so the committee never sees it.

 

[Trollest]

It's very sad that you are being lied about that.

My school already essentially treats the MCAT as p/f. Your score is blocked out in your application if it is 500 or above so the committee never sees it.

 

[Matthew9Thirtyfive]

It's very sad that you are being lied about that.

I’m not sure what you mean, but I’ve seen it. The score is seen once when your application is evaluated to determine whether you interview. When your application goes to the committee post interview, it is redacted if you scored a 500+.

 

[965978]

I’m not sure what you mean, but I’ve seen it. The score is seen once when your application is evaluated to determine whether you interview. When your application goes to the committee post interview, it is redacted if you scored a 500+.

So the numerical score counts in the pre-II process but not the post-II process?

I wouldn’t necessarily consider that as using the MCAT as a p/f exam since the score weighs heavier pre-II for most schools anyways.

 

[Gurby]

Not to undermine their values, but that's those people's choice. If someone has obligations outside of medicine. That's awesome, but they need to own it. You don't get points for having other priorities and it's a good thing. PDs and more importantly patients don't care about how much you love your kids or how often you get to the gym.

You wanna be a cardiac surgeon, GRIND!

 

[Matthew9Thirtyfive]

So the numerical score counts in the pre-II process but not the post-II process?

I wouldn’t necessarily consider that as using the MCAT as a p/f exam since the score weighs heavier pre-II for most schools anyways.

They use a 496 as a cutoff for getting an interview. If you meet that you’ve met the minimum for MCAT and whether you get one is based on other factors. And I’ve seen a number of people with 496-500 get interviews. They weigh other stuff more heavily than the MCAT.

 

[7331poas]

I’m not sure what you mean, but I’ve seen it. The score is seen once when your application is evaluated to determine whether you interview. When your application goes to the committee post interview, it is redacted if you scored a 500+.

bro that is entirely different than being MCAT blind. They still pick their interviewees off the mcat.

 

[Matthew9Thirtyfive]

bro that is entirely different than being MCAT blind. They still pick their interviewees off the mcat.

Read my other post. The cutoff for an interview is 496 (and they will interview you with a 496 if you meet the other minimums), and the people who decide if you interview aren’t the people who see your app post-interview.

No it’s not totally blind, but it might as well be given that the committee members who score you post interview have never seen your score and all you need MCAT wise is a 496 to interview. It was a little frustrating for me because I have a very good MCAT but some crappy grades from 10 years ago and had to wait much longer for an acceptance than people with practically no clinical experience and significantly lower MCATs but still above 500 (so they looked the same to the committee).

Edit: but my point is just that they do not take MCAT very highly into account.

 

[ricksimmonsrafowens]

C'mon Rick, stop depressing me

https://knowledgeplus.nejm.org/blog/exploring-acgme-core-competencies/
The six ACGME Core Competencies are as follows:

• Practice-Based Learning and Improvement
• Patient Care and Procedural Skills
• Systems-Based Practice
• Medical Knowledge
• Interpersonal and Communication Skills
• Professionalism

Step I only assesses for one of 1/6 critical domains.

I 100% agree that those skills are important. However, most of the time (>90%) in MS1 and MS2 is dedicated to study of foundations of medicine, not to extensive study of communication skills or professionalism, as these are the soft skills that should be developed in college, in medical school outside formal lectures and are then matured on clinical clerkships. like no one is teaching significant procedural skills in MS1 and MS2 except maybe putting in a foley on a mannequin and that's why it's not a focus of Step 1.

You wanna be a cardiac surgeon, GRIND!

like for real, if you want to match a surgical sub but want an easy/stress-free medical school that's not going to happen. and residency in surgery is going to be much more awful than taking step 1 can ever be.

 

[afib123]

I 100% agree that those skills are important. However, most of the time (>90%) in MS1 and MS2 is dedicated to study of foundations of medicine, not to extensive study of communication skills or professionalism, as these are the soft skills that should be developed in college, in medical school outside formal lectures and are then matured on clinical clerkships. like no one is teaching significant procedural skills in MS1 and MS2 except maybe putting in a foley on a mannequin and that's why it's not a focus of Step 1.


like for real, if you want to match a surgical sub but want an easy/stress-free medical school that's not going to happen. and residency in surgery is going to be much more awful than taking step 1 can ever be.

It is about wanting to match into a surgical subspecialty with purely networking and connections without having any test scores to back that up. When the demand is high for something, you work hard for it.

 

[7331poas]

They use a 496 as a cutoff for getting an interview. If you meet that you’ve met the minimum for MCAT and whether you get one is based on other factors. And I’ve seen a number of people with 496-500 get interviews.

Read my other post. The cutoff for an interview is 496 (and they will interview you with a 496 if you meet the other minimums), and the people who decide if you interview aren’t the people who see your app post-interview.

No it’s not totally blind, but it might as well be given that the committee members who score you post interview have never seen your score and all you need MCAT wise is a 496 to interview. It was a little frustrating for me because I have a very good MCAT but some crappy grades from 10 years ago and had to wait much longer for an acceptance than people with practically no clinical experience and significantly lower MCATs but still above 500 (so they looked the same to the committee).

Edit: but my point is just that they do not take MCAT very highly into account.

So its MCAT blind once you have made it past 95% of the applicant pool. Gotcha.

 

[ricksimmonsrafowens]

It is about wanting to match into a surgical subspecialty with purely networking and connections without having any test scores to back that up. When the demand is high for something, you work hard for it.

I went through the match for surgical subspecialty this year and trust me if you're from a low/middle tier school appyling a surgical sub, you DEFINITELY do not want the match to be dependent only on school reputation/"networking" & "connections." you're going to have a bad time without step 1/2.

everybody want to be a bodybuilder but nobody wants to lift no heavy-ass weights.

 

[anon6134]

Graduate medical educators: "We are going to judge you based off your score on this exam"

Graduate medical educators: "You guys are studying way too hard for this exam"

 

[Matthew9Thirtyfive]

So its MCAT blind once you have made it past 95% of the applicant pool. Gotcha.

Lol if you want to purposely ignore what I’m saying because it doesn’t fit what you want to think, then sure.

 

[965978]

So its MCAT blind once you have made it past 95% of the applicant pool. Gotcha.

I think he means to say it’s MCAT blind as long as you get a 496?

I would, however, argue that it’s not MCAT blind if an evaluator can see the score, even if they’re told not to consider it, because there might be unconscious bias.