Helpful advice needed!

[Goro]

Hi all,
The MD and pre MD forums are having some Chernobyl-like meltdowns over the news that Step I is going P/F.

Could any program directors, or Residents who are involved with ranking and interviewing candidates kindly go over there to try and hold back the tide of hysteria that is threatening to overload all the electrons of studentdoctor.net?

I'm a bit tired of the angst, And would hope that some of you who actually have experience with this can help allay some fears.

Those of you who are old enough to remember all the sky is falling predictions when the MCAT changed its scoring and format a few years ago, can probably appreciate this. But let me just advise you, it's worse this time.

In gratitude,
Goro

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[Gastrapathy]

I’m not sure you’re going to get what you want here. The students are concerned because this was an objective measure of performance that the programs relied on. With that measure removed, the programs will have to find another way. Whether that’s Step2CK or suddenly expecting shelf scores in deans letters or overvaluing school rank or throwing darts is too soon to say. The fallacy in the press release is the idea that this will create a gentler process. There are still more or less desirable specialties.

For GI, as a fellowship level subspecialty, I’m sure we’ll just use 2CK scores for now.

 

[ThoracicGuy]

I’m not sure you’re going to get what you want here. The students are concerned because this was an objective measure of performance that the programs relied on. With that measure removed, the programs will have to find another way. Whether that’s Step2CK or suddenly expecting shelf scores in deans letters or overvaluing school rank or throwing darts is too soon to say. The fallacy in the press release is the idea that this will create a gentler process. There are still more or less desirable specialties.

For GI, as a fellowship level subspecialty, I’m sure we’ll just use 2CK scores for now.

A fellowship uses Step scores for matching??? Why would they even care about medical school when they have IM residency as a more recent data point?

 

[Gastrapathy]

A fellowship uses Step scores for matching??? Why would they even care about medical school when they have IM residency as a more recent data point?

There is very little objective information from residency. Applicants haven’t taken IM boards and even once they have,although they get a score, it’s not public anyway and reported as P/F. For competitive IM fellowships, USMLE scores are a standard screening tool.

Here’s the charting outcomes for fellowships. You can see it matters:

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2018/10/2018-Charting-Outcomes-SMS.pdf

 

[ThoracicGuy]

There is very little objective information from residency. Applicants haven’t taken IM boards and even once they have,although they get a score, it’s not public anyway and reported as P/F. For competitive IM fellowships, USMLE scores are a standard screening tool.

Surprising... For surgical fellowships, we have our inservice scores and they are used. No one cares about step scores at that point.

 

[Gastrapathy]

Your residency is much longer and IM has never treated their inservice exam like the ABSITE. Until recently, you applied for IM fellowships early in R2 year.

 

[Goro]

I’m not sure you’re going to get what you want here. The students are concerned because this was an objective measure of performance that the programs relied on. With that measure removed, the programs will have to find another way. Whether that’s Step2CK or suddenly expecting shelf scores in deans letters or overvaluing school rank or throwing darts is too soon to say. The fallacy in the press release is the idea that this will create a gentler process. There are still more or less desirable specialties.

For GI, as a fellowship level subspecialty, I’m sure we’ll just use 2CK scores for now.

Even if the auguries are murky, I'd rather hear it from someone who knows, rather than the hyperventilation from pre-clinical med students and pre-meds.

 

[ThoracicGuy]

Your residency is much longer and IM has never treated their inservice exam like the ABSITE. Until recently, you applied for IM fellowships early in R2 year.

True, though perhaps IM should consider their inservice exam more like the ABSITE... (Though I always hated taking that thing!)

 

[Perrotfish]

Even if the auguries are murky, I'd rather hear it from someone who knows, rather than the hyperventilation from pre-clinical med students and pre-meds.

But no one knows, that's the issue. This might be a minor adjustment, where Step II becomes the new Step I. It might also be a sea change, with school ranking mattering much more and medical school becoming much more like law school, where the quality of the school you get into determines the kind of career you are going to have.

 

[Gastrapathy]

True, though perhaps IM should consider their inservice exam more like the ABSITE... (Though I always hated taking that thing!)

I suppose this could precipitate that.

 

[CopaceticOne]

@Goro - I looked at the MD thread and won't be going near it. All that popped into my head was "Be careful about what you complain about, because you may not like the alternative." I wonder if NBME shelf exam scores, Step CK score, MCAT scores, are going to be the new filters. At least all of those will be based on personal performance. I think it would be an disservice to students if which school you went to had more influence than it already does.

 

[Iux]

@Goro - I looked at the MD thread and won't be going near it. All that popped into my head was "Be careful about what you complain about, because you may not like the alternative." I wonder if NBME shelf exam scores, Step CK score, MCAT scores, are going to be the new filters. At least all of those will be based on personal performance. I think it would be an disservice to students if which school you went to had more influence than it already does.

Do you think they will really use the mcat, a test you took 4 years before starting residency, as a real screening tool for medical students who have successfully gone through a pre-clinical and clinical curriculum. The mcat wouldn’t be an accurate measurement of a medical student’s ability at that point in time.

 

[Piebaldi]

@Goro - I looked at the MD thread and won't be going near it. All that popped into my head was "Be careful about what you complain about, because you may not like the alternative." I wonder if NBME shelf exam scores, Step CK score, MCAT scores, are going to be the new filters. At least all of those will be based on personal performance. I think it would be an disservice to students if which school you went to had more influence than it already does.

Is this for certain that step I is going to become P/F? I personally think that would be a good thing - it is insanity the level of stress that step 1 creates - I think all standardized testing should be P/F. There are far too many tests that are taken and none of them realistically create any value - other than to filter poor test takers. I might venture into the premed forums at my own risk lol to see what kind of meltdown is happening. Oh so glad to be done with those days!

 

[Iux]

Is this for certain that step I is going to become P/F? I personally think that would be a good thing - it is insanity the level of stress that step 1 creates - I think all standardized testing should be P/F. There are far too many tests that are taken and none of them realistically create any value - other than to filter poor test takers. I might venture into the premed forums at my own risk lol to see what kind of meltdown is happening. Oh so glad to be done with those days!

But how do you differentiate every applicant without some numerical score. This only makes it easier for those who went to a high tier md school and harder for the rest to match the more competitive specialties. Now you transfer all the stress from step 1 to step 2 ck which is a huge mistake imo.

 

[Piebaldi]

But how do you differentiate every applicant without some numerical score. This only makes it easier for those who went to a high tier md school and harder for the rest to match the more competitive specialties. Now you transfer all the stress from step 1 to step 2 ck which is a huge mistake imo.

I honestly think ALL standardized testing should be P/F - including MCAT, Steps, Boards. As it stands it is not uncommon that those who went to better med schools get digs on better/more competitive residencies anyways. Putting so much stress on one or two tests to determine which residency one gets is kind of ridiculous imo. As someone mentioend there really was no correlation between step 1 and how well people did in residency. Memorizing pointless minutia about biochem, and answering questions in a panic about random articles with poorly worded questions durin a high stress test makes no sense whatsoever.

 

[Iux]

I honestly think ALL standardized testing should be P/F - including MCAT, Steps, Boards. As it stands it is not uncommon that those who went to better med schools get digs on better/more competitive residencies anyways. Putting so much stress on one or two tests to determine which residency one gets is kind of ridiculous imo. As someone mentioend there really was no correlation between step 1 and how well people did in residency. Memorizing pointless minutia about biochem, and answering questions in a panic about random articles with poorly worded questions durin a high stress test makes no sense whatsoever.

I understand all that and agree but again how do you screen/differentiate applicants who want to do a more competitive specialty going forward now? Step 2 will take over the same stress you had for step 1. There’s also no more second chance like if you didn’t score too well on step 1, you at least had the opportunity to redeem yourself on step 2. It’s just one shot and that’s step 2 now

 

[Iux]

This will only reinforce the monopoly the big name medical schools had already.

 

[CopaceticOne]

Do you think they will really use the mcat, a test you took 4 years before starting residency, as a real screening tool for medical students who have successfully gone through a pre-clinical and clinical curriculum. The mcat wouldn’t be an accurate measurement of a medical student’s ability at that point in time.

No, but when you have nothing... If you scored above the 95% on the MCAT you are probably on the high end of the bell curve, right?

 

[Iux]

No, but when you have nothing... If you scored above the 95% on the MCAT you are probably on the high end of the bell curve, right?

Yes, but for those who scored average on the mcat and then went on to kill the step, they won't be represented properly. Also, I find it comical that they would use a premed exam to determine where you go for your graduate medical education lol

 

[Goro]

@Goro - I looked at the MD thread and won't be going near it. All that popped into my head was "Be careful about what you complain about, because you may not like the alternative." I wonder if NBME shelf exam scores, Step CK score, MCAT scores, are going to be the new filters. At least all of those will be based on personal performance. I think it would be an disservice to students if which school you went to had more influence than it already does.

Thinking that an MCAT score would be used by PDs to screen applicants is pre-med thinking in the worst possible manner.

I'll be commenting on this whole situation overall soon. Right now, I'm avoiding the hyperventilating, lest my monitor melt onto my desk.

 

[CopaceticOne]

Yes, but for those who scored average on the mcat and then went on to kill the step, they won't be represented properly. Also, I find it comical that they would use a premed exam to determine where you go for your graduate medical education lol

Oh I agree with you. I was just positing a hypothetical.

 

[Iux]

Oh I agree with you. I was just positing a hypothetical.

I’m just praying I get to where you are within a specialty I actually want lol

 

[Goro]

No, but when you have nothing... If you scored above the 95% on the MCAT you are probably on the high end of the bell curve, right?

The trouble with this thinking is that it selects for people who can afford to study for 3+ years. It's simply too biased.

 

[CopaceticOne]

The trouble with this thinking is that it selects for people who can afford to study for 3+ years. It's simply too biased.

The truth is everything we do to separate applicants is biased.

Not picking an argument - aren't people supposed to study during undergrad which is 3+ years? I'm understanding your intent in that statement to be regarding people who can focus on studying for any test in addition to their usual course work / extra curricular / research / volunteering / shadowing. The system is already in favor of those who can afford devoting time to these other things.

I don't have a solution to propose for any of this because I understand it is a multi-faceted complex issue that people much smarter and more experienced have been dealing with for years.

 

[GoSpursGo]

Thinking that an MCAT score would be used by PDs to screen applicants is pre-med thinking in the worst possible manner.

When you get down to it, med school prestige is (largely) a proxy for MCAT anyways.

Really don't know what to make of this new P/F step 1 world. Given that I always wanted a non-competitive specialty, this probably would have made the first 2 years of med school more fun. It does suck that it probably just pushes the metric that you'll be measured against up to step 2 CK. If that doesn't become P/F in short order then I think the logical conclusion is you wind up in a situation where students are incentivised to start studying step 2 material while still in pre-clinical courses, which is obviously non-ideal.

I think the underlying problem is that there's such a disparity between what certain subspecialties and primary care specialties make. As long as there's a financial incentive to kill yourself to differentiate yourself as "the best" in order to match into a lucrative specialty, students will figure out what that thing is that differentiates themselves (step 2, med school name, research, whatever) and that will become what students focus on.

 

[rokshana]

I wonder if they discussed this with any students or PDs to see if this really is in the best interest of the process...

Something else will come into play if step 1 is p/f...CK will become more important or the shelf exams will now be reported...programs are going to want something object and students will want something to separate themselves from the crowd.

 

[Shinken]

As a residency PD I can tell you that Step 1 scores aren’t that critical for us, particularly if the complete application is strong. We are more interested in Step 2 scores, which reflect more clinical knowledge and thinking. If Step 1 became P/F it wouldn’t make sense to have a meltdown over that.

 

[Piebaldi]

When you get down to it, med school prestige is (largely) a proxy for MCAT anyways.

Really don't know what to make of this new P/F step 1 world. Given that I always wanted a non-competitive specialty, this probably would have made the first 2 years of med school more fun. It does suck that it probably just pushes the metric that you'll be measured against up to step 2 CK. If that doesn't become P/F in short order then I think the logical conclusion is you wind up in a situation where students are incentivised to start studying step 2 material while still in pre-clinical courses, which is obviously non-ideal.

I think the underlying problem is that there's such a disparity between what certain subspecialties and primary care specialties make. As long as there's a financial incentive to kill yourself to differentiate yourself as "the best" in order to match into a lucrative specialty, students will figure out what that thing is that differentiates themselves (step 2, med school name, research, whatever) and that will become what students focus on.

Yet sadly, the midlevel providers might in the future be allowed to do the same as many of the specialists? Who knows. Sorry I had to throw that in there!
The problem is that while these tests essentially are a proxy to decide which residency students get into there really are not a good measure to determine who will truly be a good specialist. If someone gets a 260 on step 1, does that really tell us whether someone will be a good dermatologist or radiation oncologist? Not really. While there should be some metric, the obsession with standardized testing is completely over the top at this time.

 

[GoSpursGo]

I wonder if they discussed this with any students or PDs to see if this really is in the best interest of the process...

They would argue that what is good for the application process is immaterial to them, since the test was never intended to be used in the way it's being used currently.

The problem is that while these tests essentially are a proxy to decide which residency students get into there really are not a good measure to determine who will truly be a good specialist. If someone gets a 260 on step 1, does that really tell us whether someone will be a good dermatologist or radiation oncologist? Not really. While there should be some metric, the obsession with standardized testing is completely over the top at this time.

The REAL problem is that the schools intentionally obfuscate how students are performing on their rotations and in classes. Making classes P/F, and even P/F rotations where everyone gets glowing comments on their MSPE is less than worthless. I know that top schools like to snobbily say that "all of our students are top applicants," but realistically no med student should be getting straight 5's on clinical evaluations. I'm sure that programs would like to be able to use those measures rather than step 1 to be able to tell who is a strong applicant, but I imagine the chances are slim that there will be any meaningful change on the part of schools.

 

[NotAProgDirector]

This decision isn't a huge surprise. My thoughts:

The problem of Step 1 Mania is multifactorial. Med students think that the value of S1 for applications is much more impactful than it is. Social media doesn't help, stories spread and everyone starts to panic that if they get a 239 they will be "screened out". Programs have had increased applications, leading to more rejections, which only worsens the problem. And a whole industry has arisen to study for steps, which also worsens the spiral.

Really fixing this problem will require a much more broad solution -- better evaluation metrics, decreasing application inflation, better data for students to assess their competitiveness, and perhaps changes to the match. Making S1 P/F is a bandaid over cellulitis -- the redness may be invisible now, but it will spread.

The sky is not falling. The same number of residency spots will be available in the 2022 match (or whenever this happens), with the same number of students applying for them. "low ranked MD schools" (whatever that actually means) aren't going to all of a sudden have all of their students matching to FM. DO's will not be squeezed out of the match. It will all basically be the same.

Programs that care about step scores will shift to S2CK. This will mean that students will need to take S2 earlier -- the current "play the game" of take S2 early if you did poorly on S1, delay until after applications if did well and only release if you did better won't work any more. Programs that had cutoffs for S1 will just create them for S2, and they will be higher since the average score on S2 is higher. Programs that care about prestige of medical school will continue to do so. The world will continue, it will honestly not be that different.

The real issue here isn't that S1 is PF, it's the threat that all of the steps could become PF. The NBME managed this process and essentially completely excluded Programs, IMG's, and DO's. I can live with S2CK scores. If there are no scores at all, then that's a huge problem for programs, and especially for IMG's. I predict (as many of you) that the insanity will just shift to S2, and it's only a matter of time until that becomes PF also.

So, we need a broader solution - something that US MD schools can live with, yet meet the needs of IMG's and programs. Any faith that I had that the NBME would be reasonable and listen to programs is shattered. Ultimately, I expect that each specialty will build their own exam -- we control it, no one can tell us what to do. Using multiple shelf exams instead of a single USMLE exam sounds interesting -- more data points, less affected by "a bad day", etc. My main problem with this solution is that I REFUSE TO ALLOW ANY SOLUTION TO INCREASE INCOME TO THE NBME. Every IMG and DO taking shelf exams would do just that.

We should remember that, at the end of the day, essentially all US grads find a residency spot and all spots are filled. So, any change in the application process just shuffles the deck -- some people might do better while others might do worse. Whether that's good or bad depends upon how you look at it, and what new metrics replace it (and whether YOU did better or worse!). For now that will be S2 which is basically the same. If S2 becomes PF and there's no new exam, then imagine the pressure on schools to increase the rate of Honors/A, etc.

 

[Piebaldi]

This decision isn't a huge surprise. My thoughts:

The problem of Step 1 Mania is multifactorial. Med students think that the value of S1 for applications is much more impactful than it is. Social media doesn't help, stories spread and everyone starts to panic that if they get a 239 they will be "screened out". Programs have had increased applications, leading to more rejections, which only worsens the problem. And a whole industry has arisen to study for steps, which also worsens the spiral.

Really fixing this problem will require a much more broad solution -- better evaluation metrics, decreasing application inflation, better data for students to assess their competitiveness, and perhaps changes to the match. Making S1 P/F is a bandaid over cellulitis -- the redness may be invisible now, but it will spread.

The sky is not falling. The same number of residency spots will be available in the 2022 match (or whenever this happens), with the same number of students applying for them. "low ranked MD schools" (whatever that actually means) aren't going to all of a sudden have all of their students matching to FM. DO's will not be squeezed out of the match. It will all basically be the same.

Programs that care about step scores will shift to S2CK. This will mean that students will need to take S2 earlier -- the current "play the game" of take S2 early if you did poorly on S1, delay until after applications if did well and only release if you did better won't work any more. Programs that had cutoffs for S1 will just create them for S2, and they will be higher since the average score on S2 is higher. Programs that care about prestige of medical school will continue to do so. The world will continue, it will honestly not be that different.

The real issue here isn't that S1 is PF, it's the threat that all of the steps could become PF. The NBME managed this process and essentially completely excluded Programs, IMG's, and DO's. I can live with S2CK scores. If there are no scores at all, then that's a huge problem for programs, and especially for IMG's. I predict (as many of you) that the insanity will just shift to S2, and it's only a matter of time until that becomes PF also.

So, we need a broader solution - something that US MD schools can live with, yet meet the needs of IMG's and programs. Any faith that I had that the NBME would be reasonable and listen to programs is shattered. Ultimately, I expect that each specialty will build their own exam -- we control it, no one can tell us what to do. Using multiple shelf exams instead of a single USMLE exam sounds interesting -- more data points, less affected by "a bad day", etc. My main problem with this solution is that I REFUSE TO ALLOW ANY SOLUTION TO INCREASE INCOME TO THE NBME. Every IMG and DO taking shelf exams would do just that.

We should remember that, at the end of the day, essentially all US grads find a residency spot and all spots are filled. So, any change in the application process just shuffles the deck -- some people might do better while others might do worse. Whether that's good or bad depends upon how you look at it, and what new metrics replace it (and whether YOU did better or worse!). For now that will be S2 which is basically the same. If S2 becomes PF and there's no new exam, then imagine the pressure on schools to increase the rate of Honors/A, etc.

Well thought out post - and I like "step 1 mania." I personally think all standardized testing should be P/F. There needs to be a better/broader solution - is remembering which enzyme in a biochemical process during step 1 really going to determine who is going to be a better dermatologist? Is guessing which correct "ethical" answer choice going to make a better orthopod? No. I think what you said actually is brilliant - have specialty specific exams perhaps - is someone who says they want to do ortho who scores a 98% on an ortho specific exam going to be better than soemoen who scores 50%? likely. spending months and thousands of dollars studying for steps is nonsense and insanity - it really is all a money grab. Step 2 CS should be done away with for anyoen who goes to a US med school too - i know that is not the point of the thread, but the point im trying to make is - a lot of these tests are just a money grab, the same way that MOC is a money grab, or that boards are. for example in the case of boards - are we saying that despite going through med school, residency, etc it's necessary to test whether residents/fellow are "truly"competent by giving them a minutia filled exam? It really makes no sense.

I honestly think that what you proposed is surprisingly one of the most sensical suggestion possible - have students take a specialty specific test, rather than taking a bunch of standarized tests that other than making money for organizations/NBME/etc they have no purpose. How many of us have memorized a bunch of pointless minutia that we have never had to use in real life and that we forget the second we finish the exams?

 

[Perrotfish]

The sky is not falling. The same number of residency spots will be available in the 2022 match (or whenever this happens), with the same number of students applying for them. "low ranked MD schools" (whatever that actually means) aren't going to all of a sudden have all of their students matching to FM. DO's will not be squeezed out of the match. It will all basically be the same.

I really don't think you have a good basis for being that confident that students from lower ranked schools (and you know exactly what that means) won't be squeezed out of better specialties. Its not like that would be an unprecedented phenomenon. The trajectory of law, business, and non medical academic careers are already determined more by the prestige of your alma mater than any other factor, there is no reason to think that the same thing couldn't happen to medicine.

Ultimately, I expect that each specialty will build their own exam -- we control it, no one can tell us what to do.

This is a horrifying idea. It would force students to effectively choose a specialty before starting rotations, and then to cram for a specialty specific exam at the expense of learning the rest of medicine. It would also leave people who failed to measure up to the exam for their hyper competitive specialties completely in the lurch.

With the current there are lots of almost but not quite AOA students who, falling short of the scores needed for ortho, go on to have happy careers in gen surg or EM. With specialty specific exams those students would have to choose early whether to focus on an achievable target early, or give the ortho exam everything they have knowing that if they fail what's left of their application will land them in a low ranked FM program.

 

[bunya12]

As someone who graduated from one of the "low-tier MD schools" and applied to the "top" programs in my specialty, albeit not a competitive specialty, I can say that without a doubt I got many/most of my interviews due to my step 1 score. I say this because at multiple places, I was either directly or indirectly told that they had never heard of my medical school, but my step 1 score was great so they considered me a great applicant and that I would likely succeed in their program.

Coming from a medical school that offered very little in terms of board prep, almost no research infrastructure as far as supporting (or even allowing) medical students to take time off for research, and limited exposure to the competitive subspecialties, several of my classmates and I, who matched to either competitive specialties or "top" places, the fact was not hidden from us that it was mostly due to our step scores.

So I absolutely believe there is merit to the concern that pre-meds/medical students have, particularly at "low-tier" schools. The focus might just shift to step 2 scores, but then what's the point of P/F since the exact same focus and problems now just moves to step 2?

 

[Perrotfish]

what's the point of P/F since the exact same focus and problems now just moves to step 2?

What's the point of this?

Best case scenario: curriculum change. A lot of medical education research is showing that the more time students spend in clinicals vs preclinicals, the better their eduction is retained in the long run. Making step 1 pass fail clears the way for schools to reduce preclinicals to as little as 1 year, leaving 3 full years for clinical education

Most likely scenario: money grab. Step 1 is only one test, which means that the test taking authorities can only fleece students of a few thousand dollars. What if every single preclinical subject exam and clinical shelf exam was a standardized NBME exam with a score that was reported to residencies? That's tens of thousands of dollars paid by each student for test taking

Worst case scenario: power grab. The academic clinicians who make decisions for medical education are not chosen at random, they come from top ranked academic powerhouses. Step 1 has long been a pesky piece of objective information that reduced the value of their institutions 200 year old names. They might have done this in the hope that step 2 couldn't really replace step 1, and that their students would have more of an advantage in the match.

 

[Raryn]

True, though perhaps IM should consider their inservice exam more like the ABSITE... (Though I always hated taking that thing!)

I suppose this could precipitate that.

No it couldn't. At least not without rule changes. APDIM forbids sharing IMITE scores with fellowships. They're meant to just be informative, not high stakes exams.

Not that I would have minded.

 

[Gastrapathy]

No it couldn't. At least not without rule changes. APDIM forbids sharing IMITE scores with fellowships. They're meant to just be informative, not high stakes exams.

Not that I would have minded.

Right, the question is whether there could be a change in the future. Particularly if all the steps go P/F

 

[Piebaldi]

No it couldn't. At least not without rule changes. APDIM forbids sharing IMITE scores with fellowships. They're meant to just be informative, not high stakes exams.

Not that I would have minded.

Really? This is interesting to know! Many other specialties do share their in training scores with fellowships.

 

[Raryn]

Really? This is interesting to know! Many other specialties do share their in training scores with fellowships.

I know. ABSITE in surgery is incredibly high stakes - I know programs that post the scores publicly. And it's explicitly shared on ERAS. Same with the CREOGs in Ob/Gyn - most fellowship programs request PDFs of your scores be emailed.

The IM-ITE was meant to be just a test for second year IM residents to see if they were on track to pass their boards. Over time, it's been applied to a larger proportion of residents - most programs have all three years take it. But it's not meant to be used for promotion, fellowship, or anything else. (Link is a PDF directly from the authors of the test)

IM-ITE is neither a qualifying nor a certifying examination. Results are confidential. Scores should never be used to assign rewards or penalties; determine eligibility for fellowship programs or certifying examinations; establish clinical competency; or provide data to accrediting and review organizations or licensing bodies.

I can't find a specific citation, but I also believe that at some point APDIM (the association of program directors in IM) had explicitly recommended that its members not share scores with fellowship programs at all - even selectively.

As I said above, I wouldn't have particularly minded if my IM-ITE scores had been shared with fellowship programs - I had done well - but it would drastically change the traditional purpose of the test - it may make it less predictive of actual board pass rates if everyone studied hard for it.

 

[Gastrapathy]

All true.

 

[NotAProgDirector]

I really don't think you have a good basis for being that confident that students from lower ranked schools (and you know exactly what that means) won't be squeezed out of better specialties. Its not like that would be an unprecedented phenomenon. The trajectory of law, business, and non medical academic careers are already determined more by the prestige of your alma mater than any other factor, there is no reason to think that the same thing couldn't happen to medicine.

Until Step 2 becomes P/F, I don't think you'll see much change. If all of the steps are P/F and there's no replacement, then I agree.

This is a horrifying idea. It would force students to effectively choose a specialty before starting rotations, and then to cram for a specialty specific exam at the expense of learning the rest of medicine. It would also leave people who failed to measure up to the exam for their hyper competitive specialties completely in the lurch.

With the current there are lots of almost but not quite AOA students who, falling short of the scores needed for ortho, go on to have happy careers in gen surg or EM. With specialty specific exams those students would have to choose early whether to focus on an achievable target early, or give the ortho exam everything they have knowing that if they fail what's left of their application will land them in a low ranked FM program.

I wasn't clear enough. I agree this is a horrible idea. I'm not happy about it at all.

But it might not be as bad as you suggest. Imagine that there are specialty exams for Ortho, Gen Surg, and EM. A student could take all three. Then, when they apply to Ortho programs, they would send only the ortho scores, same for Gen Surg and EM. It would be a real pain since they would have the cost/hassle/study issues to take 2 or more exams, but it could work. But I agree it would mean focused studying only for one specific subject, which inherently will squeeze out other content.

Best case scenario: curriculum change. A lot of medical education research is showing that the more time students spend in clinicals vs preclinicals, the better their eduction is retained in the long run. Making step 1 pass fail clears the way for schools to reduce preclinicals to as little as 1 year, leaving 3 full years for clinical education

Already mentioned on the thread is the idea that students would take CK prior to S1, focus on that during their preclinical years. I do agree that med schools might shorten preclinicals further to advance clerkship timing and Step 2.

Most likely scenario: money grab. Step 1 is only one test, which means that the test taking authorities can only fleece students of a few thousand dollars. What if every single preclinical subject exam and clinical shelf exam was a standardized NBME exam with a score that was reported to residencies? That's tens of thousands of dollars paid by each student for test taking

I agree, but I think the punchline is slightly different. Most medical schools already have their students take the shelf, and pay for it. It's possible that if this were to become "high stakes", that the costs would be passed onto students. But the "real financial win" in this scenario for the NBME would be that all IMG/FMG/DO would need to do the same thing -- and that's lots of new people taking new exams and generating lots of income. Not to mention the certainty of paid practice exams.

I have no idea how this will all settle out. As mentioned, I think it won't change much until S2 is P/F. But I will be really pissed if the NBME just starts making a bunch of new money on new exams.

 

[AMEHigh]

I wonder if they discussed this with any students or PDs to see if this really is in the best interest of the process...

Something else will come into play if step 1 is p/f...CK will become more important or the shelf exams will now be reported...programs are going to want something object and students will want something to separate themselves from the crowd.

Yes there was a comment period last year in which people could express their opinion.

 

[PTPoeny]

Really? This is interesting to know! Many other specialties do share their in training scores with fellowships.

Pediatrics is the same as IM.

 

[OnePunchBiopsy]

For anyone out there scared about the recent changes to Step 1, just remember that three things will always be more important in terms of matching:

1. Who you know. This means get involved early with the departments you're interested in at you school. Get a LoR from a big name at home.
2. Where you rotate. If you don't have a strong home program in the specialty you want, do away rotations. Get a LoR from a big name elsewhere.
3. How you interview. Try and make every pre-interview social. Show up confident and dress to impress. Always write a thank you note.

Step 1 now being P/F just makes these things more important.