How will USMLE Step 1 Changing to Pass/Fail impact current and future MD/PhDs?

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How will USMLE Step 1 Changing to Pass/Fail impact current and future MD/PhDs?

I thought I'd create a discussion thread for this -- any thoughts?

There are four common circumstances:
1. Current MD/PhDs who have already received a Step 1 score but will be applying to residencies before the pass/fail change occurs.
2. Current MD/PhDs who have already received a Step 1 score but will be applying to residencies after the pass/fail change occurs.
3. Current MD/PhDs who still have yet to take Step 1 but will be applying to residencies after the pass/fail change occurs.
4. Future MD/PhDs students who will take Step 1 and apply to residencies after the pass/fail change occurs.

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I'm curious about this as well. I'll be taking it in 2021, so I wonder whether the score will be reported as is, for a match application later in the 2020s, or whether it'll be converted to a P (assuming I can pass..). It will almost certainly have a negative effect on students from low tier MDs, so I anticipate it may have a similarly deleterious effect on lower tier MD/PhDs. OTOH, it seems like everyone from my program matched based on their research productivity anyway. ¯\_(ツ)_/¯
 
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This appears to be the main discussion for this, so I'm cross-posting my comment from the General Comments thread...

I think this absolutely helps future MD/PhD. We have been at a disadvantage for decades due to step 1 "score creep", where there has been a consistent rise in step 1 scores over time. This is especially important when the standard deviation to begin with is like 10 points (?). @Neuronix has written pretty extensively on this topic in the past. Agree with your points about research emphasis as well. The one thing that is concerning is the potential emphasis on clinical rotations, but I think that has more to do with the individual rather than the system itself.
 
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Anyone have thoughts on how this will hurt md/PhDs who did do well on step 1? I worked hard on step 1 so I wouldn’t have to worry too much on step 2 and trying to perform well on clinical rotations (especially knowing I would be rusty on my clinical skills after returning), but this change seems to have made all my hard work account for nothing. Think PDs would still want step 1 scores or not require step 2 scores before the 2023 cycle? If so, would it be better to try to finish one’s phd so that they can get their apps in by the 2022 cycle or earlier?
 
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Anyone have thoughts on how this will hurt md/PhDs who did do well on step 1? I worked hard on step 1 so I wouldn’t have to worry too much on step 2 and trying to perform well on clinical rotations (especially knowing I would be rusty on my clinical skills after returning), but this change seems to have made all my hard work account for nothing. Think PDs would still want step 1 scores or not require step 2 scores before the 2023 cycle? If so, would it be better to try to finish one’s phd so that they can get their apps in by the 2022 cycle or earlier?

Would also really like to know this. I spent 2 years of my life studying for Step 1, and if there's any possibility that program directors would not take into account our numeric scores, that would dictate my willingness to complete a PhD that would put me after the 2022 application cycle.
 
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Would also really like to know this. I spent 2 years of my life studying for Step 1, and if there's any possibility that program directors would not take into account our numeric scores, that would dictate my willingness to complete a PhD that would put me after the 2022 application cycle.
your willingness to do a PhD is dictated by whether PD accepts ur numeric step score...?
maybe you should just dip on the PhD now...
 
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your willingness to do a PhD is dictated by whether PD accepts ur numeric step score...?
maybe you should just dip on the PhD now...

Sorry for not clarifying: I meant similar to what the poster above me said, a 3 year vs 4 year PhD, with the 3 year being before the 2022 cycle, and a 4 year being after.
 
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PD at my school says there is ongoing discussion among the MSTP directors across the country and they weren't given any clarification at this point. They generally see this change as a good thing. PD says there's a possibility that, for those who receives numerical scores, the score may be reported as pass/fail in future apps once the change takes place. However, again, nothing is confirmed in regards to what exactly will happen during the transition period.
They will continue to request for more info and push for changes during the transition period that represent the best interests of MSTP students.
 
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Here are some of the web links:
Here are my personal thoughts:
  1. This is long overdue in general. Step 1 aims to determine whether a student has an adequate fundamental knowledge of basic medical sciences to enter into clinical training, a Yes or No. It has been misused for reducing review of applicants in competitive specialties with few available slots.
  2. It will emphasize other measures such as Step 2 CK, class rank, AOA, clinical grades and other exceptional qualifications like publications and fellowship grants. Your PhD should be worth more than ever in this new era.
  3. The real question is how the transition will happen. Are we going to have a mixed reporting system with Step 1 examination attempts prior to 2022 and after 2022 - i.e.: some with numeric scores and some with P/F. The short answer is we don’t know yet. However, some MD-PhD directors and I think it is likely that your score will be visible to residency directors.
  4. Those of you who have not taken the test might be thinking about the possibility of delaying the test to get a P/F. For the overwhelming majority of you, it might be more helpful to earn a high score. The longer that you are away from studying the pre-clinical material, the harder it would be to sit and take the test.
Regarding #3, I wouldn’t be surprised if NBME provides to students with numeric scores a choice for Opt-In or Out from reporting in ERAS for 3-4 years during the transition (2023-27). Regarding #2, many SOMs are now P/F for preclinical grades - Grading Systems Use by US Medical Schools
 
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The million dollar question for a lot of us is how will this change effect students at low-tier MD/PhD programs that hope to match at top residencies?
 
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The million dollar question for a lot of us is how will this change effect students at low-tier MD/PhD programs that hope to match at top residencies?
I think the impact would still be positive overall, since everyone is on the same playing field with P/F step score but MD students won't have the same extent of research experiences. Unless, step2 CK evolves to be the new step1.
 
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I have heard this in multiple venues regarding PSTPs. The overwhelming majority of PSTP directors is that Step 1 score was "slightly important" or "not at all important"). One of our MSTP directors is doing a survey on this very issue. One interpretation is that the STEP 1 scores didn’t matter that much in identifying residents for the ABIM Research pathway at institutions with PSTPs. So the change may not have that much of an impact because the majority of the applicants to PSTPs are MD/PhD trainees. Furthermore, it may push higher in importance the deliverables of your PhD training - i.e.: Manuscripts and Fellowship Grants.
 
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I feel like this will only shift the emphasis to step 2 CK, which will become the new Step 1. Schools are already redesigning their curricula to start clinical work earlier. On the other hand, we’ll have spent four+ years doing PhD research and have to jump back into a grueling clinical year and then have to take a step2, which will have gotten much more competitive. I can’t help but feel like the old system where everyone all took step 1 after the first 2-ish years of medical school was more “fair.” Now we’ll be at a disadvantage to our MD-only classmates.
 
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I have heard this in multiple venues regarding PSTPs. The overwhelming majority of PSTP directors is that Step 1 score was "slightly important" or "not at all important"). One of our MSTP directors is doing a survey on this very issue. One interpretation is that the STEP 1 scores didn’t matter that much in identifying residents for the ABIM Research pathway at institutions with PSTPs. So the change may not have that much of an impact because the majority of the applicants to PSTPs are MD/PhD trainees. Furthermore, it may push higher in importance the deliverables of your PhD training - i.e.: Manuscripts and Fellowship Grants.

Does the emphasis on graduate school deliverables potentially mean prolonged PhD training? Especially for those not at top 10 programs that, without stellar Step 1 scores, need incredible thesis work in order to prove their competitiveness at top residencies/PSTPs.
 
While there's obvious problems with using step 1 as a single differentiating metric, I have some fears of what getting rid of it may mean. 1) As an MS1, I will more than likely be taking the test for a score. I feel this can only hurt me, as a bad step score would be a red flag, but a good score wouldn't necessarily give me an advantage. 2) Increased emphasis on more subjective measures like clinical grades which vary from school to school and from attending to attending. 3) Increased emphasis on who you know/ where you went. Will this affect me personally? Probably not. I plan on doing a research track IM residency, which I will likely be more than fine to get into a program I like. But my colleagues who will be trying to match optho and derm may have a harder time. Either way, it's a tough time for current early MSTP students because we are now playing a game where we don't quite know the rules.
 
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While there's obvious problems with using step 1 as a single differentiating metric, I have some fears of what getting rid of it may mean. 1) As an MS1, I will more than likely be taking the test for a score. I feel this can only hurt me, as a bad step score would be a red flag, but a good score wouldn't necessarily give me an advantage. 2) Increased emphasis on more subjective measures like clinical grades which vary from school to school and from attending to attending. 3) Increased emphasis on who you know/ where you went. Will this affect me personally? Probably not. I plan on doing a research track IM residency, which I will likely be more than fine to get into a program I like. But my colleagues who will be trying to match optho and derm may have a harder time. Either way, it's a tough time for current early MSTP students because we are now playing a game where we don't quite know the rules.

For #1, it's too premature to say that. You'll be applying to residency with people who took the exam after the pass/fail change and there's a chance you may only need to report a pass/fail score (though no one knows right now).

For #2 and #3, that has always been the case anyway -- while there will be greater emphasis on those things (which is not necessarily a bad thing), there will also be greater emphasis on things like step 2 CK and class rank as well as a productive PhD experience.
 
As an incoming MDPhD next year, I am just extremely disappointed with the lack of clarity on the Step 1 change. It seems like everyone if flying blind atm.
 
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There are many speculations on why this decision is made, but the strongest reason for this change is mainly to put more emphasis on the CLINICAL exams rather than the basic sciences exam which makes a lot of sense to me. Programs are now forced to look for the 3 digit USMLE Step 2 CK score rather than the non clinical step 1 exam. Also since there was a drop from 6 USMLE attempts to 4 maximum it seems there will be emphasis put on the number of attempts for any exam and that includes step 1. Finally, the programs will be looking more in depth at your clinical work though your Letters of Recommendations as well as any research or publications for more specialized specialties such as Neurology.
 
As an incoming MDPhD next year, I am just extremely disappointed with the lack of clarity on the Step 1 change. It seems like everyone if flying blind atm.

Welcome to medicine. Don’t worry, it never gets any better
 
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For students who receive their exam results before the 2022 pass/fail change (but apply to residencies after the change rolls into effect): It is still undetermined whether we will report a pass/fail and/or numerical score. See United States Medical Licensing Examination

"If I received a 3-digit score on my Step 1 examination, will my 3-digit score be visible on paper and ERAS transcripts after Step 1 outcomes are reported as pass/fail?"

"The USMLE program has not yet determined how the policy change will impact score reports and transcripts. We expect to share additional information in the coming months. As additional details become available, updates will be posted to the USMLE website and social media."
 

Update - "Step 1 results will be reported as Pass/Fail no earlier than January 1, 2022. All scores for Step 1 exams taken prior to the date of the policy change will continue to be reported using the three-digit numeric score on all USMLE transcripts. The USMLE program does not retroactively alter transcripts."

Questions that arise are: If current MD/PhD students get a low numerical score (~200), does that make them look bad compared to the 99% of applicants who will report pass/fail? If they get a high numerical score (~260), does it confer any advantage? Will PDs allow current MD/PhD students (who have not yet taken the exam) to take the exam at a later time (once it switches to pass/fail)?
 
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