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I know I could have posted this link in another thread, but I just wanted to hash some things about Step I and perhaps let people learn a bit along the way about the nature of the test and what it takes to succeed over that beast.
Well, I always do well on standardized tests. Granted it's not 99th% well -- but I'm a solid 93% percenter. My SAT scores were 1480 and my MCAT scores were 33 (same score in each subject) -- I think both such scores project to about 93% or so (the SAT is a bit higher -- but you're going against the whole population there).
So, I'm not a 1590 SAT or 37 MCAT type guy who was hoping for 255 on STEP I. But, I didn't think I would do as badly as I did. Honestly, I was hoping for a 222 or so and I'd call it a day.
So, needless to say the score shocked me. But, given how I took to medical school I can't see it's too surprising. Here are some myths I feel my experience with the beast tell:
1. Your score is not going to be related to your standardized test taking abilities. As you saw, my SATs and MCATs were decent -- not great -- but decent. However, I was not able to rely upon my test taking skills for STEP I. Unfortunately, you can't really "game" the test -- like finding too many obvious wrong answers/hoping to reason ou the right answer/or even doing something like finishing your Orgo passages first.
I'm a slow, but good reader and I just barely finished each section. That might have been a mistake on STEP I. Unlike the MCAT, this test is forcing to see if you can quickly learn what is and what is not important about a given patient or disease. It's not looking at comprehension as much.
Even the NBME says that the best indicator of performance is your SHELF grades if your school does the shelf. And, I'd say that's freakily correct. I was right below average for my med school (which gets the average on STEP I) on shelf exams and that's how I did upon STEP I. I always said I'd make up for lost ground when it came to STEP I but I was not able to do so.
2. Your score is going to reflect the amount of work you put in for the first two years of medical school. For people about to take the test and have not put in too much work -- I'm sorry. But, really, you start preparing for this test from Day I of Med School. You have to start making associations (like not only what does liver cancer look like but that Hep vaccines are really a cancer preventing vaccine) and you have to start learning what is important quick -- and retain it.
I do fault most medical schools a bit for killing any desire/ability to study for STEP I effectively in this sense. Most of the classes at my American med school were so much about picky facts it was ridiculous. Most tests would not be written to emphasize the important stuff (which was in there still) but to see how much we understood super-specialized lectures. For instance, probably 80% of our tests were like thus: about 30 lectures given by 6-8 different people and each person writing about 3-4 questions per lecture they gave. Now, of their 3-4 questions I'd say about 1-2 were STEP I worthy. The rest just forced you to memorize their stupid lecture notes.
The top schools -- like Penn or NYU at least -- actually let students take STEP I after third year. I can't recommend that approach enough. The test is not entirely clinical but clinical experience does help. Moreover, you knowledge about something like CHF is not just from bullet point lists in a book. You actually goddam saw it, helped diagnose it, and treated it. You remember it more than you'd ever like. People say "But, oh my god that's so far away from when you had Biochem!" But that's bullcrap. You are still going to spend the same four days on that subject you would anyways and there's not THAT MUCH biochem on Step I.
Now, I was able to do well on some tests and I did bad upon some tests. But, I really had to freaking work for the tests I did well on. And that sucked. It really sucked. It meant no other real life than medical school. I like reading, I like being outside, and I like talking to people. But, if I wanted to real well, it was harder to do that stuff.
People in med school do well. But, I'd say 70% of the time such people are robotic specimens of the human race. They are all med school all the time and they work hard to get what they want. In many ways, you want that in your doctor. But, it just was not me.
That said, I was a mediocre student who studied just to stay alive and pass courses -- it was not a studying to UNDERSTAND the material. And, that right there is Strike 1-2-3 for Step I. You can pass the test still -- but to do really well, you have to be able to understand what is going on with the material.
Medicine is so strange like that. Memorization -- tons of it, lots of it -- can get you far enough and takes a lot of discipline to do. But, to excel, you still got to have a bit more left in the tank. I mean, you got to integrate what you're learning. You got to apply it. I have no problem doing that and it's what I'm good at -- but, ug, the memorization part destroys me. And, so, I lost out that aspect of Step I.
3. The Kaplan Q-Bank prognostication is probably accurate. I was hitting 54% for all of Q-Bank -- and I think that projects to my score.
I know you need 60% to hit the American med student average and, for the life of me, I was not able to hit it that number on Q-bank. I'd just forget stuff -- like public health minutiae when I learned something new (again, it's why you need to get to the applying stage well before that 4-6 weeks a school gives you to study for the test).
I did actually do one thing though -- I pounded some Pharm for 2-3 days before the test since I always forget that stuff and I ended up receiving "a very much above average performance" on it for the test -- higher than I was during practice. But, I did bad, really bad, in Cardio and Respiratory which I thought I knew so go figure. IT IS ALWAYS A TRADEOFF IF YOU ENTER THE STUDY PERIOD HAVING A WEAK "FUND" OF KNOWLEDGE
4. Stick to a couple books and know them well. I have a book buying disease and it killed me. Honestly, the Kaplan books/BRS Path/First Aid and Q-Bank are enough to destroy that test. You really must do Q-Bank and do it right I feel though (understand what you got wrong and take the test in sets of 50 from different subject every once in a while).
5. If you want to destroy the test -- I'm talking ENT level destroy -- be a robot. Forget knowing about the world or what's going on it. Forget trying to romance a lady and really trying to get to know her and be in a relationship that is more than sex and convenience. Forget trying to be involved in your society or school organizations. Forget trying to read for pleasure. Forget tyring to work on your public speaking. Forget trying to keep up closely with friends from undergrad. Forget all that. For most of us, who by the very definition of how the IQ scale is determined (105 average, standard deviation of 15 right?) -- our IQ is not going to allow being able to have a life and have it all in medical school.
Listen, you can still get 225ish on the test and do a lot less -- albeit more than I did. But, wow, it sucks. I did just above the bare minimum in medical school and that's still a hell of a lot. And, it still was not enough to hit the American medical student average. Whether that says more about me or the test I'm not sure. But, wow, that's the type of hard working field we've chosen.
STEP is a proxy for how hard you've worked and for how long. That's it. Nothing more. There is a reason IMG's who can barely speak get 240s on this test -- they study for half a year.
What's sad for me is that I'm really having to rethink where I have to go to residency right now because of this test. I'm more relaxed and energetic about third year than lots of my classmates. And, I know I can relate to patients better than some of the robot-studiers who surely will be going into Ortho etc. And, I really never wanted to be in any of the ADORE (Anes/derm/orthooptho/radio/ENT,ER) residencies. I wanted to do medicine or pediatrics at a good teaching hospital because I like to teach and be in such learning environments.
But, with a 207 I'm not sure where I can go or what I'll be able to do. And it's all because I thought my standardized test taking ability would save me and my subpar medical career on STEP I.
It does not -- it absolutely does not. And , I hope future readers of this rambling/cathartic/and (I hope) educative post will understand that and simply not make the same mistake I did.
Good luck on STEP I you all. I hope no one has to feel like I'm feeling after they finish it.
Well, I always do well on standardized tests. Granted it's not 99th% well -- but I'm a solid 93% percenter. My SAT scores were 1480 and my MCAT scores were 33 (same score in each subject) -- I think both such scores project to about 93% or so (the SAT is a bit higher -- but you're going against the whole population there).
So, I'm not a 1590 SAT or 37 MCAT type guy who was hoping for 255 on STEP I. But, I didn't think I would do as badly as I did. Honestly, I was hoping for a 222 or so and I'd call it a day.
So, needless to say the score shocked me. But, given how I took to medical school I can't see it's too surprising. Here are some myths I feel my experience with the beast tell:
1. Your score is not going to be related to your standardized test taking abilities. As you saw, my SATs and MCATs were decent -- not great -- but decent. However, I was not able to rely upon my test taking skills for STEP I. Unfortunately, you can't really "game" the test -- like finding too many obvious wrong answers/hoping to reason ou the right answer/or even doing something like finishing your Orgo passages first.
I'm a slow, but good reader and I just barely finished each section. That might have been a mistake on STEP I. Unlike the MCAT, this test is forcing to see if you can quickly learn what is and what is not important about a given patient or disease. It's not looking at comprehension as much.
Even the NBME says that the best indicator of performance is your SHELF grades if your school does the shelf. And, I'd say that's freakily correct. I was right below average for my med school (which gets the average on STEP I) on shelf exams and that's how I did upon STEP I. I always said I'd make up for lost ground when it came to STEP I but I was not able to do so.
2. Your score is going to reflect the amount of work you put in for the first two years of medical school. For people about to take the test and have not put in too much work -- I'm sorry. But, really, you start preparing for this test from Day I of Med School. You have to start making associations (like not only what does liver cancer look like but that Hep vaccines are really a cancer preventing vaccine) and you have to start learning what is important quick -- and retain it.
I do fault most medical schools a bit for killing any desire/ability to study for STEP I effectively in this sense. Most of the classes at my American med school were so much about picky facts it was ridiculous. Most tests would not be written to emphasize the important stuff (which was in there still) but to see how much we understood super-specialized lectures. For instance, probably 80% of our tests were like thus: about 30 lectures given by 6-8 different people and each person writing about 3-4 questions per lecture they gave. Now, of their 3-4 questions I'd say about 1-2 were STEP I worthy. The rest just forced you to memorize their stupid lecture notes.
The top schools -- like Penn or NYU at least -- actually let students take STEP I after third year. I can't recommend that approach enough. The test is not entirely clinical but clinical experience does help. Moreover, you knowledge about something like CHF is not just from bullet point lists in a book. You actually goddam saw it, helped diagnose it, and treated it. You remember it more than you'd ever like. People say "But, oh my god that's so far away from when you had Biochem!" But that's bullcrap. You are still going to spend the same four days on that subject you would anyways and there's not THAT MUCH biochem on Step I.
Now, I was able to do well on some tests and I did bad upon some tests. But, I really had to freaking work for the tests I did well on. And that sucked. It really sucked. It meant no other real life than medical school. I like reading, I like being outside, and I like talking to people. But, if I wanted to real well, it was harder to do that stuff.
People in med school do well. But, I'd say 70% of the time such people are robotic specimens of the human race. They are all med school all the time and they work hard to get what they want. In many ways, you want that in your doctor. But, it just was not me.
That said, I was a mediocre student who studied just to stay alive and pass courses -- it was not a studying to UNDERSTAND the material. And, that right there is Strike 1-2-3 for Step I. You can pass the test still -- but to do really well, you have to be able to understand what is going on with the material.
Medicine is so strange like that. Memorization -- tons of it, lots of it -- can get you far enough and takes a lot of discipline to do. But, to excel, you still got to have a bit more left in the tank. I mean, you got to integrate what you're learning. You got to apply it. I have no problem doing that and it's what I'm good at -- but, ug, the memorization part destroys me. And, so, I lost out that aspect of Step I.
3. The Kaplan Q-Bank prognostication is probably accurate. I was hitting 54% for all of Q-Bank -- and I think that projects to my score.
I know you need 60% to hit the American med student average and, for the life of me, I was not able to hit it that number on Q-bank. I'd just forget stuff -- like public health minutiae when I learned something new (again, it's why you need to get to the applying stage well before that 4-6 weeks a school gives you to study for the test).
I did actually do one thing though -- I pounded some Pharm for 2-3 days before the test since I always forget that stuff and I ended up receiving "a very much above average performance" on it for the test -- higher than I was during practice. But, I did bad, really bad, in Cardio and Respiratory which I thought I knew so go figure. IT IS ALWAYS A TRADEOFF IF YOU ENTER THE STUDY PERIOD HAVING A WEAK "FUND" OF KNOWLEDGE
4. Stick to a couple books and know them well. I have a book buying disease and it killed me. Honestly, the Kaplan books/BRS Path/First Aid and Q-Bank are enough to destroy that test. You really must do Q-Bank and do it right I feel though (understand what you got wrong and take the test in sets of 50 from different subject every once in a while).
5. If you want to destroy the test -- I'm talking ENT level destroy -- be a robot. Forget knowing about the world or what's going on it. Forget trying to romance a lady and really trying to get to know her and be in a relationship that is more than sex and convenience. Forget trying to be involved in your society or school organizations. Forget trying to read for pleasure. Forget tyring to work on your public speaking. Forget trying to keep up closely with friends from undergrad. Forget all that. For most of us, who by the very definition of how the IQ scale is determined (105 average, standard deviation of 15 right?) -- our IQ is not going to allow being able to have a life and have it all in medical school.
Listen, you can still get 225ish on the test and do a lot less -- albeit more than I did. But, wow, it sucks. I did just above the bare minimum in medical school and that's still a hell of a lot. And, it still was not enough to hit the American medical student average. Whether that says more about me or the test I'm not sure. But, wow, that's the type of hard working field we've chosen.
STEP is a proxy for how hard you've worked and for how long. That's it. Nothing more. There is a reason IMG's who can barely speak get 240s on this test -- they study for half a year.
What's sad for me is that I'm really having to rethink where I have to go to residency right now because of this test. I'm more relaxed and energetic about third year than lots of my classmates. And, I know I can relate to patients better than some of the robot-studiers who surely will be going into Ortho etc. And, I really never wanted to be in any of the ADORE (Anes/derm/orthooptho/radio/ENT,ER) residencies. I wanted to do medicine or pediatrics at a good teaching hospital because I like to teach and be in such learning environments.
But, with a 207 I'm not sure where I can go or what I'll be able to do. And it's all because I thought my standardized test taking ability would save me and my subpar medical career on STEP I.
It does not -- it absolutely does not. And , I hope future readers of this rambling/cathartic/and (I hope) educative post will understand that and simply not make the same mistake I did.
Good luck on STEP I you all. I hope no one has to feel like I'm feeling after they finish it.
