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These view represent my own personal views/opinion, and not those of any organization, entity, or school that I am affiliated with. These views are not advice.
There are many issues with USMLE going pass fail for all DO students and mid/low tier MDs going into ANY field, especially competitive specialties and programs.
Random thoughts/predictions I have
- Every DO student effectively has to take USMLE Step 2 CK to maximize their residency prospects.
- DO and mid/low tier MD students have little to no school name brand, limited access to prestigious LORs, limited access to large academic departments + research. They must find a way to overcome these hurdles.
- Personal connections will play a much larger role in getting key audition rotations, interviews and matching. Prestigious personal connections are astronomically more difficult to get at DO or mid/low tier MD schools.
- The great equalizer, the USMLE step 1 score, was the opportunity for students at DO and mid/low tier MD schools to demonstrate their equivalency and/or superiority to students at top MD schools. That opportunity to overcome your school's lack of prestige/pedigree is now gone. It will be harder to get audition rotations and interviews from smaller schools.
- USMLE Step 1 scores come out after second year, giving students a year to game plan their audition rotations, LORs, research projects, and target programs based on their competitiveness. That is now gone, as most students will receive their Step 2 CK score after third year. Students lives will be more uncertain now and they will have little to no time to create a plan of action to maximize their chances to match to their dream programs. What if you score a 235-240 on Step 2 CK but have already set up 4 aways in Derm, started 4 research projects, etc? You will now have only 1-2 months to create a new game plan on where to do audition rotations, whether or not you want to apply to a back up, take a year off for research, etc.
- The NBOME has an opportunity to make COMLEX open to MDs. Objective metrics are important and have a place in education. While the USMLE step 1 scores were definitely overemphasized, the solution should not have been to eliminate the last remaining objective metric programs have, but rather to create additional standardized objective metrics through which programs could assess candidates in addition to STEP scores.
- USMLE Step 1 mania will now become Step 2 mania, I predict that schools will shorten preclinical education, start clinicals in second year, move Step 2 CK to beginning of third year and focus more overall on content tested on Step 2 CK. Hopefully clinical rotation grading, preclinical grading, Deans letters, and LORs become more objective and standardized so that programs have some type of metrics beyond just the Step 2 CK score to gauge academic/clinical acumen of applicants.
- This adds uncertainty for nearly all DO and mid/low tier MD students, making mental health more complicated moving forward. Now students will likely obsess over intangibles and subjective things like networking, LORs, research connections, etc. (again all of which disproportionately benefit elite MD schools/students). Students can no longer rely on themselves to perform well enough on STEP 1 to enhance their opportunities.
- The MCAT is now an extremely important exam for the future of a student. In the absence of LCME/COCA creating new objective academic metrics for program directors, medical schools will become more like law schools where prestige is an extremely important factor in determining where you end up post graduation.
In short, USMLE pass/fail solves little to nothing, complicating matters for students at smaller medical schools while shifting most of the problem to USMLE Step 2 CK
Moving forward
If you are running a DO or mid/low tier MD school, I would change curriculum so that preclinical education is compacted into year one, clinicals begin second year, and everyone takes USMLE Step 2 CK end of second year. I would also invest heavily in GME creation in both specialty and primary care , wet lab creation for research, research funding, creating partnerships/contracts with local universities to enhance research access.
If I was LCME/COCA I would develop standards and elements that create standardized objective metrics (standardized grading for preclincial and clinical years across all schools in country, standardized Deans letters, etc.) so that a student's competitiveness is based on a greater number of objective variables instead of just one (Step 2 CK).
I would love to hear your thoughts.,
There are many issues with USMLE going pass fail for all DO students and mid/low tier MDs going into ANY field, especially competitive specialties and programs.
Random thoughts/predictions I have
- Every DO student effectively has to take USMLE Step 2 CK to maximize their residency prospects.
- DO and mid/low tier MD students have little to no school name brand, limited access to prestigious LORs, limited access to large academic departments + research. They must find a way to overcome these hurdles.
- Personal connections will play a much larger role in getting key audition rotations, interviews and matching. Prestigious personal connections are astronomically more difficult to get at DO or mid/low tier MD schools.
- The great equalizer, the USMLE step 1 score, was the opportunity for students at DO and mid/low tier MD schools to demonstrate their equivalency and/or superiority to students at top MD schools. That opportunity to overcome your school's lack of prestige/pedigree is now gone. It will be harder to get audition rotations and interviews from smaller schools.
- USMLE Step 1 scores come out after second year, giving students a year to game plan their audition rotations, LORs, research projects, and target programs based on their competitiveness. That is now gone, as most students will receive their Step 2 CK score after third year. Students lives will be more uncertain now and they will have little to no time to create a plan of action to maximize their chances to match to their dream programs. What if you score a 235-240 on Step 2 CK but have already set up 4 aways in Derm, started 4 research projects, etc? You will now have only 1-2 months to create a new game plan on where to do audition rotations, whether or not you want to apply to a back up, take a year off for research, etc.
- The NBOME has an opportunity to make COMLEX open to MDs. Objective metrics are important and have a place in education. While the USMLE step 1 scores were definitely overemphasized, the solution should not have been to eliminate the last remaining objective metric programs have, but rather to create additional standardized objective metrics through which programs could assess candidates in addition to STEP scores.
- USMLE Step 1 mania will now become Step 2 mania, I predict that schools will shorten preclinical education, start clinicals in second year, move Step 2 CK to beginning of third year and focus more overall on content tested on Step 2 CK. Hopefully clinical rotation grading, preclinical grading, Deans letters, and LORs become more objective and standardized so that programs have some type of metrics beyond just the Step 2 CK score to gauge academic/clinical acumen of applicants.
- This adds uncertainty for nearly all DO and mid/low tier MD students, making mental health more complicated moving forward. Now students will likely obsess over intangibles and subjective things like networking, LORs, research connections, etc. (again all of which disproportionately benefit elite MD schools/students). Students can no longer rely on themselves to perform well enough on STEP 1 to enhance their opportunities.
- The MCAT is now an extremely important exam for the future of a student. In the absence of LCME/COCA creating new objective academic metrics for program directors, medical schools will become more like law schools where prestige is an extremely important factor in determining where you end up post graduation.
In short, USMLE pass/fail solves little to nothing, complicating matters for students at smaller medical schools while shifting most of the problem to USMLE Step 2 CK
Moving forward
If you are running a DO or mid/low tier MD school, I would change curriculum so that preclinical education is compacted into year one, clinicals begin second year, and everyone takes USMLE Step 2 CK end of second year. I would also invest heavily in GME creation in both specialty and primary care , wet lab creation for research, research funding, creating partnerships/contracts with local universities to enhance research access.
If I was LCME/COCA I would develop standards and elements that create standardized objective metrics (standardized grading for preclincial and clinical years across all schools in country, standardized Deans letters, etc.) so that a student's competitiveness is based on a greater number of objective variables instead of just one (Step 2 CK).
I would love to hear your thoughts.,
