No longer scoring step exams

[Agast]

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well Snap -I don’t want to be condescending.

And thanks for the feedback.

Agast, if you wanted someone to watch a couple of videos so you could discuss, how would you go about doing it without sounding condescending?

I would directly link the video, give my analysis, and then see if they were interested in responding.

Asking for a book report is kinda lame

And if I remember correctly, the biggest controversy over Chappelle’s cold open was whether it was anti-Semitic. I believe Jon Stewart and others commented from the standpoint of being Jewish themselves. I don’t consider myself the arbiter of what is anti-Semitic. It seems appropriate to let the Jewish community reach their own consensus.

 

[Agast]

I agree that epidural man is coming from a place of love. Chapelle is very intelligent, insightful, and funny man. It could be very useful for her to hear his take on things compared to a patronizing white liberal such as Jon Stewart. Jon Stewart is patronizing here, not epidural man.

You clearly missed that Stewart defended Chapelle. They’re good friends. Maybe your homework should be to watch what Stewart said lolololol

 

[bedrock]

You clearly missed that Stewart defended Chapelle. They’re good friends. Maybe your homework should be to watch what Stewart said lolololol

I only watched Chappell not Stewart. I wrongly assumed Stewart was a patronizing liberal in this situation because that is generally what I seen from him and Colbert in the past few years.

I can’t stand either of them nowadays so I wont watch their current shows.

I find it interesting how ratings for all the late talk shows fell off a cliff once they revealed their true far left political views.

Funny that no one took the time for market research and to consider that only 1/3 of the country labels themselves a democrat. (1/3 republican and 1/3 independent). So, maybe just maybe for both of them to now do a show that looks down their nose at half of the country wasn’t a great idea for the long term survival of their shows.

 

[drrosenrosen]

Am I not hearing or are you not hearing? I told you I agree that everyone should get in on their own merits. That would destroy most elite universities as tons of people (my understanding is that up to 40% of admissions) to elite undergrads come from some sort of connection/legacy type nonsense.

Do I agree with affirmative action? No I don't. However the goal of affirmative action is to consider that scores for example on standardized tests are not all equal. Does a rich white person have a massive advantage in their parents paying for a private tutor to work with them for however long to prepare them for an MCAT, step or whatever? How does that compare to the poor ethnic person who has to work to get through? Or the person who doesn't speak English as a native speaker? English is a second language for me. My parents for example never gave me an excuse for not succeeding but it's 10 times as difficult to take these types of tests when your native language is not English.

Regardless do you consider the affluent, Native speaking person to be the same as someone who comes from poverty, who has no resources, has to work, etc? That's the whole point of "affirmative action." Does a test make one physician better than another? By that metric, then Dermatologists are the best and brightest.

Do you know that in my native country, Psychiatry is one of the most coveted residencies - it's considered a luxury and a status of wealth to be able to afford a private psychiatrist due to a Freudian influence.

The point being that suggesting that everyone is the same, particularly not taking into account minority circumstances fails to take into account the whole of the person.

You can disagree if you'd like. But you do a disservice to those of us who have worked just as hard as everyone else, who don't have wealthy parents, and have spent countless hours studying, learning, and who take great care of our patients every day. You to tell someone that you are uncertain of the skill set of another physician simply bc they are a minority is just outrageous.

Learn to trust your colleagues by the measure of their skill set - not their ethnicity. Otherwise you are guilty of the same thing you are suggesting you are trying to have admissions committees avoid.

You bring up a good point, which is the economically disadvantaged applicant. It is a fact that historically, minorities are more likely to be economically disadvantaged. I'm sure you noticed that Bedrock himself comes from a poor background. Perhaps socioeconomic background, irrespective of race, is something that should be given consideration in admissions decisions.

 

[Doctodd]

Couldn’t agree more. We now will have neurosurgeons with 180s

Great scores on these exams show 1) intelligence and 2) work ethic

the lawyers will definitley benefit. The patients wont.

 

[Doctodd]

I only watched Chappell not Stewart. I wrongly assumed Stewart was a patronizing liberal in this situation because that is generally what I seen from him and Colbert in the past few years.

I can’t stand either of them nowadays so I wont watch their current shows.

I find it interesting how ratings for all the late talk shows fell off a cliff once they revealed their true far left political views.

Funny that no one took the time for market research and to consider that only 1/3 of the country labels themselves a democrat. (1/3 republican and 1/3 independent). So, maybe just maybe for both of them to now do a show that looks down their nose at half of the country wasn’t a great idea for the long term survival of their shows.

they are subsidized....they dont need ratings

 

[Doctodd]

And FYI- Orthopedics is notoriously racist and sexist. I've seen plenty of atrocious things done by Orthopedic physicians and departments. It is a white all boy's club. So any non-white non male person in Ortho will have a hell of a time.

that was a racist and anecdotal statement, dont you think?

 

[Baron Samedi]

On the original topic:

I am curious if P/F steps will have the effect of making residency matching and the medical school experience more difficult? Without an increase in residency slots and increasing medical school slots, won't these become even more competitive?

Rather than relying on a good Step 1 score, applicants will have to set themselves apart on clinical rotations instead(probably for the better). Step study was difficult, but once it was done it was done. Applicant X can no longer coast on his X rotation because he got a 265 and wants to go into Y. Going for Honors on rotations, research, volunteer work, etc. will be the new metrics that make applicants stand out.

 

[kstarm]

I personally like the move away from high stakes testing. I remember being sick as hell during my step 2 test and scoring lower than my practice tests on it. I am sure many people have stories of less than ideal circumstances when going into these tests that are similar, and at the time I was in school, Step 1 score basically determined what specialties were open to you or not. What I have heard is that there are people that do well on tests and step tests score correlate well with board test scores so residency want students who will pass boards so their rates look good. Sitting in on residency admissions I know we had a Step 1 cut off. You didn't get a chance to interview if your score was below X and I believe that was true for most programs. The question really gets at: how well does that correlate with being a good physician? We rail against MOC as well, for similar reasons, how well does jumping through the hoops correlate with being a good physician? We don't have a great way to easily determine that and it continues to evolve. I think moving away from a single test to determine your destiny is good, but I am not sure what is the best way. I honestly wish they did way more psychological evaluations to better determine who the narcissists and others with personality disorders are and either try to help them or weed them out. In my experience that correlates more with board sanctions/fraud than other metrics, but I don't have data to know for sure.

 

[RoloTomassi]

On the original topic:

I am curious if P/F steps will have the effect of making residency matching and the medical school experience more difficult? Without an increase in residency slots and increasing medical school slots, won't these become even more competitive?

Rather than relying on a good Step 1 score, applicants will have to set themselves apart on clinical rotations instead(probably for the better). Step study was difficult, but once it was done it was done. Applicant X can no longer coast on his X rotation because he got a 265 and wants to go into Y. Going for Honors on rotations, research, volunteer work, etc. will be the new metrics that make applicants stand out.

Seems like most schools have moved to P/F classes too. So school name, research, letters/connections, and Step 2 are deciding factors

 

[epidural man]

Couldn’t agree more. We now will have neurosurgeons with 180s

Great scores on these exams show 1) intelligence and 2) work ethic

How does doing well on an exam prove work ethic?

I know some very hard working farmers (I grew up in Idaho) who are very intelligent who do horrible in school and tests.

My brother and I took the same psychology class in college. We both studied the same. I consider my brother wicked smart (maybe I’m biased) and I did great at the exams, he hardly passed. I was just way better at taking exams. This skill doesn’t translate to doing a skill like removing a spinal tumor.

 

[NeuResurgens]

I disagree. Neurosurgery takes no brain power. It takes a lot of training that requires a very specific skill set.

This discussion is silly.

The mental dexterity demand of the chosen field is not what drives people to the field. It has always been money. High paying jobs are the highest demand and so with traditional measuring sticks (test scores), this drives the smartest to them. After years of this, I suspect people then start to assume that it takes the smartest to be that physician.

Honestly, the smartest people should do anesthesia. 🙂. That is the most Intellectually challenging field, OBVIOUSLY.

I agree with the latter parts of the post - it was always money, and to a lesser degree lifestyle plays a role in which specialties are most competitive.

I'll add the caveat that neurosurgery does not low brain power. It may be different where you are, but at my program we do a lot of nonoperative management and tend to manage our patients comorbidities ourselves beyond what some of the other surgical specialties do, so we put those step scores to use. Anesthesia, IM and primary care do still require more brain power however. Managing drug interactions and gritty pathophysiology requires a ton of thought and foresight without visualizing the issue directly (like surgery does).

 

[epidural man]

I agree with the latter parts of the post - it was always money, and to a lesser degree lifestyle plays a role in which specialties are most competitive.

I'll add the caveat that neurosurgery does not low brain power. It may be different where you are, but at my program we do a lot of nonoperative management and tend to manage our patients comorbidities ourselves beyond what some of the other surgical specialties do, so we put those step scores to use. Anesthesia, IM and primary care do still require more brain power however. Managing drug interactions and gritty pathophysiology requires a ton of thought and foresight without visualizing the issue directly (like surgery does).

Oh I hope I didn’t imply neurosurgeons aren’t brilliant. Historically they are top of the class.

My point was that being willing and able to work 100 hr work weeks is probably a much stronger prediction of success than test scores.

Truth is, most people in medical school are smart enough for any of the professions.

 

[Ferrismonk]

Seems like most schools have moved to P/F classes too. So school name, research, letters/connections, and Step 2 are deciding factors

My school classes were pass/fail. What happened in residency is that there was a minimum Step grade cutoff for consideration just to narrow the field a bit, but then interview and rotating at that location (basically a long interview) were the deciding factors. It was good for our residency program.

 

[nopain1234]

I know some very hard working farmers (I grew up in Idaho) who are very intelligent who do horrible in school and tests.

My brother and I took the same psychology class in college. We both studied the same. I consider my brother wicked smart (maybe I’m biased) and I did great at the exams, he hardly passed. I was just way better at taking exams. This skill doesn’t translate to doing a skill like removing a spinal tumor.

I love how we make this topic so complicated. This isn’t rocket science.

Typically people who study harder do better on exams. MIND BLOWN

 

[nopain1234]

Oh I hope I didn’t imply neurosurgeons aren’t brilliant. Historically they are top of the class.

My point was that being willing and able to work 100 hr work weeks is probably a much stronger prediction of success than test scores.

Truth is, most people in medical school are smart enough for any of the professions.

This just simply is false. I knew a lot of very average people in med school who did family or psych and thank god they didn’t do anything else

 

[callmeanesthesia]

This just simply is false. I knew a lot of very average people in med school who did family or psych and thank god they didn’t do anything else

I think you’re confusing the effect of step score filtering for high-paying specialties with the actual cognitive requirements of the specialties. I’ll echo what others above have said - some of the smartest doctors I’ve known have been internal medicine and related sub specialists. Family medicine have to know a simply staggering amount of medical information to be good at their jobs. We should be only allowing our best and brightest into primary care, but our best and brightest surprisingly aren’t willing to settle for making barely six figures when they could do derm and make four times as much with half the work. It’s the demand for the specialty due to income, not the cognitive demand of the specialties. Neurosurgery, I think, is a whole separate beast because undoubtedly you have to be smart, but you also have to be willing to put your entire life on hold for 7 years for that residency (“how do you hide a $100 bill from a neurosurgeon?”).

 

[RoloTomassi]

Another point that hasn't been mentioned is that students will put in the effort required to hit a target score based on their interests.

If someone is dead set on derm, they know they have to get a top score to be competitive, whereas someone going into psych might barely study and get an average score.

 

[lobelsteve]

Please keep the politically and racially charged posts like this in the private forum.