The neuroticism though isn't completely unfounded. It's hard to deny that the higher your board score, the better your odds are at matching into the specialty and into the location that you prefer. You can be the nicest guy, be a superstar on rotations, but a 210 Step 1 will shut you out simply because you won't make the screen. Going hardcore and spending 12 hours a day studying starting in M1 is of course ridiculous because it isn't mentally sustainable, but shutting yourself away for a handful of months before your Step 1 isn't unreasonable. The whole match process of matching is complex, but if you think about it as playing odds, for certain specialties, a strong Step 1 gives you the best chance at being considered. I say for certain specialties because if your goal is family medicine, there's no reason why you should kill yourself trying to get a 260+. After you have the match letter in your hand though, the purpose that the Step 1 serves is minuscule say for possibly applying to fellowships later.
Yeah I think this is the right attitude. Depending on the specialty, step 1 isn't going to be worth the time and effort. If you're going for academic neurosurg or plastics or whatever, and you come from a mid-tier school, I can see doing what you have to do to give yourself every chance at a high score, but understand that this is not the MCAT. The test will be minimally like the practice exams.
Having
just taken the exam, I can tell you 100% that it is random enough and weird enough that there are no guarantees, especially in the > 250 range. I got some questions on things I thought were
completely overkill to study because they weren't in UFAP at all. I got questions on low-yield FA topics. Most importantly though, I got tons and tons of vague, obscure questions that were unclear and nearly impossible to answer. I was scoring 260+ on NBMEs and UWSAs towards the end and I marked 15-20 per section on the real deal. This was not so different from my UW blocks as I flag liberally, but the difference is that when I flagged stuff on the real thing, I really didn't know. All I can say is that I almost wish I just took it at baseline, prior to the pool change, with class knowledge still in my head. I was constantly trying to pull things from the back of my mind, including stuff from M1 and even prior.
Also, people who take this after a clinical year have a massive, massive advantage.
I think PDs must know how random it is. I had a few topics that were among my lowest in UW pop up over and over, while many other huge topics were massively underrepresented. I think I had 2 cardio and immuno questions on the whole thing. A friend of mine took it sitting right next to me and said she basically took an immuno exam combined with obscure anatomy.
This test wasn't designed originally to be scored linearly. Obviously accuracy isn't their 1st priority or you wouldn't have people on here getting a 240 and a 265 on the same test 4 days out both getting a 255. The base of knowledge they are pulling from isn't UFAP. UFAP is just the highest yield. The NBME sees nothing as "off limits." So UFAP just introduces you to the highest yield stuff, and on test day you get your socks blown off trying to pick between 5 study types you've never heard of on an obscure biostats question. There are experimental questions, but there were too many weird questions for them all to be experimental, and even if they throw those away, you're looking at a very small # of questions to accurately assess someone's overall understanding of the principles of medicine.
I've also heard from IM PDs are the top of the top (e.g. MGH, JHH), that the score only helps if they see you as a particular type of person. Obviously they fill their spots with geniuses, but they want a well-rounded class. You need a 260+ if you're scoring a spot in that class by virtue of your sheer brilliance and scientific acumen. 240+ is fine if they see you as a future leader and you have some serious accomplishments on your resume.
