Pass/Fail Boards

[dohopeful13]

I've seen a few threads touch upon this subject already, but as many here know a meeting was held last month with representatives from medical schools, the AAMC, AMA, NMBE, etc. to discuss making the USMLE pass/fail. Preliminary recommendations are expected to be released in May or June. I think most agree if this happens, it will lead to more emphasis being placed on school prestige, research, and connections, which many DOs lack. this link has a list of the attendees, and given that there is exactly one osteopathic representative out of the entire list (seriously, even FMGs got two reps), I doubt DOs will get a whole lot of say in the decision one way or the other.

I wanted to have a deeper discussion on how this might affect DOs

1) I would assume this would be the final nail in the coffin for competitive specialties unless you have a serious connection to a program. Want to be a surgeon? Re-apply and go MD. Want ortho or Derm? Get into a top 25 school.

2) How would applicants be distinguished from the growing number of other DO applicants? Would the COMLEX follow suit and become P/F?

3) Where do IMGs/FMGs fall into this? Would carib students in particular be totally squeezed out (with the exception of IMG hotbeds like NYC) without board scores? Would their elimination actually help accommodate the growing number of American grads in the match? How would FMGs from other countries (not carib) have any objective way to be compared to American grads?

4) When would this change realistically be implemented? Would schools be given a few years to re-design their curriculum? Would new, specialty dependent exams be shoved onto us?

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[AlbinoHawk DO]

If this happens, it'll be a world where auditions will become the only way to open doors. I don't see any difference for top schools. It's very rare that top 25 will produce people that get board scores of 200. I would think IMG/FMG will be SOL in this scenario except with PDs that were FMGs/IMGs themselves

 

[Azmkv]

Would they give us few years before they implement this even if it passes? Otherwise, I think it would be unfair for a lot of DO students who were oblivious to this unforeseen future. A lot of DO students, including myself who will be starting this fall, decided to go to DO route because we thought we could work hard, despite of the uphill battles, and prove ourselves through the USMLE board scores that we can compete for the competitive residencies.. If they implement this plan right away, there will be literally 0 chance for any DO to match any some-what-good residency program IMHO. In this case, I might have to just drop my DO admission and reapply next cycle...

 

[Moose A Moose]

This is how it should be. You’ll have more emphasis on curriculum understanding and real medicine vs ‘test prep’.

Auditions will become more important once again. Another good thing. Welcome to the need to be a well-rounded worker, as well as academically apt.

It will lead to more US grads getting residency vs this ridiculous surplus of IMG/FMG.


It’s going to pass.

 

[shadowlightfox]

The program directors will also be pissed off at this news if it comes into fruition. That means no easy cutoff for them anymore.

 

[fldoctorgirl]

This is how it should be. You’ll have more emphasis or curriculum understanding and real medicine vs ‘test prep’.

Auditions will become more important once again. Another good thing. Welcome to the need to be a well-rounded worker, as well as academically apt.

It will lead to more US grads getting residency vs this ridiculous surplus of IMG/FMG.

It’s going to pass.

How is this a good thing? We will have no way to distinguish ourselves, and prove that we are just as good, for any semi-competitive specialty.

 

[shadowlightfox]

I don't think it's just DO students who will be facing the brunt of this. Pretty much any med school that's not the elite top 10 will have students worrying about this. This clearly doesn't seem like a DO-only problem.

 

[DrStephenStrange]

Well, on the DO side we'll still have a scored COMLEX. I'm guessing PDs could use that in some way or fashion.

 

[DO2015CA]

Would they give us few years before they implement this even if it passes? Otherwise, I think it would be unfair for a lot of DO students who were oblivious to this unforeseen future. A lot of DO students, including myself who will be starting this fall, decided to go to DO route because we thought we could work hard, despite of the uphill battles, and prove ourselves through the USMLE board scores that we can compete for the competitive residencies.. If they implement this plan right away, there will be literally 0 chance for any DO to match any some-what-good residency program IMHO. In this case, I might have to just drop my DO admission and reapply next cycle...

lol yes.. in your opinion. You need to define the specialty and then define what good means to you. Within primary care specialties, there are great ACGME programs that take COMLEX only students. And then in some specialties there are programs that won't touch a DO regardless of their 270. This is a very uninformed opinion and its not your fault, but reality isn't black and white. As SDN always states, if you can go MD then do it.

 

[DO2015CA]

Well, on the DO side we'll still have a scored COMLEX. I'm guessing PDs could use that in some way or fashion.

meh programs that require/want USMLE do so because they don't understand or respect the COMLEX scoring system.. so my guess is they wouldn't use COMLEX numbers for the filter. They would be more likely to filter out by either took USMLE and passed or just filter out all DOs.

 

[dohopeful13]

How is this a good thing? We will have no way to distinguish ourselves, and prove that we are just as good, for any semi-competitive specialty.

I think it COULD be a good thing if the result is Caribbean students and FMGs get squeezed out due to not having board scores. Would solve the problem of the rapid school expansion vs residency spots. That said, it would come at cost of truly make DO the primary care degree with no way to get anything higher. I would personally rather gamble on myself and keep board scores.

 

[DO2015CA]

I think it COULD be a good thing if the result is Caribbean students and FMGs get squeezed out due to not having board scores. Would solve the problem of the rapid school expansion vs residency spots. That said, it would come at cost of truly make DO the primary care degree with no way to get anything higher. I would personally rather gamble on myself and keep board scores.

My mindset is a little different than others when it comes to carib students. They are first and foremost Americans and have paid taxes like the rest of us. So I think if they make it through the island ring of fire then they should be held on even footing as at stateside students (at least DOs LOL). I absolutely loathe the practices of their schools, but this is not the student's fault. I support 2 tiered matching where american carib students would go in the first match and then all international students would be in the second.

 

[Moose A Moose]

How is this a good thing? We will have no way to distinguish ourselves, and prove that we are just as good, for any semi-competitive specialty.

Do well in class, network early and set up rotations at sites of interest. Just like a couple decades ago, med school geography is going to play a bigger role in residency and career.

 

[Espressso]

I think this is a great thing. There's a doc and professor I follow on twitter who is heavily invested in this topic and his arguments for transitioning to a p/f set up is extremely intriguing. I just have to find him, forgot his name.

Really, as Moose said above, it would mean more emphasis on actually learning and less on high yield test topics. I think it would probably hinder DOs at first, but I think this is a necessary step towards a true merger of the two degrees.

I think if this passes, and usmle becomes p/f, then the next step would be for comlex to follow suit, and then after that, all the programs will require usmle and comlex will shift into a opp-centered exam designed for OMM/NMM residencies, that can be taken by both DO and MD students who want those residencies. That would be ideal.

All in all, the step exams are a set of licensing exams. In any other profession, that means pass/fail.

Oh also, federal law for letting US MDs/DOs get first dibs on residency would have to be a follow up move IMO

 

[dohopeful13]

My mindset is a little different than others when it comes to carib students. They are first and foremost Americans and have paid taxes like the rest of us. So I think if they make it through the island ring of fire then they should be held on even footing as at stateside students (at least DOs LOL). I absolutely loathe the practices of their schools, but this is not the student's fault. I support 2 tiered matching where american carib students would go in the first match and then all international students would be in the second.

I agree those students deserve a chance, I was just saying they would likely feel a big squeeze without board scores, which would help DO overall. That said, if we want to end those shady practices, the first step is honestly making them non viable options. How you accomplish that without ruining the lives of a lot of hardworking kids is another question.


That said, I’m not as 100% confident P/F will happen soon as others in this thread. Momentum is gaining but there would be a lot of push back from PDs, FMGs, lower tier schools, etc. not to mention the there is a lot of money in the business of test prep that will be lost.

 

[fldoctorgirl]

All in all, the step exams are a set of licensing exams. In any other profession, that means pass/fail.

I agree with this and I think it would be better for both learning and mental health if the exams were P/F, I just have serious concern for how this would look for DOs and those from lower-tier MD schools when it comes time to apply for residency.

 

[Chibucks15]

I agree with this and I think it would be better for both learning and mental health if the exams were P/F, I just have serious concern for how this would look for DOs and those from lower-tier MD schools when it comes time to apply for residency.

Make Step 2 more important. That's actual clinical knowledge anyway so its more representative for you as a physician. All the random esoteric nonsense on step 1 doesn't separate good physicians from bad ones, it separates people who can memorize factoids like the Kreb's cycle that has literally no bearing on future practice

 

[QueenJames]

lmaoooo damnnnnnnnn.

Sucks to be an incoming DO student right 'bout now.

Only 48 more weeks to go baby!

 

[shadowlightfox]

I think this is a great thing. There's a doc and professor I follow on twitter who is heavily invested in this topic and his arguments for transitioning to a p/f set up is extremely intriguing. I just have to find him, forgot his name.

Really, as Moose said above, it would mean more emphasis on actually learning and less on high yield test topics. I think it would probably hinder DOs at first, but I think this is a necessary step towards a true merger of the two degrees.

I think if this passes, and usmle becomes p/f, then the next step would be for comlex to follow suit, and then after that, all the programs will require usmle and comlex will shift into a opp-centered exam designed for OMM/NMM residencies, that can be taken by both DO and MD students who want those residencies. That would be ideal.

All in all, the step exams are a set of licensing exams. In any other profession, that means pass/fail.

Oh also, federal law for letting US MDs/DOs get first dibs on residency would have to be a follow up move IMO

But then how will this factor into applying for competitive residencies. Sure, extracurriculars will become way more important, but with pass/fail, I anticipate competitive places getting way more applicants than they are now used to merely because the board score threshold would be gone.

 

[Trollest]

I can't believe you replied to him.

meh programs that require/want USMLE do so because they don't understand or respect the COMLEX scoring system.. so my guess is they wouldn't use COMLEX numbers for the filter. They would be more likely to filter out by either took USMLE and passed or just filter out all DOs.

 

[DrStephenStrange]

I can't believe you replied to him.

Wow... I see how it is fam. Point taken. I'll keep my mouth shot next time.

 

[Cheeni17]

I have to say no for the following reasons.
1. I haven’t met that many if any people who barely passed that were super strong in clinical. Passing is way too easy to make that the standard.
2. A lot of step one knowledge IS useful for clinicals. Moreso step two yes but my step exam was VERY clinical.
3. We would then be stratified via our MCAT (school prestige). Do you fellow DO students really want that?
4. Not everyone has loaded parents to pay for a crap ton of auditions. Making auditions and connections more important than they are just favors the haves more than the have nots.
5. PDs would have a near infinite amount of apps to go thru. They would set a filter in some other way. And while we seem to have some optimism here what makes one think it won’t be auto screening out of DOs ?
6. people just won’t work as hard without a hard goal to obtain if they all know they will be viewed equal.
7. Grades? Some schools are PF so that won’t work.
8. A person who makes a 260 has a much greater knowledge base than a 205. Scores closer together not so much. I wouldn’t want a 205 as my doctor no matter how nice they are.
9. We have no other objective way to compare applicants.
10. Not stirring the water but I feel those advocating this probably didn’t do well on boards so there is an emotional component to this.

Before tossing out a yes to this just remember we will be judged via school prestige (MCAT UG GPA) just like law/ pharm/ MBA/dentistry......... which would have a lower correlation with physician performance than step. I can assure you that.

Doesn’t matter if you blow the BAR out of the water if you went to cesspool USA law school. It’s your LSAT that determines your future.


-end rant

 

[Cheeni17]

You sound pretty naive and clueless with very limited interactions with practicing physicians.

No I’ve been around them quite a while. I understand if you disagree but you have to offer a rebuttal not snide. Did you do poorly on step?

 

[Cheeni17]

Make Step 2 more important. That's actual clinical knowledge anyway so its more representative for you as a physician. All the random esoteric nonsense on step 1 doesn't separate good physicians from bad ones, it separates people who can memorize factoids like the Kreb's cycle that has literally no bearing on future practice

My step two was yes much more clinical but not much use for some of the deeper specialties. But yes I agree

 

[Cheeni17]

Nope. I did above average. But your stance is extremely naive and lacks any understanding of the history of the usmle or the career output of those who have taken it

So you offer any evidence of this or is this just snide ? According to PD, student, resident surveys they tend to agree. See link

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[Chibucks15]

My step two was yes much more clinical but not much use for some of the deeper specialties. But yes I agree

make step 1 a competency exam like it should be, and have step 2 be the main differentiation. Its roughly the same system as it is now, but that way you're at least studying something useful to the vast majority of future (non research) physicians. But noooo that would be too easy of a solution

 

[Cheeni17]

No matter this won’t change any time soon since PDs and NBME both benefit from numerical step. As do more intelligent people

 

[sunshinefl]

To those saying that the actual intent is to be a licensing exam and thus it should be pass/fail, I would like to point out that they are already pass/fail for that purpose. There is a pass line. The score is just also reported.

 

[Chibucks15]

To those saying that the actual intent is to be a licensing exam and thus it should be pass/fail, I would like to point out that they are already pass/fail for that purpose. There is a pass line. The score is just also reported.

But don’t even report a score. Or put it in quartiles or something. Agonizing over every question of an ever increasing (doubling) medical knowledge base, when the exam focuses on crazy factoids that don’t mean jack for being a doctor, is a large reason why we are where we are.

Med students are as type A as it gets. People will try to learn every little thing. Having people literally and figuratively kill themselves over learning esoteric nonsense that doesn’t have a bearing on future physicians at all seems like a bad route to go. Especially when everyone dumps the useless stuff right after the exam

 

[sumtimesuwonder]

make step 1 a competency exam like it should be, and have step 2 be the main differentiation. Its roughly the same system as it is now, but that way you're at least studying something useful to the vast majority of future (non research) physicians. But noooo that would be too easy of a solution

I agree with this. I always thought it was also kind of strange to differentiate someone based on skills/knowledge that they acquired before they were even able to see patients and that occurred a whole two years before residency starts. The extra 6-8 months of clinical experience should matter more than it does now.

 

[Espressso]

Agreed with those saying more emphasis on Step 2. And keep the scoring for that one, and have that be the differentiating factor for residency apps. I know a lot of DO students now who are contemplating waiting to take step until third year to get more clinical experience under their belt. It doesn't have to be like that. Also if step 1 was pass/fail, auditions would be more important. Which I think is a good thing.

I have to say no for the following reasons.
1. I haven’t met that many if any people who barely passed that were super strong in clinical. Passing is way too easy to make that the standard.
2. A lot of step one knowledge IS useful for clinicals. Moreso step two yes but my step exam was VERY clinical.
3. We would then be stratified via our MCAT (school prestige). Do you fellow DO students really want that?
4. Not everyone has loaded parents to pay for a crap ton of auditions. Making auditions and connections more important than they are just favors the haves more than the have nots.
5. PDs would have a near infinite amount of apps to go thru. They would set a filter in some other way. And while we seem to have some optimism here what makes one think it won’t be auto screening out of DOs ?
6. people just won’t work as hard without a hard goal to obtain if they all know they will be viewed equal.
7. Grades? Some schools are PF so that won’t work.
8. A person who makes a 260 has a much greater knowledge base than a 205. Scores closer together not so much. I wouldn’t want a 205 as my doctor no matter how nice they are.
9. We have no other objective way to compare applicants.
10. Not stirring the water but I feel those advocating this probably didn’t do well on boards so there is an emotional component to this.

Before tossing out a yes to this just remember we will be judged via school prestige (MCAT UG GPA) just like law/ pharm/ MBA/dentistry......... which would have a lower correlation with physician performance than step. I can assure you that.

Doesn’t matter if you blow the BAR out of the water if you went to cesspool USA law school. It’s your LSAT that determines your future.


-end rant

A couple points on this...

#3: I'm a DO student and I think this is a still a better move. Step 1 should just be "can you make it through the first two years? sweet no go on to clinicals"
#4: everything about medical school is favoring the "haves" and not the "have nots". Making auditions more important is a better move for everyone.
#8: you're kidding? lol. Do you go to all your doctor appointments asking for which one had the highest step 1 score? That's hilarious and also a really weak argument.
#9: yeah we do, step 2. People can focus more on step 2, which is much more relevant and clinically-based.

No matter this won’t change any time soon since PDs and NBME both benefit from numerical step. As do more intelligent people

Your comment is implying that only less intelligent people are pushing for a p/f step exam. This is far from the case. If you've made to medical school I'd say you're fairly intelligent. We're just having a discussion about how to improve the current set up. Intelligently.

 

[bigindian4891]

I wouldn’t want a 205 as my doctor no matter how nice they are.

This is where I stopped reading your post. Its the kind of mindset that makes people psychotic about board scores.

 

[BorntobeDO?]

The program directors will also be pissed off at this news if it comes into fruition. That means no easy cutoff for them anymore.

Oh contraire monsieur. There still is a 'non-lcme' filter and you can still filter by failed boards after that. Life is good.

 

[BorntobeDO?]

Would they give us few years before they implement this even if it passes? Otherwise, I think it would be unfair for a lot of DO students who were oblivious to this unforeseen future. A lot of DO students, including myself who will be starting this fall, decided to go to DO route because we thought we could work hard, despite of the uphill battles, and prove ourselves through the USMLE board scores that we can compete for the competitive residencies.. If they implement this plan right away, there will be literally 0 chance for any DO to match any some-what-good residency program IMHO. In this case, I might have to just drop my DO admission and reapply next cycle...

Now your beginning to understand.

Why do you think you deserve this chance just because you got into a DO school? This process doesn't owe you anything, and it will remind you of that every step of the way. You should work hard NOW for the MD if you are really worried about this. Most people won't. Some of us would like the whole process to be better, but we aren't the ones running things.

 

[BorntobeDO?]

lmaoooo damnnnnnnnn.

Sucks to be an incoming DO student right 'bout now.

Only 48 more weeks to go baby!

I am with you brother, I hope it happens next year, then we will see about DO's 'doing better than ever.'

 

[Cheeni17]

Not sure if half the people here have even taken step but mine was very clincial and I used much of it during third year. My step two was not much diff from step one and step one tested stuff I would hope any physician would use.
Actually had a few of the same questions basically.
Now changing med school curriculum would be something I’d be more interested in to less basic science and more use. But don’t forget it’s basic science knowledge that sets us apart from midlevels.
There was a post in the MD forums where most people wanted to keep step scored via the survey.
Im not sure why the sentiment is so much toward a PF test in this thread.

No wonder the licensing boards think we are a bunch of cry babies. We want the PE /CS eliminated and PF board exams. God forbid people have to know things nowadays

 

[Cheeni17]

This is where I stopped reading your post. Its the kind of mindset that makes people psychotic about board scores.

If people think boards are stressful wait until they make life saving decisions

 

[Cheeni17]

Agreed with those saying more emphasis on Step 2. And keep the scoring for that one, and have that be the differentiating factor for residency apps. I know a lot of DO students now who are contemplating waiting to take step until third year to get more clinical experience under their belt. It doesn't have to be like that. Also if step 1 was pass/fail, auditions would be more important. Which I think is a good thing.



A couple points on this...

#3: I'm a DO student and I think this is a still a better move. Step 1 should just be "can you make it through the first two years? sweet no go on to clinicals"
#4: everything about medical school is favoring the "haves" and not the "have nots". Making auditions more important is a better move for everyone.
#8: you're kidding? lol. Do you go to all your doctor appointments asking for which one had the highest step 1 score? That's hilarious and also a really weak argument.
#9: yeah we do, step 2. People can focus more on step 2, which is much more relevant and clinically-based.




Your comment is implying that only less intelligent people are pushing for a p/f step exam. This is far from the case. If you've made to medical school I'd say you're fairly intelligent. We're just having a discussion about how to improve the current set up. Intelligently.

If the test was made pf they need to raise the bar. You can pass step knowing not much. And the title of this post makes it sound like all tests should be PF. Why the change to step two being graded? It’s very similar to step 1. Kicking the can down the road doesn’t help anyone.


If anyone actually bothers to click the link I put (it’s not broken) one would see its most the sub 220 USMLE group that wants pass fail. I wonder why........

 

[AlbinoHawk DO]

I have to say no for the following reasons.
1. I haven’t met that many if any people who barely passed that were super strong in clinical. Passing is way too easy to make that the standard.
2. A lot of step one knowledge IS useful for clinicals. Moreso step two yes but my step exam was VERY clinical.
3. We would then be stratified via our MCAT (school prestige). Do you fellow DO students really want that?
4. Not everyone has loaded parents to pay for a crap ton of auditions. Making auditions and connections more important than they are just favors the haves more than the have nots.
5. PDs would have a near infinite amount of apps to go thru. They would set a filter in some other way. And while we seem to have some optimism here what makes one think it won’t be auto screening out of DOs ?
6. people just won’t work as hard without a hard goal to obtain if they all know they will be viewed equal.
7. Grades? Some schools are PF so that won’t work.
8. A person who makes a 260 has a much greater knowledge base than a 205. Scores closer together not so much. I wouldn’t want a 205 as my doctor no matter how nice they are.
9. We have no other objective way to compare applicants.
10. Not stirring the water but I feel those advocating this probably didn’t do well on boards so there is an emotional component to this.

Before tossing out a yes to this just remember we will be judged via school prestige (MCAT UG GPA) just like law/ pharm/ MBA/dentistry......... which would have a lower correlation with physician performance than step. I can assure you that.

Doesn’t matter if you blow the BAR out of the water if you went to cesspool USA law school. It’s your LSAT that determines your future.


-end rant

Some programs like UAZ-Tucson psychiatry don't even look at your step 1. They look exclusively at your step 2 score.

Auditions can be expensive, but I think almost every school has financial aid that's tailored toward doing auditions. I have no family money whatsoever and never felt that i couldn't do auditions due to finances.

260 is definitely a better student academically than a 205, but it doesn't say much about work ethic or applying clinical knowledge. I also don't think Pass/Fail means the equivalent of 190 (whatever it is now to pass) will be the minimum. I bet it will be at least 210. At some point, higher score doesn't translate to being better in a field. I know some docs that were pure stupid that failed USMLE and barely passed the FLEX (old FMG exam) that are now faculty at USC/UCLA in fields like Ophthalmology, Neurology, etc. You might not want a 205 as your doctor, but I bet you've already had doctors that could never even hit that goal.

I think the best point you make is that there needs to be some kind of objective way to compare and perhaps the solution would be P/F step 1 and scored step 2

 

[AlbinoHawk DO]

Well, on the DO side we'll still have a scored COMLEX. I'm guessing PDs could use that in some way or fashion.

I would think that will not matter. I know people that passed COMLEX 550 easily and then failed USMLE. I really doubt anyone will care about a COMLEX

 

[NotAProgDirector]

Changing S1 to P/F isn't a huge game changer, it just shuffles the process a bit. If S1 does become P/F, then S2 will become incredibly important. Students will need to take it early, so they have scores before applications go out. S2 may be more clinically relevant, so perhaps this is a good idea. But this does mean that students have only "one chance". In the current system, you take S1, if your score is really good then you can delay S2 until later and apply with your S1; and if your score is poor you can take S2 early and try to do better. Now, all the pressure will be on S2. So instead of students "freaking out" on S1, it will all be focused on S2. Students will demand "dedicated" S2 study time. It really changes almost nothing.

If the USMLE made all steps P/F, then we have a real problem. But programs would respond with specialty specific exams. Whether this is "good" or "bad" depends upon your viewpoint. It would be yet another exam to take (with more costs), students might have to take multiple exams (IM if you want a prelim along with Neuro, for example). Students would be able to take the exam multiple times (perhaps), but that then leads to the possibility of getting a worse score the second time, and what that would "mean".

Programs are going to demand some sort of standardized exam score. UME leaders who state that these exams "cause undue stress" for their students are deluding themselves if they think that they can make this stress go away. Pushing the exams later in training could cause more problems -- at present, if you get a crappy S1 score you know your derm career is basically over. In this new system, you might not get your exam score until immediately before you apply for spots.

In no case is this going to "squeeze" anyone out of spots. Programs that take DO's will continue to do so. Programs that don't won't change. There are more spots than US grads.

To the UME leaders who are pushing for this, I have an interesting question: Why don't we make the MCAT pass/fail also at the same time? It's causing lots of stress for college students interested in medical school.

 

[Lawpy]

Changing S1 to P/F isn't a huge game changer, it just shuffles the process a bit. If S1 does become P/F, then S2 will become incredibly important. Students will need to take it early, so they have scores before applications go out. S2 may be more clinically relevant, so perhaps this is a good idea. But this does mean that students have only "one chance". In the current system, you take S1, if your score is really good then you can delay S2 until later and apply with your S1; and if your score is poor you can take S2 early and try to do better. Now, all the pressure will be on S2. So instead of students "freaking out" on S1, it will all be focused on S2. Students will demand "dedicated" S2 study time. It really changes almost nothing.

If the USMLE made all steps P/F, then we have a real problem. But programs would respond with specialty specific exams. Whether this is "good" or "bad" depends upon your viewpoint. It would be yet another exam to take (with more costs), students might have to take multiple exams (IM if you want a prelim along with Neuro, for example). Students would be able to take the exam multiple times (perhaps), but that then leads to the possibility of getting a worse score the second time, and what that would "mean".

Programs are going to demand some sort of standardized exam score. UME leaders who state that these exams "cause undue stress" for their students are deluding themselves if they think that they can make this stress go away. Pushing the exams later in training could cause more problems -- at present, if you get a crappy S1 score you know your derm career is basically over. In this new system, you might not get your exam score until immediately before you apply for spots.

In no case is this going to "squeeze" anyone out of spots. Programs that take DO's will continue to do so. Programs that don't won't change. There are more spots than US grads.

To the UME leaders who are pushing for this, I have an interesting question: Why don't we make the MCAT pass/fail also at the same time? It's causing lots of stress for college students interested in medical school.

Good post, thanks!

 

[AlbinoHawk DO]

My mindset is a little different than others when it comes to carib students. They are first and foremost Americans and have paid taxes like the rest of us. So I think if they make it through the island ring of fire then they should be held on even footing as at stateside students (at least DOs LOL). I absolutely loathe the practices of their schools, but this is not the student's fault. I support 2 tiered matching where american carib students would go in the first match and then all international students would be in the second.

I would favor pretty much any US citizen/green card holder having dibs over importing doctors. I would also think there could be a scenario where we have a 3 tier system where we have AMG (MD/DO), Carib and then FMG. Stateside applicants are paying tuition into America. Their tuition money goes to fund jobs and research for people here. The carib also pays off rotation sites, so I think their shady practices could hurt stateside students if they are given equal access to residency

Another option I could see done is that residency of FMGs be counted here but they must pass the steps and do a fellowship, If you are a general practitioner without residency, maybe they could still have access to FM or choose to do residency in their home country and come here for fellowship

 

[AlbinoHawk DO]

Changing S1 to P/F isn't a huge game changer, it just shuffles the process a bit. If S1 does become P/F, then S2 will become incredibly important. Students will need to take it early, so they have scores before applications go out. S2 may be more clinically relevant, so perhaps this is a good idea. But this does mean that students have only "one chance". In the current system, you take S1, if your score is really good then you can delay S2 until later and apply with your S1; and if your score is poor you can take S2 early and try to do better. Now, all the pressure will be on S2. So instead of students "freaking out" on S1, it will all be focused on S2. Students will demand "dedicated" S2 study time. It really changes almost nothing.

If the USMLE made all steps P/F, then we have a real problem. But programs would respond with specialty specific exams. Whether this is "good" or "bad" depends upon your viewpoint. It would be yet another exam to take (with more costs), students might have to take multiple exams (IM if you want a prelim along with Neuro, for example). Students would be able to take the exam multiple times (perhaps), but that then leads to the possibility of getting a worse score the second time, and what that would "mean".

Programs are going to demand some sort of standardized exam score. UME leaders who state that these exams "cause undue stress" for their students are deluding themselves if they think that they can make this stress go away. Pushing the exams later in training could cause more problems -- at present, if you get a crappy S1 score you know your derm career is basically over. In this new system, you might not get your exam score until immediately before you apply for spots.

In no case is this going to "squeeze" anyone out of spots. Programs that take DO's will continue to do so. Programs that don't won't change. There are more spots than US grads.

To the UME leaders who are pushing for this, I have an interesting question: Why don't we make the MCAT pass/fail also at the same time? It's causing lots of stress for college students interested in medical school.

Perhaps because MCAT is completely different ballgame. Aside from very few people, almost anyone that graduates from medical school has the capacity to do any specialty. Only reason that derm is hard to get into is because of the money you make and how cushy the job is. There' no real reason to be a 260. Also we've seen specialties change. Psych was a joke that you applied to because you failed board scores. Now you have people going unmatched at DO schools with >220. You're telling me you need someone thats a 260 to be good physicians in this field? What about people who had a bad day at the testing center or someone that just got lucky because 90% of their questions were stuff that come easy to them?

I think something will need to exist to stratify students outside of grades and licensing exams. It'll definitely be interesting to see how it goes.

 

[DrStephenStrange]

I would think that will not matter. I know people that passed COMLEX 550 easily and then failed USMLE. I really doubt anyone will care about a COMLEX

When I said that I was really talking about the far ends of the spectrum. The people that scored in the 400s and the ones that scored in the 700s. I think it could be used like that. Someone who barely pass the COMLEX clearly has some issues and is at risk of failing other board examinations later vs someone who killed it and who is in the 90th+ percentile that person clearly knows his stuff. I think PDs could use that as a differentiating factor for DOs. Plus with USMLE P/F, do you think programs that requires USMLE will keep that up? Because obviously the USMLE wouldn't matter anymore.

meh programs that require/want USMLE do so because they don't understand or respect the COMLEX scoring system.. so my guess is they wouldn't use COMLEX numbers for the filter. They would be more likely to filter out by either took USMLE and passed or just filter out all DOs.

 

[Trollest]

I apologize. I guess i am just exhausted with the topic. Not all of us have those A1 connection. I.e., family friend who is a physician.

Wow... I see how it is fam. Point taken. I'll keep my mouth shot next time.

@AlbinoHawk DO Yes! Just like we tell everyone that they need to at least have a 512 to go to ivy league school or a 3.7 gpa to graduate with honors.

You're telling me you need someone thats a 260 to be good physicians in this field?

No one cares about them?? Dude, you are an adult. You are responsible for your action.

What about people who had a bad day at the testing center or someone that just got lucky because 90% of their questions were stuff that come easy to them?

 

[ciestar]

Not sure if half the people here have even taken step but mine was very clincial and I used much of it during third year. My step two was not much diff from step one and step one tested stuff I would hope any physician would use.
Actually had a few of the same questions basically.
Now changing med school curriculum would be something I’d be more interested in to less basic science and more use. But don’t forget it’s basic science knowledge that sets us apart from midlevels.
There was a post in the MD forums where most people wanted to keep step scored via the survey.
Im not sure why the sentiment is so much toward a PF test in this thread.

No wonder the licensing boards think we are a bunch of cry babies. We want the PE /CS eliminated and PF board exams. God forbid people have to know things nowadays

I took step 1, no, I didn’t do particularly great on it but I seem to struggle on exams. I don’t necessarily agree with Pass/Fail Step 1, but a higher Step 1 score doesn’t say who is more a competent clinician. A ton of people can regurgitate random facts but if they cannot translate that into clinical practice, what good is it?

BTW, none of my preceptors seem to think i am inept. My shelf scores say the same. Unfortunately, Step 1 got me but I don’t believe I will be a lesser physician because I underperformed on Step 1.

 

[Trollest]

Looks like a few people from this thread would have been better off applying to NP or PA programs. This is MEDICAL SCHOOL not clinical school.

 

[sunshinefl]

Looks like a few people from this thread would have been better off applying to NP or PA programs. This is MEDICAL SCHOOL not clinical school.

Yupp user name checks out in this thread.

 

[Trollest]

Nah, maybe you should think about pathologist, oncologists, anesthesiologist and other non clinicians? How about derms? You know you have to understand the mechanism behind those rashes. Reciting medscape careplan won't get you bonus point on the wards, my 15 y/o sister could do the same.

With this attitude, I am not surprised that NP and PA want their autonomy. I mean what would be the difference if MD degree was turn into a long-winded clinical degree.

Yupp user name checks out in this thread.