Pass/Fail Boards

[Chibucks15]

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.

2/10. Need a better troll effort outta you cmon now. You don’t need to know some of the minute stuff that comes out on step. Ask any actual practicing physician.

At a certain point, you have to have a high stakes exam. Personally, I’d rather have it be on material that is useful to my chosen specialty. I would much rather study that then random factoids about the formation of the embryo and what stage it’s in at a certain point.

One idea I’ve heard is making step kinda like MCAT and have sections. So if you want ortho you better kill the MSK and physiology portion, but if you mess up slightly on psych or OB PDs could just kinda push that aside. I don’t need a hip surgeon who knows the DSM 5 like the back of his hand.

There isn’t an easy fix, but going down the road we are is just gonna be worse in terms of mental stress on people, and at a point how many suicides are too much? The system needs changing somehow

---

Members don't see this ad.

 

[ricksimmonsrafowens]

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.

Great post!

 

[ricksimmonsrafowens]

2/10. Need a better troll effort outta you cmon now. You don’t need to know some of the minute stuff that comes out on step. Ask any actual practicing physician.

At a certain point, you have to have a high stakes exam. Personally, I’d rather have it be on material that is useful to my chosen specialty. I would much rather study that then random factoids about the formation of the embryo and what stage it’s in at a certain point.

One idea I’ve heard is making step kinda like MCAT and have sections. So if you want ortho you better kill the MSK and physiology portion, but if you mess up slightly on psych or OB PDs could just kinda push that aside. I don’t need a hip surgeon who knows the DSM 5 like the back of his hand.

There isn’t an easy fix, but going down the road we are is just gonna be worse in terms of mental stress on people, and at a point how many suicides are too much? The system needs changing somehow

Have you taken Step 1/2? The score report breaks down your performance by system - cardiovascular, MSK, nutrition, GI, etc. I feel like a lot of people arguing for pass/fail grading to step have never taken the exam. From my test taking experience with Step 1, 2CK, 2CS the exam is focused on relevant clinical scenarios & clinical reasoning. Making it pass/fail won't reduce stress level of students at all... if you have a below average Step and are a USMD but are aiming for FM & community IM - you will match provided there are no red flags on the application otherwise. If you are interested in plastic surgery making step P/F won't change your stress level at all... You would still have to perform at a great level on Step 2, do multiple away rotations, publish and possibly do a research year, honor most or all of the clerkships. In fact, as APD said, at least with the current numerical grading on Step exams, there is a chance for students to redeem themselves if they underscore on Step 1. There is an IM resident I know who scored <210 on Step 1 due to poor study habits but then she scoredin 260s on Step 2 and was able to match great university IM program even though she didn't have great research, connections, etc. Her great match was mostly due to her Step 2 improvement and it's unclear if she would have done as well on Step 2 if she didn't have to "prove herself" after Step 1 (in her own words).

 

[Cheeni17]

Have you taken Step 1/2? The score report breaks down your performance by system - cardiovascular, MSK, nutrition, GI, etc. I feel like a lot of people arguing for pass/fail grading to step have never taken the exam. From my test taking experience with Step 1, 2CK, 2CS the exam is focused on relevant clinical scenarios & clinical reasoning. Making it pass/fail won't reduce stress level of students at all... if you have a below average Step and are a USMD but are aiming for FM & community IM - you will match provided there are no red flags on the application otherwise. If you are interested in plastic surgery making step P/F won't change your stress level at all... You would still have to perform at a great level on Step 2, do multiple away rotations, publish and possibly do a research year, honor most or all of the clerkships. In fact, as APD said, at least with the current numerical grading on Step exams, there is a chance for students to redeem themselves if they underscore on Step 1. There is an IM resident I know who scored <210 on Step 1 due to poor study habits but then she scoredin 260s on Step 2 and was able to match great university IM program even though she didn't have great research, connections, etc. Her great match was mostly due to her Step 2 improvement and it's unclear if she would have done as well on Step 2 if she didn't have to "prove herself" after Step 1 (in her own words).

Yeah i think this thread has a lot of people studying for step and getting wrecked on NBMEs and due to their own poor study habits want to project their anger onto the current systems possible flaws.
Love it when people who haven’t even taken it yet come here and complain that it’s clinicaly worthless. The test tests things any physician should understand. To say it’s not clinical enough it laughable since we use physiology daily and that was a big part of my test. Even step two had a little physio on it.

I do think each major specialty should have a major exam taken prior to applying for auditions in addition to step two. Make it very clinical and related to what you are applying to. Tests are not super great predictors but all these people here stating they want pass fail because they can’t handle the stress don’t understand you need some way to measure objectively.

 

[Cheeni17]

2/10. Need a better troll effort outta you cmon now. You don’t need to know some of the minute stuff that comes out on step. Ask any actual practicing physician.

At a certain point, you have to have a high stakes exam. Personally, I’d rather have it be on material that is useful to my chosen specialty. I would much rather study that then random factoids about the formation of the embryo and what stage it’s in at a certain point.

One idea I’ve heard is making step kinda like MCAT and have sections. So if you want ortho you better kill the MSK and physiology portion, but if you mess up slightly on psych or OB PDs could just kinda push that aside. I don’t need a hip surgeon who knows the DSM 5 like the back of his hand.

There isn’t an easy fix, but going down the road we are is just gonna be worse in terms of mental stress on people, and at a point how many suicides are too much? The system needs changing somehow

You have some good ideas but take the test first before wanting to fix the process. Trolleys has good points and just because someone who hasn’t even sat the test yet disagrees doesn’t make them a troll. Step has very little embryo it’s usually related to a disease or something clinicaly relevant. It’s not pointless at that level.

 

[Cheeni17]

Yupp user name checks out in this thread.

Have you even sat step yet? If not you have not much to add to the conversation if sitting there and calling out people you disagree with who have probably already sat boards

 

[Cheeni17]

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

This is a good post but I think one can hit 205 just rolling their head on the keyboard. I don’t doubt that 270 doesn’t make much better of a doc than 240 but yeah the pass rate should be 220 if it’s pass fail.

The nbme has been making step more clinics in the past years and it isn’t much diff than step two as far as I can tell

 

[Roark10]

N=1 and we’re all unique snowflakes, but I think that there is intrinsic value in the pressure cooker that is studying for step 1. There were lots of topics that I didn’t fully understand from class that step required me to solidify. Studying for hundreds of hours for step really helped me establish a foundation of knowledge for my entire career - and in a medical world full of increasing specialization, it is important to know what is a problem and what is benign in all fields. It’s a painful, but extremely valuable process. Sure, there are some useless things on step but overall it is a beautifully written test and a worthy challenge. If the pressure is removed, I wonder what will happen to that foundation for future students. I think the curriculum of most medical schools would have to be revamped, because as is most (opinion) are not effective in establishing one.

 

[Cheeni17]

To add if step isn’t very clinical then why do schools who have people take it post clinical year do better? Seeing real patients helps no?

Maybe all schools should be required to push it back to year three so we can all enjoy learning medicine and performing in third year then study for both at once?

I feel there are many better ways than just tossing it to pass fail. We have more than two options here. The one I always liked was to require several smaller subject exams instead of one or two big ones. Since I will give sentiment that a single bad day should not ruin one persons future.

So far a I haven’t seen a bunch of great ideas thrown out (myself included) judt back and forth bickering aided by the stress of those currently studying for step

 

[shadowlightfox]

To add if step isn’t very clinical then why do schools who have people take it post clinical year do better? Seeing real patients helps no?

No, seeing patients does not help, and I don't even know if that's the best argument. For starters one could argue that they had more time to study by extending it into their third year and hence the source of why they did better, not because of the clinical experience per se. Thus, that example is very prone to having confounding variables.

In fact, I'm even starting to question the merit of actual clinical rotations even helping for step 2 or the wards. I don't know if I'm unique with this, but there is a lot of disparity between how physicians in real life operate in terms of management approach, and how you are expected to do things "by the books." On some days, you may be lucky and the patients you see and the way the physician deals with them is perfectly in sync with what the test wants you to do, but in other days, not so much.

I think that having a strong foundation by studying for step 1 helps students have the foundation to do well third year or at least not easily get lost in third year, not the other way around. I highly doubt the merit of doing well in your early clinical rotations helping you set yourself up for a strong rotation.

 

[Chibucks15]

Have you taken Step 1/2? The score report breaks down your performance by system - cardiovascular, MSK, nutrition, GI, etc. I feel like a lot of people arguing for pass/fail grading to step have never taken the exam. From my test taking experience with Step 1, 2CK, 2CS the exam is focused on relevant clinical scenarios & clinical reasoning. Making it pass/fail won't reduce stress level of students at all... if you have a below average Step and are a USMD but are aiming for FM & community IM - you will match provided there are no red flags on the application otherwise. If you are interested in plastic surgery making step P/F won't change your stress level at all... You would still have to perform at a great level on Step 2, do multiple away rotations, publish and possibly do a research year, honor most or all of the clerkships. In fact, as APD said, at least with the current numerical grading on Step exams, there is a chance for students to redeem themselves if they underscore on Step 1. There is an IM resident I know who scored <210 on Step 1 due to poor study habits but then she scoredin 260s on Step 2 and was able to match great university IM program even though she didn't have great research, connections, etc. Her great match was mostly due to her Step 2 improvement and it's unclear if she would have done as well on Step 2 if she didn't have to "prove herself" after Step 1 (in her own words).

I know I haven't taken it but as I'm studying for it and talking to mentors there's lots of things that they chuckle that we even have to know. I know its broken down into sections but its not like the PDs give that a second thought in terms of stratifying applicants. Obviously there's still gonna be high stakes. I'm not advocating for an easy road by any means. My idea is just to make the higher stakes portion about more than memorizing zanki flashcards and selling your soul to the app. Making it actually about clinical knowledge that can make you a better doctor, not a robot who can regurgitate little facts that don't matter. And before whoever was talking about NPs and all that comes in, we still should have to know the mechanisms of drugs and things like that, we can't be algorithm based, but a shift for something better isn't a bad idea. Can you really say everything you learned for step is super useful for being a clinically based physician?

There isn't an easy fix, as I've stated. But I've almost lost a friend and several classmates to this monster and the system needs to change. As medical knowledge doubles so will zanki and other resources, and it will eventually become impossible unless there's a paradigm shift. Just because the knowledge is growing doesn't mean that med students won't try to know every little detail in order to gain an edge. The neurotic-ism is strong with med students

 

[Roark10]

. Can you really say everything you learned for step is super useful for being a clinically based physician?

No, biochem immediately comes to mind. You bring up some good points. The test does sort of stratify information. Biochem questions are largely rote memorization and are gimmes if you put in the work (I know this is one of the problems you are talking about) while there will be complicated clinical questions that you'll swear there are two right answer choices. Besides the ability to memorize tiny details, if you take a look at STEP as a whole, you will see a lot of themes that are very relevant clinically. How do you react to an intimidating situation in a career that will be full of them? How do you utilize the things that you do know in an unknown, complicated scenario? Do you know yourself and your learning style well enough to be able to know which resources are effective for you in a world full of options? These are important things.

You're right - there is no easy fix and there will always be high stakes. Like it or not, medical education has a lot of problems and the medical system is full of them as well. I'm interested in hearing other legitimate alternatives as well. Perhaps it is simply shifting the ratio of questions you need to just memorize facts for (although that is something a physician needs to do to) and the ones that are complicated clinical scenarios with 1000 comorbidities from 40:60 to more 25:75 - but that honestly sounds like an even more stressful, long test.

 

[Chibucks15]

No, biochem immediately comes to mind. You bring up some good points. The test does sort of stratify information. Biochem questions are largely rote memorization and are gimmes if you put in the work (I know this is one of the problems you are talking about) while there will be complicated clinical questions that you'll swear there are two right answer choices. Besides the ability to memorize tiny details, if you take a look at STEP as a whole, you will see a lot of themes that are very relevant clinically. How do you react to an intimidating situation in a career that will be full of them? How do you utilize the things that you do know in an unknown, complicated scenario? Do you know yourself and your learning style well enough to be able to know which resources are effective for you in a world full of options? These are important things.

You're right - there is no easy fix and there will always be high stakes. Like it or not, medical education has a lot of problems and the medical system is full of them as well. I'm interested in hearing other legitimate alternatives as well. Perhaps it is simply shifting the ratio of questions you need to just memorize facts for (although that is something a physician needs to do to) and the ones that are complicated clinical scenarios with 1000 comorbidities from 40:60 to more 25:75 - but that honestly sounds like an even more stressful, long test.

I don’t have a problem with the majority of questions I come across. But there’s definitely a subsection that I don’t see any utility to test unless you’re doing it just to stratify people who memorize every tiny detail. Like I got NBME questions asking what the characteristics of the developing fetus were at 21 weeks and the answer choices were vague and complex. Save those for specialty specific learning later on ya know?

 

[fldoctorgirl]

I don’t see any utility to test unless you’re doing it just to stratify people who memorize every tiny detail

I feel like you could make the same argument about school exams though-- there's a good chunk of questions that make sense and most of the class can answer, and then there's the 5-10% of questions that are on random factoids from the corner of the powerpoint slides that will separate those who get A's from those who get B+'s. Any time you're not in a P/F system, scores will be stratified this way, I think.

 

[Chibucks15]

I feel like you could make the same argument about school exams though-- there's a good chunk of questions that make sense and most of the class can answer, and then there's the 5-10% of questions that are on random factoids from the corner of the powerpoint slides that will separate those who get A's from those who get B+'s. Any time you're not in a P/F system, scores will be stratified this way, I think.

But with school exams, you have a set amount of material. With boards, it becomes increasingly next to impossible to cover it all simply due to massive change in material amount

 

[Cheeni17]

But with school exams, you have a set amount of material. With boards, it becomes increasingly next to impossible to cover it all simply due to massive change in material amount

It’s supposed to be near impossible so people don’t get 300s. I do agree that non useful stuff could be removed but I still felt as most was useful. No test is perfect. But usmle was much better than my clsss exams which tested a lot of pointless stuff. I just don’t feel the battle is with USMLE but more the med school curriculum variances which make USMLE more important than it should be.

We have to memorize a lot of material to be good at our jobs so asking for less of that isn’t going to help the problem.

 

[Cheeni17]

No, seeing patients does not help, and I don't even know if that's the best argument. For starters one could argue that they had more time to study by extending it into their third year and hence the source of why they did better, not because of the clinical experience per se. Thus, that example is very prone to having confounding variables.

In fact, I'm even starting to question the merit of actual clinical rotations even helping for step 2 or the wards. I don't know if I'm unique with this, but there is a lot of disparity between how physicians in real life operate in terms of management approach, and how you are expected to do things "by the books." On some days, you may be lucky and the patients you see and the way the physician deals with them is perfectly in sync with what the test wants you to do, but in other days, not so much.

I think that having a strong foundation by studying for step 1 helps students have the foundation to do well third year or at least not easily get lost in third year, not the other way around. I highly doubt the merit of doing well in your early clinical rotations helping you set yourself up for a strong rotation.

You bring good points. I did feel as if I had less study time third year though. Docs not following textbook stuff is a problem in all careers not sure if that is point specific.

 

[Cheeni17]

I always thought (it would never happpen)not would be better to give a set of exams that are the same to all us med students that we must pass before clinicals with all the same set resources to use. Then med school itself could be focused more on clincial skills and rotations. Then we are graded on those sets of exams thus making step less important or not even there. STEP was created from the plague of med school varience so if we want to fix problems we should attack that. It’s the same story as the MCAT. Would we want MCAT to be pass fail and only gpa to matter? People would be flocking to the easiest schools out there

 

[puahate]

The mean Step scores needed will just keep rising. Everyone will just be squeezed out. Medicine is becoming less worthwhile.

I don't know what will happen but just make sure you are on the ball day one in medical school.

 

[shadowlightfox]

You bring good points. I did feel as if I had less study time third year though. Docs not following textbook stuff is a problem in all careers not sure if that is point specific.

It also doesn't help if your first two rotations are internal medicine and surgery. Doesn't matter how "Step 1-like" IM is, if you're too busy on service, you're not gonna have time to study. And surgery is self-explanatory. All the other students in all the other rotations will have a relatively easier time to continue studying for step 1, while you on one of these two aforementioned services is being precluded from studying and even starting to forget materials. Thus, this is actually one of the reasons why I argued that it's dumb and even potentially unfair and detrimental to have Step 1 in the middle of your third year. Third year should solely be for Step 2 studying.

 

[AlbinoHawk DO]

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.



@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.



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

Premed is a different ballgame that should be reformed, but this conversation is about med school and residency, so I won't get off-topic.

Sure, you (we) are an adult. Who said otherwise? That makes no point against what I said

Also, you have probably never been in the real world. The way you try to say that we should have been PA just shows you don't understand the difference between physician oriented clinical knowledge and PA clinical knowledge. People here are rightfully talking about clinical knowledge as it applies to our profession

 

[eberge3]

DOs have done a solid job in the past 10 years matching in solid competitive specialties and ACGME programs (much better than ever before at least). P/F USMLE will take away any advantage DO's would have over an MD candidate and will ultimatly limit them to primary care in my OP. Would be unfortunate to judge candidates on school purstige and audition rotations in a world where some programs are already excluding DO's from being able to audition with them. Doesn't make much sense to me. USMLE tests basic fundamental science knowledge.

 

[AlbinoHawk DO]

DOs have done a solid job in the past 10 years matching in solid competitive specialties and ACGME programs (much better than ever before at least). P/F USMLE will take away any advantage DO's would have over an MD candidate and will ultimatly limit them to primary care in my OP. Would be unfortunate to judge candidates on school purstige and audition rotations in a world where some programs are already excluding DO's from being able to audition with them. Doesn't make much sense to me. USMLE tests basic fundamental science knowledge.

Almost every DO that I know that matched into competitive ACGME didn't only have the grades but auditions as well. Pass/Fail will make it so your performance will matter most. I have seen more DOs being passed over regardless of perfect audition over a good number

 

[ricksimmonsrafowens]

talking to mentors there's lots of things that they chuckle that we even have to know.

I understand the way they feel, but their experience with step 1 15+ years ago is not equivalent to our experience. My experience and that of my peers is that the exams are clinically focused and do test clinical acumen well. UWorld, other Q banks approximate what's on Step 1 well but not 100%. Wait until you take 1 to make the criticism that it's not clinically driven.

. Can you really say everything you learned for step is super useful for being a clinically based physician?

I have felt that strong preparation for Step 1 has 100% made me a better student as an MS3. They process of learning comprehensively about medical sciences and the diligence required to study medical material in depth to score well on Step 1 will pay off on your shelf exams and Step 2, and in taking care of your patients.

 

[Chibucks15]

I understand the way they feel, but their experience with step 1 15+ years ago is not equivalent to our experience. My experience and that of my peers is that the exams are clinically focused and do test clinical acumen well. UWorld, other Q banks approximate what's on Step 1 well but not 100%. Wait until you take 1 to make the criticism that it's not clinically driven.


I have felt that strong preparation for Step 1 has 100% made me a better student as an MS3. They process of learning comprehensively about medical sciences and the diligence required to study medical material in depth to score well on Step 1 will pay off on your shelf exams and Step 2, and in taking care of your patients.

I'm not saying strong prep isn't bad. My point is with all the resources that come out, it will continue to be more and more necessary for NBME to use either insanely minute details or tricky worded questions to stratify applicants. Which won't affect the top performers (which apparently is most of SDN) but the average people like myself get boned. And the people that are struggling to pass will continue to get worse and worse situations and fail. Pair that with how broken the tuition situation is and that makes the physician suicide situation worse.

Extensive knowledge of the sciences is necessary to be a physician. And learning the pathology and physiology is super important and what makes us doctors. But you cannot in your right mind tell me some of the crazy BS we get tested on (I know it isn't the majority of the test but its enough to be meaningful) is in any way helpful. Foe example, my question I got about the specific stage of development at a given time period, before the fetus is even remotely close to being viable, has no bearing on being a clinician, other than fun factoids to tell patients and research topics. And there are plenty more questions like it. With how fast medical knowledge expands nowadays, its only gonna get worse in terms of pure volume we need to know. Eventually it will be impossible. and I'm in the camp of better to change things ahead of time then be reactionary after the system blows up

 

[Cheeni17]

Say all boards are pass fail. How will the following be addressed ?

DO schools usually have less research opportunities than MD


many auditions are already full for top programs. Are PDs really going to take on more work via having more students auditioning. I would say they would put a price tag once students on lining up out the doors on many programs already to audition at. Some programs charge DOs a premium already to rotate there.

We can’t ignore school pedigree. What makes people think auditions will solve this. Internships for law and business don’t give lower tier schools much opportunity they take their own at high levels.

How will PDs responsd? APD says there will be a graded MCQ test no matter what likely. How can we prevent from just kicking the can down the road?

How till PDs screen people out? They want s way and will make one one way or another. Even not so great programs get thousands of apps per spot. Of course it’s usually a bunch of I/FMG but what will their screening be? 10000 audition rotations? Would limited apps to 30 programs be useful? I’ve talked to PDs who say eras has been taking about this

Real questions looking for real answers

 

[ricksimmonsrafowens]

But you cannot in your right mind tell me some of the crazy BS we get tested on (I know it isn't the majority of the test but its enough to be meaningful) is in any way helpful.

Do not focus on those questions. Yes there are wtf questions on every standardized exam. Yes, they are there to stratify the 260 from the 270. You do not need to answer all of them correctly to do well on the test or to pass the test. Focus on studying the basic concepts in medicine (renal, acid base, cardiovascular, endocrine, GI, neuro) that are tested over and over again and you will do well. Step 1 does not test fun factoids - your Q banks may because the Q bank writers need to create questions they can sell to you, but Step 1 does not. It is very much a critical thinking and knowledge exam.

 

[sunshinefl]

Have you even sat step yet? If not you have not much to add to the conversation if sitting there and calling out people you disagree with who have probably already sat boards

I will in 2 months. However I’m not even advocating for only pass/fail report or that it’s not relevant or “projecting my anger about getting wrecked on NBMEs” as you stated in another post. I’m just responding to that particular user’s ranting about how they don’t want to be seen by a 205 step 1 doctor as if
A—step 1 determines a doctor’s worthiness
B—there aren’t 2 more years of medical school and 3+ years of residency training before they are an independent physician
C—there aren’t more licensing exams and checkpoints along the way
D—they have any clue what their doctors step 1 scores are

 

[Roark10]

Say all boards are pass fail. How will the following be addressed ?

DO schools usually have less research opportunities than MD


many auditions are already full for top programs. Are PDs really going to take on more work via having more students auditioning. I would say they would put a price tag once students on lining up out the doors on many programs already to audition at. Some programs charge DOs a premium already to rotate there.

We can’t ignore school pedigree. What makes people think auditions will solve this. Internships for law and business don’t give lower tier schools much opportunity they take their own at high levels.

How will PDs responsd? APD says there will be a graded MCQ test no matter what likely. How can we prevent from just kicking the can down the road?

How till PDs screen people out? They want s way and will make one one way or another. Even not so great programs get thousands of apps per spot. Of course it’s usually a bunch of I/FMG but what will their screening be? 10000 audition rotations? Would limited apps to 30 programs be useful? I’ve talked to PDs who say eras has been taking about this

Real questions looking for real answers

I don’t think auditions alone will help anything. I can only speak about my experience as someone going into general surgery. I did 4 Sub-Is at four very different settings (2 community, 2 large academic centers). Expectations of you will vary widely. No matter how much initiative you show or how good you are at retracting it can be hard to stick out. You’re going to struggle with something that seems trivial to residents simply because it’s the first time you are ever doing that task. If 50 audition at a place, 5 will stick out for the right reasons, 5 will stick out for the wrong reasons, and 40 will be hard to remember for attendings. I imagine this is true in all fields to varying degrees. At some point, there has to be some sort of scored MCQ test, step 1/2 or a specialty dependent test. Mental health is no joke and should never be treated as such. But, medicine and medical school are stressful by it’s very nature and making step 1 pass/fail won’t change that. For starters, school administrations can listen to students and make changes more rapidly and not just for future classes. DO schools specifically - we can make better guidelines for preceptors to fill out Evals and step up our MSPE game. We can stop hyping STEP 1 as the end-all-be-all. I think programs look at everything (scores, performance on rotations, performance on Sub-Is, research, life experiences, personal statement, etc). Rarely, and in only in the extremes competitive specialties is a bad Step 1 not overcomable.

 

[BorntobeDO?]

Say all boards are pass fail. How will the following be addressed ?

DO schools usually have less research opportunities than MD


many auditions are already full for top programs. Are PDs really going to take on more work via having more students auditioning. I would say they would put a price tag once students on lining up out the doors on many programs already to audition at. Some programs charge DOs a premium already to rotate there.

We can’t ignore school pedigree. What makes people think auditions will solve this. Internships for law and business don’t give lower tier schools much opportunity they take their own at high levels.

How will PDs responsd? APD says there will be a graded MCQ test no matter what likely. How can we prevent from just kicking the can down the road?

How till PDs screen people out? They want s way and will make one one way or another. Even not so great programs get thousands of apps per spot. Of course it’s usually a bunch of I/FMG but what will their screening be? 10000 audition rotations? Would limited apps to 30 programs be useful? I’ve talked to PDs who say eras has been taking about this

Real questions looking for real answers

You can address all of this by starting your own residencies. That is, of course, the simplest, but most expensive solution. And if my years of DO school have taught me anything its that things that cost money or that take more than small effort on admins part are almost always rejected. But making the exams pass/fail would be the checkmate to DO school expansion.

They would have to get better or way cheaper. Cause no matter what people saying about wanting to be rural primary care, at least half of them want to believe that if they work hard, they might just get to be one of the 'superstars.' Take that away, and a lot of DO schools won't fill or will dip really deep into the applicant pool. They are selling hope, a P/F step would kill that hope.

 

[Ho0v-man]

I think it’s kind of dumb that a 241 is considered magically better than a 238 or whatever. But there’s no way this should be P/F. I say this just because that leaves 100% of preparing me to be a third year clinical student on the med school curriculum. That’s ridiculous! We’d all just be memorizing our schools terrible PowerPoints and listening out for hints from crappy PhD faculty. That doesn’t even address the not insignificant amount of people who cheat in preclinical. If this was P/F, we’d all just do the bare minimum and be even more worthless in third year.

I might get on board with a H/HP/P/F type system so people aren’t stratified by insignificant differences. But whatever.

 

[BorntobeDO?]

I think it’s kind of dumb that a 241 is considered magically better than a 238 or whatever. But there’s no way this should be P/F. I say this just because that leaves 100% of preparing me to be a third year clinical student on the med school curriculum. That’s ridiculous! We’d all just be memorizing our schools terrible PowerPoints and listening out for hints from crappy PhD faculty. That doesn’t even address the not insignificant amount of people who cheat in preclinical. If this was P/F, we’d all just do the bare minimum and be even more worthless in third year.

I might get on board with a H/HP/P/F type system so people aren’t stratified by insignificant differences. But whatever.

I would argue that your med school GPA is probably a better indicator of future success in residency anyway. It took a lot more time to make that number than the board score. Similar to how highschool GPA is a better indicator of success than SATs.

If I'm a PD looking for someone to work with who will be consistently performing at a top level, I would probably put more weight on the rank and GPA than just the board score. I understand the thinking behind the wanting a national standardized test, but I am not sure it actually tells most PD's what they really should want to know. I hear a lot about 'making sure they can pass boards' as a rationale for Step. But that's a bit short sighted. If I am working with someone, I want them to take even the small stuff seriously and to put in the work on a daily basis. That is rather easily demonstrated in grades, rather than national tests which kind of encourage people to ignore consistent effort on 'low yield' daily things in order to focus on 'the test.'

 

[Ho0v-man]

I would argue that your med school GPA is probably a better indicator of future success in residency anyway. It took a lot more time to make that number than the board score. Similar to how highschool GPA is a better indicator of success than SATs.

If I'm a PD looking for someone to work with who will be consistently performing at a top level, I would probably put more weight on the rank and GPA than just the board score. I understand the thinking behind the wanting a national standardized test, but I am not sure it actually tells most PD's what they really should want to know. I hear a lot about 'making sure they can pass boards' as a rationale for Step. But that's a bit short sighted. If I am working with someone, I want them to take even the small stuff seriously and to put in the work on a daily basis. That is rather easily demonstrated in grades, rather than national tests which kind of encourage people to ignore consistent effort on 'low yield' daily things in order to focus on 'the test.'

I hear what your saying but my class rank would be a good bit higher if I didn’t go back and make sure I understood stuff from 6+ months ago on a regular basis and teach myself the stuff that my school never seemed to even bother with. It would be a lot easier to focus on my classes and nothing else and I’d know less overall for doing so.

Also, since board pass rates are the only things keeping schools from completely phoning it in, can you imagine how much of a joke preclinical education would become if there was no incentive to retain info and do well?

As much as I hate this process, I think I’m better for it. And I’m not a typical SDN step destroyer type either.

 

[ricksimmonsrafowens]

Thatdoesn’t even address the not insignificant amount of people who cheat in preclinical.

this is unrelated to the topic of thread but I really couldn't believe that people were cheating in pre-clinical classes until like 5 people were caught when I was an MS1. Our school has Honors/A/B/C grading which was probably contributing. Totally unreal experience.

 

[BorntobeDO?]

I hear what your saying but my class rank would be a good bit higher if I didn’t go back and make sure I understood stuff from 6+ months ago on a regular basis and teach myself the stuff that my school never seemed to even bother with. It would be a lot easier to focus on my classes and nothing else and I’d know less overall for doing so.

Also, since board pass rates are the only things keeping schools from completely phoning it in, can you imagine how much of a joke preclinical education would become if there was no incentive to retain info and do well?

As much as I hate this process, I think I’m better for it. And I’m not a typical SDN step destroyer type either.

You still have to pass p/f tests. My experience with nursing school was that you still took it seriously, I didn't know anyone in my class that was goofing off before the NCLEX, they all wanted a job. But the actual test didn't determine where you went. If you wanted to go to the icu, you did a rotation there and showed out. That part is nice. Its kind of crap that one bad day could make people not match despite consistent good effort. That doesn't happen in other professions. And I think long term, it would be good if medicine went that way as well.

 

[Ho0v-man]

this is unrelated to the topic of thread but I really couldn't believe that people were cheating in pre-clinical classes until like 5 people were caught when I was an MS1. Our school has Honors/A/B/C grading which was probably contributing. Totally unreal experience.

I didn’t realize it was happening until administration made some stink about it. Asked around and found out some folks had most of the test questions and answers before first semester even started. It’s unreal. But it doesn’t affect me.

 

[ricksimmonsrafowens]

I didn’t realize it was happening until administration made some stink about it. Asked around and found out some folks had most of the test questions and answers before first semester even started. It’s unreal. But it doesn’t affect me.

yepp, the only person I complete with is my own inertia or my own lack of drive to give less than 100% of myself to whatever I have or want to do. once I stopped comparing myself to others in med school I started to feel way better.

 

[Ho0v-man]

You still have to pass p/f tests. My experience with nursing school was that you still took it seriously, I didn't know anyone in my class that was goofing off before the NCLEX, they all wanted a job. But the actual test didn't determine where you went. If you wanted to go to the icu, you did a rotation there and showed out. That part is nice. Its kind of crap that one bad day could make people not match despite consistent good effort. That doesn't happen in other professions. And I think long term, it would be good if medicine went that way as well.

I don’t totally disagree with you and I wish clinical skills could be more heavily emphasized like you’ve described above. But the nclex isn’t a good example. They don’t have anymore tests to take. They don’t have anymore formal training. (I know there’s still more to learn). We have 5+ years of formal training after that.

 

[BorntobeDO?]

I don’t totally disagree with you and I wish clinical skills could be more heavily emphasized like you’ve described above. But the nclex isn’t a good example. They don’t have anymore tests to take. They don’t have anymore formal training. (I know there’s still more to learn). We have 5+ years of formal training after that.

Why would having more tests make any difference? They all should be pass/fail.

Let me put it this way: What is the most important test/qualification for most physicians? Board eligibility/certification in their chosen specialty. Those tests are pass/fail. I see no reason why the tests below them, that are surely not as important to your future practice, shouldn't be pass/fail only also. I have never asked a specialist what he scored on his boards, but I care very much about how he practices and treats people. The boards are to assess a minimal level of competency, and when you start trying to use them for more than that, the purpose is twisted and importance is placed on things that it shouldn't be.

The only reason that the boards have scores is to help residency's stratify applicants easily without digging into their apps much. And I don't think that's a good enough reason to keep doing it this way. Sure doing auditions would be stressful, but its appropriate and would help people focus on skills that actually matter rather than the memorization of minutia. Plus instead of spamming a billion apps out, people would be forced to actually figure out where they wanted to go so they could audition. Thats a big plus to me if I'm a PD. Its pretty hard to hide bad behavior for a month. But I am off the soap box, time for me to actually work.

 

[sumtimesuwonder]

I'm not saying that ALL boards should be pass/fail. There absolutely needs to be a way to stratify students that come from different curricula/locations/schools that is standardized. It also isn't about stress. If you can't handle the stress of a standardized test than how can you handle real life as a physician? I'm saying that having the one that matters the most occur two years before you are a fully matured medical student isn't giving anyone the complete picture of the knowledge of the student once they enter residency. I'm saying Step 2 should be the one that matters, make Step 1 pass/fail so that you can at least prove that you are minimally competent to understand what is happening on rotations/ wont hurt anybody. This could also lead to DO schools standardizing their rotations a little bit more in order to prepare students a little better for their boards. (Maybe).

 

[Chibucks15]

I'm not saying that ALL boards should be pass/fail. There absolutely needs to be a way to stratify students that come from different curricula/locations/schools that is standardized. It also isn't about stress. If you can't handle the stress of a standardized test than how can you handle real life as a physician? I'm saying that having the one that matters the most occur two years before you are a fully matured medical student isn't giving anyone the complete picture of the knowledge of the student once they enter residency. I'm saying Step 2 should be the one that matters, make Step 1 pass/fail so that you can at least prove that you are minimally competent to understand what is happening on rotations/ wont hurt anybody. This could also lead to DO schools standardizing their rotations a little bit more in order to prepare students a little better for their boards. (Maybe).

Agreed. I still honestly haven't figured out how to study most effectively and I'm finishing M2. And sure people will ask for a dedicated study period, but I'm sure we could find a way to eliminate something because 4 weeks dedicated seems like enough based on how people talk about step 2 (honestly have no real idea though) I have 2 FMs and 2 IMs next year, I'd trade one of those FM months for sure

 

[Cheeni17]

You can address all of this by starting your own residencies. That is, of course, the simplest, but most expensive solution. And if my years of DO school have taught me anything its that things that cost money or that take more than small effort on admins part are almost always rejected. But making the exams pass/fail would be the checkmate to DO school expansion.

They would have to get better or way cheaper. Cause no matter what people saying about wanting to be rural primary care, at least half of them want to believe that if they work hard, they might just get to be one of the 'superstars.' Take that away, and a lot of DO schools won't fill or will dip really deep into the applicant pool. They are selling hope, a P/F step would kill that hope.

What this post doesn’t answer any questions

 

[Cheeni17]

I'm not saying that ALL boards should be pass/fail. There absolutely needs to be a way to stratify students that come from different curricula/locations/schools that is standardized. It also isn't about stress. If you can't handle the stress of a standardized test than how can you handle real life as a physician? I'm saying that having the one that matters the most occur two years before you are a fully matured medical student isn't giving anyone the complete picture of the knowledge of the student once they enter residency. I'm saying Step 2 should be the one that matters, make Step 1 pass/fail so that you can at least prove that you are minimally competent to understand what is happening on rotations/ wont hurt anybody. This could also lead to DO schools standardizing their rotations a little bit more in order to prepare students a little better for their boards. (Maybe).

This is why I said above step 1 could be after third year. Someone above said it wouldn’t work bc people get varying amt of time to study but I have to add in many of the top schools give several months across the board to prep for steps 1/2 at the same time after finishing mandantory rotations. These are the places with 1.5 preclinical curriculum which I like because you get to experience the real world sooner which is something most med students need badly in the 2019 climate of pass fail boards and participation trophies

 

[Cheeni17]

I don’t think auditions alone will help anything. I can only speak about my experience as someone going into general surgery. I did 4 Sub-Is at four very different settings (2 community, 2 large academic centers). Expectations of you will vary widely. No matter how much initiative you show or how good you are at retracting it can be hard to stick out. You’re going to struggle with something that seems trivial to residents simply because it’s the first time you are ever doing that task. If 50 audition at a place, 5 will stick out for the right reasons, 5 will stick out for the wrong reasons, and 40 will be hard to remember for attendings. I imagine this is true in all fields to varying degrees. At some point, there has to be some sort of scored MCQ test, step 1/2 or a specialty dependent test. Mental health is no joke and should never be treated as such. But, medicine and medical school are stressful by it’s very nature and making step 1 pass/fail won’t change that. For starters, school administrations can listen to students and make changes more rapidly and not just for future classes. DO schools specifically - we can make better guidelines for preceptors to fill out Evals and step up our MSPE game. We can stop hyping STEP 1 as the end-all-be-all. I think programs look at everything (scores, performance on rotations, performance on Sub-Is, research, life experiences, personal statement, etc). Rarely, and in only in the extremes competitive specialties is a bad Step 1 not overcomable.

I agree with this. People when thinking of auditions honestly think they will “shine” (dunning Krueger or whatever it’s called) but more often end up shooting themselves in the foot. They also think of things such as IM where you can actually show knowledge on rotations. As you said on surgery (and even more so radiology) are you really going to impress people? Probably not.

Not to mention all residencies want people who can pass their ITEs/licensure boards which is another reason people want people with good boards not just pass fail. I have yet to see much of a good argument for PF boards besides emotion and snowflake syndrome. The one good thing I have seen is I agree it sucks that people are judged on their first two years prior to seeing patients. That should possibly be changed. But it’s still not advocating for PF which is the purpose of this thread. Push step 1 back after third year and give everyone a few months to study for it maybe?

 

[Cheeni17]

I think it’s kind of dumb that a 241 is considered magically better than a 238 or whatever. But there’s no way this should be P/F. I say this just because that leaves 100% of preparing me to be a third year clinical student on the med school curriculum. That’s ridiculous! We’d all just be memorizing our schools terrible PowerPoints and listening out for hints from crappy PhD faculty. That doesn’t even address the not insignificant amount of people who cheat in preclinical. If this was P/F, we’d all just do the bare minimum and be even more worthless in third year.

I might get on board with a H/HP/P/F type system so people aren’t stratified by insignificant differences. But whatever.

Step prep have me much more useful knowledge than most school lectures. People usually can’t tell this until it’s retrospective. It’s unbelievable how people say “I don’t need to know this to be a doctor” yet have not left the step cave and progressed into the real world. This is sdn though and hence why I never post but this topic was just to dumb to pass up

 

[atomheart]

The effects on competitive DO matches will be negligible: programs that don't like them will continue to screen them. There is already a high and arbitrary bar getting into competitive specialties, and typically these applicants' portfolios go above and beyond test scores.

The majority of the effect on DOs will occur for screening of interviews and away rotator spots for low-mid competitiveness programs in which test scores are the primary discriminator of applicant quality.

Actually, many students fail to see this change from the perspective of programs. The current problem is there's more applications than spots. There is a high demand to find applicants that are (1) actually interested in the specialty (2) have a good reason to be interested in the program and (3) will make a good resident. For example, the anesthesia match is heavily score driven because they need residents to pass the next set of tests, and often gets applications from competitive surgical applicants who use the specialty as a backup match. The solution for this field and others may involve students taking optional specialty specific exams prior to the application cycle.

 

[joeception]

I understand the push for P/F as it could potentially be argued for with the mental health perspective as is school grades, but it would need to be replaced with clear recommendations of how to select students for residencies moving forward. Otherwise I see a possibility of medicine becoming an increasingly elitist process where those with connections are the only ones able to succeed, it is far from perfect now but at least the undeserved / Low SES people have a shot.

 

[TheRealCookieMonster]

I see a few people talking about "solving" or "fixing" a problem by changing or not changing the step. What problem are we referring to?

 

[BorntobeDO?]

What this post doesn’t answer any questions

Then your asking the wrong questions:

 

[atomheart]

I see a few people talking about "solving" or "fixing" a problem by changing or not changing the step. What problem are we referring to?

What is the difference between a candidate that makes a 230 and one that makes a 231? 232? 233?

What is the difference between two candidates that both passed step?

The problems are (1) how are residencies supposed to objectively compare candidates and (2) does the measure of comparison have internal validity in predicting resident outcomes?