Pass/ Fail Step 1

[Slavic Scot]

I understand that pushing things onto Step 2 CK will have unintended consequences, but the pressure is already there. Historically scores on Step 2 have been significantly higher than Step 1 despite students having little or no dedicated study time. We presume this is because spending a year working in clinical settings may actually be an effective way for students to learn clinical knowledge.


There was a time, just a few years ago, when Step 1 was less important than it is now. Students still studied hard, passed their exams, and went on to become perfectly competent physicians. So I don't buy the argument that relieving some of the stress around Step 1 will result in deleterious effects on learners. And 6 weeks isn't going to make or break anyone's knowledge base. Without use you will shed most of that information quite rapidly.

The percentile ranks are higher? I understand the numbers are literally higher, but they correspond to the same percentiles. I don't think anyone cares if a 230 is 50th percentile or a "240" is or a "50" or "5", as long as there are percentiles.

This is a 100% true statement that no one is arguing against. Mostly because that's not at all what people are discussing.

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[PhillyMed777]

We are a competitive society and I don't want to change things with regards to step 1. We need some kind of objective measure to compare candidates. I want to know who went to the farthest extend and truly suffered, while performing well under high pressure, to obtain a good outcome on step 1. As someone who has been there, done that, I personally understand what it takes and I admire those who are willing to undertake a similar path and be uncomfortable. We are getting too soft these days.

 

[Lucca]

We are a competitive society and I don't want to change things with regards to step 1. We need some kind of objective measure to compare candidates. I want to know who went to the farthest extend and truly suffered, while performing well under high pressure, to obtain a good outcome on step 1. As someone who has been there, done that, I personally understand what it takes and I admire those who are willing to undertake a similar path and be uncomfortable. We are getting too soft these days.

lol y does everyone in this profession in this country insist on suffering for no reason. That Step 1 gives you a number doesn’t make it “objective”. Objective with respect to what? Knowing stuff is really important, yah, but that we measure knowing stuff really well (and even this assumption might be specious) and all of other qualities we care about very poorly or not at all is still a pretty brain dead way to try to figure out who is “the best”.

Literally no other developed country trains their med students up this way and still, somehow, produce perfectly competent physicians.

I’m less worried about people getting “soft” or whatever than I am about everyone being absolutely out for themselves. Having a rational training pipeline takes back seat to My Career Prospects, maximum cynicism, etc.

 

[7331poas]

lol y does everyone in this profession in this country insist on suffering for no reason. That Step 1 gives you a number doesn’t make it “objective”. Objective with respect to what? Knowing stuff is really important, yah, but that we measure knowing stuff really well (and even this assumption might be specious) and all of other qualities we care about very poorly or not at all is still a pretty brain dead way to try to figure out who is “the best”.

Literally no other developed country trains their med students up this way and still, somehow, produce perfectly competent physicians.

I’m less worried about people getting “soft” or whatever than I am about everyone being absolutely out for themselves. Having a rational training pipeline takes back seat to My Career Prospects, maximum cynicism, etc.

I think a potentially larger problem is more people will go unmatched. I can easily see a person getting straight honors on clerkship and a Pass on step 1 applying plastics. If they had a 260 they might have been safe. but without a pass, they could easily go unmatched.

I think now that step 1 is P/F, you absolutely need to apply to a backup because you have no idea where you stand.

 

[olabrador23]

We are a competitive society and I don't want to change things with regards to step 1. We need some kind of objective measure to compare candidates. I want to know who went to the farthest extend and truly suffered, while performing well under high pressure, to obtain a good outcome on step 1. As someone who has been there, done that, I personally understand what it takes and I admire those who are willing to undertake a similar path and be uncomfortable. We are getting too soft these days.

There is a reason why there is "race" in the "human race" (jk)

lol y does everyone in this profession in this country insist on suffering for no reason. That Step 1 gives you a number doesn’t make it “objective”. Objective with respect to what? Knowing stuff is really important, yah, but that we measure knowing stuff really well (and even this assumption might be specious) and all of other qualities we care about very poorly or not at all is still a pretty brain dead way to try to figure out who is “the best”.

Literally no other developed country trains their med students up this way and still, somehow, produce perfectly competent physicians.

I’m less worried about people getting “soft” or whatever than I am about everyone being absolutely out for themselves. Having a rational training pipeline takes back seat to My Career Prospects, maximum cynicism, etc.

wow...

 

[Slavic Scot]

...produce perfectly competent physicians...

That is not at all what we are discussing.

I have greater aspirations than being a "perfectly competent physician"

 

[chlorocruorin]

What if they made made step 1 P/F and said who ever can bench the most will get preference in residencies?

 

[enalli]

Under external pressure? Unlikely. But the dilemma for all faculty right now (whether they know it or not) is either teach to what the students perceive is board relevant, or get ignored by an increasingly large proportion of the class.

You're missing a third option there: become better teachers.

If one of your main objectives is to get med students interested in lectures again, then changing Step 1 reporting would probably be number 100 in a 100-item list of how I would achieve this--numbers 1 through 99 being "get better lecturers."

A lot (most?) of pre-clinical faculty are comically bad teachers. They have so little insight that of course they think "a disengaged student? It must be the boards' fault!" Pathoma isn't successful just because he says "this is extremely high-yield" and "examiners love to go after this" every 5 seconds; he is a fantastic teacher, which for most students is a breath of fresh air.

 

[Med Ed]

The percentile ranks are higher? I understand the numbers are literally higher, but they correspond to the same percentiles. I don't think anyone cares if a 230 is 50th percentile or a "240" is or a "50" or "5", as long as there are percentiles.

The point isn't the percentiles, or even the raw scores. You've probably heard some permutation of "two months for Step 1, two weeks for Step 2, and you take Step 3 with a No. 2 pencil." There is a general recognition that the Step exams require less preparation because they progressively align more with clinical relevant content. Hence, if I were looking for a marker of student readiness/desirability in resident selection, Step 2 would already be a better choice than Step 1.

This is a 100% true statement that no one is arguing against. Mostly because that's not at all what people are discussing.

It is certainly germane when there are people expressing fear that medical students will become slackers en masse if Step 1 goes P/F. They are ignoring the fairly recent history of Step 1's role in medical education.

 

[Slavic Scot]

The point isn't the percentiles, or even the raw scores. You've probably heard some permutation of "two months for Step 1, two weeks for Step 2, and you take Step 3 with a No. 2 pencil." There is a general recognition that the Step exams require less preparation because they progressively align more with clinical relevant content. Hence, if I were looking for a marker of student readiness/desirability in resident selection, Step 2 would already be a better choice than Step 1.

"Historically scores on Step 2 have been significantly higher than Step 1 despite students having little or no dedicated study time"

With respect, I'm not sure what your point is. It is a standardized test. People will fall in the normal distribution no matter how little they study. I suspect it is easier to be 50th percentile because there is less emphasis on step 2 than step 1, and people feel less need to crush it. If step 1 becomes pass/fail, step 2 will just get that same emphasis.


"become perfectly competent physicians"

"It is certainly germane when there are people expressing fear that medical students will become slackers en masse if Step 1 goes P/F. They are ignoring the fairly recent history of Step 1's role in medical education."

I'm just going to highlight that again. That is clearly not what people are concerned about. People are well aware that passing step shows minimum competency. I don't just want to be a "perfectly competent physician" from my state school, muscled out of competitive residencies by top school graduates, nepotism, and arbitrary/subjective grading and extra work, in an environment where top school graduates are already overrepresented in competitive residencies.

 

[Med Ed]

You're missing a third option there: become better teachers.

Your average PhD who is lecturing to medical students is there for one of three reasons:

1. Brand new assistant professor, can't say no to anything
2. Lost grant funding and the department needs to extract something it can use while he/she writes more grants
3. Tenured, twilight of career, similar to #2 except DGAF about anything

None of these scenarios are recipes for the drive to become better teachers. Historically, teaching medical students has been meted out in departments as a form of punishment and/or penance.

If one of your main objectives is to get med students interested in lectures again,

No, I think lectures are a waste of time for everyone involved.

 

[sargon2123]

It's pretty moot to hear out anyone at a top school giving their opinion about this. They have everything to gain from the other students who have everything to lose.

 

[Slavic Scot]

It's pretty moot to hear out anyone at a top school giving their opinion about this. They have everything to gain from the other students who have everything to lose.

There's another group. People interested in primary care that don't care about their peers' aspirations.

 

[Goro]

Your average PhD who is lecturing to medical students is there for one of three reasons:
1. Brand new assistant professor, can't say no to anything
2. Lost grant funding and the department needs to extract something it can use while he/she writes more grants
3. Tenured, twilight of career, similar to #2 except DGAF about anything

None of these scenarios are recipes for the drive to become better teachers. Historically, teaching medical students has been meted out in departments as a form of punishment and/or penance.

I remember reading years ago that Faculty at MD schools who won teaching awards would get flak from their Chairs because teaching excellence was somehow viewed as taking away from research productivity.


4. Some of us actually LIKE teaching! We at DO schools also don't have those pesky scholarship requirements like PIs do at MD schools, so we can devote more time for teaching. Note: given the criticisms I hear for LMU and other schools, not all faculty take teaching seriously, or if you stick your school in deep rural America, it may be harder to recruit competent faculty.

#1 is more nuanced because new PIs also get protected time to set up their labs and write their first sets of grants.

There's another group. People interested in primary care that don't care about their peers' aspirations.

Actually, NBME and NBOME don't care about your career aspirations, either. They just want to make sure that you are competent in the medical knowledge and clinical thinking domains.

 

[7331poas]

Actually, NBME and NBOME don't care about your career aspirations, either. They just want to make sure that you are competent in the medical knowledge and clinical thinking domains.

If that were true then why score step 2? Why score clerkships?

I think your reasoning here is very reductionist.

I'm just going to highlight that again. That is clearly not what people are concerned about. People are well aware that passing step shows minimum competency. I don't just want to be a "perfectly competent physician" from my state school, muscled out of competitive residencies by top school graduates, nepotism, and arbitrary/subjective grading and extra work, in an environment where top school graduates are already overrepresented in competitive residencies.

The prevailing mindset from the people who want P/F is to just to make it P/F and let the PDs and the medical students face the consequences.

Imagine if medical school admissions went to P/F for both MCAT and GPA. It would be chaos. But for some reason we accept that for residency.

Surely a person who got over a 500 on the MCAT and a 3.0 GPA is capable of being a "perfectly competent physician".

 

[Goro]

If that were true then why score step 2? Why score clerkships?

I think your reasoning here is very reductionist.



The prevailing mindset from the people who want P/F is to just to make it P/F and let the PDs and the medical students face the consequences.

Imagine if medical school admissions went to P/F for both MCAT and GPA. It would be chaos. But for some reason we accept that for residency.

Surely a person who got over a 500 on the MCAT and a 3.0 GPA is capable of being a "perfectly competent physician".

From the mouth of the NBOME guy who came to our campus. I've heard similar from MD students who met thier NBME counterparts. The wise @Med Ed has discussed the motivations of NBME previously in this thread...several times.

 

[chlorocruorin]

Imagine if medical school admissions went to P/F for both MCAT and GPA. It would be chaos. But for some reason we accept that for residency.

Surely a person who got over a 500 on the MCAT and a 3.0 GPA is capable of being a "perfectly competent physician".

But Getting above a 500 does not give individuals the right to practice medicine in the US. The mcat’s Purpose is to stratify applicants to a certain extent. Getting above a C in organic chemistry also can produce “perfectly competent physicians”. The reason why there is a push for P/F is because USMLE step 1 was never meant to stratify applicants like how it is today and it hinders diversity in residency and adversely affects the mental health of medical students for no real reason. The entire application process seems to be flawed, so I would expect there would be guideline changes in addition to P/F step 1. It’s standardized, but not everyone has access to the same resources. Getting a 235 will be considered a bad score for some Residencies in 20 years, but per the data right now, there most likely won’t be any significant performance increases so what was the point then?

 

[AnatomyGrey12]

The reason why there is a push for P/F is because USMLE step 1 was never meant to stratify applicants like how it is today

Just because something is used in a different manner than was initially intended doesn't delegitimize that use.

it hinders diversity in residency

Gonna need a citation. Also, you think making it P/F would help? Right...... because when it's P/F and the residencies pick based on prestige of medical school, which is often highly correlated to prestige of undergrad, which is highly correlated to a high SES that will DEFINITELY help diversity

dversely affects the mental health of medical students for no real reason.

You are insane if you think any of the stress on medical students would change. All it does is move the stress to other things, and very realistically could make it worse overall.

but not everyone has access to the same resources

Yes they do. Anki is literally free. And loan money is enough to cover all the other resources as overall they are fairly cheap.

 

[olabrador23]

If that were true then why score step 2? Why score clerkships?

I think your reasoning here is very reductionist.

The prevailing mindset from the people who want P/F is to just to make it P/F and let the PDs and the medical students face the consequences.

Imagine if medical school admissions went to P/F for both MCAT and GPA. It would be chaos. But for some reason we accept that for residency.

Surely a person who got over a 500 on the MCAT and a 3.0 GPA is capable of being a "perfectly competent physician".

From the mouth of the NBOME guy who came to our campus. I've heard similar from MD students who met thier NBME counterparts. The wise @Med Ed has discussed the motivations of NBME previously in this thread...several times.

@7331poas you are looking at what they do vs @Goro you are taking their words for it.

(I knew a good old saying for this but forgot it now )

 

[chlorocruorin]

Just because something is used in a different manner than was initially intended doesn't delegitimize that use.


Gonna need a citation. Also, you think making it P/F would help? Right...... because when it's P/F and the residencies pick based on prestige of medical school, which is often highly correlated to prestige of undergrad, which is highly correlated to a high SES that will DEFINITELY help diversity


You are insane if you think any of the stress on medical students would change. All it does is move the stress to other things, and very realistically could make it worse overall.


Yes they do. Anki is literally free. And loan money is enough to cover all the other resources as overall they are fairly cheap.

Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates. - PubMed - NCBI

Evidence for Increasing Diversity in Graduate Medical Education: The Competence of Underrepresented Minority Residents Measured by an Intern Objective Structured Clinical Examination

Some have commented that the limited number of underrepresented minorities (URMs) in United States' residency programs is due to a lack of qualified candidates. At the University of Michigan, an objective structured clinical examination is administered ...

www.ncbi.nlm.nih.gov

Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews - PubMed

When USMLE Step 1 scores are used to screen applicants for a residency interview, a significantly greater proportion of African-American students will be refused an interview.

www.ncbi.nlm.nih.gov

Minorities score much lower on Step 1 on avg (table 2 on the second article), so it doesn't take a rocket scientist to realize that residences over emphasizing on step 1 doesn't benefit everyone. But as the data i posted, minorities score on par and even higher in some cases on OSCEs.

You're making an assumption about what could happen, but likely won't.

Also, who said mental health issues would cease? You're literally stretching TF out of everything I'm saying.

Just because everyone on SDN uses the same resources doesn't mean everyone does.

 

[AnatomyGrey12]

You're making an assumption about what could happen, but likely won't.

Based on... what? You're missing the fact that it already happens but is somewhat mitigated by the fact that many PDs will choose the candidate that is better in a head to head comparison (of which Step 1 is the only standardized criteria). Take away the standardized element and I don't see how you can claim that PDs "likely won't" simply select for people from more prestigious, well known schools.

Also, who said mental health issues would cease? You're literally stretching TF out of everything I'm saying.

Then why even say, "adversely effects medical student mental health for no real reason" if you weren't insinuating that making it P/F would somehow change this? If that is "stretching" what you are saying then you need to make your point more clear.

Just because everyone on SDN uses the same resources doesn't mean everyone does.

What resources are people using that aren't available to everyone? Serious question. This isn't the MCAT where there are hoards of medical students paying 5k for prep courses. In fact, in my anecdotal experience the people paying for prep courses are doing so because they are terrified they are going to fail, not because they think it will help them kill it. My statement stands, everyone has access to the same resources. That's not an excuse.

Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates. - PubMed - NCBI

Evidence for Increasing Diversity in Graduate Medical Education: The Competence of Underrepresented Minority Residents Measured by an Intern Objective Structured Clinical Examination
Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews. - PubMed - NCBI

In the first study they claim "competitive for programs" and then go on to highlight lower Step 1 scores, lower Step 2 CK scores (which many on here believe should be the test of choice for residencies), and lower rates of AOA... You want ortho then compete with your peers for ortho. So essentially, the first and third studies don't really have evidence for the conclusions they state, and honestly don't really give much of a conclusion outside of "maybe this is happening and Step 1 might be the cause" and there really isn't evidence for any of it. The second isn't surprising to anyone and the same result would happen if you swapped the URM test group with ORM residents with equal scores. I find the entire premise of these studies to be wanting

 

[chlorocruorin]

In the first study they claim "competitive for programs" and then go on to highlight lower Step 1 scores, lower Step 2 CK scores (which many on here believe should be the test of choice for residencies), and lower rates of AOA... You want ortho then compete with your peers for ortho. So essentially, the first and third studies don't really have evidence for the conclusions they state, and honestly don't really give much of a conclusion outside of "maybe this is happening and Step 1 might be the cause" and there really isn't evidence for any of it. The second isn't surprising to anyone and the same result would happen if you swapped the URM test group with ORM residents with equal scores. I find the entire premise of these studies to be wanting

Are you understanding the point that’s trying to be made? Read your response then go back to my original claim. Thats like saying choosing applicants based on athletic they are doesn’t negatively affect people who don’t play sports. “They need to become more athletic”
You asked for literature and got it. No matter where you stand it’s crazy how you can’t see the cons to keeping step 1 the way it is

 

[AnatomyGrey12]

You asked for literature and got it.

Sorry, I should have clarified, I want to see GOOD literature.

No matter where you stand it’s crazy how you can’t see the cons to keeping step 1 the way it is

I have yet to see how the cons of keeping it are worse than the cons of changing it to P/F.

 

[Goro]

So I don't buy the argument that relieving some of the stress around Step 1 will result in deleterious effects on learners.

It seems that for a lot of people in this thread "deleterious" means "I won't get into MGH IM or Ortho at JHU!!!"

I say that partially in jest, but I am sympathetic to the career aspirations of SDNers. Thus, I'd like to see the anxieties about PDs choosing people by school reputation as opposed to what's in the residency app addressed.

 

[7331poas]

Underrepresented Minority Applicants Are Competitive for Orthopaedic Surgery Residency Programs, but Enter Residency at Lower Rates. - PubMed - NCBI

Only looked at your first link since I knew it was going to be misleading. From the results,

"Sixty-one percent of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants (P < 0.0001). White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had higher Step 2 Clinical Knowledge scores and higher odds of Alpha Omega Alpha membership compared with Black, Hispanic, and Other groups "

Then they conclude that the only reason why minority applicants were admitted at a lower rate was because of their scores, without even bothering to address why they think someone with lower scores and AOA status are "equally qualified".

 

[7331poas]

It seems that for a lot of people in this thread "deleterious" means "I won't get into MGH IM or Ortho at JHU!!!"

Which is a valid concern. I chose my school because of a scholarship. Now I am realizing that was a mistake.

 

[olabrador23]

Which is a valid concern. I chose my school because of a scholarship. Now I am realizing that was a mistake.

(would you be going to be opposing P/F if you were at a T20 school? jk)

I have not seen anyone that is defending a position purely on principles. T20 people and people with low / average scores would like to see P/F happen, the ones with high scores and from lower tiered schools would not. If there were (more) T20 people to oppose the change, that would be awesome. I do think this change is unfair as it favors / biases certain groups at the expense of others while the way it is now still puts more focus and control in hands of the individuals instead and allows them to continue to be competitive.

The way the "discussion" is going right now, I see it as a battle between different groups of different interests - who is/are more powerful thus will be successful to achieve what they want at the end. If this thinking is right, then the change to P/F will happen as T20 are obviously having more resources / power to push their agenda. (Unless the rest unites to fight the change as it will be affecting them big... there is power in numbers...)

 

[jhenj529]

(would you be going to be opposing P/F if you were at a T20 school? jk)

I have not seen anyone that is defending a position purely on principles. T20 people and people with low / average scores would like to see P/F happen, the ones with high scores and from lower tiered schools would not. If there were (more) T20 people to oppose the change, that would be awesome. I do think this change is unfair as it favors / biases certain groups at the expense of others while the way it is now still puts more focus and control in hands of the individuals instead and allows them to continue to be competitive.

The way the "discussion" is going right now, I see it as a battle between different groups of different interests - who is/are more powerful thus will be successful to achieve what they want at the end. If this thinking is right, then the change to P/F will happen as T20 are obviously having more resources / power to push their agenda. (Unless the rest unites to fight the change as it will be affecting them big... there is power in numbers...)

Outside of maybe the top 5 schools, making step 1 P/F would probably do more harm to the other 15 schools than the slight bump it may give them

 

[olabrador23]

Outside of maybe the top 5 schools, making step 1 P/F would probably do more harm to the other 15 schools than the slight bump it may give them

if that is so, we would hear them (the other 15) opposing the change already?

 

[Med Ed]

"Historically scores on Step 2 have been significantly higher than Step 1 despite students having little or no dedicated study time"

With respect, I'm not sure what your point is. It is a standardized test. People will fall in the normal distribution no matter how little they study. I suspect it is easier to be 50th percentile because there is less emphasis on step 2 than step 1, and people feel less need to crush it. If step 1 becomes pass/fail, step 2 will just get that same emphasis.


"become perfectly competent physicians"

"It is certainly germane when there are people expressing fear that medical students will become slackers en masse if Step 1 goes P/F. They are ignoring the fairly recent history of Step 1's role in medical education."

I'm just going to highlight that again. That is clearly not what people are concerned about. People are well aware that passing step shows minimum competency. I don't just want to be a "perfectly competent physician" from my state school, muscled out of competitive residencies by top school graduates, nepotism, and arbitrary/subjective grading and extra work, in an environment where top school graduates are already overrepresented in competitive residencies.

May I ask where you are in your education?

 

[chlorocruorin]

Only looked at your first link since I knew it was going to be misleading. From the results,

"Sixty-one percent of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants (P < 0.0001). White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had higher Step 2 Clinical Knowledge scores and higher odds of Alpha Omega Alpha membership compared with Black, Hispanic, and Other groups "

Then they conclude that the only reason why minority applicants were admitted at a lower rate was because of their scores, without even bothering to address why they think someone with lower scores and AOA status are "equally qualified".

Because qualification doesn't mean the same board score?? lol

Ok let me break it down.

Minorities score lower on avg on step 1

Residencies continue to overemphasize step 1 in admissions

Who gets the short end of the stick?

Does step 1 correlate WELL with specialty boards, clinical skills, etc.? .....No

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

 

[Neopolymath]

Because qualification doesn't mean the same board score?? lol

Ok let me break it down.

Minorities score lower on avg on step 1

Residencies continue to overemphasize step 1 in admissions

Who gets the short end of the stick?

Does step 1 correlate WELL with specialty boards, clinical skills, etc.? .....No

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

Guys, we have done it. We have found the guy who will try to make this a race issue (without realizing it would cause the exact opposite effect but I digress.) We can all rest easy now knowing that SDN did not have a thread in which someone didn't mention race, midlevels, or DOs. It was getting close.

 

[7331poas]

Because qualification doesn't mean the same board score?? lol

Ok let me break it down.

Minorities score lower on avg on step 1

Residencies continue to overemphasize step 1 in admissions

Who gets the short end of the stick?


Does step 1 correlate WELL with specialty boards, clinical skills, etc.? .....No

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

Like I said, some of us accepted scholarship offers, others decided to stay at their home institution due to family. No one predicted that the USMLE would do this after we committed to a school.

 

[chlorocruorin]

Guys, we have done it. We have found the guy who will try to make this a race issue (without realizing it would cause the exact opposite effect but I digress.) We can all rest easy now knowing that SDN did not have a thread in which someone didn't mention race, midlevels, or DOs. It was getting close.

Are you going to be that guy who says everything is a race war? Lol, this is a discussion that is being discussed regarding the future of USMLE per their website. This has nothing to with race, but more to do with the consequences of Step 1 right now. You're weird/odd interest in wanting this to be a race issue is weird bro lol

 

[DexterMorganSK]

At the end of the day, it all comes down to how much $$$ can the people involved in this change get!!

But

"An opportunity for medical students and their advocates to force change on this issue may still exist. The organizations that convened InCUS are seeking public comments until July 26, 2019"

'Secretive Meeting' Threatens USMLE Reform, Critics Say

Changes to USMLE scoring were proposed after a closed-door meeting. Critics of the recommendations say they are inadequate and threaten to undermine meaningful reform.

www.medscape.com

 

[5yewy5r]

Because qualification doesn't mean the same board score?? lol

Ok let me break it down.

Minorities score lower on avg on step 1

Residencies continue to overemphasize step 1 in admissions

Who gets the short end of the stick?

Does step 1 correlate WELL with specialty boards, clinical skills, etc.? .....No

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

If residencies want to incorporate a more "holistic" review process to increase diversity, that is fine with me. Necessarily that would mean lessening the importance of step 1 score in the application. But I don't see why that necessitates making step 1 P/F - that would just screw over everyone not at T20s immediately unless some other exam becomes the focus (like step 2).

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

One could just as well argue "you want to get in those good residencies? You should've [gotten a higher step 1 score]." What's the difference? Not to mention that a system like that basically mirrors the situation with law schools, which to me does not seem to be a more equitable or meritocratic system. Also, guess what is the most important metric for getting into those coveted T14 law schools? The LSAT, a standardized exam... My guess is that if step 1 goes P/F and no suitable replacement arises to be the objective stratifier, the MCAT will become even more disproportionately important to medical school admissions than it is now.

 

[TheRealCookieMonster]

suffering

lol suffering... some heavy language there.

We can all rest easy now knowing that SDN did not have a thread in which someone didn't mention race, midlevels, or DOs.

I can't even imagine SDN without those.

 

[AnatomyGrey12]

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

Lol congratulations, you played yourself.

 

[olabrador23]

Only looked at your first link since I knew it was going to be misleading. From the results,

"Sixty-one percent of minority applicants were accepted into an orthopaedic residency versus 73% of White applicants (P < 0.0001). White and Asian applicants and residents had higher USMLE Step 1. White applicants and matriculated candidates had higher Step 2 Clinical Knowledge scores and higher odds of Alpha Omega Alpha membership compared with Black, Hispanic, and Other groups "

Then they conclude that the only reason why minority applicants were admitted at a lower rate was because of their scores, without even bothering to address why they think someone with lower scores and AOA status are "equally qualified".

Because qualification doesn't mean the same board score?? lol

Ok let me break it down.

Minorities score lower on avg on step 1

Residencies continue to overemphasize step 1 in admissions

Who gets the short end of the stick?

Does step 1 correlate WELL with specialty boards, clinical skills, etc.? .....No

Hate to be the one that said it, but yall's same reasoning in "You want ortho then compete with your peers for ortho." - @AnatomyGrey12
okay you want to get in those good residences? You should've competed with your peers in UG to get that T10 offer, then this P/F **** wouldn't matter to you as much.

I think the word "minority" used here is kinda misleading. URM is more appropriate. (As the above points out, Asians are not counted as "minority" in medicine).

The more I think about this, it is always the fight to determine what groups of people get what. Not about being on principles or being fair. Imho, the race should be designed so that the participants could compete on the individual's merits. The indvidual should earn what he / she wants on their own work. It should not be about what group the individual belongs to. Is this country's Constitution is for equal opportunities for every individual or groups of people?

At the end of the day, it all comes down to how much $$$ can the people involved in this change get!!

But

"An opportunity for medical students and their advocates to force change on this issue may still exist. The organizations that convened InCUS are seeking public comments until July 26, 2019"

'Secretive Meeting' Threatens USMLE Reform, Critics Say

Changes to USMLE scoring were proposed after a closed-door meeting. Critics of the recommendations say they are inadequate and threaten to undermine meaningful reform.

www.medscape.com

yeah, they are taking your comments but who gets to decide? I think it is made so that people would think that this is a democratic process.

 

[plshelpvanxious]

Do you think we'll start to see more schools shifting back to graded preclinical curriculum if this happens?
I'm at a low-mid tier school with p/f preclinical curriculum and the thought of a p/f step1 gives me a lot of mixed feelings. It's one less thing to stress about, but also one less thing to potentially help set me apart.

 

[Deecee2DO]

If residencies want to incorporate a more "holistic" review process to increase diversity, that is fine with me. Necessarily that would mean lessening the importance of step 1 score in the application. But I don't see why that necessitates making step 1 P/F - that would just screw over everyone not at T20s immediately unless some other exam becomes the focus (like step 2).



One could just as well argue "you want to get in those good residencies? You should've [gotten a higher step 1 score]." What's the difference? Not to mention that a system like that basically mirrors the situation with law schools, which to me does not seem to be a more equitable or meritocratic system. Also, guess what is the most important metric for getting into those coveted T14 law schools? The LSAT, a standardized exam... My guess is that if step 1 goes P/F and no suitable replacement arises to be the objective stratifier, the MCAT will become even more disproportionately important to medical school admissions than it is now.

Id much rather have Step be the stratifier than the MCAT. At least Step is about medicine. If we put MCAT and Step together Step is considerably more relevant to our careers as physicians if we are comparing it to the largely irrelevant exam known as the MCAT

 

[deleted731525]

There's another group. People interested in primary care that don't care about their peers' aspirations.

And another group, idealist who wish that there could be a better way to stratify applicants.

 

[Goro]

Do you think we'll start to see more schools shifting back to graded preclinical curriculum if this happens?
I'm at a low-mid tier school with p/f preclinical curriculum and the thought of a p/f step1 gives me a lot of mixed feelings. It's one less thing to stress about, but also one less thing to potentially help set me apart.

I wouldn't count on that. We like our students to NOT stress about grades.

 

[Lawpy]

Do you think we'll start to see more schools shifting back to graded preclinical curriculum if this happens?
I'm at a low-mid tier school with p/f preclinical curriculum and the thought of a p/f step1 gives me a lot of mixed feelings. It's one less thing to stress about, but also one less thing to potentially help set me apart.

I wouldn't count on that. We like our students to NOT stress about grades.

might as well make clinical grades P/F too, considering they're also stressful considering their subjectivity. apparently a few schools are already taking this approach

 

[AnatomyGrey12]

might as well make clinical grades P/F too, considering they're also stressful considering their subjectivity. apparently a few schools are already taking this approach

Yeah my school is essentially P/F for clinical grades. There is an honors grade too but getting it is a complete crapshoot. They just handed us the criteria for honors on my first rotation and it is insane. The attending has to 1. recommend you for honors, 2. basically write a 500 word essay why you should get it. and then 3. a committee evaluates all the students and their grades/evals and decides who should get it. It's extremely dumb.

Essentially you can do everything right and still not get it purely because the committee has decided they don't want to give any more than X amount out (it's like 8%).

 

[Lawpy]

Yeah my school is essentially P/F for clinical grades. There is an honors grade too but getting it is a complete crapshoot. They just handed us the criteria for honors on my first rotation and it is insane. The attending has to 1. recommend you for honors, 2. basically write a 500 word essay why you should get it. and then 3. a committee evaluates all the students and their grades/evals and decides who should get it. It's extremely dumb.

Essentially you can do everything right and still not get it purely because the committee has decided they don't want to give any more than X amount out (it's like 8%).

That sounds absurd but i wouldn't be surprised if some of the old school attendings on here would strongly support this

 

[AnatomyGrey12]

That sounds absurd but i wouldn't be surprised if some of the old school attendings on here would strongly support this

I'm sure that's actually why we have it that way lol. The older attendings make up most of the committee I think.

 

[Chibucks15]

Make it P/HP/H which corresponds to like 210/230/250.

That way people who want to kill it still can, but people don’t worry over 3 points or so and it should eliminate a lot of the stress of people in this gauntlet of a process

 

[kb1900]

Yeah my school is essentially P/F for clinical grades. There is an honors grade too but getting it is a complete crapshoot. They just handed us the criteria for honors on my first rotation and it is insane. The attending has to 1. recommend you for honors, 2. basically write a 500 word essay why you should get it. and then 3. a committee evaluates all the students and their grades/evals and decides who should get it. It's extremely dumb.

Essentially you can do everything right and still not get it purely because the committee has decided they don't want to give any more than X amount out (it's like 8%).

Your school is hurting it’s own students. My school gives >35% honors and >35% high pass. (Tho our shelf scores are < 20% of our grade). My school is also very pro the pass/fail step 1 movement because its self serving. Analogous to having 70% of students get H/HP per rotation being self-serving for the school

Sure the distribution is on our MSPE but something tells me that the distribution is not as closely looked at as the final grade. No different than comparing GPAs despite undergrads with grade deflation/inflation

 

[sargon2123]

If this actually happens I’m throwing my derm ambition out the window. When exactly will we know for sure? I’m trying to time research progress in general, and I bet that and general networking are going to become much more important for even specialties like psych and EM with creeping competitiveness.