Pass/ Fail Step 1

[afib123]

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Step 1 is far more than 20% basic sciences. The dictum from the NBME is to abandon straight recall questions and instead frame every single item around a clinical vignette or experimental scenario. Essentially they are embedding a basic science exam in questions that appear clinically focused. That's not to say that Step 1 does not contain bona fide clinical questions. The NMBE has been deliberate in making Step 1 a bit more clinical than it used to be, while trying to infuse some basic science content into Step 2. In essence making the two exams a little more alike than in years past. In some ways this reflect the fact that the old school 2 years of class and 2 years in the hospital isn't how medical school is done anymore.



Remove or marginalize the basic sciences too much and congrats, you just created a really long and expensive DNP program.



Students don't need to see patients earlier. Practically every allopathic school in the country now has "early clinical exposure" with preceptorships or other experiences. If physical exam skills are deteriorating the reason is actually Step 1 itself. Getting students interested in anything other than Step 1 for the first two years of medical school has become a lost cause.

"Physical examination?"
"Step 1."
"Critical analysis?"
"Step 1."
"Interpersonal skills?"
"Step 1."
"Clinical reasoning?"
"Step 1."

And so on.

If you're not directly involved in UME then it's understandably difficult to appreciate the situation, but basically over the past 5 years the entire system has gone into core meltdown. The students currently inside the machine obviously lack perspective, and cannot see that while Step 1 has been an important milestone since its inception, things weren't always like this. Medical students in the past took for granted the luxury of developing themselves across multiple domains in a manner that currently seems quaint.

I would disagree with you. You have to strike a balance between basic science and clinical skills. I love the basic sciences. But all that basic sciences is not good if you can't translate that into clinical practice. Any good physician is one that can integrate the both. I have been on the medicine service and received consults from other specialities for insulin and hypertension management! I mean learning the pathophysiology of insulin production is good. Don't get me wrong. But if you cannot manage inpatient diabetes as a doctor, that is shameful. Learning about arteriosclerosis in hypertension is good but not if you don't know the basic management of that as any kind of doctor! That is where the curriculum needs to change. That stuff needs to be incorporated into Step 1 and the curriculum. I am not sure how many non IM/FM/Peds residents can accurately characterize heart murmurs, extra heart sounds, read an EKG, etc. What is the use of learning hours and hours on flow volume loops if you can't do a basic cardiac exam or learn to read simple EKGs. Same way I am not sure how IM/Peds residents know what kind of sutures there are, how to suture, how to tie knots. All this stuff needs to be incorporated into the first 2 years. Making Step 1 pass or fail is not going to teach students these skills.

Changing the curriculum and testing this stuff will. Just because step 1 is made pass or fail does NOT mean people will stop using sketchy, pathoma and boards and beyond. People use that stuff because they are tired and fed up of how outdated the clinical curriculum and lecturers are. Just making step 1 pass or fail is not going to prevent people from coming to class. They will use outside resources to pass the test instead of getting the highest score on it.

I think the way to go is changing the curriculum. Making it more clinically relevant. Making step 1 more clinically relevant.

I would advocate for removing shelf exams, step 2, clinical grades and encouraging students to spend time on the wards 3rd year. All those skills you talk about such as critical analysis, interpersonal skills, and clinical reasoning come starting in 3rd year when students are waiting to go home to study for a shelf exam. Take that stupid shelf exam out, give medical students more clinical responsibilities and those skills will improve.
Leave the first 2 years to study for a test. Teach the stuff that you want people to know. Test people on that stuff. Let people take actual responsibility third and fourth year than being burdened by redundant shelf exams and step 2.
Of course, you might have a different opinion. I don't subscribe to that. I don't think making step 1 pass or fail will do anything.

 

[wontonsoup]

Step 1 is far more than 20% basic sciences. The dictum from the NBME is to abandon straight recall questions and instead frame every single item around a clinical vignette or experimental scenario. Essentially they are embedding a basic science exam in questions that appear clinically focused. That's not to say that Step 1 does not contain bona fide clinical questions. The NMBE has been deliberate in making Step 1 a bit more clinical than it used to be, while trying to infuse some basic science content into Step 2. In essence making the two exams a little more alike than in years past. In some ways this reflect the fact that the old school 2 years of class and 2 years in the hospital isn't how medical school is done anymore.



Remove or marginalize the basic sciences too much and congrats, you just created a really long and expensive DNP program.



Students don't need to see patients earlier. Practically every allopathic school in the country now has "early clinical exposure" with preceptorships or other experiences. If physical exam skills are deteriorating the reason is actually Step 1 itself. Getting students interested in anything other than Step 1 for the first two years of medical school has become a lost cause.

"Physical examination?"
"Step 1."
"Critical analysis?"
"Step 1."
"Interpersonal skills?"
"Step 1."
"Clinical reasoning?"
"Step 1."

And so on.

If you're not directly involved in UME then it's understandably difficult to appreciate the situation, but basically over the past 5 years the entire system has gone into core meltdown. The students currently inside the machine obviously lack perspective, and cannot see that while Step 1 has been an important milestone since its inception, things weren't always like this. Medical students in the past took for granted the luxury of developing themselves across multiple domains in a manner that currently seems quaint.

So I haven't taken step 1 yet and I'm totally spit-balling here, but has anyone discussed breaking up Step 1 into a few smaller, less high-stakes exams? I suppose the idea of averaging S1/2 is kinda similar, but do you think replacing the 8 hour behemoth career-deciding exam with 2-3 shorter exams would be better? Strong students who had a bad day would get some leeway and the pressure would be a little lower going into any particular exam. Then again, I don't know if I like the idea of potentially multiple dedicated study periods and extending the ridiculous test anxiety away from just the single 4-8 week period.

 

[JooceMan137]

More than step 1, the clinical curriculum needs to be changed. Students are becoming horrible in their physical exam skills. People need to start seeing patients earlier.

Hmm, that’s interesting because my school (US MD school) incorporates clinical skills sessions throughout the entire first 2 years. For instance, when we’re doing the GI block, we also have once weekly (with exam weeks off) of simulated patient interactions with GI related stuff (GI pain, etc) and were also required to pass a clinical skills practical exam to receive honors in the course.

Also, we have mentorships for the first two years, meaning we have to shadow and participate (essentially do a rotation without being graded for it, just a feedback form) with an attending for each of the two years (one attending first year, another attending second year). We usually have to achieve a minimum amount of hours before a deadline, so it isn’t a fixed weekly type thing.

I personally found these sessions helpful for getting me ready for 3rd year (starting next week). I was under the impression that this was pretty standard for most US schools.

 

[afib123]

Hmm, that’s interesting because my school (US MD school) incorporates clinical skills sessions throughout the entire first 2 years. For instance, when we’re doing the GI block, we also have once weekly (with exam weeks off) of simulated patient interactions with GI related stuff (GI pain, etc) and were also required to pass a clinical skills practical exam to receive honors in the course.

Also, we have mentorships for the first two years, meaning we have to shadow and participate (essentially do a rotation without being graded for it, just a feedback form) with an attending for each of the two years (one attending first year, another attending second year). We usually have to achieve a minimum amount of hours before a deadline, so it isn’t a fixed weekly type thing.

I personally found these sessions helpful for getting me ready for 3rd year (starting next week). I was under the impression that this was pretty standard for most US schools.

Well it is good you guys do it once a week. I go to pretty decent US MD school as well and we had a few sessions and to take a osce at the end of each module too.

But I didn't think that's enough going into third year. Doing fake exams on healthy patients is much different from examining real complicated patients which comes through lot of practice. And it is not just about the physical exam skills. It is about integrating your exam with clinical reasoning and coming up with a diagnosis. And also managing common medical issues. Sure that is what 3rd year is for, but I am not sure that is enough.

This stuff needs a lot of practice and you need to start early to become good at it. And every doctor needs to know this stuff not just the medicine residents or FM residents. Like I said try to get non IM/FM/Peds residents to read EKGs, characterize heart murmurs, extra heart sounds, etc. You will see how bad they are. I had a patient when on the medicine service be discharged with atrial fibrillation from a surgical service. Either they had no idea what irregularly irregular rhythm is like or were lazy. He came back with AMS and possible stroke. We get consulted for insulin management for diabetic patients. We get consulted for hypertension management. I mean I find those skills essential for any kind of doctor. You need to start teaching these skills and they need to be tested on Step 1. Same way, try to get IM residents to something as basic as throwing down good sutures and you will see many will struggle with it.

 

[deleted888443]

Is there a chance they could just make step 1 reported as P/F to PDs, regardless of when you took the exam? I feel like that would piss off alot of people who already took the exam and got 250+...

 

[afib123]

My main point is 1) NOT to make step 1 pass or fail. 2) If it needs to be changed, change the content of it and change the curriculum as well

We will see what happens. It won't affect me, so I am fortunately allowed to witness and comment on it without being affected by it

 

[afib123]

Is there a chance they could just make step 1 reported as P/F to PDs, regardless of when you took the exam? I feel like that would piss off alot of people who already took the exam and got 250+...

Most people that are pissed off are those ones and the ones that they think they will get a 250+.

I don't think many people with 210s or 200s are the ones opposing this change

 

[Med Ed]

I would advocate for removing shelf exams, step 2, clinical grades and encouraging students to spend time on the wards 3rd year.

As long as we're in fantasy land, what else would you like to do?

 

[Med Ed]

Is there a chance they could just make step 1 reported as P/F to PDs, regardless of when you took the exam?

No.

 

[VA Hopeful Dr]

Well it is good you guys do it once a week. I go to pretty decent US MD school as well and we had a few sessions and to take a osce at the end of each module too.

But I didn't think that's enough going into third year. Doing fake exams on healthy patients is much different from examining real complicated patients which comes through lot of practice. And it is not just about the physical exam skills. It is about integrating your exam with clinical reasoning and coming up with a diagnosis. And also managing common medical issues. Sure that is what 3rd year is for, but I am not sure that is enough.

This stuff needs a lot of practice and you need to start early to become good at it. And every doctor needs to know this stuff not just the medicine residents or FM residents. Like I said try to get non IM/FM/Peds residents to read EKGs, characterize heart murmurs, extra heart sounds, etc. You will see how bad they are. I had a patient when on the medicine service be discharged with atrial fibrillation from a surgical service. Either they had no idea what irregularly irregular rhythm is like or were lazy. He came back with AMS and possible stroke. We get consulted for insulin management for diabetic patients. We get consulted for hypertension management. I mean I find those skills essential for any kind of doctor. You need to start teaching these skills and they need to be tested on Step 1. Same way, try to get IM residents to something as basic as throwing down good sutures and you will see many will struggle with it.

While I appreciate the idealism, you're missing some key things about the world here.

After medical school, you learn your specialty. Medicine is getting more and more specialized which requires skills outside of your area to atrophy.

Beyond that, what does an orthopedic surgeon have to gain by managing insulin? First, they don't do it nearly as often us IM/FM so they won't be as comfortable with it. Second, in the time it takes them to get a diabetic under control they could have seen probably 2-3 patients in their clinic with just ortho issues (you know, the stuff us PCP types expect them to deal with). Third, in the legal climate in the US why would they take on something that isn't directly in their wheel house? Fourth, if they aren't actively keeping up then how they learned to do things in med school might not be standard of care anymore. So they either do a bad job or have to spend time/energy learning about things not in their field.

So yes, in an ideal world we're all doctors and we'd all be good at everything. But there's only so much time in the day and only so much space in a person's brain.

 

[Oh_Gee]

As long as we're in fantasy land, what else would you like to do?

free massages q1d

 

[sargon2123]

If this comes to fruition and one goes to a mid tier school, would networking and pubs be able to set one apart from students who go to a top tier school further away and outside the area if we are all vying for one’s (original person in question) competitive home program. Or is the competitive home program certainly going to shun it’s own students because it is a mid tier school?

 

[olabrador23]

If this comes to fruition and one goes to a mid tier school, would networking and pubs be able to set one apart from students who go to a top tier school further away and outside the area if we are all vying for one’s (original person in question) competitive home program. Or is the competitive home program certainly going to shun it’s own students because it is a mid tier school?

I think it is reasonable to guess that the old saying, "it's who you know, not what you know", is going to apply in this case...

 

[sargon2123]

It's crazy how much our career can be determined by seeing the right SDN threads at the right times.

 

[JooceMan137]

Apparently the PF Step 1 is in the works (I hope I’m wrong).

Does anyone know how this will effect current students who say just took step 1 or are taking it soon?

 

[olabrador23]

Apparently the PF Step 1 is in the works (I hope I’m wrong).

Does anyone know how this will effect current students who say just took step 1 or are taking it soon?

Probably no one knows at this time as they have not decided yet if S1 P/F is official. But they do say they might implement it soon at the end of 2019 and throughout 2020.

as many have said above, as soon as S1 becomes P/F, PDs will look at S2 scores instead as there is no way to compare people with scored S1 to the people with S1 P/F. Students are going to compete for residencies based on their S2 scores then until S2 becomes P/F. If PDs all get together to make new exams to screen for their specialty's residency applications, then the game restarts all over again.

So I guess that the people with high S1 scores will try to apply / get in residencies as soon as they can before S1 P/F happens. The people with low or average S1 scores might not care too much.

 

[JooceMan137]

Probably no one knows at this time as they have not decided yet if S1 P/F is official. But they do say they might implement it soon at the end of 2019 and throughout 2020.

as many have said above, as soon as S1 becomes P/F, PDs will look at S2 scores instead as there is no way to compare people with scored S1 to the people with S1 P/F. Students are going to compete for residencies based on their S2 scores then until S2 becomes P/F. If PDs all get together to make new exams to screen for their specialty's residency applications, then the game restarts all over again.

So I guess that the people with high S1 scores will try to apply / get in residencies as soon as they can before S1 P/F happens. The people with low or average S1 scores might not care too much.

So does that mean that since I just took step 1, I will have a score I can present on my residency application?

 

[olabrador23]

So does that mean that since I just took step 1, I will have a score I can present on my residency application?

yes as it is still being scored now. I guess you are still going to have to report your S1 score even in the case S1 P/F is official.

 

[olabrador23]

So does that mean that since I just took step 1, I will have a score I can present on my residency application?

So I guess that the people with high S1 scores will try to apply / get in residencies as soon as they can before S1 P/F happens. The people with low or average S1 scores might not care too much.

yes as it is still being scored now. I guess you are still going to have to report your S1 score even in the case S1 P/F is official.

another thought, if your S1 score is still being reported when S1 P/F is official, then PDs are going to see if you had struggled with S1 (low score) while there is no way to tell that for those with S1 P/F.

 

[7331poas]

yes as it is still being scored now. I guess you are still going to have to report your S1 score even in the case S1 P/F is official.

Thats quite the assumption. The USMLE could easily just report P/F for all students in a given residency cycle.

 

[olabrador23]

Thats quite the assumption. The USMLE could easily just report P/F for all students in a given residency cycle.

Yeah, I was guessing on that one based on what I read from Med Ed's reply to Quavo above in this thread. (Since his sig is Physician / Faculty, I was assuming that he might know something).

Is there a chance they could just make step 1 reported as P/F to PDs, regardless of when you took the exam? I feel like that would piss off alot of people who already took the exam and got 250+...

No.

It has not been clear yet to me what the true intention of USMLE people is and who they really want to benefit by this S1 P/F move. So far, many have guessed that students from T20 schools would gain the most from the move and others would get screwed. After the move, if they exclusively reported S1 P/F, my guess is that they would only screw the people who have high S1 scores and leave the people having low / average scores intact. If they then reported the scores for the ones who already took it, that would probably not make the competitiveness of those having low / average scores any much worse but still be giving the people with high step scores a fighting chance.

So my guess is, it is going to depend on how big of the slice of the cake that they want for T20 to keep reporting scored S1 for the people who already took it. We'll see soon...

 

[Med Ed]

It has not been clear yet to me what the true intention of USMLE people is and who they really want to benefit by this S1 P/F move.

The "USMLE people" are the National Board of Medical Examiners (NBME).

Discussion about revising the USMLE scoring system has occurred periodically. Just over ten years ago the NBME convened the Committee to Evaluate the USMLE Program (CEUP) which published its recommendations in 2008. Ten years before that a group was convened to study the issue, and published its recommendations in 2000. Ten years before that a group was convened to study how the scoring system from the old NBME Part I and II exams should translate forward into the new USMLE, which was published in 1990.

If you just read the references from this 2011 article you'll be pretty up to speed on the history of controversy surrounding USMLE/NBME scoring.

So here we are again, pondering what should be done with a test designed for binary medical licensing decisions that has morphed into a primary tool for resident selection. I doubt much will change in the end. The NBME has gotten rather attached to its flagship exam over the years, and I think would be loathe to convert it to P/F.

The main beneficiaries of a P/F switch would be faculty who teach in the first 1.5-2 years of medical school. They could ostensibly divert student attention back toward preparing for the wards instead of a single national MCQ exam. The program directors, however, would scream bloody murder over this, and justifiably so.

Whatever emerges from InCUS redux, the revisions will not simply involve making Step 1 P/F in isolation. If they do anything they will likely change several aspects of the UME to GME transition in order to generate some sort of mutually (un)acceptable compromise.

 

[olabrador23]

The "USMLE people" are the National Board of Medical Examiners (NBME).

Discussion about revising the USMLE scoring system has occurred periodically. Just over ten years ago the NBME convened the Committee to Evaluate the USMLE Program (CEUP) which published its recommendations in 2008. Ten years before that a group was convened to study the issue, and published its recommendations in 2000. Ten years before that a group was convened to study how the scoring system from the old NBME Part I and II exams should translate forward into the new USMLE, which was published in 1990.

If you just read the references from this 2011 article you'll be pretty up to speed on the history of controversy surrounding USMLE/NBME scoring.

So here we are again, pondering what should be done with a test designed for binary medical licensing decisions that has morphed into a primary tool for resident selection. I doubt much will change in the end. The NBME has gotten rather attached to its flagship exam over the years, and I think would be loathe to convert it to P/F.

The main beneficiaries of a P/F switch would be faculty who teach in the first 1.5-2 years of medical school. They could ostensibly divert student attention back toward preparing for the wards instead of a single national MCQ exam. The program directors, however, would scream bloody murder over this, and justifiably so.

Whatever emerges from InCUS redux, the revisions will not simply involve making Step 1 P/F in isolation. If they do anything they will likely change several aspects of the UME to GME transition in order to generate some sort of mutually (un)acceptable compromise.

Thank you very much for the information there! I am learning!

One thing I am thinking is that, would all potential problems from the move to P/F outweigh the potential benefit you are pointting there (i.e.. helping put the students' attention back to the wards instead of focusing on studying for exam)? It seems to me that moving to P/F is more problematic than beneficial as it is going to take out the one subjective metric of the whole residency's selection process (as the need for (a) subjective standards is always there to rank the students / candidates).

I mean, like someone has pointed out above, might the better and more appropriate solution be the redesign of medical school curriculum if the real intention is to help focus students' effort back to the ward?

Can we also make use of Steps exams, more for that intention / purpose by redesigning the content and question styles of the exams (making it even more clinical relevant) instead of making P/F?

Also, what is your opinion about the question of score reporting when the P/F happens? Would only P/F be reported or the scores still be reported for the people already took the exam? (I was guessing from your reply to Quavo that the scores would still be reported... but if you could clarify. Thanks).

 

[enalli]

The main beneficiaries of a P/F switch would be faculty who teach in the first 1.5-2 years of medical school. They could ostensibly divert student attention back toward preparing for the wards instead of a single national MCQ exam.

Is this true? Is the average pre-clinical faculty member out there under pressure to teach to the boards? Because I can guarantee you that the PhDs who taught me in the first year had never seen a Step 1 question.

I was part of the curriculum re-design committee as a fourth-year and the basic science faculty had a very haughty "we don't teach to the boards" attitude--saying that exact phrase multiple times. The problem was that they thought they were "teaching to the wards." I'm not sure where they got that impression, but I can assure you they were not doing that either.

 

[olabrador23]

Is this true? Is the average pre-clinical faculty member out there under pressure to teach to the boards? Because I can guarantee you that the PhDs who taught me in the first year had never seen a Step 1 question.

I was part of the curriculum re-design committee as a fourth-year and the basic science faculty had a very haughty "we don't teach to the boards" attitude--saying that exact phrase multiple times. The problem was that they thought they were "teaching to the wards." I'm not sure where they got that impression, but I can assure you they were not doing that either.

that leaves only the people from T20 to benefit from this P/F move...

 

[kb1900]

Is this true? Is the average pre-clinical faculty member out there under pressure to teach to the boards? Because I can guarantee you that the PhDs who taught me in the first year had never seen a Step 1 question.

I was part of the curriculum re-design committee as a fourth-year and the basic science faculty had a very haughty "we don't teach to the boards" attitude--saying that exact phrase multiple times. The problem was that they thought they were "teaching to the wards." I'm not sure where they got that impression, but I can assure you they were not doing that either.

Moreover I don’t see how a increased emphasis on step 1 results in lowered preparedness for the wards at all. Preclinical professors do not teach to the boards at all and they are probably aware they’ll never do better than pathoma or BnB with that regard.

at my institution at least, having students do weekly h+ps and presentations on different floors starting spring m1 was the most impactful curriculum change when it came to how pleased clerkship directors and preceptors were with their rotation students.

 

[Med Ed]

Thank you very much for the information there! I am learning!

One thing I am thinking is that, would all potential problems from the move to P/F outweigh the potential benefit you are pointting there (i.e.. helping put the students' attention back to the wards instead of focusing on studying for exam)? It seems to me that moving to P/F is more problematic than beneficial as it is going to take out the one subjective metric of the whole residency's selection process (as the need for (a) subjective standards is always there to rank the students / candidates).

I think you mean objective metric, and it's not the only one, it's just the most convenient one. If we strip this issue down to its simplest form, I think it comes out to this: should we continue to rely on a metric of questionable value simply because it exists? I don't think so. And I believe that if the situation is actually "fixed" in some way, future students will look back on the present situation and wonder why everyone was so obstinate.

I mean, like someone has pointed out above, might the better and more appropriate solution be the redesign of medical school curriculum if the real intention is to help focus students' effort back to the ward?

The problem is that larger numbers of students are fixated on Step 1 to the exclusion of all else, and given the nature of the system they are not irrational in being this way. I don't believe any amount of curricular redesign will solve the current mess.

Can we also make use of Steps exams, more for that intention / purpose by redesigning the content and question styles of the exams (making it even more clinical relevant) instead of making P/F?

That's called Step 2 CK.

Also, what is your opinion about the question of score reporting when the P/F happens? Would only P/F be reported or the scores still be reported for the people already took the exam? (I was guessing from your reply to Quavo that the scores would still be reported... but if you could clarify. Thanks).

I don't understand your question.

 

[Med Ed]

Is this true? Is the average pre-clinical faculty member out there under pressure to teach to the boards? Because I can guarantee you that the PhDs who taught me in the first year had never seen a Step 1 question.

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.

I was part of the curriculum re-design committee as a fourth-year and the basic science faculty had a very haughty "we don't teach to the boards" attitude--saying that exact phrase multiple times. The problem was that they thought they were "teaching to the wards." I'm not sure where they got that impression, but I can assure you they were not doing that either.

No system will completely prevent stupid people from doing bad things.

 

[bobjonesbob]

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.

On a somewhat tangential topic...these faculty aren't needed to teach at all. There's absolutely no need to have 200 different phds across the country teaching biochemistry to preclinicall students. The best few should work together and create recorded lectures that everyone in the country is watching. This goes for basically every preclinical topic with the exception of physical exam courses and anatomy lab.

 

[AnatomyGrey12]

should we continue to rely on a metric of questionable value simply because it exists? I don't think so

So we should we blindly make changes simply for the sake of change? Until there is a concrete plan whose outcomes have been studied and thoughtfully implemented then absolutely nothing should be changed.

And I believe that if the situation is actually "fixed" in some way, future students will look back on the present situation and wonder why everyone was so obstinate.

And what does "fixed" look like to you? What happens if there are significant negative affects that have disastrous effects that make the current problem look relatively tame?

or get ignored by an increasingly large proportion of the class.

Oh those poor PhDs.... *clutches pearls


Color me extremely unimpressed with these statements.... I'm seeing a lot of "quick we need to do something!" instead of any actual planning that will have any real improvement. Your reasons for why this could be a good idea are extremely poor.

 

[Med Ed]

So we should we blindly make changes simply for the sake of change? Until there is a concrete plan whose outcomes have been studied and thoughtfully implemented then absolutely nothing should be changed.

Have you read the InCUS summary report?

And what does "fixed" look like to you?

It would be a marked improvement if current medical students weren't writing pieces like this one.

Oh those poor PhDs.... *clutches pearls

There's no need to be an a-hole simply for the sake of being an a-hole. Trust me, whatever disdain you have for the poor PhD's, the feeling is mutual.

Color me extremely unimpressed with these statements....

Ditto.

AnatomyGrey12]I'm seeing a lot of "quick we need to do something!" instead of any actual planning that will have any real improvement.

Have you read the InCUS summary report?

Look, I get it. Your a medical student who recently took Step 1, so you're basically the Dunning-Kruger effect incarnate.

 

[Med Ed]

On a somewhat tangential topic...these faculty aren't needed to teach at all. There's absolutely no need to have 200 different phds across the country teaching biochemistry to preclinicall students. The best few should work together and create recorded lectures that everyone in the country is watching.

These exist in a slightly different form called "textbooks." I'm showing my age, I know.

This goes for basically every preclinical topic with the exception of physical exam courses and anatomy lab.

Medical students have never gone to class. Forty years ago it was note-taking services, twenty years ago it was syllabi, now it's Boards & Beyond. A more significant change has been the shift away from faculty-authored exams and toward the NBME's Customized Assessment Service.

 

[AnatomyGrey12]

Have you read the InCUS summary report?

Yes. Most uneventful.

It would be a marked improvement if current medical students weren't writing pieces like this one.

Lol once again an article by students solely at top schools, which are the ONLY ones who would benefit from the current proposal.

There's no need to be an a-hole simply for the sake of being an a-hole. Trust me, whatever disdain you have for the poor PhD's, the feeling is mutual.

Whose being an a-hole? I never said I had disdain for PhDs, you made a stupid argument about how a P/F Step would make people to stop ignoring class lectures, of which there really isn't any reason for students to do so. The days of listening to a lecturer are disappearing, as there are more effective ways to study.

Have you read the InCUS summary report?

Answered above.

Your a medial student who recently took Step 1, so you're basically the Dunning-Kruger effect incarnate.

Getting petty I see. Must have touched a nerve.

A more significant change has been the shift away from faculty-authored exams and toward the NBME's Customized Assessment Service.

Which is a marked improvement, and should be implemented at every school in the country.

 

[Med Ed]

Yes. Most uneventful.

Then you should agree that any proposed changes are being made to address specific issues. They are not being considered merely for the sake of change, as you assert. The conclusion of the report was essentially "more study with more stakeholders is needed." We may not like what they produce, but they aren't running off half-cocked quite yet.

Lol once again an article by students solely at top schools, which are the ONLY ones who would benefit from the current proposal.

At the risk of sounding like a broken record, a simple shift of Step 1 to P/F would leave a scored Step 2 CK intact, which would leave a well known national standard in place so as not to disadvantage those at non-top 20 schools. Step 2 CK has risen in the ranking of importance on the PD survey, and I see it becoming more of an unwritten rule to take it and post a score before applying for residency (although this remains specialty-dependent).

I agree that converting both Steps 1 and 2 CK to P/F while making CS a scored exam would disadvantage lower tiered schools, and I think is a terrible idea.

Whose being an a-hole?

"Oh those poor PhDs.... *clutches pearls" is, IMHO, kind of an a-hole statement. So, to answer your question, you.

Getting petty I see. Must have touched a nerve.

You wish, little fella.

 

[7331poas]

So now instead of learning step 1 content during pre-clinical, I just skim through First Aid and immediately start memorizing step 2 board material.

The problem doesnt change. I don't understand why PDs dont just prioritize the Step 2 CK score if it that exam really does reflect the "true" content that doctors need to know. Why put absolute pressure on students to preform on a singular exam? Why harm the students who aren't at the name brand institutions?

 

[Slavic Scot]

And step 2 is taken when? Just an incoming student, but my understanding is that it's taken pretty late, so late that if you bomb then you really don't have a chance to create/institute backup plans.

I just don't see how this benefits anyone not from a top school.

 

[Espressso]

So now instead of learning step 1 content during pre-clinical, I just skim through First Aid and immediately start memorizing step 2 board material.

The problem doesnt change. I don't understand why PDs dont just prioritize the Step 2 CK score if it that exam really does reflect the "true" content that doctors need to know. Why put absolute pressure on students to preform on a singular exam? Why harm the students who aren't at the name brand institutions?

Per bold -- That is literally the problem that we are debating a fix for.

And you would still have to learn step 1 content, in order to pass the exam. Not to mention learning the step 1 material really well will set the foundation for step 2 material.

This is a weak argument IMO

 

[7331poas]

Per bold -- That is literally the problem that we are debating a fix for.

And you would still have to learn step 1 content, in order to pass the exam. Not to mention learning the step 1 material really well will set the foundation for step 2 material.

This is a weak argument IMO

except right now it isnt all on step 1, there is also step 2. And now they are eliminating step 1 and the only thing left is Step 2. The change has quite literally worsened the problem.

Like I said, just mandate that students take Step 2 before ERAS and let the PDs decide how they want to use the scores.

 

[olabrador23]

I think you mean objective metric, and it's not the only one, it's just the most convenient one. If we strip this issue down to its simplest form, I think it comes out to this: should we continue to rely on a metric of questionable value simply because it exists? I don't think so. And I believe that if the situation is actually "fixed" in some way, future students will look back on the present situation and wonder why everyone was so obstinate.

The problem is that larger numbers of students are fixated on Step 1 to the exclusion of all else, and given the nature of the system they are not irrational in being this way. I don't believe any amount of curricular redesign will solve the current mess.

That's called Step 2 CK.

yes, thanks.

I don't understand your question.

sorry for the confusion.

my question was, when S1 P/F is official, what do you think how USMLE would report the score for the people had already taken scored S1 exam? Would their scores be reported as P/F then or still be reported the way it is now (i.e., numerically 1-300)?

 

[VA Hopeful Dr]

yes, thanks.




sorry for the confusion.

my question was, when S1 P/F is official, what do you think how USMLE would report the score for the people had already taken scored S1 exam? Would their scores be reported as P/F then or still be reported the way it is now (i.e., numerically 1-300)?

Probably still reported the way it is now.

Not that it matters in any way, but I took the MCAT back when it was a 2 digit score. If someone were to ask what my score was, I'd tell them the 2 digit score because that's what I have.

 

[olabrador23]

Probably still reported the way it is now.

Thanks!

If so, the people with low scores would probably look bad vs the ones with P/F, while those with high scores would still be fine competitively.

Not that it matters in any way, but I took the MCAT back when it was a 2 digit score. If someone were to ask what my score was, I'd tell them the 2 digit score because that's what I have.

I think as long as those numbers could be converted back to percentile then everything would be fine.

 

[Med Ed]

my question was, when S1 P/F is official,

Um, that's far from decided.

what do you think how USMLE would report the score for the people had already taken scored S1 exam? Would their scores be reported as P/F then or still be reported the way it is now (i.e., numerically 1-300)?

There are a couple of problems with retroactively converting scored reports to straight P/F. One is that the NBME would get sued sixteen ways to Sunday. Also, the scores have already been released. There's no putting that genie back in the bottle.

So no, it's not going to happen.

 

[VA Hopeful Dr]

Thanks!

If so, the people with low scores would probably look bad vs the ones with P/F, while those with high scores would still be fine competitively.



I think as long as those numbers could be converted back to percentile then everything would be fine.

If you are applying for residency at the same time as people who scores are pass-fail only, you already look worse.

 

[7331poas]

If you are applying for residency at the same time as people who scores are pass-fail only, you already look worse.

Of course the alternative is true too, if you are P/F and you are applying to a competitive specialty you are pretty much excluded.

 

[Med Ed]

And step 2 is taken when? Just an incoming student, but my understanding is that it's taken pretty late, so late that if you bomb then you really don't have a chance to create/institute backup plans.

Get ready for more and more schools to push Step 1 to the end of M3, meaning students will take two huge exams in succession without much time for a backup plan.

 

[VA Hopeful Dr]

Of course the alternative is true too, if you are P/F and you are applying to a competitive specialty you are pretty much excluded.

Someone didn't get the joke

 

[olabrador23]

Get ready for more and more schools to push Step 1 to the end of M3, meaning students will take two huge exams in succession without much time for a backup plan.

why???

 

[AnatomyGrey12]

At the risk of sounding like a broken record, a simple shift of Step 1 to P/F would leave a scored Step 2 CK intact, which would leave a well known national standard in place so as not to disadvantage those at non-top 20 schools. Step 2 CK has risen in the ranking of importance on the PD survey, and I see it becoming more of an unwritten rule to take it and post a score before applying for residency (although this remains specialty-dependent).

As was mentioned above all this does is add even more stress (isn't student wellness also being touted as a reason for a P/F Step 1), because now students don't have time to change course if Step 1 isn't what they were expecting. It also puts the pressure on a singular exam.

I will say I think that people should take Step 2 before applying, I could get behind programs requiring that.

And you would still have to learn step 1 content, in order to pass the exam. Not to mention learning the step 1 material really well will set the foundation for step 2 material.

This is a weak argument IMO

If I didn't have to focus on getting a high Step score I would have taken Step 6 weeks before I did. What would happen is people simply wouldn't study Step 1 material as in depth as they do currently. There were simply things I solidified during dedicated which wouldn't have happened if I hadn't of had to sit down and study all the material in an extremely integrative way like I did during those 6 weeks.

 

[olabrador23]

As was mentioned above all this does is add even more stress (isn't student wellness also being touted as a reason for a P/F Step 1), because now students don't have time to change course if Step 1 isn't what they were expecting. It also puts the pressure on a singular exam.

I will say I think that people should take Step 2 before applying, I could get behind programs requiring that.



If I didn't have to focus on getting a high Step score I would have taken Step 6 weeks before I did. What would happen is people simply wouldn't study Step 1 material as in depth as they do currently. There were simply things I solidified during dedicated which wouldn't have happened if I hadn't of had to sit down and study all the material in an extremely integrative way like I did during those 6 weeks.

yeah, that is the main crux that keeps me scratching my head as the proposed changes are even worse than no change and the "official" reasoning for the change would hardly make any sense to me. P/F or not P/F and alternatives should be studied exhaustively and it would take some time. Instead, they proposed a schedule on InCUS (i.e. only a year from discussing to implementing changes) - sounds like someone is really in a hurry...

 

[Med Ed]

As was mentioned above all this does is add even more stress (isn't student wellness also being touted as a reason for a P/F Step 1), because now students don't have time to change course if Step 1 isn't what they were expecting. It also puts the pressure on a singular exam.

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.

I will say I think that people should take Step 2 before applying, I could get behind programs requiring that.

Agreed.

If I didn't have to focus on getting a high Step score I would have taken Step 6 weeks before I did. What would happen is people simply wouldn't study Step 1 material as in depth as they do currently. There were simply things I solidified during dedicated which wouldn't have happened if I hadn't of had to sit down and study all the material in an extremely integrative way like I did during those 6 weeks.

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.