Pass/ Fail Step 1

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Chibucks15 said:
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
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People already shouldn't worry about 2-3 points; the most important part of your USMLE score is the fact that it is gets you through PDs' ERAS filters. After that, the USMLE scores take a back seat to the rest of your application.
 
Little Green Mensch said:
People already shouldn't worry about 2-3 points; the most important part of your USMLE score is the fact that it is gets you through PDs' ERAS filters. After that, the USMLE scores take a back seat to the rest of your application.
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Of course people stress about 237 vs 240. Were med students. That’s what happens. It shouldn’t but it does
 
Vladimir7 said:
I’m just trying to figure out what the point of the score is. Do you know?
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The original purpose of the exam was to ensure a minimal level of competence. In the current era, residency programs use it as a quick and easy way to stratify applicants. The problem is that most people agree that it is not a good test of who will be a better doctor, and tends to lead to perverse incentives for medical students and medical schools alike. And the problem with making it pass/fail is that what will likely happen is that school prestige or some other factors that dont necessarily correlate well with how good of a doctor somebody will be, will take it's place.

My opinion is that the current system is fairer but also gives medical students every incentive to only focus on excelling at a multiple choice test, at the expense of spending more time learning how to be physician(and this isn't me advocating for what some would call "flowerly bs", there are a lot of important things that arent really testable in a multiple choice format)
 
CleganeBowlis4Real said:
The original purpose of the exam was to ensure a minimal level of competence. In the current era, residency programs use it as a quick and easy way to stratify applicants. The problem is that most people agree that it is not a good test of who will be a better doctor, and tends to lead to perverse incentives for medical students and medical schools alike. And the problem with making it pass/fail is that what will likely happen is that school prestige or some other factors that dont necessarily correlate well with how good of a doctor somebody will be, will take it's place.

My opinion is that the current system is fairer but also gives medical students every incentive to only focus on excelling at a multiple choice test, at the expense of spending more time learning how to be physician(and this isn't me advocating for what some would call "flowerly bs", there are a lot of important things that arent really testable in a multiple choice format)
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Yeah that's part of the problem. I don't love the increasing focus on Step 1, but I don't think making it pass/fail is a good solution.
 
7331poas said:
All these people complaining about step 1 not being a meaningful measure are the same people advocating for clinical grades, research output, med school ranking to characterize your application.

Thinking emoji
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I’m neither of those things and I think it’s a good challenging test having taken it, but a multiple choice test isn’t the best way to ‘prove you’re smarter and willing to grind’. I was busting my butt and my absolute ceiling was a 240. And I’m sure there are tons of people who were lower than that.

It isn’t a true measure of hard work because there are different inherent abilities to take tests and such. Plus with the way the test is currently structured there are a ton of things on there that are useless clinically. Why should we use it as the sole benchmark?

Pass/fail is a terrible idea for most people, but there should be some alteration in how it’s used, because it’s making people lock themselves in a room for a year and ignore everything else, which in turn hurts (some people’s) ability to connect with patients and interact with staff. It’s painfully evident the more experience I have
 
Chibucks15 said:
I’m neither of those things and I think it’s a good challenging test having taken it, but a multiple choice test isn’t the best way to ‘prove you’re smarter and willing to grind’. I was busting my butt and my absolute ceiling was a 240. And I’m sure there are tons of people who were lower than that.

It isn’t a true measure of hard work because there are different inherent abilities to take tests and such. Plus with the way the test is currently structured there are a ton of things on there that are useless clinically. Why should we use it as the sole benchmark?

Pass/fail is a terrible idea for most people, but there should be some alteration in how it’s used, because it’s making people lock themselves in a room for a year and ignore everything else, which in turn hurts (some people’s) ability to connect with patients and interact with staff. It’s painfully evident the more experience I have
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Oh boy imagine if someone made this argument about getting an high MCAT or GPA in undergrad. SDN would light the pitchforks and say those are infallible measures!! Even I realize that this whole debate and changes are just another way of taking our power away we have in the match and make it more like getting into medical school. They're just trying to put a facade of care about clinical relevance and diversity on so that we're more compliant about losing power.
 
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Chibucks15 said:
I’m neither of those things and I think it’s a good challenging test having taken it, but a multiple choice test isn’t the best way to ‘prove you’re smarter and willing to grind’. I was busting my butt and my absolute ceiling was a 240. And I’m sure there are tons of people who were lower than that.

It isn’t a true measure of hard work because there are different inherent abilities to take tests and such. Plus with the way the test is currently structured there are a ton of things on there that are useless clinically. Why should we use it as the sole benchmark?

Pass/fail is a terrible idea for most people, but there should be some alteration in how it’s used, because it’s making people lock themselves in a room for a year and ignore everything else, which in turn hurts (some people’s) ability to connect with patients and interact with staff. It’s painfully evident the more experience I have
Click to expand...

...and what is your solution?
 
Chibucks15 said:
I’m neither of those things and I think it’s a good challenging test having taken it, but a multiple choice test isn’t the best way to ‘prove you’re smarter and willing to grind’. I was busting my butt and my absolute ceiling was a 240. And I’m sure there are tons of people who were lower than that.

It isn’t a true measure of hard work because there are different inherent abilities to take tests and such. Plus with the way the test is currently structured there are a ton of things on there that are useless clinically. Why should we use it as the sole benchmark?

Pass/fail is a terrible idea for most people, but there should be some alteration in how it’s used, because it’s making people lock themselves in a room for a year and ignore everything else, which in turn hurts (some people’s) ability to connect with patients and interact with staff. It’s painfully evident the more experience I have
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Step 1 isn't used as the sole benchmark though? It's an important part to the application with all other things too.

People have a better argument for making the MCAT pass/fail which the AAMC tried by explicitly saying 500+ = pass. Yet that clearly didn't happen. Changing Step 1 will just annoy PDs, hinder career goals and make everything worse except for those who were lucky enough to attend top schools.
 
Lawper said:
Step 1 isn't used as the sole benchmark though? It's an important part to the application with all other things too.

People have a better argument for making the MCAT pass/fail which the AAMC tried by explicitly saying 500+ = pass. Yet that clearly didn't happen. Changing Step 1 will just annoy PDs, hinder career goals and make everything worse except for those who were lucky enough to attend top schools.
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I mean, it kinda is. To my understanding, lots of places have a Step 1 cutoff below which they won't even consider your application.
 
VA Hopeful Dr said:
I mean, it kinda is. To my understanding, lots of places have a Step 1 cutoff below which they won't even consider your application.
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Same goes for med school admissions. I do not see why we dont make MCAT and GPA pass/fail if making Step 1 P/F is acceptable.

Surely MCAT and GPA does not predict patient outcomes...
 
sunshinefl said:
I don’t know if they’re hard cutoffs, but almost every IM and FM programs (even community) I have looked at publishes minimums.
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How different are these minimums from the score needed to pass Step 1? It'd be a bit surprising if those programs listed minimums of 210 or something similar.
 
7331poas said:
Same goes for med school admissions. I do not see why we dont make MCAT and GPA pass/fail if making Step 1 P/F is acceptable.

Surely MCAT and GPA does not predict patient outcomes...
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I'm not arguing for or against here, just correcting a point.
 
Lawper said:
How different are these minimums from the score needed to pass Step 1? It'd be a bit surprising if those programs listed minimums of 210 or something similar.
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Just a sampling. I’m in Florida with modest aspirations for primary care in Florida.
 
aldol16 said:
The point of the Step 1 score is to measure how well you did on Step 1. That's all it can claim to objectively measure.
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RESULTS: Eighty studies involving a total of 41,704 participants were included in the meta-analysis. Seventeen different selection strategies and 17 outcomes were assessed across these studies. The strongest positive associations referred to examination-based selection strategies, such as the US Medical Licensing Examination (USMLE) Step 1, and examination-based outcomes, such as scores on in-training examinations. Moderate positive associations were present for medical school marks and both examination-based and subjective outcomes. Minimal or no associations were seen for the selection tools represented by interviews, reference letters and deans' letters.
(From "Associations between residency selection strategies and doctor performance: a meta-analysis")

Step 1 and Step 2-CK study summaries (general studies): https://www.usmle.org/pdfs/incus/InCUS_Reference_List-Section1.pdf
Step 1 and Step 2-CK study summaries (specialty-specific studies): https://www.usmle.org/pdfs/incus/InCUS_Reference_List-Section2.pdf

For those who are actually interested in the predictive validity of the Step 1 and Step 2CK exams, there's literature out there. But a lot of SDN folks prefer to rely on speculation and anecdotes.
 
Osminog said:
RESULTS: Eighty studies involving a total of 41,704 participants were included in the meta-analysis. Seventeen different selection strategies and 17 outcomes were assessed across these studies. The strongest positive associations referred to examination-based selection strategies, such as the US Medical Licensing Examination (USMLE) Step 1, and examination-based outcomes, such as scores on in-training examinations. Moderate positive associations were present for medical school marks and both examination-based and subjective outcomes. Minimal or no associations were seen for the selection tools represented by interviews, reference letters and deans' letters.
(From "Associations between residency selection strategies and doctor performance: a meta-analysis")

Step 1 and Step 2-CK study summaries (general studies): https://www.usmle.org/pdfs/incus/InCUS_Reference_List-Section1.pdf
Step 1 and Step 2-CK study summaries (specialty-specific studies): https://www.usmle.org/pdfs/incus/InCUS_Reference_List-Section2.pdf

For those who are actually interested in the predictive validity of the Step 1 and Step 2CK exams, there's literature out there. But a lot of SDN folks prefer to rely on speculation and anecdotes.
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OK I have to ask, did you actually look at the studies you posted? Because an awful lot of those don't address anything that matters. A number basically say "higher step scores correlate with better residency match results", one even manages to correlate step 2ck with disciplinary action by the medical board.
 
VA Hopeful Dr said:
OK I have to ask, did you actually look at the studies you posted? Because an awful lot of those don't address anything that matters. A number basically say "higher step scores correlate with better residency match results", one even manages to correlate step 2ck with disciplinary action by the medical board.
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Right. They're not all studies that directly address the exams' predictive validity, but some of them are.
 
Osminog said:
RESULTS: Eighty studies involving a total of 41,704 participants were included in the meta-analysis. Seventeen different selection strategies and 17 outcomes were assessed across these studies. The strongest positive associations referred to examination-based selection strategies, such as the US Medical Licensing Examination (USMLE) Step 1, and examination-based outcomes, such as scores on in-training examinations. Moderate positive associations were present for medical school marks and both examination-based and subjective outcomes. Minimal or no associations were seen for the selection tools represented by interviews, reference letters and deans' letters.
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Uhhhh let's do some critical analysis instead of just quoting the abstract. The strongest effect sizes for USMLE 1 correlations were seen with in-training exams and licensing exams. Is it surprising that somebody who does well on USMLE 1 will do well on exams in the future? People have done studies correlating MCAT with USMLE for this same reason. Somebody who does well on USMLE 1 probably has the work ethic and test-taking ability to do well on other exams.

The effect size for USMLE 1 correlated with subjective measures such as in-training evals and professionalism was moderate to weak. Surprisingly, the strongest effect size for these metrics was observed with USMLE 2 and med school overall grade. In terms of your career, I would say that professionalism and in-training evaluations are much more important than your score on in-training or licensing exams, given that you at least pass them.

So, again, the only thing the USMLE 1 can claim to objectively predict with a high level of certainty is performance on the USMLE 1. That correlation is 1.0.
 
Lawper said:
Wait lots of places? Are you referring to this in general or just the super competitive specialties and programs?
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sunshinefl said:
I don’t know if they’re hard cutoffs, but almost every IM and FM programs (even community) I have looked at publishes minimums.
Click to expand...
Lawper said:
How different are these minimums from the score needed to pass Step 1? It'd be a bit surprising if those programs listed minimums of 210 or something similar.
Click to expand...

Generally, where you'll see the cutoffs is for highly ranked programs in whatever specialty you're looking at and for most programs in the competitive specialties. Some will employ filters of 230. The tippity top ones might even employ filters of 240.

For reference, you need a 194 to pass Step 1. National average is around 230.
 
7331poas said:
Same goes for med school admissions. I do not see why we dont make MCAT and GPA pass/fail if making Step 1 P/F is acceptable.

Surely MCAT and GPA does not predict patient outcomes...
Click to expand...
The difference is medical schools benefit off of using those metrics. They don't benefit much from step 1 the way it is currently. They don't want to fix the problem at HAND, which is most of the lectures we get are poorly put together and outdated compared to the information only. Fix THAT first, then come back to this issue.
 
aldol16 said:
Generally, where you'll see the cutoffs is for highly ranked programs in whatever specialty you're looking at and for most programs in the competitive specialties. Some will employ filters of 230. The tippity top ones might even employ filters of 240.

For reference, you need a 194 to pass Step 1. National average is around 230.
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Oh come on, this is A MILLION times worse when applying to medical school. I was told if your MCAT was under the median by 3 -4 points, you have no chance. Same goes with a GPA .3 points the school's median. I'm sick of this propaganda being fueled by SDN.
 
7331poas said:
Same goes for med school admissions. I do not see why we dont make MCAT and GPA pass/fail if making Step 1 P/F is acceptable.

Surely MCAT and GPA does not predict patient outcomes...
Click to expand...
Dude mcat doesn’t determine competence in terms on practicing medicine in the US. You’re comparing two different test with two completely different goals? I passed the mcat, can I practice medicine in the US? No, tbh I actually failed the mcat but still got in...now what does that mean?
 
jhenj529 said:
Oh come on, this is A MILLION times worse when applying to medical school. I was told if your MCAT was under the median by 3 -4 points, you have no chance. Same goes with a GPA .3 points the school's median. I'm sick of this propaganda being fueled by SDN.
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What propaganda? What are you even talking about right now?
 
aldol16 said:
What propaganda? What are you even talking about right now?
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It's this propaganda that PD employ too strict cut offs for s1, and that we should make it pass fail to take the pressure off of students. Medical schools have been doing it forever when selecting students, yet there's no uproar.
 
chlorocruorin said:
Dude mcat doesn’t determine competence in terms on practicing medicine in the US. You’re comparing two different test with two completely different goals? I passed the mcat, can I practice medicine in the US? No, tbh I actually failed the mcat but still got in...now what does that mean?
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No, but if you get a 500 or above that mean's you'll likely succeed in medical school. If 500 is the minimum for success in medical school, yet school's are selecting people with 520++ scores, then that test isn't being used right either
 
jhenj529 said:
It's this propaganda that PD employ too strict cut offs for s1, and that we should make it pass fail to take the pressure off of students. Medical schools have been doing it forever when selecting students, yet there's no uproar.
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Yeah I didn't say that buddy. I'm very much against making Step 1 pass/fail for reasons I have already stated before.
 
mcat determines in part, Whether or not an applicant can be a doctor and train at a particular medical school. USMLE is whether or not a medical student can preform up to a standard competency regulated by the US. I couldve used my mcat to apply to be a freaking PA or PhD.
 
chlorocruorin said:
mcat determines in part, Whether or not an applicant can be a doctor and train at a particular medical school. USMLE is whether or not a medical student can preform up to a standard competency regulated by the US. I couldve used my mcat yo apply to be a freaking PA or PhD.
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S1 is probably the most powerful bargaining tool you have. I wouldn't be so ready to give it up.
 
jhenj529 said:
It's this propaganda that PD employ too strict cut offs for s1, and that we should make it pass fail to take the pressure off of students. Medical schools have been doing it forever when selecting students, yet there's no uproar.
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There's no uproar because that's not a good comparison. Had I not gotten into medical school, I still have an undergraduate degree to fall back on.

A medical degree without a residency is mostly worthless.
 
VA Hopeful Dr said:
There's no uproar because that's not a good comparison. Had I not gotten into medical school, I still have an undergraduate degree to fall back on.

A medical degree without a residency is mostly worthless.
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More propaganda. 30 years ago, that may have been the case. But now, it's almost bonkers how crazy medical schools go with MCAT and GPA. You can still get a residency if you get a 200 on step and are a US MD/DO grad. It almost is pass fail, if you're only goal is to get a residency in a noncompetitive specialty.
 
VA Hopeful Dr said:
There's no uproar because that's not a good comparison. Had I not gotten into medical school, I still have an undergraduate degree to fall back on.

A medical degree without a residency is mostly worthless.
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Well, yes but I don't think that's the issue here. It's not that MDs are going unmatched because of low Step 1 scores. There are unfilled spots in the match every year. It's because people aren't getting the specialties they want because of Step 1 cutoffs.
 
chlorocruorin said:
Dude mcat doesn’t determine competence in terms on practicing medicine in the US. You’re comparing two different test with two completely different goals? I passed the mcat, can I practice medicine in the US? No, tbh I actually failed the mcat but still got in...now what does that mean?
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Does mcat determine the capability of a medical student? If not, why not make it pass fail?
 
Lawper said:
It's in a way pass/fail with pass = 500+ according to AAMC.
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This the crux of the issue. You can't get into any MD school with a 500. A step score with a 200 WILL get you into a residency.
 
jhenj529 said:
More propaganda. 30 years ago, that may have been the case. But now, it's almost bonkers how crazy medical schools go with MCAT and GPA. You can still get a residency if you get a 200 on step and are a US MD/DO grad. It almost is pass fail, if you're only goal is to get a residency in a noncompetitive specialty.
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Nothing you have written is in any way related to what I wrote.
 
Lawper said:
Maybe not MD schools but a medical school could be possible. I think a 500 is okay for some DO schools.
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IF is the key word. There's no guarantee. With the match structured the way it is, you almost have 99% chance matching into A residency with that score. The same cannot be said about DO schools and a 500 MCAT
 
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