Pass/Fail USMLE Step 1 - Residency Impact

[petomed]

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One theory is that the mania will shift directly to Step 2. Given that many DO's already opt to sit for the USMLE, I was curious if there is any data to support the idea that one pathway to residency may benefit more than the other. This landed me on the repository for match data:

Match Data

Core to the NRMP’s mission is the development and distribution of data reports and publications that inform national conversations about the transition to residency and advance understanding of the…

www.nrmp.org

From here, there is aggregate match data for MD's and DO's.

MD:

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdf

DO:

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_DO-Senior_final.pdf

Most importantly, USMLE data is reported for DO's that sat for Step 1 and Step 2. Comparing the summary statistics for MD's vs. DO's listed in each specialty for Step 2 shows pretty consistently that DO's matched into the same specialty as MD's, but with a lower Step 2 score. There are of course many other facets that go into matching, however comparing Step 2 mean score for those that matched seems fare. All else equal, DO's matching into residency with a lower Step 2 mean score may imply that once Step 1 becomes pass / fail, the DO will have an advantage if they score the same on Step 2 as a MD. In fact, the data presented here already supports that idea.

I'd be happy to see more data on this, as I am no expert on match. What are your thoughts here?

 

[DocJanItor]

All else equal, DO's matching into residency with a lower Step 2 mean score may imply that once Step 1 becomes pass / fail, the DO will have an advantage if they score the same on Step 2 as a MD. In fact, the data presented here already supports that idea.

First off, when Step 1 becomes P/F, all things will NOT be equal. Right now there are only 2 exams that give a numerical value for performance. One is taken before or after your 3rd year, the other is taken sometime during your 4th year. When Step 1 becomes P/F, only Step 2 will be there to give PDs some kind of number to compare between candidates.

Further, some students elect to defer their Step 2 test date until after residency applications are submitted. This is usually for students who already have a sufficient Step 1 score for their desired specialty (as Step 1 is currently weighted more by most PDs). One of my friends deferred his Step 2 until February (literally the last week to take it this year) and scored a 220 because he already had plenty of interviews.

Once Step 2 is the only scored test, EVERYONE will have to take it before applications are submitted. That will usually be sometime between March and August of their M4 year, and everyone will be trying to score well. This will also significantly alter the distribution of the test scores.

I think what you're claiming is significantly beyond what a simple comparative analysis is able to demonstrate, particularly when the rules of the game will change so much.

 

[Goro]

This has been discussed to death, as yes, Step 2 will become very important as a screening tool, but evals, LORs, networking and audition rotations will also come into play. School reputation? Probably good for PDs familiar with grads of the schools, and of course, Really Top Schools will have a bonus. Still, PDs have mentioed that coming from Stanford/Harvard class schools doesn't automatically mean that one isn't an a-s-s-h-o-l-e

 

[petomed]

This has been discussed to death, as yes, Step 2 will become very important as a screening tool, but evals, LORs, networking and audition rotations will also come into play. School reputation? Probably good for PDs familiar with grads of the schools, and of course, Really Top Schools will have a bonus. Still, PDs have mentioed that coming from Stanford/Harvard class schools doesn't automatically mean that one isn't an a-s-s-h-o-l-e

Understood and agreed. It is interesting though. Even if you compare current Step 1 scores for matched MD's and DO's, you'll find the DO is matching into the same spots as the MD, but doesn't require as high of a score. Couple that with the intangibles you mentioned and to me, that means either the DO has a more well-rounded application, or there is bias somewhere that may provide an advantage to a DO with the same Step score as a MD.

 

[petomed]

First off, when Step 1 becomes P/F, all things will NOT be equal. Right now there are only 2 exams that give a numerical value for performance. One is taken before or after your 3rd year, the other is taken sometime during your 4th year. When Step 1 becomes P/F, only Step 2 will be there to give PDs some kind of number to compare between candidates.

Further, some students elect to defer their Step 2 test date until after residency applications are submitted. This is usually for students who already have a sufficient Step 1 score for their desired specialty (as Step 1 is currently weighted more by most PDs). One of my friends deferred his Step 2 until February (literally the last week to take it this year) and scored a 220 because he already had plenty of interviews.

Once Step 2 is the only scored test, EVERYONE will have to take it before applications are submitted. That will usually be sometime between March and August of their M4 year, and everyone will be trying to score well. This will also significantly alter the distribution of the test scores.

I think what you're claiming is significantly beyond what a simple comparative analysis is able to demonstrate, particularly when the rules of the game will change so much.

The ability to waylay taking an exam you mentioned, does this exist only for a MD or only for a DO? If so then having a deadline change will disproportionately impact that student. However, if both the MD and DO have the ability to delay their Step exam test day, then it is a moot point.

 

[DocJanItor]

Understood and agreed. It is interesting though. Even if you compare current Step 1 scores for matched MD's and DO's, you'll find the DO is matching into the same spots as the MD, but doesn't require as high of a score. Couple that with the intangibles you mentioned and to me, that means either the DO has a more well-rounded application, or there is bias somewhere that may provide an advantage to a DO with the same Step score as a MD.

Or it could mean that DOs were deferring more frequently to avoid having a negative impact to their residency application. The point is that step 2 is not currently a strong metric for residency consideration. In the future it will be.

 

[Meridian32]

Even if you compare current Step 1 scores for matched MD's and DO's, you'll find the DO is matching into the same spots as the MD, but doesn't require as high of a score. Couple that with the intangibles you mentioned and to me, that means either the DO has a more well-rounded application, or there is bias somewhere that may provide an advantage to a DO with the same Step score as a MD.

The Match is not biased to provide an advantage to DOs - if anything, DOs are at a disadvantage. You can see this in the substantially higher match rates for MDs vs. DOs in the more competitive specialties such as Dermatology or any of the surgical specialties (Neurosurgery, Otolaryngology, etc.). You are right that in many specialties the mean reported Step 2 scores seem to be a little higher for matched MDs vs. matched DOs, but I think a more likely explanation for this is that it is confounded by the fact that the more competitive programs in each specialty tend to favor MDs - e.g., in my field, internal medicine, the most competitive 20-30 residency programs in the country match nearly exclusively MDs and also have higher mean Step 1/2 scores due to competitiveness.

 

[Creative-thinker]

The Match is not biased to provide an advantage to DOs - if anything, DOs are at a disadvantage. You can see this in the substantially higher match rates for MDs vs. DOs in the more competitive specialties such as Dermatology or any of the surgical specialties (Neurosurgery, Otolaryngology, etc.). You are right that in many specialties the mean reported Step 2 scores seem to be a little higher for matched MDs vs. matched DOs, but I think a more likely explanation for this is that it is confounded by the fact that the more competitive programs in each specialty tend to favor MDs - e.g., in my field, internal medicine, the most competitive 20-30 residency programs in the country match nearly exclusively MDs and also have higher mean Step 1/2 scores due to competitiveness.

I have heard it is also a disadvantage to Foreign medical students , along with Caribbean medical Students.

 

[obaa6755]

OMS-II here. Does anyone know if it would be worth it to still take the Step 1 now that it is pass/fail if trying to match into a competitive specialty like dermatology?

 

[Ho0v-man]

Yes. Still take it.

OMS-II here. Does anyone know if it would be worth it to still take the Step 1 now that it is pass/fail if trying to match into a competitive specialty like dermatology?

 

[obaa6755]

Yes. Still take it.

Our career advisor says DO students can take step 2 without taking step 1. Would you recommend that route? Why or why not?

 

[Ho0v-man]

Because you’ll be screened out without step 1.

Step 1 studying is very helpful for step 2.

I’d always heard step 2 was easy and step 1 was a ridiculous test of minutiae. Step 2 was literally the hardest test I’ve ever taken. Having a solid step 1 foundation saved my butt. If you can’t study enough to pass step 1, you’ll likely underperform and maybe even fail step 2. Derm is a tough match, it’d be nice to have good scores for a backup specialty if you don’t get it.

Edit: your advisor is probably stupid.