Questions about the USMLE

[deleted962973]

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Tbh I hope it goes completely P/F.

Hell no. You’ll end up with far more weight on things like research and preclinical grades, which no one wants. Maybe something like a quartile system where they just tell you scored in the top 25, top 50, etc

 

[efle]

Hell no. You’ll end up with far more weight on things like research and preclinical grades, which no one wants. Maybe something like a quartile system where they just tell you scored in the top 25, top 50, etc

The research game has also blown up into a monster of its own. For the most competitive specialties the AVERAGE numbers of posters/pubs on ERAS is 15-18. My friends aiming for things like academic neurosurg spend all their time finding ways to fluff up their research list, like doing a million mindless chart review data extractions for middle authorship, or presenting the same stupid small summer project at 8 different conferences. Having just a couple good longitudinal involvements in projects is perceived as killing your chances. Research years are also becoming a lot more common.

These numbers are up SEVERAL FOLD from just ten years ago. It's all madness and clearly a far cry from actual value added to their candidacy

 

[Med Ed]

What's up with First Aid tripling in size since Y2K? Are they testing that much more or was it just missing huge swaths of info back in the day

Think about First Aid's business model. Every single year it has to convince a new class of medical students to buy the latest edition. It has done this by adding more stuff - more pages, more content, more pictures, more color - to get some daylight between each year's version.

While the amount of medical knowledge obviously continues to mushroom, the USMLE content outline hasn't changed much over the years. Foundational medical knowledge is still foundational medical knowledge.

 

[LBJLA23]

OP has been accepted to medical school. Chill. It's a valid question and your comment adds nothing to this conversation.

Wrong. He's still a premed. Step 1 should not be on his radar. He should be enjoying his last few months rather than be a neurotic pre-med.

 

[mariposas905]

Wrong. He's still a premed. Step 1 should not be on his radar. He should be enjoying his last few months rather than be a neurotic pre-med.

Sorry guys! I should have clarified earlier about my question. I was actually posting it for a friend who's studying for Step 1 as an IMG and didn't have an SDN account. I figured I'd just post it as myself to make things simple, so that my friend could follow the thread. In any case, I have been accepted to med school and thought the information would help me later on. However, I did not mean to be neurotic or anything of that sort with this thread (I know some people won't believe me, but I really did ask this question only for my friend lol) Anyway, I agree that now isn't the time for me to be worrying about USMLE, and in reality I'm not. I'm more concerned with picking a school atm 🙄

 

[efle]

Think about First Aid's business model. Every single year it has to convince a new class of medical students to buy the latest edition. It has done this by adding more stuff - more pages, more content, more pictures, more color - to get some daylight between each year's version.

While the amount of medical knowledge obviously continues to mushroom, the USMLE content outline hasn't changed much over the years. Foundational medical knowledge is still foundational medical knowledge.

That's fair. But you said the average was a 217, and now that's bottom quartile. And a 245 was the cap which is wild to think about, since that's now achieved by a full quartile of students.

Surely that kind of drift doesnt come about from more pictures, what's expected of a basic student has to have expanded a lot. Unless people didn't really push themselves to show everything they knew back then. When did it become normal to grind all day every day for 6-8 weeks of dedicated?

 

[Med Ed]

That's fair. But you said the average was a 217, and now that's bottom quartile. And a 245 was the cap which is wild to think about, since that's now achieved by a full quartile of students.

We're really hampered by the fact that the NBME has never divulged its system for generating a three digit score. Step 1 is an odd test for a number of reasons. One of them is that its ostensible purpose is to evaluate whether a taker has a minimum fund of medical knowledge. It would therefore make sense for Step 1 to be a criterion-referenced test. But it's not. It's a norms-referenced test, build around the notion that 5-6% of US allopathic students should fail it on the first attempt.

Surely that kind of drift doesnt come about from more pictures, what's expected of a basic student has to have expanded a lot. Unless people didn't really push themselves to show everything they knew back then.

Students were pushed just as hard back in the day, if not harder. With lecture/lab from 8-5 every day there was plenty of content to learn/memorize. Now you have Adderall, back then people just took straight methamphetamine. One of the differences is that up to a few years ago you spent M1/M2 taking faculty-authored exams, so you might spend months learning things like head & neck anatomy and histology, subjects that have little bearing on board exams.

Now more schools are moving toward administering exams composed of NBME questions, so there is less and less drive to expose students to science subjects that aren't "high yield." This has facilitated students being able to detach entirely from the formal curriculum and just UFAP at home.

When did it become normal to grind all day every day for 6-8 weeks of dedicated?

I don't have a good answer for this. My medical school had a very traditional calendar which included a legit summer between M2 and M3. I remember studying hard for 4 or 5 weeks. I don't recall anyone going much longer, although there was certainly enough of a window to do so.

 

[puahate]

Is STEP 1 scaled or curved?

 

[Goro]

This is somewhat anecdotal, but consistent across multiple program directors I know personally. The general feeling is that Step 1 scores have no real predictive power in terms of differentiating good residents from bad ones. One told me that the program's best residents are the ones with lower scores (meaning 220-240), because they tended to have strong interpersonal skills and could therefore function effectively in the clinical environment.

Imagine the shock of horror among all the hyperacheivers who define their lives and self-worth by exam scores and think that medical education ends with Step I!

 

[deleted962973]

Imagine the shock of horror among all the hyperacheivers who define their lives and self-worth by exam scores and think that medical education ends with Step I!

Well I don’t think it’s that students want to define their worth by their exam scores... but program directors certainly do, which fosters that mindset

 

[curbsideconsult]

Well I don’t think it’s that students want to define their worth by their exam scores...

Are you sure about that?

 

[Trollest]

I call bs on this. Flashcard do make you a BETTER physician. The hate that flashcard get its insane.

It's tatamount to Socrates telling his student that writing was detrimental to the mind.

We're thinking about it from our own perspectives though, where we want to be able to distinguish ourselves and have all doors open to us because of it.

Put yourself in a faculty member's shoes. Ten years ago your small groups would be an active discussion where people asked about things that really need an expert to clarify. You felt you were teaching people how to think in ways they will use on the wards.

Now, it's a small minority of students that want to engage with you because most people are grinding flashcards on their phone. Nobody cares about spending 20 minutes building a good thorough differential for your example case, because the skill they really need to practice is skimming a vignette in 50 seconds and eliminating options on a multiple choice list.

I can see why students and residency directors love the scaled scores, but I can also see how stakeholders in good preclinical medical education are growing to hate it. And if I could flip a switch that reset things to the former kind of classroom, even if that comes at the expense of Joe Stateschool being able to match Plastics, I think I'd flip it for the greater good.

 

[puahate]

Are you sure about that?

I dont care about these scores im just trying to get into uro or ent.

 

[deleted938090]

I call bs on this. Flashcard do make you a BETTER physician. The hate that flashcard get its insane.

It's tatamount to Socrates telling his student that writing was detrimental to the mind.

What can a flashcard give you that a computer couldn't? What's important is knowing how to apply the concepts and how to extract information from a patient, not memorizing things you can look up.

 

[efle]

I call bs on this. Flashcard do make you a BETTER physician. The hate that flashcard get its insane.

It's tatamount to Socrates telling his student that writing was detrimental to the mind.

Wait what are you calling BS on? You don't think students tune out of small group to anki on their phone? Or you think they do, but it's actually beneficial to their future patients to flashcard instead of working the cases with the faculty specialist?

 

[rball]

Wait what are you calling BS on? You don't think students tune out of small group to anki on their phone? Or you think they do, but it's actually beneficial to their future patients to flashcard instead of working the cases with the faculty specialist?

It’s actually fairly uncommon for med students who kill step to then go ahead and do poorly on the wards and in caring for patients. Studying hard to destroy step in a spaced repetition manner rather than cramming, via flashcard or otherwise, gives you a broad base of knowledge that will benefit your future patients immensely. There is tremendous overlap between skills needed to destroy step (such as critical thinking, forming differentials, etc) and to do well in caring for patients.

Many flashcard users are “good” students who are attentive in class. many small group sessions are also fairly useless. The problem you’re describing is reflective of individual students and of inefficient teaching, not of flashcards.

 

[efle]

It’s actually fairly uncommon for med students who kill step to then go ahead and do poorly on the wards and in caring for patients. Studying hard to destroy step in a spaced repetition manner rather than cramming, via flashcard or otherwise, gives you a broad base of knowledge that will benefit your future patients immensely. There is tremendous overlap between skills needed to destroy step (such as critical thinking, forming differentials, etc) and to do well in caring for patients.

Many flashcard users are “good” students who are attentive in class. many small group sessions are also fairly useless. The problem you’re describing is reflective of individual students and of inefficient teaching, not of flashcards.

Maybe we had completely different experiences with our schools' faculty led small groups. I never went through example cases/differentials with a specialist and came out afterwards thinking wow, my future patients would have been better off if I spent that time refreshing on the citric acid cycle, accumulated substrates in lysosomal storage diseases, etc.

If someone wants to flashcard during dedicated as their study method, or do it at home during the year, totally fine by me. But because of the numbers of hours for a deck the size of Bros/Zanki, all my friends are CONSTANTLY grinding their reviews in all our small groups and lectures. You can blame the students if you want, or say the Hopkins faculty are bad at teaching, but I don't buy either of those. It's too widespread and they're great.

And if you ask anybody about why they zanki it's never "to make sure I'm more knowledgable on the wards." Its all about that step prep.

 

[Gurby]

Saw this meme on Reddit and thought of you guys:

 

[Med Ed]

Saw this meme on Reddit and thought of you guys:

The central problem is that both sides have a point. Yes, you need a Step 1 score that doesn't get you screened out. But that alone doesn't get interviewed and ranked by competitive programs. You also need strong clerkship grades, evals, letters, a solid MSPE, good interviews, and (perhaps) a great Step 2 CK performance. The school's fear is that after 2 years in Step 1 mode, the resulting zombies will suddenly find themselves ill-prepared to play the new game, and will suffer for it.

 

[Trollest]

How? Do you mind elaborating? Ill-prepared in what sense?

It kind of read like you are valuing mediocracy over efficacy..

The central problem is that both sides have a point. Yes, you need a Step 1 score that doesn't get you screened out. But that alone doesn't get interviewed and ranked by competitive programs. You also need strong clerkship grades, evals, letters, a solid MSPE, good interviews, and (perhaps) a great Step 2 CK performance. The school's fear is that after 2 years in Step 1 mode, the resulting zombies will suddenly find themselves ill-prepared to play the new game, and will suffer for it.

 

[Trollest]

That's your school and faculty fault for not enforcing the rules. Professionalism is highly valued at mine;

Wait what are you calling BS on? You don't think students tune out of small group to anki on their phone? Or you think they do, but it's actually beneficial to their future patients to flashcard instead of working the cases with the faculty specialist?

 

[efle]

That's your school and faculty fault for not enforcing the rules. Professionalism is highly valued at mine;

Sure, I guess one response to the situation is to ban cellphone/laptop use in the lecture halls and small group rooms. I think the majority of schools are uncomfortable with that approach.

But I'm still lost on what you were calling BS about in the description I gave. Saying the school should squash the problem admits it's a real problem, and students are prioritizing flashcards >> classroom learning with faculty and peers. What exactly do you disagree about?

 

[wontonsoup]

Well I'm currently studying for Step1 in my dedicated period. I can tell you my Gestalt impression from trying to read all the tea leaves. I'll put the body of the rant into a spoiler tag cuz its long.

Spoiler: ranting about step1

#1 thing of interest is this big recent push to switch USMLE to pass/fail, like the Bar exam works for law licensing. The idea is that it was never meant to be a selector for clinical residency training, and its abuse for this purpose has started causing problems. Namely, it's caused medical students to ignore valuable prep for the wards/their faculty led coursework, in favor of spending all their time on Anki flashcarding and Qbank questions. So there was a big convention in Philadelphia a few weeks ago where all the main players (NBME, AMA, AAMC, etc) got together to discuss. A summary recommendation draft is expected in the next couple months. You can check out their page on USMLE over here: www.usmle.org/incus/?#timeline

In short, it might be that in a year or two the USMLE reports things differently, perhaps by quartile or even fully by Pass/Fail. On the other hand they might tell all these organizations of med students & faculty to go to heck, and instead keep the scaled system at the behest of residency directors.

#2 thing of interest is the recent retirement of the old practice NBMEs, with the rollout of a few new ones to replace them. This is supposedly because the old ones had lost their predictive validity. Of note surrounding all this is that there was new leadership as of a year or two ago, so there may be a shift in priority on how people are tested. For example, cutting back on rote recall questions about esoteric enzymes, and instead focusing on application of principles like reading basic imaging or EKGs.

#2.a - the NBMEs are, statistically speaking, very differently composed than the actual Step 1. To get an average predicted score (230) on an NBME you need to hit more than 80% correct. In other words, the tests are so easy, they compress the entire top half of the curve into a handful of questions, such that an average student (230) and a top end student (255+) are only differentiated by about 1/8th of questions. The real step 1 has a much lower average percent correct, allowing for a much better bell curve and many more differentiating questions between the low end, middle, and high end. In short, this means the NBMEs are not that useful for a lot of high performing students and feel extremely different to take. One big impact this has is training people to take their sweet time because the NBME prompts are so short and straightforward and you can't afford to make any errors. Then people get to the actual step1 and feel like they got hit by a train and barely managed to finish (or didn't even finish some blocks), because of how much longer and more difficult the average questions are.

#2.b - Uworld lets you see the percent getting each question correct, and there's a really interesting trend. Questions that can be answered by having a flashcard memorized tend to get absolutely dominated by modern med students. E.g. I just had a question today that asked about which sub-protein of the histone complex is the one outside the core (answers were like Histone Protein 1, Histone Protein 2, Histone Protein 3...)

~80% of people got this correct. Absolutely blew my mind that such a vast majority knew this off the top of their head. What principle is this testing? Who cares. It's in zanki. Gotta know it.

Meanwhile, questions that can't really be flashcarded and require reasoning through a system - e.g. "which of these conditions would cause the following change in this Cardiac Output vs End Diastolic Volume plot" - will have a minority answering correctly.

It really seems like the rise of Anki/Sketchy/Pathoma/Boards&Beyond/obsessive step preparation from the first day of school, has fundamentally changed the game of preclinical medical education (arguably, for the worse). Students are cramming far, far more information into their heads than ever before, but potentially at a loss of time spent understanding the underlying systems.

Ironically, the likely response from the USMLE is going to be to start testing more understanding and less knowledge...if they keep reporting a scaled score at all, that is. I've seen recent high scorers say that only half a dozen of their 280 questions were "first aid facts" and the other 98% was applying fundamentals. I believe them. The days of buzzwords and nice direct NBME type stuff is gone. You're no longer going to get a vignette that starts with "20 year old athlete collapses on the field..." where you can glance at the answers and smash Hypertrophic Cardio without bothering to read the rest. Instead, you're gonna get some long vignette based on a rare hereditary syndrome nobody has ever heard of, where you get a few key EKG findings and they ask you to derive from that which ion channel is mutated.

TLDR:

If the exam or how we experience it truly is changing, and I think it is, the summary of what to expect is basically:

1) You absolutely must nail any factoid recall question, because a lot of students are straight up memorizing 24,000+ flashcards (Zanki) and they will know it. Always.
2) The test writers have to protect their bell curve distribution. In response to the above, they could go for even more esoteric knowledge checks. Or, more likely, there will be a lot more very challenging questions that can't be put on a flashcard. Expect a lot of graphs, imaging, up-and-down arrow tables, and questions that they know will be unfamiliar territory to everybody that they want you to get through via identifying and applying basic principles.

So basically it will became MCAT: Final Boss Edition.

 

[rball]

Maybe we had completely different experiences with our schools' faculty led small groups. I never went through example cases/differentials with a specialist and came out afterwards thinking wow, my future patients would have been better off if I spent that time refreshing on the citric acid cycle, accumulated substrates in lysosomal storage diseases, etc.

If someone wants to flashcard during dedicated as their study method, or do it at home during the year, totally fine by me. But because of the numbers of hours for a deck the size of Bros/Zanki, all my friends are CONSTANTLY grinding their reviews in all our small groups and lectures. You can blame the students if you want, or say the Hopkins faculty are bad at teaching, but I don't buy either of those. It's too widespread and they're great.

And if you ask anybody about why they zanki it's never "to make sure I'm more knowledgable on the wards." Its all about that step prep.

We didnt have zanki back when I was in preclinicals, but yes people were still studying stuff on the side during those sessions. I guess we did have different experiences; I went to a well regarded school (not trying to brag at all) but many of the faculty led sessions were inefficient (its no surprise that many schools are moving towards self-study methods+pbl/tbl). You have to learn how to crawl before you can walk, and some of these sessions were too focused on providing high level/abstract clinical knowledge that was not all that useful in learning/understanding/applying the material. There is no time after med school to relearn the basic fundamental knowledge that you need to master to do well on step.

My point is just that working hard to destroy step and building a base of knowledge to do well in wards and as a physician do overlap tremendously. Some people may find that zanki is best way to do this, others may not. But using zanki doesnt mean that students are just memorizing minutae or arent learning valuable clinical knowledge.

The fact that there is a mismatch between zanki and curricula actually reflects pretty poorly on the curricula and not flashcards: zanki is based primary on costanzo and pathoma, two gold standards that are essential for understanding fundamentals of physiology and pathology.

I personally think its great that students are working harder and more efficiently to build a broad/deep base of knowledge and figuring out how to prioritize. It bodes well for their future in the career when these skills are essential.

 

[Goro]

Sure, I guess one response to the situation is to ban cellphone/laptop use in the lecture halls and small group rooms. I think the majority of schools are uncomfortable with that approach.

But I'm still lost on what you were calling BS about in the description I gave. Saying the school should squash the problem admits it's a real problem, and students are prioritizing flashcards >> classroom learning with faculty and peers. What exactly do you disagree about?

A simpler solution, which works at my school and others, is to have the students grade each team member for their participation. Students tend to NOT like team mates who refuse to pull their own weight.

 

[efle]

A simpler solution, which works at my school and others, is to have the students grade each team member for their participation. Students tend to NOT like team mates who refuse to pull their own weight.

Haha our admin is so concerned about student mental health / preventing competitiveness they wont even give preclinical grades or AOA any more. Cant see them doing this. Interesting way to keep people accountable though

 

[Med Ed]

How? Do you mind elaborating? Ill-prepared in what sense?

It kind of read like you are valuing mediocracy over efficacy..

Here are the top twelve items from the 2019 Program Director's Survey necessary to grant an interview:

You will note that Step 1 is cited most frequently, but it's only one factor of many. Once an applicant has been interviewed, here is are the factors to rank that individual:

You will note that the interview experience now becomes a huge factor.

My point is that while Step 1 is clearly very important in this process, it is only one piece of a larger puzzle. The sooner medical students figure out that they will have to walk and chew gum at the same time, the better off they are.

 

[Trollest]

This

We didnt have zanki back when I was in preclinicals, but yes people were still studying stuff on the side during those sessions. I guess we did have different experiences; I went to a well regarded school (not trying to brag at all) but many of the faculty led sessions were inefficient (its no surprise that many schools are moving towards self-study methods+pbl/tbl). You have to learn how to crawl before you can walk, and some of these sessions were too focused on providing high level/abstract clinical knowledge that was not all that useful in learning/understanding/applying the material. There is no time after med school to relearn the basic fundamental knowledge that you need to master to do well on step.

My point is just that working hard to destroy step and building a base of knowledge to do well in wards and as a physician do overlap tremendously. Some people may find that zanki is best way to do this, others may not. But using zanki doesnt mean that students are just memorizing minutae or arent learning valuable clinical knowledge.

The fact that there is a mismatch between zanki and curricula actually reflects pretty poorly on the curricula and not flashcards: zanki is based primary on costanzo and pathoma, two gold standards that are essential for understanding fundamentals of physiology and pathology.

I personally think its great that students are working harder and more efficiently to build a broad/deep base of knowledge and figuring out how to prioritize. It bodes well for their future in the career when these skills are essential.

 

[Trollest]

I agree but correct me if I am wrong but it looks as if you were implying that using ZANKI negatively affected your personal skills/ interview skills.

And I totally disagree with that.

It's not rocket science; low yield school material presented in a disastrous way vs B&B, pathoma lecture + Zanki?

I'd take the latter any day!

Here are the top twelve items from the 2019 Program Director's Survey necessary to grant an interview:

View attachment 257695

You will note that Step 1 is cited most frequently, but it's only one factor of many. Once an applicant has been interviewed, here is are the factors to rank that individual:

View attachment 257697

You will note that the interview experience now becomes a huge factor.

My point is that while Step 1 is clearly very important in this process, it is only one piece of a larger puzzle. The sooner medical students figure out that they will have to walk and chew gum at the same time, the better off they are.

 

[siliso]

I wonder what’s the connection between step 1 cramming mania and the rise of true Pass Fail preclinicals. There’s nothing left to gun on but step 1 and it’s created a new kind of monster.

 

[Med Ed]

I agree but correct me if I am wrong but it looks as if you were implying that using ZANKI negatively affected your personal skills/ interview skills.

And I totally disagree with that.

It's not rocket science; low yield school material presented in a disastrous way vs B&B, pathoma lecture + Zanki?

I'd take the latter any day!

I have not impugned any particular study modality. But there is undoubtedly a point of diminishing returns for Step studying, and only partial overlap between the skills that get you ahead on MCQs and skills that get you ahead in clinical settings.

 

[Goro]

Here are the top twelve items from the 2019 Program Director's Survey necessary to grant an interview:

View attachment 257695

You will note that Step 1 is cited most frequently, but it's only one factor of many. Once an applicant has been interviewed, here is are the factors to rank that individual:

View attachment 257697

You will note that the interview experience now becomes a huge factor.

My point is that while Step 1 is clearly very important in this process, it is only one piece of a larger puzzle. The sooner medical students figure out that they will have to walk and chew gum at the same time, the better off they are.

This is why the humanistic domains make up 6/7 of the required competencies for medical students AND residents. Scientific/medical knowledge is but one other domain.

 

[Goro]

I wonder what’s the connection between step 1 cramming mania and the rise of true Pass Fail preclinicals. There’s nothing left to gun on but step 1 and it’s created a new kind of monster.

The push towards P/F grading is motivated more to help alleviate student stress and better their mental health. Boards is never mentioned in these discussions, IIRC.

 

[siliso]

The push towards P/F grading is motivated more to help alleviate student stress and better their mental health. Boards is never mentioned in these discussions, IIRC.

Right, I’m just wondering if the unintended consequence was displacing most of the stress to step 1 instead.

 

[Med Ed]

Right, I’m just wondering if the unintended consequence was displacing most of the stress to step 1 instead.

It's certainly a factor, but P/F grading has been around much longer than the Step 1 mania we are currently experiencing.

I suspect a significant driver, which happens to be more recent, is the proliferation of self-assessment exams and the inception of Reddit. The combination of these two seems to work even the most stoic student into a lather.

 

[scrapy]

Is step 1 seriously going to go true p/f within two years!? I’m entering med school this August, and there’s very little chance I’ll get off my T20 school waitlists. How screwed am I if this happens? I’m willing to power through and get just one shot on this test, because if it’s taken out and school name starts to matter even more than it does...

 

[chlorocruorin]

Is step 1 seriously going to go true p/f within two years!? I’m entering med school this August, and there’s very little chance I’ll get off my T20 school waitlists. How screwed am I if this happens? I’m willing to power through and get just one shot on this test, because if it’s taken out and school name starts to matter even more than it does...

Omg, you're totally screwed

 

[chlorocruorin]

Numerical Versus Pass/Fail Scoring on the USMLE: What Do Medical Students and Residents Want and Why? - PMC

Although the primary purpose of the US Medical Licensing Examination (USMLE) is assessment for licensure, USMLE scores often are used for other purposes, more prominently resident selection. The Committee to Evaluate the USMLE Program currently is ...

www.ncbi.nlm.nih.gov

this article was posted in 2011...

 

[Med Ed]

Is step 1 seriously going to go true p/f within two years!?

Omg, totally.

 

[scrapy]

Well clearly there are a lot of people opposed to true p/f step 1. Let me rephrase, do we know anything about how step 1 will change? Has it changed significantly in the past few years?

 

[Lucca]

Well clearly there are a lot of people opposed to true p/f step 1. Let me rephrase, do we know anything about how step 1 will change? Has it changed significantly in the past few years?

In May the committee that met last month will release their recommendations and then we’ll see if anyone plans to do anything with them and what they even are

 

[Med Ed]

Well clearly there are a lot of people opposed to true p/f step 1. Let me rephrase, do we know anything about how step 1 will change?

I'll post it again. Note the timeline.

 

[Goro]

Well clearly there are a lot of people opposed to true p/f step 1. Let me rephrase, do we know anything about how step 1 will change? Has it changed significantly in the past few years?

While it is anticipated that the conference will focus on numeric score reporting vs. Pass/Fail score reporting, other score reporting options will be considered.

 

[Med Ed]

While it is anticipated that the conference will focus on numeric score reporting vs. Pass/Fail score reporting, other score reporting options will be considered.

It is rather sad that the students entering medical school in the last few years (and going forward) will never know a medical education experience that does not revolve around USMLE. After pondering the situation at great length, I have come to essentially agree with the large majority of what Dr. Bryan Carmody is saying on his blog. Making Step 1 P/F would cause some short-term problems, but in my opinion the long-term benefits would likely outweigh them by a significant margin.

The only other option is to blow up Step 1 and build a new assessment that is more relevant to practice. But that would be an extremely lengthy and daunting process, with no guarantee of success.

 

[efle]

This guy nails what I've been trying to describe:

Spoiler: Malignant Step Climate

If you are a physician who is not currently involved in preclinical medical education, you may be surprised by how much things have changed since you took the USMLE – even if you took it fairly recently. This opinion is informed by my own experience.
I took Step 1 in 2005. I remember not even thinking much about Step 1 until the last few months of second year. After my finals at the end of May, I took a couple of days off to clear my head. Then, I studied for about 2 weeks, took Step 1, and went on to my clerkships. It wasn’t the most fun time of my life, but it was hardly the worst thing I’ve ever gone through.
Flash forward to 2016, when I took on an official teaching role at my medical school. Pretty quickly, it became apparent to me that since I had taken the exam, preparation for Step 1 had entered a malignant phase.
When I walk around my medical school, I see students:

• Carrying First Aid for the USMLE Step 1 from the first week of class
• Frantically studying Pathoma for the last 30 seconds before a lecture begins
• Answering UWorld questions on their phone as they walk down the hall
• Working through their Anki deck of pharmacology trivia during required lectures on topics relevant to the real-life practice of medicine, but not tested on Step 1
• Struggling to mentally stay afloat amidst the realization that, at any given moment that they are not studying, someone else is – and there aren’t enough residency spots for everyone

But don’t accept my anecdotes. Look for yourself at the rising mean Step 1 scores; the explosion in growth of the for profit test prep industry; declining class attendance; disengagement from any educational activity not deemed “high yield” for Step 1; or increasing burnout in students who aren’t even halfway through medical school.
The problem isn’t the students. They are smart, efficient, and single-minded in pursuit of the goal we’re telling them is so important.
The problem is their environment. Today’s students are squeezed more and more by an educational system that has been perverted, where memorizing basic science trivia has become prioritized over learning to be a doctor in the truest sense of the word.
Students have described this as the “Step 1 Climate” – and in it, there is no doubt that climate change is occurring. In fact, the temperature increases a little every year, and it’s getting pretty stifling. The fact that people like me don’t remember it being so hot back in the day is a poor excuse for not looking at the thermometer now.

I wish all our faculty could be as woke as this guy. Half of them keep saying stuff about "just pass the exam lol"

For people interested in matching competitively it's a zero sum game that's become all-consuming in preclinical years. Hope it really does change

 

[Lucca]

It is rather sad that the students entering medical school in the last few years (and going forward) will never know a medical education experience that does not revolve around USMLE. After pondering the situation at great length, I have come to essentially agree with the large majority of what Dr. Bryan Carmody is saying on his blog. Making Step 1 P/F would cause some short-term problems, but in my opinion the long-term benefits would likely outweigh them by a significant margin.

The only other option is to blow up Step 1 and build a new assessment that is more relevant to practice. But that would be an extremely lengthy and daunting process, with no guarantee of success.

“My point here isn’t to convince you of the merit of a particular method for triaging applications. My point is to empower you to recognize that if you are a program director, you are in the best position to know what predicts success in your program or specialty – not me. And not the NBME, either.

We owe it to our students and their patients to cultivate and create a culture that rewards traits and achievements that truly benefit society. The problem is, the presence and ready accessibility of Step 1 scores makes it too easy to avoid this hard work. So define residency success. Measure residency success. Study residency success. Stop outsourcing your responsibility to the NBME.”

Hard agree with this from the blog post

 

[efle]

So define residency success. Measure residency success. Study residency success. Stop outsourcing your responsibility to the NBME

Which brings us full circle to the fear that residency directors will do no such thing. They'll instead turf it to medical admissions committees to identify the cream of the crop, and set up their screens based on where you were trained.

Someone should message him asking for a blog post where he roleplays residency director and figures out how to identify the 10% worth interviewing while blinded to standardized scores, preclinical grades or rank, and medical school attended. I'd love to see how he avoids just going after schools with inflated clinical grading (cough Yale cough) where everybody gets Honors, or how he can use two equally glowing letters of recommendation to pick someone to skip over.

God forbid he turn to extracurriculars/research, where it's already become a circus of who can milk the most out of their 8 week summer chart review to build the most inflated ERAS.

 

[Lawpy]

It is rather sad that the students entering medical school in the last few years (and going forward) will never know a medical education experience that does not revolve around USMLE. After pondering the situation at great length, I have come to essentially agree with the large majority of what Dr. Bryan Carmody is saying on his blog. Making Step 1 P/F would cause some short-term problems, but in my opinion the long-term benefits would likely outweigh them by a significant margin.

The only other option is to blow up Step 1 and build a new assessment that is more relevant to practice. But that would be an extremely lengthy and daunting process, with no guarantee of success.

So just out of curiosity, what are your thoughts on making the MCAT pass/fail and why?

 

[Lucca]

Which brings us full circle to the fear that residency directors will do no such thing. They'll instead turf it to medical admissions committees to identify the cream of the crop, and set up their screens based on where you were trained.

Someone should message him asking for a blog post where he roleplays residency director and figures out how to identify the 10% worth interviewing while blinded to standardized scores, preclinical grades or rank, and medical school attended. I'd love to see how he avoids just going after schools with inflated clinical grading (cough Yale cough) where everybody gets Honors, or how he can use two equally glowing letters of recommendation to pick someone to skip over.

God forbid he turn to extracurriculars/research, where it's already become a circus of who can milk the most out of their 8 week summer chart review to build the most inflated ERAS.

Just do a PhD

 

[Med Ed]

Someone should message him asking for a blog post where he roleplays residency director and figures out how to identify the 10% worth interviewing while blinded to standardized scores, preclinical grades or rank, and medical school attended.

Going a little reductio ad absurdum, aren't we?

If Step 1 went P/F tomorrow there would still be all the other elements of ERAS that program directors already use to make decisions: LORs, the MSPE, clerkship grades, Step 2 CK, etc.