MD & DO *Rant / Opinion* Program Directors and the Evaluation of P/F Step 1 - please feel free to weigh in.

[Rogue42]

I was perusing a thread on here regarding this topic, and I keep seeing whispers / talk that for the match of the Class of 2023 that some residency programs are going to be looking blindly at applications before looking at scores or that they will view scored USMLEs the same as P/F since some applicants will have a P/F (pending when you took the exam and the school you go to). Or some other form of the aforementioned process due to mixed scores or to prepare for the following year when everyone will have a P/F. Etc, etc.

This is just insanity to me - especially as I take a break from studying for my Step 1.

I have many mixed emotions; there are many things in USMLE Step 1 that are just not relevant to real patient care, yet you need to know them to do well - not pass, but just to do well. When I am studying for those things, all I can think is how awful Step 1 became in the race for the highest score for the best specialty because residencies, much like medical schools, want to show off how great their residents / prestigious they are. Does my step score define whether or not I'll be a good *insert any competitive specialty* resident? No. Therefore, I can understand why it is becoming P/F.

On the other hand, when I make a 240 (*hopefully*), I am going to want it to count for something. Otherwise, I busted my tail-end for next-to-nothing seeing that a "passing" score on the Step 1 means that I am not a danger to patients during my third year of school which I - and many others - could achieve with no more than a couple of weeks of studying. Look, I also understand that it truly is not for "next-to-nothing" since the information, and the understanding of the information is relevant medicine, and I need this knowledge for practice. But, man, if I got passed over for a competitive specialty by someone with a "Pass" when I (or insert anyone else in the same hypothetical boat) had a high Step 1, then it would certainly feel like I studied for nothing. I know I keep talking about competitive specialties, but this could also apply to competitive locations or whatever have you.

I wish PDs could just be honest and upfront about what the plan is for match in *checks notes* all of a year and half for the Class of 2023. But I know that is difficult due to all of the things they are going to have to consider along with how much change that PDs are also experiencing with the changing of Step to P/F. I understand that it is a change for everyone on every level of education. Especially since they are faced with the possibility that some applicants will have a scored exam while other will just have a P/F, and the year following that, they will all be P/F, and they are going to need to know what kind of system they can use to go about selecting applicants. I did not write this post just to talk bad about PDs or what is happening behind the scene, because I do know everyone's plate is full.

I just also feel like the Class of 2023 has gotten one of the shortest ends of a stick as far as medical education goes. We got put smack dab in the middle of changing boards, changing the way that boards are viewed by PDs, put into the middle of a pandemic, had to learn the last 1/4 of first year and most of second year online, and man, just the challenges that we have faced / are facing. If you are a C/O of 2023 member and are still plugging along, then we are very perseverant.

But all of this gives me so much anxiety at the end of the day, I have so many unanswered questions that are simply unanswerable; just keeps me up at night.

Thanks for coming to my rant, please feel free to weigh-in.

(P.S. if this post is unacceptable in community standards, then mods, please feel free to lock-it)

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[AzBasRad]

The resident selection criteria vary widely among residency programs and the specifics are never fully shared w/ applicants or the general public. Even before Step 1 went P/F and Step 2 CS was cancelled, the chair at a moderately competitive speciality told me that they prioritize applicants w/ all Steps completed (1,2, CS) for IVs. In another *low-tier* program at a different speciality, a resident in the selection committee told me that they do not look at AMGs with very high Step 1 scores, because they rarely come to the program. From the class '21 panic thread, there were discussions on how some PDs were unaware that med students were only allowed 1 away rotation.

Bottom line, don't worry about it. Even if a PD tells you how they would utilize Step 1/ Step 2 CK, their selection methods may not be universal among the speciality. Concentrate on having a the best possible application by the time ERAS rolls around.

 

[Redpancreas]

I agree with AzBasRad that these considerations are all internal and nontransparent. It's been like that forever.

As for your rant, I do acknowledge that many in your class are inconvenienced in that you have to do the standard Step 1 drill because PDs refuse to put out a standard statement about blinding and then enter the new arms race for Step 2CK as I anticipate everyone will have it now that we all know it's coming. C/O 2022 and prior had both tests to deal with but most filtered by Step 1 alone. C/O 2024 at face value seems like they're going to have a much easier time as they can focus on Step 2 CK. I will inject here though that it may be a curse in disguise in that a good number may slouch and shoot themselves in the foot for Step 2 CK tempted by the P/F Step 1.

Just try to convince yourself the Step 1 material is relevant to Step 2 CK and power forward. I get it's not the ideal situation. I don't think it's the fault of a single PD but then is it the fault of governing bodies for not simply stating Step 2 CK is required prior to ERAS? Maybe...but there's probably some technicality that's preventing them for doing that because it seems like the common sense thing to do. Another positive way to look at it is that you have two exams to show your stuff. If you mess up Step 2 CK with 230s but then got a 240+ on Step 1, some places may be able to see both and give some lenience to it.