step 1&2 combined?
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There's no indication that they're going to do that yet.
And the first time a new format of the USMLE would be introduced would be for the class entering in 2010, so that means we've got at least 4 years before we see a new format of the USMLE, probably more.
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This is a summary of the official information released this year (including the information about comprehensive USMLE that was released on June 10th, 2008)
http://biochemistryquestions.wordpr...for-step-i-during-the-first-semester-of-2008/
http://biochemistryquestions.wordpr...for-step-i-during-the-first-semester-of-2008/
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No way it will impact the entering class of 2010. I suspect it will take about 4 years to implement any changes once they are enacted. None have been yet. It's still at the proposal stage. I would anticipate another year of meetings to hash out details. Thus you'd have to go to the high school board to find folks who are going to be impacted by this change.
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There is no point for them to change the USMLE format.
I have no idea why the NBME would care one way or another that program directors use the USMLE to evaluate residency candidates. The people that should be annoyed are the program directors themselves. PD's are the ones that have to deal with the consequences of ranking people in such a ludicrous manner.
There isn't much reason why someone needs a 240 to do derm or plastics. But good luck getting that message across to derm or plastics program directors. If they want to place the USMLE ahead of clerkship evals and extracurricular research, its their prerogative.
I have no idea why the NBME would care one way or another that program directors use the USMLE to evaluate residency candidates. The people that should be annoyed are the program directors themselves. PD's are the ones that have to deal with the consequences of ranking people in such a ludicrous manner.
There isn't much reason why someone needs a 240 to do derm or plastics. But good luck getting that message across to derm or plastics program directors. If they want to place the USMLE ahead of clerkship evals and extracurricular research, its their prerogative.
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Yeah, but it doesn't work like that. A high Step I score and good clerkship evals/research aren't mutually exclusive. So the people who match derm or plastics are a pool of people who were the best of those who applied, knowing full well they'd need good grades, Step I, evals, & research. And while you may not "need" a 240 to do any particular specialty, if it's a measure of medical knowledge and it's a standardized assessment we all have to take, I see no reason why it's not legitimate to use it as a selection criterion. It's not like they don't value other things, it's just that it's competitive enough to fill up all the spots with applicants who've got an all-around stellar application, which includes a high Step I score.
I believe the "party line" answer (from talking to a doctor who was a representative to the NBME) is this:
The USMLE is a licensing exam (in three parts). Since it's only stated objective is to say "Yes, this guy is competent to be a doctor" or "No, he is not", it should be a binary test: Pass/no pass. There's no reason to report an actual "score" since it's irrevelent to "Did you pass or not?"
My personal interpretation is that they don't want the public finding out that the Family Practice doctor taking care of Grandma's myriad medical problems or the pediatrician treating sick little Jimmy maybe got forty points lower than the dermatologist treating Cindy's acne.
The issue of the best doctors leaving primary care specialties REALLY bothers the public (look how often they publish articles about in Newseek, NY Times, etc.) so the NBME doesn't want to have an objective measure saying "The people who do the best on the exam that says if they get to be a doctor or not go into these fields, on average" because it just reinforces that stereotype.
What I see for the future if this "Gateway" combined Step 1/Step 2 with pass fail only goes through is that somebody is going to step forward (heck, maybe even the NBME if they can be sneaky enough about it) and offer med students the option to take something like the "Residency Preparedness Examination" which gives an objective score to be used in residency applicants to compare across schools. Program directors desire the information the old step 1 gave them so they start demanding the med students take it. The real losers are the med students who have to study for another examination and (conceivably) pay out the nose for it.
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Meh, this information has been available for years. Hasn't made too much noise in the news. Outside of medicine, who even knows what U.S.M.L.E. is an acronym for. Shucks, I sure didn't know what it was before medical school.
Anyhow, I don't think its a shocker that neurosurgeons tend to be some of the stronger test-takers in medical school.
I agree it's been known by the people in the know for years, but I think the public is still in the dark about it. Before I went to medical school my mom told me "You should really think about being a dermatologist. Not that many people would want to work with skin, right?"
There was also that New York times article last year about the Harvard couple matching in Derm (Sorry for beating up on Derm, it's only for illustrative purposes) where the writer played on the fact that a lot of people think the "smartest" students go into CV Surgery, not Plastic Surgery.
I'm not saying someone is going to blow this thing wide open like Watergate, but I could totally see 60 Minutes or the New Yorker doing an expose on licensing exam scores and what doctors go where and seeing the public upset about it.
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Yeah, it has only become big news of late, as the aging baby boomers have created a primary care "shortage", at the same time that both parties have made healthcare reform a hot button topic for the upcoming election. Americans are paying through the nose for healthcare, and so the notion that there are not enough doctors, and that they won't get to see the best ones as their PCPs are pretty untenable for some.
The NBME wants no part of this and has been troubled for a while that their minimum competency tests are being used in this manner, so proposals to move Step 1 beyond the match date and make it pass fail have been on the table. As added incentive, the fact that the number of US students has been increased since 2005 but that residency slots aren't being increased is going to mean more and more competition for slots both domestically and for IMGs, and as more and more US students are pushed down into those slots traditionally occupied by IMGs, the NBME doesn't want to get caught in the debate as to whether IMGs with higher scores really should be getting slots over US students who are bumping them out. So they are making their position known --If they say the test is a minimum competency P/F test, they eliminate this issue -- anyone who passes the test is equal and so residencies can bump out whomever they choose.
Clearly program directors are going to need some yardstick by which to select residents. I suspect they will focus more heavily on rotation grades, shelves and evals for a while, but ultimately enact some specialty specific tests for folks who want to go into a given field. Which probably will result in med students taking tests for several specialties, to keep doors open. So instead of one USMLE test, folks may end up taking 3-4 specialty specific exams during third year. Wouldn't want to be them.
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Heard from my school's student affairs office that the NBME is trying to combine Step1/2 by year 2014.
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Because of this:
http://www.nrmp.org/data/chartingoutcomes2007.pdf
Average USMLE score for matched dermatology residency was 240.
Define "plenty of people" and "far less step1 #s"?
Based upon the above link...
78% of those people scoring between 251-260 matched into derm.
70% of those between 241-250
65% of those between 231-240
61% of those between 221-230
50% of those between 211-220
29% of those between 201-210
0% of those between 191-200
Notice a trend?
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Not only that, but these are highly self-selecting and interview offer-based selecting, so the individuals who were below the 240 average had enough going for them other than Step I to get interviews & confidence to stay in the match long enough to be a candidate for that 50% chance of matching. So the point is, the average joe off the street with a 211 doesn't have a 50% chance of matching derm.
