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Is this official already? I haven't seen a press release.
 
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Well I'll be. I thought they were going to come to their senses and abandon this idea.

I don't think MilMed effects will be much different than civilian effects. All residency programs will now have different scoring metrics for how applicants are weighted. Higher shift towards clerkship grades (which aren't standardized between schools), Step 2 perhaps and even MCAT (woof).
 
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Iux

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Do you think they will really use the mcat, a test you took 4 years before starting residency, as a real screening tool for medical students who have successfully gone through a pre-clinical and clinical curriculum. The mcat wouldn’t be an accurate measurement of a medical student’s ability at that point in time.
 

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No. But if you have seen or heard the discussions ideas as crazy as weighing MCAT higher have been floated.

Honestly having Step I pass/fail won't be the worst thing in the world AS LONG AS it is made very transparent how programs are now going to objectively weigh applicants. That is what nobody knows yet. My guess is Step 2 just becomes the new Step 1. Probably better all around as it is more clinically oriented exam vice basic science and statistics heavy.
 
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Iux

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No. But if you have seen or heard the discussions ideas as crazy as weighing MCAT higher have been floated.

Honestly having Step I pass/fail won't be the worst thing in the world AS LONG AS it is made very transparent how programs are now going to objectively weigh applicants. That is what nobody knows yet. My guess is Step 2 just becomes the new Step 1. Probably better all around as it is more clinically oriented exam vice basic science and statistics heavy.
I guess medical students will have to take step 2 a little earlier to make it in time for the military match
 

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I actually foresee this hurting the above average to high performing student from a below average school. There will certainly be a bit of a bias towards “known entities” that rotate with a program, but in the past a great Step 1 score could really cause folks to potentially look less at what Med school was involved. As they say, a high performer at a “bad” Med school is still likely going to do fine, but a struggling learner at a bad school is a recipe for disaster. If you have less of a way to discriminate who is who then you’re going to have to look for other clues.

While I can understand the desire to make this change I think that it is going to be harder to stand out as a Med student.

In the end I’m sure people much smarter than me have done all this analysis and determined the end result is worth whatever drawbacks there are. Programs will adapt and find other discriminators, but for the military they have some work to do in regards to GMESB scoring once the change happens.




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Iux

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I actually foresee this hurting the above average to high performing student from a below average school. There will certainly be a bit of a bias towards “known entities” that rotate with a program, but in the past a great Step 1 score could really cause folks to potentially look less at what Med school was involved. As they say, a high performer at a “bad” Med school is still likely going to do fine, but a struggling learner at a bad school is a recipe for disaster. If you have less of a way to discriminate who is who then you’re going to have to look for other clues.

While I can understand the desire to make this change I think that it is going to be harder to stand out as a Med student.

In the end I’m sure people much smarter than me have done all this analysis and determined the end result is worth whatever drawbacks there are. Programs will adapt and find other discriminators, but for the military they have some work to do in regards to GMESB scoring once the change happens.




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Maybe just swap how they weigh step 1 with step 2 and also look at comlex for DO medical students
 

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Maybe just swap how they weigh step 1 with step 2 and also look at comlex for DO medical students
Step 2 isn’t required before match day from what I remember (someone please correct me if I’m wrong here as I don’t have the ‘schedule’ at hand)


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The problem is timing. Step 2 is so late that students will have to set up there awaits before they know their scores. Will matter most for the wannabe Derm, Ortho, ENT types. Will make school rep all the more important. Potentially a positive for USUHS students I suppose
 

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Maybe taking step 2 earlier will be the solution. PDs will need some sort of numerical value to screen applicants
 

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Yeah I have a feeling there will be a trend to taking Step 2 early since it is still scored. Previously if you had a high Step 1 you would delay the Step 2 as long as possible because it could only hurt you whereas if you had a low Step 1 you could take Step 2 early to show it was a fluke or you can improve. It may not be a hard requirement, but it will probably be a de facto one.
 
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Yeah I have a feeling there will be a trend to taking Step 2 early since it is still scored. Previously if you had a high Step 1 you would delay the Step 2 as long as possible because it could only hurt you whereas if you had a low Step 1 you could take Step 2 early to show it was a fluke or you can improve. It may not be a hard requirement, but it will probably be a de facto one.
Would taking it in July at the end of third year be early enough?
 

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The problem isn’t having Step2 done in time for selection, it’s having it done in time to guide the students 4th year strat
 

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Would taking it in July at the end of third year be early enough?
I can't answer this. I'm too far removed and it was never a concern for me. I am not familiar enough with the timing of the entire process. I know the military match occurs earlier so it may be harder to push for early Step 2 scores than in the civilian system, but again, I'm pretty ignorant on the details of how it could play out. I just know that, for civilian match anyway, it is possible to do Step 2 early enough that it can effect interview/match. With Step 1 being pass/fail, but Step 2 being scored I can see a push for programs wanting to see that Step 2.

While admitting ignorance to the process, I just can't fathom why they would make Step 1 pass/fail, but not Step 2 and 3 ... It just seams like a half measure to placate the "let's try not to be too competitive" folks while still allowing for the exact thing to continue to occur. And seriously, Step 3 isn't pass/fail? I mean it essentially is because I can't think of any scenario where someone cares about your Step 3 score. Pass = state license eligible regardless of passing by 1 point or 50 points.
 

Iux

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The problem isn’t having Step2 done in time for selection, it’s having it done in time to guide the students 4th year strat
Idk if this is a dumb question as I’m going to entering medical school in the fall. But when you say 4th year strat, do you mean having your step 2 done early enough to understand what specialties you are competitive for and devising a backup plan if you’re not competitive for your desired specialty? I know within the civilian match, having your step 2 done in July will allow you to have your score posted on your residency apps when they first go out on September 15th. What’s the equivalent date for the military match?
 

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Idk if this is a dumb question as I’m going to entering medical school in the fall. But when you say 4th year strat, do you mean having your step 2 done early enough to understand what specialties you are competitive for and devising a backup plan if you’re not competitive for your desired specialty? I know within the civilian match, having your step 2 done in July will allow you to have your score posted on your residency apps when they first go out on September 15th. What’s the equivalent date for the military match?
Yes, that's essentially what he is talking about. Students want to know if they are competitive for programs like Derm or Plastics before scheduling interview rotations at the beginning of fourth year.
 
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DrMetal

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maybe one day we'll stop using all of these tests, and judge students/applicants by: a) can they work hard? b) can they talk to another human being? c) can they exercise common sense. What a travesty that would be . . .
 

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maybe one day we'll stop using all of these tests, and judge students/applicants by: a) can they work hard? b) can they talk to another human being? c) can they exercise common sense. What a travesty that would be . . .
And how would you suggest one be able to accurately gather this data when you have one 30 minute interview or at most a 4 week rotation?

I’m not saying that isn’t important information though, as it is.


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And how would you suggest one be able to accurately gather this data when you have one 30 minute interview or at most a 4 week rotation?

I’m not saying that isn’t important information though, as it is.


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Work ethic is my big thing. I want the guy or gal who can demonstrate evidence of a strong work ethic, the student who's worked construction jobs for 60 hours/week, has dealt with people in a variety of stressful contexts, etc etc.

Also the applicant that does things other than medicine. When we talk about burnout among physicians, I often ask, what do you do outside of medicine? what do you like to read (don't say NEWJM, Annals)? what are you hobbies? You'd be surprised home often I get the deer in headlights look. And I can't help but think no hobbies? How did you go through 35 years of life without developing any other interests? Pass the whiskey . . .
 

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I don't agree with the above btw. If you're going to have the test, let it be scored, let it count for something, and let there be gradations to differentiate the good/bad/ugly. The problem here is now Step 2 will gain more emphasis (maybe that's a good thing) and in due time they'll probably require students to take Step 3 before graduating from med school (why not, there wasn't a whole lot of difference between 2 and 3. I know some interns who took it as early as October, only a few months removed from med school).
 

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I don't agree with the above btw. If you're going to have the test, let it be scored, let it count for something, and let there be gradations to differentiate the good/bad/ugly. The problem here is now Step 2 will gain more emphasis (maybe that's a good thing) and in due time they'll probably require students to take Step 3 before graduating from med school (why not, there wasn't a whole lot of difference between 2 and 3. I know some interns who took it as early as October, only a few months removed from med school).
The examination company sets when you can take the test and they require you to be a graduate to take Step 3, so I don’t see that happening. If they did this to step 1, they will shortly do it to Step 2 as well. The purpose of the “licensing exams” was purported to be for determining licensure competence. One doesn’t need a score for that, it’s a binary question.

Personally I’d rather see them go to a quartile type squaring and put people in large groups. Or even halve it, upper and lower or thirds or something. A weak score from a student at a weak school has some veracity to concerns for success. More and more schools are going to pass/fail so now you have applicants who essentially have zero useful academic data on an applications. Then you look at their Deans letter to see if they break out and no, you see that 90% of the class is on the right side of the graph and so even though they do have “honors” so does everyone else.




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I actually foresee this hurting the above average to high performing student from a below average school. There will certainly be a bit of a bias towards “known entities” that rotate with a program, but in the past a great Step 1 score could really cause folks to potentially look less at what Med school was involved. As they say, a high performer at a “bad” Med school is still likely going to do fine, but a struggling learner at a bad school is a recipe for disaster. If you have less of a way to discriminate who is who then you’re going to have to look for other clues.
It's a death sentence for IMGs, bad news for FMGs, and a disaster for lower tier med schools (of which DO schools are disproportionately represented).

It's also punishment for those med students who set lofty goals for competitive specialties and then back up those ambitions with intense hard work over an extended period.

In general the biggest proponents of P/F anything are people who have done poorly or who expect to do poorly. I don't really understand why any PD would get on board with the idea to get rid of the single objective data point they have to rank applicants, except that career educators tend to be a little more on the touchy-feely side of the bell curve, and people do dumb things to virtue signal.
 

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I have to wonder: if the trend continues toward P/F everything in medical school will some specialties start making their own entrance exams? Like if you want to do ortho or derm or neurosurgery or whatever there is a specific test run by the relevant board for admission to residency. Seems like it would be a big headache to create but they do all already do in service exams. Haven’t heard anyone suggest that before but it seems like a thing that could happen if program directors truly wind up with nothing but the schools reputation and an interview (and possibly an interview rotation) to judge people on.

Not that I’m advocating for that, I can see there being some major problems with a system like that. It just seems like a thing that could happen.
 

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it favors the graduates of the elite expensive private schools over the responsible kid who went to state u.
Money won’t come into play so much.

The most expensive schools are typically private ones. Many of the DO programs, many of the Carib, and lots of MD programs.

Some of the most expensive schools have some of the lowest reputations (DO and MD). For every Harvard and Penn there are double that many schools that are same cost and below average performers. And some of the state schools are up there with the best of ‘em.

What this will do is make the reputation of the medical schools much more important. Which is a bummer.

Many IMG/FMGs and DOs are going to get hurt by this. I understand the idea that the USMLE has elements of bias, but not nearly as much bias as medical school admissions has.
 

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When deciding between state U and an ivy, reasonable people could have argued for state U in the past due to the cost difference and relatively level playing field. Now, maybe not
 

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Money won’t come into play so much.

The most expensive schools are typically private ones. Many of the DO programs, many of the Carib, and lots of MD programs.

Some of the most expensive schools have some of the lowest reputations (DO and MD). For every Harvard and Penn there are double that many schools that are same cost and below average performers. And some of the state schools are up there with the best of ‘em.

What this will do is make the reputation of the medical schools much more important. Which is a bummer.

Many IMG/FMGs and DOs are going to get hurt by this. I understand the idea that the USMLE has elements of bias, but not nearly as much bias as medical school admissions has.
I agree, it'll be a bummer if medical school reputation starts counting for more. I'm curious how you think the USMLE is biased. In my estimation it is very objective; anyone can pick up a copy of first aid and memorize.
 

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The exam is objective but enough people complained that the ones who were doing well were either “good test takers” or people who had the money for prep courses. Selection bias?

I’ve met many people who are “bad test takers” yet are genuinely great people. Would I want them being my neurosurgeon, trauma surgeon or orthopedic surgeon? No, but I’d want them as my friend or colleague.

Our generation knew that step 1 was a make or break test. Therefore everyone knew that they had to spend as much time, money, effort, etc as possible to score well. First Aid costs 50 bucks. If you don’t have money for Kaplan or another course then spend your time memorizing it on your own. Those who didn’t score well either didn’t have the ability or consciously chose not to put in enough of the above to compete.

If you don’t like your career being hinged on a single test then don’t go in to medicine. You also might not have the intellectual, emotional or physical ability to make a split second decision to save someone’s life or let them die on the table.
 

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I’ve met many people who are “bad test takers” yet are genuinely great people. Would I want them being my neurosurgeon, trauma surgeon or orthopedic surgeon? No, but I’d want them as my friend or colleague.
.
You have any proof of correlation between Step 1 score and being a good/successful surgeon?

My guess is the folks looked at that and found there was none or minimal.

In my specialty they actually did a study and found that the final year of residency inservice exam had the best correlation with Board passage. (Not that Board Passage = good surgeon necessarily either)




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Our generation knew that step 1 was a make or break test. Therefore everyone knew that they had to spend as much time, money, effort, etc as possible to score well. First Aid costs 50 bucks. If you don’t have money for Kaplan or another course then spend your time memorizing it on your own. Those who didn’t score well either didn’t have the ability or consciously chose not to put in enough of the above to compete.

If you don’t like your career being hinged on a single test then don’t go in to medicine. You also might not have the intellectual, emotional or physical ability to make a split second decision to save someone’s life or let them die on the table.
Oh man, the classic "Back in my day..." argument. Are you seriously implying that those unable to memorize the Kreb Cycle or coagulation cascade don't have the intellectual ability to be good surgeons?

I also enjoy the "if you don't like it, get out," mentality.

Full disclosure, I agree it's a terrible idea to make the exam pass/fail for the multitude of reasons already outlined all over this forum and the web at large, but basically you need something, however imperfect, to stratify candidates for jobs. I just find it ironic that someone on this forum that champions military medicine and lectures others to 'stop complaining and improve the system!' then turns up his nose to others trying to improve a $hitty system.
 
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Oh man, the classic "Back in my day..." argument. Are you seriously implying that those unable to memorize the Kreb Cycle or coagulation cascade don't have the intellectual ability to be good surgeons?
Knowledge of the Kreb Cycle has no relationship to being a good surgeon, the ability to learn it does. Putting in the years steady, deliberate, and mostly solitary practice that allows you to memorize that knowledge and then reproduce it under pressure correlates very well with the ability to put in the years of steady, deliberate, mostly solitary practice that leads to surgical expertise.

You know what has no bearing at all on being a good surgeon? Research. There is no correlation between the quality of a neurosurgeon and their ability to churn out publications, its a completely different skill set. But that already overemphasized part of the application is going to be much more important now that they are getting rid of the application's most objective data point.
 
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Matthew9Thirtyfive

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The problem is timing. Step 2 is so late that students will have to set up there awaits before they know their scores. Will matter most for the wannabe Derm, Ortho, ENT types. Will make school rep all the more important. Potentially a positive for USUHS students I suppose
We take step 1 in Jan/feb of third year and half to take step 2 by oct/November of fourth year. So still kind of too late since new residency apps are due in August.
 

militaryPHYS

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Oh man, the classic "Back in my day..." argument. Are you seriously implying that those unable to memorize the Kreb Cycle or coagulation cascade don't have the intellectual ability to be good surgeons?

I also enjoy the "if you don't like it, get out," mentality.

Full disclosure, I agree it's a terrible idea to make the exam pass/fail for the multitude of reasons already outlined all over this forum and the web at large, but basically you need something, however imperfect, to stratify candidates for jobs. I just find it ironic that someone on this forum that champions military medicine and lectures others to 'stop complaining and improve the system!' then turns up his nose to others trying to improve a $hitty system.
How will this improve the system? USMLE even said in their press release they made the decision “For the overall experience of medical students” with nothing discussed about having a better way that they plan to objectively rank people. A ranking that determines access to training programs that take 3 to 7 years from someone’s life.

All of the other things used to weight the application are already there and used along side step 1. Take away step 1 score (objective, independent data point) and you’re going to run in to problems discussed by everyone else. Hurting IMG grads and grads who didn’t go to top schools, etc etc.

I only champion things that are proven to be good or useful to majority of people. Military medicine is NOT one of those things.
 
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militaryPHYS

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Same for ortho. Recent study showed strongest correlation with Step 2 for ortho.


Again, doesn’t matter what number it is or who writes the test, but there should be an agreed upon neutral, objective exam to rank applicants. Maybe all of the programs do know what the new system will be but haven’t shared it with the public. Until then I’m assuming they are making a change hastily before the end game is prepared. Kind of like sending out dependents and retirees to the community without fixing tricare reimbursement and ensuring access to civilian docs. :unsure:
 
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How does this affect the military match for DOs? Will it pretty much be the same as the civilian residencies where DOs are even more screwed now because they don’t have a good STEP 1 score they can showcase? Someone said in a different thread that the military is more friendly to DOs, but I was wondering how true that is.
 

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I believe they are going push the step changes back at least a year because the c/o 2023 residency application year will have applicants with a P/F score at schools that take step 1 at the end of third year and applicants with a numerical score at schools that take it at the end of second year. This will cause a huge headache for PDs and it won't be fair for applicants.
 

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Same for ortho. Recent study showed strongest correlation with Step 2 for ortho.
There should be no correlation. If someone's digging into my back, I wanna know how many cases they've done and their complication rate. Period. I don't give 2 craps about what they scored on a multiple choice exam 15 years ago.

It's an interesting psyche we physicians have. We seem to place more value on our test scores than on our experience. No other profession does this.

When looking for an engineer, we don't ask him what he scored on his PE 10 years ago. We ask how many bridges have you built?
A lawyer how many cases have you tried, their results?
A scientist, your publications and patents (not their GRE score).

An yet of our physicians, even 20 years out of school, we ask what was your Step 1 score, are you BC'd and doing MOC ?!

Well I'm glad I scored a 260 on Step 1, had a 4.0 in medical school, and won the Nobel prize as a student. I'm set for life.
 
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DrMetal

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some specialties start making their own entrance exams?
This is exactly what's going to happen. We're a test-taking-crazy bunch, we'll essentially have a bunch of 'mini-step' exams, maybe they'll use the shelf exams.
 
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There should be no correlation.
I think you're making the argument that multiple choice exam skills don't correlate to surgical competence. Sure, but in order to become a practicing surgeon (or most any board certified physician these days), you must be able to pass multiple choice board exams. That is where the correlation is being made.
 
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