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Can someone explain a little more why low-tier MD/DO students get shafted? Please excuse my ignorance :angelic:

Edit: Thanks, @ruledaworlds
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PierreMD said:
Can someone explain a little more why low-tier MD/DO students get shafted? Please excuse my ignorance :angelic:
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If school prestige made some difference before, then a student with a higher step 1 score from a lower ranked school could arguably get into the same residency as someone from a higher ranked school. If everyone is going to pass before going into residency, how can you even differentiate applicants? Probably the biggest detail is the school that you attended--that directly plays into what type of clinical education you will receive and networking opportunities you have.
 
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FutureSurgical said:
Everyone seems like they're in favor of this decision in the MD subforums.
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What? No everyone agrees Step 1 mania was total crap and are glad it's dead. But the change is objectively bad for many reasons because of the vagueness surrounding it and now the shifted focus on Step 2
 
yungdoc said:
Serious question: would attending a #30 ranked school be a significant advantage over attending a #45 ranked school in light of this change?
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The problem with this sudden change is that we actually have no idea what the repercussions will be on the weight of school prestige in the new way residency programs assess candidates. I feel like the ranking or reputation of the school's specific department would matter more for applications as 45 vs 30 is not that big of a difference. However, this change might actually have a ripple effect on med school admissions this cycle and onwards. People who might have previously chosen to go to cheaper schools or lower ranked schools with scholarship might reconsider now.
 
If STEP2 CK suddenly has increased emphasis, my primary concern is how we're essentially moving our primary barometer of competitiveness for specialties/programs so much closer to the residency application deadline (unless I'm misreading the schedule). I feel like this will just increase the pressure on M1s/M2s to load up on ECs/research/research years without having a relative gauge of how competitive we really are until we get our STEP2 scores back.

Say your score is lower than anticipated. Doesn't the margin of error for increasing competitiveness through taking a research year, or doing more aways, etc. suddenly reduce to zero? We would have no way of "making up" for a lower score like in the past.
 
SeaHusky said:
If STEP2 CK suddenly has increased emphasis, my primary concern is how we're essentially moving our primary barometer of competitiveness for specialties/programs so much closer to the residency application deadline (unless I'm misreading the schedule). I feel like this will just increase the pressure on M1s/M2s to load up on ECs/research/research years without having a relative gauge of how competitive we really are until we get our STEP2 scores back.

Say your score is lower than anticipated. Doesn't the margin of error for increasing competitiveness through taking a research year, or doing more aways, etc. suddenly reduce to zero? We would have no way of "making up" for a lower score like in the past.
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Yeah this is the problem. The changes are completely and utterly idiotic because they shifted the panic and chaos from Step 1 to Step 2 with less time to prepare.

The common sense approach would be to change both exams to quartiles or P/F or keep both exams unchanged. You don't just change one exam and expect the problem to go away
 
DevinBookerMD said:
Can anyone tell me if this should change the school I pick? Deciding between UCI, BU, Einstein, and stony brook. On the waitlist for Keck. Is there a difference in prestige at any of these? I was going to pick UCI before this news fwiw.
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bump
 
renman97 said:
Not sure if this has been reported here or not, but it looks like USMLE has decided to make Step 1 P/F beginning in 2022. Rejoice!

Home | United States Medical Licensing Examination

www.usmle.org www.usmle.org
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****. I'm stuck in the midwest permanently now.

I really shouldn't have turned down all those interview invites 😱

Edit: Can someone tell me if I'll be fine at a T-40 school? I really rejected interview invites left and right for in-state tuition and now I feel like I might actually be screwed.
 
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From a current M4 standpoint, I would have much rather had the USMLE do away with step 2 cs versus making step 1 P/F. Yes, step 1 studying was a nightmare. But it gave you an early benchmark in regards to what residencies you might be able to consider. Your performance also gave you feedback and room for improvement on step 2.

I am a bit concerned about the logistics of this change. I agree with the sentiment above that step 2 CK will become the new step 1. Step 2 CK is much more clinically relevant anyway (you actually use the info you learn) and it should be weighted higher, in my opinion. Step 1 is a memory test while step 2 CK is better at testing how you think. However, this now becomes a one chance ordeal, which puts an insane amount of pressure on one day of your life.

Also, you traditionally take a good amount of dedicated time off to study for step 1 due to its importance. Step 2 CK? 4 weeks at most. Since people haven't taken this test quite as seriously as step 1, I think the curves have historically been a bit kinder. Now, if everyone starts gunning for step 2 CK like their life depends on it, I would predict that the average will increase dramatically.

It will also practically become mandatory that you complete step 2 CK before you submit ERAS (mid-September of 4th year). From the residency applicant standpoint, this score will be essential for you so you are applying to the right programs. This score will also be essential for residency programs as it is now the only standardized benchmark. Normally, people who have good step 1 scores can hold off on CK and complete away rotations prior to studying to get good letters of rec, go to programs they're seriously considering. People in my class took CK anytime from June through November. This change will really decrease 4th year flexibility, I would think May, June, July would be the dates for CK. Schools may have to change their schedules (impact TBD).

Lastly, Step 2 CK resources are also lagging behind (again less emphasis = less money going into these resources). Luckily UWorld is gold and Amboss will probably make a lot more money, but all the other resources I tried to use for Step 2 CK were mediocre at best.

I could just see this being a logistical nightmare.

Lastly, addressing the low tier question:
As a low tier medical student who got lots of love from "top" programs this season, I do think this freak out about low tier schools is unnecessary. If we're comparing a top 20 school vs. un-ranked, than sure, go top 20 if you like it there. But no one is splitting hairs. My step 1 was decent (enough so not to be a red flag), but I really think it was my research, extracirriculars, step 2 ck score, letters of rec and clerkship grades/comments that got me top interviews. There was zero mention ever of my step 1 score. I do agree that DO students and IMG/FMGs are more likely to be affected but I wouldn't freak out if you're going to a low tier school. There are lots of ways to stand out!
 
Robin-jay said:
They didn't used to.
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completely false. They've always mattered. What in fact didn't use to matter is Step 1, certainly not to the extent it does today, and any current attending physician will tell you the same.

if you think school ranking didnt matter in the current meta you havent been reading the match thread every year.

if you think this change will mean that every single slot at every competitive residency/specialty will be filled by T20 grads you are also living in a mathematically implausible fantasy land.

If you think theres nothing you can do to differentiate yourself as a medical student, it's because the meta for the past few years has been to do nothing substantial other than study for Step 1 for the greater part of preclinical. The school you go to can have a big impact on the resources available for you to distinguish yourself and people should probably consider that more heavily now.

The situation is genuinely nervewracking wrt DO and IMG students and we'll see what happens there.
 
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Lucca said:
completely false. They've always mattered. What in fact didn't use to matter is Step 1, certainly not to the extent it does today, and any current attending physician will tell you the same.

if you think school ranking didnt matter in the current meta you havent been reading the match thread every year.

if you think this change will mean that every single slot at every competitive residency/specialty will be filled by T20 grads you are also living in a mathematically implausible fantasy land.
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I know they always mattered, it was more of showing the terrible situation this has become. It has only "increased" in mattering, and that's bad. And probably to a much higher extent than simply T20 vs all other schools.
 
DevinBookerMD said:
bump
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I think this depends on what region you want to end up in. I've heard it's hard to get to the West coast for residency (particularly if you're not coming from a west coast program), so if your long term goal is to live on the west coast, I'd go to med school on the west coast.

Out of the other three, on the residency interview trail, I felt like Boston U applicants got the most respect. Plus, being in Boston, I think it helps you get looks from the Harvard hospitals for residency (if that's even an interest of yours). Granted, if you want to live in NYC, there were plenty of Stony Brook/Montefiore applicants when I interviewed in NYC.

In summary:
Residency west coast? Stay west coast for med school.
Residency in NYC? Any program, maybe slight advantage to NYC programs
Boston or elsewhere east coast? BU

Also look at their match lists! See where people in previous classes matched for residency.
 
All the speculation regarding lower tiered schools ONLY holds true if residency directors start caring more about school prestige. From a reasonable perspective, assuming PDs are rational, there are far better metrics of applicant analysis such as gpa, class rank, extracurriculars, LoRs, ability to be social and interview well and beyond before school prestige would even be considered. I think this change will emphasize LoRs, being sociable and likable, and interview capabilities to have similar weight with step 2 & 3. If this is true, this could filter out the robotic, awkward yet high achievers at prestigious MD schools.
 
It looks like current MS1s will be the last people to take a scored step 1. That's me. LOL.
 
Pstar9 said:
All the speculation regarding lower tiered schools ONLY holds true if residency directors start caring more about school prestige. From a reasonable perspective, assuming PDs are rational, there are far better metrics of applicant analysis such as gpa, class rank, extracurriculars, LoRs, ability to be social and interview well and beyond before school prestige would even be considered. I think this change will emphasize LoRs, being sociable and likable, and interview capabilities to have similar weight with step 2 & 3. If this is true, this could filter out the robotic, awkward yet high achievers at prestigious MD schools.
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GPA really won't matter besides being a weed out because most top ranked schools are P/F pre-clinical without ranking.

Unfortunately it looks like this change will serve as a disadvantage to minority students because appearance will be an important factor for clinical rankings.
 
Gregor_Mendel said:
It looks like current MS1s will be the last people to take a scored step 1. That's me. LOL.
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While you do have more pressure Step 1 is completely within your control.

I would rather take Step 1 than rely on my appearance and boot licking during clinicals.
 
Sunbodi said:
While you do have more pressure Step 1 is completely within your control.

I would rather take Step 1 than rely on my appearance and boot licking during clinicals.
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Looking at other threads, it looks like all reported scores will be p/f after 2022. In other words, we're ****ed.
 
Gregor_Mendel said:
Looking at other threads, it looks like all reported scores will be p/f after 2022. In other words, we're ****ed.
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The decision said this would take effect no earlier than January of 2022. So we don't actually know when this will take effect. Just that it will happen after December 31, 2021. Who knows, it could take a year or more before they implement it...
 
Gregor_Mendel said:
It looks like current MS1s will be the last people to take a scored step 1. That's me. LOL.
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Unless you go to a school like mine. We take step in 3rd year, so there will be a super small cohort of us trying to match in 2023 with only P/F while everyone else has scores. Hurray!
 
throwaway2020MD said:
Lol so the incoming class doesn’t even know whether to gun for step or spend time doing ECs.
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Definitely focus on ECs.

My school is P/F unranked for pre-clinical so I do not care what my grades look like so long as I pass. I'll spend every hour of my life in a lab instead. Thanks AAMC.
 
Pstar9 said:
All the speculation regarding lower tiered schools ONLY holds true if residency directors start caring more about school prestige. From a reasonable perspective, assuming PDs are rational, there are far better metrics of applicant analysis such as gpa, class rank, extracurriculars, LoRs, ability to be social and interview well and beyond before school prestige would even be considered. I think this change will emphasize LoRs, being sociable and likable, and interview capabilities to have similar weight with step 2 & 3. If this is true, this could filter out the robotic, awkward yet high achievers at prestigious MD schools.
Click to expand...





Most schools are shifting to pass/fail so no GPA and some schools don't report class rank. People used to use FREIDA and other services to determine which residencies to apply to based on step score so now that's not a thing. ECs have almost always taken a backburner to other factors. That leaves LoRs, research, Step 2, and clinical grades as things in your control and and two of those are influenced heavily by what school you attend. This will either lead to schools leaning heavily on step 2, or school reputation or a bit of both. Without a good standard metric it’s almost impossible to tell where you should be applying to residency when there’s no past history of other students. 2024 cycle gonna be a ****show unless they make significant changes across the board.
 
There are many issues with USMLE going pass fail for all DO students and mid/low tier MDs going into ANY field, especially competitive specialties and programs.

Random thoughts/predictions I have

- Every DO student effectively has to take USMLE Step 2 CK to maximize their residency prospects.

- DO and mid/low tier MD students have little to no school name brand, limited access to prestigious LORs, limited access to large academic departments + research. They must find a way to overcome these hurdles.

- Personal connections will play a much larger role in getting key audition rotations, interviews and matching. Prestigious personal connections are astronomically more difficult to get at DO or mid/low tier MD schools.

- The great equalizer, the USMLE step 1 score, was the opportunity for students at DO and mid/low tier MD schools to demonstrate their equivalency and/or superiority to students at top MD schools. That opportunity to overcome your school's lack of prestige/pedigree is now gone. It will be harder to get audition rotations and interviews from smaller schools.

- USMLE Step 1 scores come out after second year, giving students a year to game plan their audition rotations, LORs, research projects, and target programs based on their competitiveness. That is now gone, as most students will receive their Step 2 CK score after third year. Students lives will be more uncertain now and they will have little to no time to create a plan of action to maximize their chances to match to their dream programs. What if you score a 235-240 on Step 2 CK but have already set up 4 aways in Derm, started 4 research projects, etc? You will now have only 1-2 months to create a new game plan on where to do audition rotations, whether or not you want to apply to a back up, take a year off for research, etc.

- The NBOME has an opportunity to make COMLEX open to MDs. Objective metrics are important and have a place in education. While the USMLE step 1 scores were definitely overemphasized, the solution should not have been to eliminate the last remaining objective metric programs have, but rather to create additional standardized objective metrics through which programs could assess candidates in addition to STEP scores.

- USMLE Step 1 mania will now become Step 2 mania, I predict that schools will shorten preclinical education, start clinicals in second year, move Step 2 CK to beginning of third year and focus more overall on content tested on Step 2 CK. Hopefully clinical rotation grading, preclinical grading, Deans letters, and LORs become more objective and standardized so that programs have some type of metrics beyond just the Step 2 CK score to gauge academic/clinical acumen of applicants.

- This adds uncertainty for nearly all DO and mid/low tier MD students, making mental health more complicated moving forward. Now students will likely obsess over intangibles and subjective things like networking, LORs, research connections, etc. (again all of which disproportionately benefit elite MD schools/students). Students can no longer rely on themselves to perform well enough on STEP 1 to enhance their opportunities.

- The MCAT is now an extremely important exam for the future of a student. In the absence of LCME/COCA creating new objective academic metrics for program directors, medical schools will become more like law schools where prestige is an extremely important factor in determining where you end up post graduation.

In short, USMLE pass/fail solves little to nothing, complicating matters for students at smaller medical schools while shifting most of the problem to USMLE Step 2 CK

Moving forward

If you are running a DO or mid/low tier MD school, I would change curriculum so that preclinical education is compacted into year one, clinicals begin second year, and everyone takes USMLE Step 2 CK end of second year. I would also invest heavily in GME creation in both specialty and primary care , wet lab creation for research, research funding, creating partnerships/contracts with local universities to enhance research access.

If I was LCME/COCA I would develop standards and elements that create standardized objective metrics (standardized grading for preclincial and clinical years across all schools in country, standardized Deans letters, etc.) so that a student's competitiveness is based on a greater number of objective variables instead of just one (Step 2 CK).
 
Any speculation on knowledge that it would be a fixed score to pass or would it be percentile based on those who take the test?
 
Sunbodi said:
****. I'm stuck in the midwest permanently now.

I really shouldn't have turned down all those interview invites 😱

Edit: Can someone tell me if I'll be fine at a T-40 school? I really rejected interview invites left and right for in-state tuition and now I feel like I might actually be screwed.
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Dear god chill out you’ll be fine
 
swanthumb898 said:
Any speculation on knowledge that it would be a fixed score to pass or would it be percentile based on those who take the test?
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i don't think how they score will change, just how they report it. so a passing score by today's standard will be the benchmark you need to get. A passing score is like a 195(?) or something like that right now, so if you score 195 or above, you "pass".
 
So is there going to be any point of doing Step 1 as a DO now that it wont even matter anymore? lol
 
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Pstar9 said:
All the speculation regarding lower tiered schools ONLY holds true if residency directors start caring more about school prestige. From a reasonable perspective, assuming PDs are rational, there are far better metrics of applicant analysis such as gpa, class rank, extracurriculars, LoRs, ability to be social and interview well and beyond before school prestige would even be considered. I think this change will emphasize LoRs, being sociable and likable, and interview capabilities to have similar weight with step 2 & 3. If this is true, this could filter out the robotic, awkward yet high achievers at prestigious MD schools.
Click to expand...
This is some next level gunning. Telling other students that they don't have to worry about class rank or Step examinations but need to focus on being sociable and likeable because those are screening metrics that can be applied to thousands of applications in an objective manner. Very clever.
 
WaterFlow said:
Step 1 is required to take Step 2
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I know that applies to the conventional MD program, but I see people are able to even take Step 2 before they do Step 1 as potential IMGs. I feel like it might be similar for DOs. I know you have to take Step 1 and 2 for Step 3. But DOs dont need to do any of them to graduate. I'm not sure if DOs even bother to do Step 3.
 
BlueBerriess said:
I know that applies to the conventional MD program, but I see people are able to even take Step 2 before they do Step 1 as potential IMGs. I feel like it might be similar for DOs. I know you have to take Step 1 and 2 for Step 3. But DOs dont need to do any of them to graduate. I'm not sure if DOs even bother to do Step 3.
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Well you def need to take it to be eligible for step 3:

"To be eligible for Step 3, before submitting your application, you must:
  • pass Step 1, Step 2 CK, and Step 2 CS, AND
  • obtain the MD degree or the DO degree from an LCME- or AOA-accredited US or Canadian medical school, OR
  • obtain the equivalent of the MD degree from a medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and obtain ECFMG Certification.

    The USMLE program recommends that, for Step 3 eligibility, applicants should have completed, or be near completion of, at least one postgraduate training year in an accredited US graduate medical education program that meets state board licensing requirements."

source: United States Medical Licensing Examination | USMLE Bulletin | Eligibility
 
You know what has always been funny is that on this forum subsection we talk a lot about how only premeds really care about DO v MD. But on the topic of program directors being rational, how there are many "top tier academic" programs in a "competitive" specialty that will automatically screen you out for being a DO without taking a single look at any of your performance metrics. So frankly, I'm not sure what the precedent is in which we frame "rational" behavior but if it is by the aforementioned "designators" then I don't think it's conducive towards the attitude that there will be more sympathy for soft metrics and ruling out applicants from HYPS schools.
 
This video pretty much sums it up:



There definitely needs to be reform, but this change seems like an obscene miscalculation that will ignite nepotism, elitism, gunning, and increased barriers within the medical education system.

I am open to other viewpoints- is there something that I am missing here?
 
C. Diff said:
This is some next level gunning. Telling other students that they don't have to worry about class rank or Step examinations but need to focus on being sociable and likeable because those are screening metrics that can be applied to thousands of applications in an objective manner. Very clever.
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Did we read the same post? My post never said that. I now understand why CARS is so heavily emphasized.
 
BlueBerriess said:
So is there going to be any point of doing Step 1 as a DO now that it wont even matter anymore? lol
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WaterFlow said:
Step 1 is required to take Step 2
Click to expand...
BlueBerriess said:
I know that applies to the conventional MD program, but I see people are able to even take Step 2 before they do Step 1 as potential IMGs. I feel like it might be similar for DOs. I know you have to take Step 1 and 2 for Step 3. But DOs dont need to do any of them to graduate. I'm not sure if DOs even bother to do Step 3.
Click to expand...
WaterFlow said:
Well you def need to take it to be eligible for step 3:

"To be eligible for Step 3, before submitting your application, you must:
  • pass Step 1, Step 2 CK, and Step 2 CS, AND
  • obtain the MD degree or the DO degree from an LCME- or AOA-accredited US or Canadian medical school, OR
  • obtain the equivalent of the MD degree from a medical school outside the US and Canada that is listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and obtain ECFMG Certification.

    The USMLE program recommends that, for Step 3 eligibility, applicants should have completed, or be near completion of, at least one postgraduate training year in an accredited US graduate medical education program that meets state board licensing requirements."

source: United States Medical Licensing Examination | USMLE Bulletin | Eligibility
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"Exam prerequisite for Step 2 Clinical Skills
The USMLE program is implementing an examination prerequisite for Step 2 Clinical Skills (CS)—specifically, all examinees will be required to pass Step 1 in order to take Step 2 CS. Further details are forthcoming and this policy will take effect no earlier than March 1, 2021.

In taking this action, the USMLE Composite Committee, the governing body of USMLE, considered multiple factors to ensure that the program fulfills its ongoing mission to protect the public by providing medical licensing authorities with a secure, high-quality assessment of prospective physicians.

The committee reviewed data indicating that the vast majority of examinees routinely take and pass Step 1 before attempting Step 2 CS. Limiting access to Step 2 CS to those individuals with a track record of prior success on a USMLE Step protects the integrity of the exam and limits the time and resources examinees might commit unnecessarily without first having demonstrated success along the path to licensure. The committee also noted similar prerequisite policies in other exam programs for medical licensure, which require examinees to first pass a knowledge exam before a performance exam.

For more information regarding this policy change, please review the FAQs below."

Source: United States Medical Licensing Examination
 
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Pstar9 said:
Did we read the same post? My post never said that. I now understand why CARS is so heavily emphasized.
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It's okay, I'll take the ad hom in order to deride you for thinking that this will actually r/o any high achiever from a prestigious MD school. Also your statement about PDs being rational and then equating that to sociability and likability bearing the same weight as Step 2 and Step 3. I'm guessing no one makes an effort to call you out on this because you're so far gone it's too pointless to try to tether you back to reality.
 
Are they really gonna retroactively change scores from three digit to P/F? That seems like utter BS.
 
WaterFlow said:
"Exam prerequisite for Step 2 Clinical Skills
The USMLE program is implementing an examination prerequisite for Step 2 Clinical Skills (CS)—specifically, all examinees will be required to pass Step 1 in order to take Step 2 CS. Further details are forthcoming and this policy will take effect no earlier than March 1, 2021.

In taking this action, the USMLE Composite Committee, the governing body of USMLE, considered multiple factors to ensure that the program fulfills its ongoing mission to protect the public by providing medical licensing authorities with a secure, high-quality assessment of prospective physicians.

The committee reviewed data indicating that the vast majority of examinees routinely take and pass Step 1 before attempting Step 2 CS. Limiting access to Step 2 CS to those individuals with a track record of prior success on a USMLE Step protects the integrity of the exam and limits the time and resources examinees might commit unnecessarily without first having demonstrated success along the path to licensure. The committee also noted similar prerequisite policies in other exam programs for medical licensure, which require examinees to first pass a knowledge exam before a performance exam.

For more information regarding this policy change, please review the FAQs below."

Source: United States Medical Licensing Examination
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Ah so it will be a pre req in the upcoming years, good to know. Guess that conflicts with past online posts.
 
unclened said:
This video pretty much sums it up:



There definitely needs to be reform, but this change seems like an obscene miscalculation that will ignite nepotism, elitism, gunning, and increased barriers within the medical education system.

I am open to other viewpoints- is there something that I am missing here?
Click to expand...

says he doesn't have an opinion yet, he needs time for research, and talks even about the confirmation bias......... proceeds to state his opinion and evidence that confirms his bias =P
 
ObjectiveBoba said:
I'm curious if making Step 1 P/F will have upstream effects on medical school admissions. The main argument for placing such an emphasis on the MCAT was its correlation with Step 1 so it's possible that medical schools may de-emphasize the MCAT as well.
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That's actually a fallout fear of my mine. Although, I think , like passing step is hard enough that scoring the MCAT makes sense ( as in, somebody should still break 505 or something to have a high enough chance of merely passing step I- I also feel like the threshold for passing may be increased. Also- dedicated time would still be used to study for Step- isn't passing not easy, orc it's easier than getting a groundbreaking score, but it isn't like , chill.
 
I'm not sure that medical school prestige is going to be the new factor that residencies care about. Generally when there is a competitive selection process and they get rid of objective measurements, the point is to increase racial/ethnic diversity. If you're a high achieving white or asian medical student regardless of where you go to school, it's likely that you will now be at a greater disadvantage when trying to match.
 
Its always been said it doesn't matter where you go to medical school but where you go to residency. People have been told to go to a cheaper school. Take a scholarship offer or just go to your state school. Not any more.

Big blow to DO schools and low tier MD schools. Even mid tier MD schools I feel like will have an effect.
 
tri99 said:
As an admitted DO with one pending MD decision this just made the anticipation 10x worse
Click to expand...

DO won’t change. Goodbye MD students who do bad on step 2 when DOs don’t. Goodbye FMG and Caribbean.
 
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