Step 1 now will be P/F

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Was just talking with our PD about that exact question. There will likely be a time in the near future where everything we obtain from applicants' medical school and national tests will be a series of passes or fails. I think the away rotation and LOR will become significant factors in programs taking specific people.
 
personally dont understand this at all. Im a DO that crushed step 1, i know with 100% certainty that this was a large factor for why i was able to match to a solid anesthesia program. i fear that DO students now are completely ****ed. relegated back to primary care
 
THIS IS A GOOD THING.

With a standard deviation of 20 points, the test really is ****ty to begin with. Being able to show competency by passing a test that asks questions like "giving this drug will increase which of the following inside the cell - cAMP, cGMP, or AMP"... I mean wtf? I know some of you older gentlemen/woman didn't have to put up with this ****, but try to look outside the box for a minute. This WILL make stratifying students more difficult, yes. But maybe this is exactly the thing that will finally push us to stop opening up so many ****ty medical schools (like mine that opened up less than a decade ago), and start opening up more GME programs/spots. Then things will go back to the way they used to be, where students get to go into the field they are genuinely interested in. Right now, we really get put in a box of specialties we are competitive enough to get into instead of what we have a passion for. Leading to more, you guessed it, physician burnout. Yes, Mass Gen will figure out a way to stratify applicants. I promise. But take off the foggy glasses for 5 minutes and try to think about why PD's have to stratify applicants in the first place. Imagine if instead of having 1000 applicants per program, you only had 300 because there were more spots available for applicants. We have a worsening physician shortage anyway.

Sorry DO/IMG students. This really does screw you over.
 
It is a stupid test requiring you to memorize inane facts that you forget the day after you take it because you never use that information ever again. How many countless hours of energy and productivity have been wasted on that dumb exam? The nursing schools are running laps around us in making education more efficient and we’re sequestering ourselves in a library for 6 straight weeks memorizing the Krebs Cycle. It’s old world thinking. It’s time to move on.
 
GravelRider said:
It is a stupid test requiring you to memorize inane facts that you forget the day after you take it because you never use that information ever again. How many countless hours of energy and productivity have been wasted on that dumb exam? The nursing schools are running laps around us in making education more efficient and we’re sequestering ourselves in a library for 6 straight weeks memorizing the Krebs Cycle. It’s old world thinking. It’s time to move on.
Click to expand...

That’s what makes us a physician and them a nurse. A physician is more than medical facts.


Sent from my iPhone using SDN mobile
 
Here's a question, does step 1 score really matter to the level of skills\complexity a specialty requires? If not, then we can have people like as gasexplorer said, have people who actually really enjoy a certain specialty rather than who scrambled into another one because their score or match didn't work out because of scores. Could be an upside...
 
It's important to learn these things. Understanding basic physiology, chemistry, etc. of how the body works is a part of what makes our breadth of knowledge so much more than other health care workers. But to say that you should choose or exclude someone just because they may have forgotten a tiny detail of minutia is ignorant. Get a basic understanding of these things and show that you meet a certain level (pass) of competency. The test has a 20 point standard error (there's only ~90 between passing and the top score). Two applicants walk in, take the same exact test, answer every question the same except one student just happened to review x fact instead of y fact that the other student looked over. The test could possibly drop you up to 30 percentiles. How is this the right way to go about selecting residents? Why do old people always assume the current system is the best system. Are you so enamored in your almighty wisdom and experience that you cannot even attempt to look outside the box?
 
GravelRider said:
Memorizing the Kreb’s cycle makes us physicians? I don’t think so.
Click to expand...

It makes you stronger to future suffering, as what could be worse than memorizing useless pathways into the odd hours of the night. Gotta make those synapses!
 
GasExplorer said:
THIS IS A GOOD THING.

With a standard deviation of 20 points, the test really is ****ty to begin with. Being able to show competency by passing a test that asks questions like "giving this drug will increase which of the following inside the cell - cAMP, cGMP, or AMP"... I mean wtf? I know some of you older gentlemen/woman didn't have to put up with this ****, but try to look outside the box for a minute. This WILL make stratifying students more difficult, yes. But maybe this is exactly the thing that will finally push us to stop opening up so many ****ty medical schools (like mine that opened up less than a decade ago), and start opening up more GME programs/spots. Then things will go back to the way they used to be, where students get to go into the field they are genuinely interested in. Right now, we really get put in a box of specialties we are competitive enough to get into instead of what we have a passion for. Leading to more, you guessed it, physician burnout. Yes, Mass Gen will figure out a way to stratify applicants. I promise. But take off the foggy glasses for 5 minutes and try to think about why PD's have to stratify applicants in the first place. Imagine if instead of having 1000 applicants per program, you only had 300 because there were more spots available for applicants. We have a worsening physician shortage anyway.

Sorry DO/IMG students. This really does screw you over.
Click to expand...

You forget that the main stakeholder for this change is the AAMC. They are also the ones who initially caused this explosion in number of medical schools. Trust me, they aren’t looking out for the good of the profession.
 
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GasExplorer said:
It's important to learn these things. Understanding basic physiology, chemistry, etc. of how the body works is a part of what makes our breadth of knowledge so much more than other health care workers. But to say that you should choose or exclude someone just because they may have forgotten a tiny detail of minutia is ignorant. Get a basic understanding of these things and show that you meet a certain level (pass) of competency. The test has a 20 point standard error (there's only ~90 between passing and the top score). Two applicants walk in, take the same exact test, answer every question the same except one student just happened to review x fact instead of y fact that the other student looked over. The test could possibly drop you up to 30 percentiles. How is this the right way to go about selecting residents? Why do old people always assume the current system is the best system. Are you so enamored in your almighty wisdom and experience that you cannot even attempt to look outside the box?
Click to expand...

Sounds like someone’s a sh***y test taker.
 
ace_inhibitor111 said:
You forget that the main stakeholder for this change is the AAMC. They are also the ones who initially caused this explosion in number of medical schools. Trust me, they aren’t looking out for the good of the profession.
Click to expand...

The AAMC can now mask crappy applicants from all these fly by night MD schools they’ve managed to build in the last 15 years.

Oh just focus on helping each other and learning...BS.

They don’t want quality control anymore

an MD just became a little less valuable today...thanks AAMC. Good to know that when medicine needs a good back stabbing we will know whose wielding the knife

How will the cut off be determined? - I’m sure they won’t raise it

Do they still have a number they can use but just don’t reveal it?
 
Guess what some specialties suck less than others and will always have more applicants than spots. This was one of the few objective measures that could give someone a boost if they worked hard. Evals are subjective, P/F is meaningless. Think of all the bull**** tests you’ve taken to get to this point in a medical career. Now one that actually matters goes P/F?
 
GravelRider said:
Memorizing the Kreb’s cycle makes us physicians? I don’t think so.
Click to expand...

We're literally having to reteach everyone that lactate is actually a normal byproduct of catecholamine surges and that not every lactate elevation is pathologic, so I'm not sure your hot take that learning basic metabolism is worthless really holds up.
 
vector2 said:
We're literally having to reteach everyone that lactate is actually a normal byproduct of catecholamine surges and that not every lactate elevation is pathologic, so I'm not sure your hot take that learning basic metabolism is worthless really holds up.
Click to expand...

Dont use your sorcery babble here. Everyone knows lactate is from hypoperfusion duh.
 
Well this will finally put to rest all of those questions about cost vs prestige when choosing med school. Now more than ever prestige is all that matters. And people thought Yale med couldn’t get any easier....
 
GasExplorer said:
THIS IS A GOOD THING.

With a standard deviation of 20 points, the test really is ****ty to begin with. Being able to show competency by passing a test that asks questions like "giving this drug will increase which of the following inside the cell - cAMP, cGMP, or AMP"... I mean wtf? I know some of you older gentlemen/woman didn't have to put up with this ****, but try to look outside the box for a minute. This WILL make stratifying students more difficult, yes. But maybe this is exactly the thing that will finally push us to stop opening up so many ****ty medical schools (like mine that opened up less than a decade ago), and start opening up more GME programs/spots. Then things will go back to the way they used to be, where students get to go into the field they are genuinely interested in. Right now, we really get put in a box of specialties we are competitive enough to get into instead of what we have a passion for. Leading to more, you guessed it, physician burnout. Yes, Mass Gen will figure out a way to stratify applicants. I promise. But take off the foggy glasses for 5 minutes and try to think about why PD's have to stratify applicants in the first place. Imagine if instead of having 1000 applicants per program, you only had 300 because there were more spots available for applicants. We have a worsening physician shortage anyway.

Sorry DO/IMG students. This really does screw you over.
Click to expand...
There are a lot of already competitive specialties out there that don’t have a physician shortage. This actually hurts primary care where we actually do have a need. Now, many of the medical students who barely pass the thing with a 200 step score who would have been deterred and gone to primary care, instead, will go after more competitive specialties because they aren’t screened out yet. This just causes the number of applications for competitive specialties to go up and primary care to go down.

Yeah, there are dumb, minute facts to memorize for the USMLE that have little translation to actual clinical competency. But it’s a way for standardization that isn’t completely subjective, unlike LoRs/clerkship Evals which will likely become even more important with this change.
 
GravelRider said:
It is a stupid test requiring you to memorize inane facts that you forget the day after you take it because you never use that information ever again. How many countless hours of energy and productivity have been wasted on that dumb exam? The nursing schools are running laps around us in making education more efficient and we’re sequestering ourselves in a library for 6 straight weeks memorizing the Krebs Cycle. It’s old world thinking. It’s time to move on.
Click to expand...
The nursing education is running laps around us because they are willing to lower requirements and also they have little to no stratification in specialties. If you want to make medical school like nursing then have 6 year mbbs degrees with admissions straight from high school. Residency is a year long and afterwards we have unrestricted license to practice anything. Then doctors who want to practice advanced specialties just have to find a mentor to teach them. The time it takes to because a specialist like the mentor is arbitrary, simply based on when a doctor "feels ready". So just like an NP can be family practice today and psych or derm tomorrow based on whenever they feel like it. A doctor who feels ready to do plastic surgery can just start doing it, mentor or no, years of training or no.
 
What do you guys think this means for the class of 2023 students, such as myself, who may have an interest in anesthesia? Am I just going to have to crush my audition rotations?

Edit: Specifically DO students
 
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Some serious psychobabble here.......

"Our student, resident and physician members voted to endorse a pass/fail policy, in part, because we know our current residency selection system is causing significant distress for our students. The AMA is currently supporting new ideas in the transition from medical school to residency through our funding of the Reimagining Residency Initiative and our Accelerating Change in Medical Education Consortium. We look forward to working with our colleagues across the continuum of medical education in developing improvements in physician education transitions.”
– Susan Skochelak, MD MPH, Chief Academic Officer for the AMA
 
I think many Residency Programs will strongly prefer candidates who have taken Step 2 CK. This score will be used as a main factor for Matching at many competitive programs.

Perhaps, the AAMC will move up the Step 2 CK date so the score is available prior to applying to residency programs? If not, Med Students will either need to be from a Top 10-15 Med School or be extremely confident in their Step 2 CK prep so when the actual score is released that number/percentile would boost the applicant's chances.

I predict many specialties like Ortho, Derm, ENT, Neurosurgery, Urology, etc will all "highly recommend" a step 2 CK score be on file with the program prior to that program's committee meeting to determine the Match list.

As for interview selection that gets harder as well as the Step 1 was a good screening tool.

DO students should simply plan on taking Step 2 CK (the only Step exam they need) and crushing it. This will definitely help in Matching any specialty.

As for this rule change hurting primary care may I suggest that it will actually help primary care. Some med students will not do well enough on Step 2 CK to match into a competitive field. These students will all need "back-up" specialties in place like primary care and perhaps, Anesthesiology. The less competitive specialties will not require a Step 2 CK to MATCH so many med students will be needing that back-up choice IMHO.
 
madiso30 said:
What do you guys think this means for the class of 2023 students, such as myself, who may have an interest in anesthesia? Am I just going to have to crush my audition rotations?

Edit: Specifically DO students
Click to expand...

The Step 1 numerical score/percentile is available to those taking the exam in 2021. Will that be you? Simply take the exam prior to 12/30/2021 and the AAMC will issue you a numerical score.


" This policy will take effect no earlier than January 1, 2022 with further details to follow later this year." AAMC
 
The NBME Comprehensive Basic Science Examination (CBSE) is administered by many medical schools to identify students performing below expectations11 or to test student progress,12

we also found a significant positive correlation between the score during the NBME Medicine CSSE and the score in the USMLE Step 2 CK. There was also a significant correlation between the scores in the USMLE Step 1 and USMLE Step 2 CK. This correlation supports prior work done by Monteiro et al,18 who reported that the USMLE Step 1 is a significant predictor of the USMLE Step 2 CK score.


www.dovepress.com

[Full text] Predicting performance on the United States Medical Licensing Examinat | AMEP

Predicting performance on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge using results from previous examinations Humberto M Guiot,1,2 Hilton Franqui-Rivera1,3 1Division of Infectious Diseases, Department of Medicine, University of Puerto Rico School of...
www.dovepress.com www.dovepress.com
 
BLADEMDA said:
The Step 1 numerical score/percentile is available to those taking the exam in 2021. Will that be you? Simply take the exam prior to 12/30/2021 and the AAMC will issue you a numerical score.


" This policy will take effect no earlier than January 1, 2022 with further details to follow later this year." AAMC
Click to expand...
That's what I figured. Not gonna lie, got a bit scared by some rumors circulating around here, reddit, and my school that they may retroactively change our scores to P/F even if we take it in 2021. Sounds silly how that I think about it.
 
According to the USMLE, most medical students take Step 2 CK in their fourth year. Some students feel the best time to tackle the Step 2 CK is when clinical science knowledge from their rotations is still fresh in their minds.

HOW DO I APPLY?

The test is administered by appointment on a year-round basis. Once you begin applying, you’ll choose a three-month eligibility period for testing. You’ll get an email letting you know that your scheduling permit is available, and then you can visit the Prometric® test center website to schedule your test date.

The USMLE Step 2 CK can be taken at Prometric test centers worldwide. Keep in mind that your test center choices will depend on which part of the USMLE exam series you’re scheduling. Not all exams are offered at all centers.
 
BLADEMDA said:
According to the USMLE, most medical students take Step 2 CK in their fourth year. Some students feel the best time to tackle the Step 2 CK is when clinical science knowledge from their rotations is still fresh in their minds.

HOW DO I APPLY?

The test is administered by appointment on a year-round basis. Once you begin applying, you’ll choose a three-month eligibility period for testing. You’ll get an email letting you know that your scheduling permit is available, and then you can visit the Prometric® test center website to schedule your test date.

The USMLE Step 2 CK can be taken at Prometric test centers worldwide. Keep in mind that your test center choices will depend on which part of the USMLE exam series you’re scheduling. Not all exams are offered at all centers.
Click to expand...

Well I guess this will be the new metric.
 
IMHO, the best strategy is to plan on taking Step 2 CK in the early summer of your 4th year but I could see some students even taking it in June near the end of their rotations.

The results would be available by the time you apply for Residency.
 
RadsWFA1900 said:
I’m sure that’s a high bar.
Click to expand...

Maybe a screening tool used by Ortho, ENT, Neurosurgery and Derm, etc? This gives them a number to screen for interviews while waiting on the final Step 2 CK score. I doubt that actually happens because the more likely scenario is that med students must have their Step 2 CK score prior to being granted an interview with a recommended date of submission no later than October 01.
 
vector2 said:
We're literally having to reteach everyone that lactate is actually a normal byproduct of catecholamine surges and that not every lactate elevation is pathologic, so I'm not sure your hot take that learning basic metabolism is worthless really holds up.
Click to expand...

So you’re agreeing with me that memorizing the Kreb’s cycle for Step 1 is pointless, right? Because the current system doesn’t seem to be working as you are implying. I’m not saying that information is not important, I am saying how that information is taught and how that knowledge is measured is antiquated.
 
GravelRider said:
So you’re agreeing with me that memorizing the Kreb’s cycle for Step 1 is pointless, right? Because the current system doesn’t seem to be working as you are implying. I’m not saying that information is not important, I am saying how that information is taught and how that knowledge is measured is antiquated.
Click to expand...

I doubt you will convince most Residency Directors to abandon Step 2 CK scores as the new metric. Good or bad, like it or not, that score will make or break most Med Students' application to a competitive specialty.
 
BLADEMDA said:
Maybe a screening tool used by Ortho, ENT, Neurosurgery and Derm, etc? This gives them a number to screen for interviews while waiting on the final Step 2 CK score. I doubt that actually happens because the more likely scenario is that med students must have their Step 2 CK score prior to being granted an interview with a recommended date of submission no later than October 01.
Click to expand...

I’d make all students submit step 2 then if they can’t or won’t release step 1 scores. And I’d make damn sure the bar is set much higher. These med students need to be made aware that.

Stress doesn’t end because you took the MCAT.
 
I think the best solution for this problem is for each specialty to have SLOE type of evals where your performance on the rotations strongly reflects on the strength of your applications
 
bic_atlantis said:
I think the best solution for this problem is for each specialty to have SLOE type of evals where your performance on the rotations strongly reflects on the strength of your applications
Click to expand...
Except that is a terrible idea. Medical students are ROUTINELY underutilized and pushed to the side in favor of resident education. There is no place to actually shine on rotations...especially academic rotations.
 
MirrorTodd said:
Except that is a terrible idea. Medical students are ROUTINELY underutilized and pushed to the side in favor of resident education. There is no place to actually shine on rotations...especially academic rotations.
Click to expand...

Medical students are just above candy striper in the pecking order. They can’t do anything right

When they talk ... everyone else wants them to stop

When they don’t talk then everyone thinks they aren’t interested or dumb

When they give an answer it’s usually wrong and their notes and just superfluous and get in the way.

A lot of them are just learning how to behave in. Clinical environment

Rotation Evals are way too variable. An objective test is better for evaluating appitude is needed. Evals for rotation have a place but a different role in education
 
So as someone attending one of the newer osteopathic schools, does this make this impossible matching back to a program near my home state (new york), even if its one of the "malignant sweatshop" programs that normally accepts IMGS
 
MirrorTodd said:
Except that is a terrible idea. Medical students are ROUTINELY underutilized and pushed to the side in favor of resident education. There is no place to actually shine on rotations...especially academic rotations.
Click to expand...

Forget shining. Especially in the back of those huge roving gangs of white coats that roam the academic medical center halls, I couldn’t even hear most of the time.

The smaller rotations with only you and a resident/attending were much better.
 
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Given the absurdly high number of applications programs receive, there simply must be some kind of objective / quantifiable metric to sort through these when deciding who to invite to interview. My program has 14 PGY1 spots per year, this last cycle we received 1200 applications and interviewed about 150 people.

A P/F USMLE and an overall culture shift to softer more touchy feely metrics will only work if there is a cap on the number of programs applicants can apply to, as to allow more careful evaluations and readings of each applicant's letters. However at the end of the day we also need residents who we are confident can do pass their boards. Step 1 and step 2 are both strongly correlated with this. Yes it is our job to train them clinically, but we can't replace a weak overall medical knowledge base with a strong one.

I agree that some of the more esoteric things tested on step 1 are of dubious usefulness, but the reality is that even if students ultimately forget the specifics of the Krebs cycle or intracellular signaling pathways, having learned this material in depth at some point is still very important - it builds a certain "physiologic intuition" and understanding about how basic physiology and pharmacology work. This is an important framework that will be built upon in residency with more specialty-specific information - and is especially important to truly mastering the clinical science of anesthesiology.

I can't imagine where we would possibly begin if we had 1200 personal statements, letters of rec, and ERAS applications to sift through without any actual objective metric - like a step 1 cutoff - to at least get things started.

Other than Step 1 / 2, the next best thing are the third year clerkship grades, but these grades are becoming more and more useless as the grade distribution varies wildly from school to school. At some places 70% of students get an honors in their medicine / surgery rotations, while other places it's more like 15% max. When at applicant has all honors but so did half their class it really hurts that applicant because those honors grades are worth less. P/F schools are even more useless. The explosion of new DO schools of uncertain reputation where most all the students scatter across the country for 3rd year is even more of a problem because you now have a bunch of random different private practice attendings evaluating the students, making comparisons impossible.

So now with Step 1 moving to pass/fail, step 2 CK will effectively replace it as our initial screening metric. If I were an applicant interested in a highly competitive specialty or particular program this would stress me out even more than step 1 did. At least if you do so-so on step 1 you have a chance to (A) "redeem" yourself with a stellar step 2, or (B) re-evaluate your expectations and make sure you apply to a backup specialty.
 
GravelRider said:
So you’re agreeing with me that memorizing the Kreb’s cycle for Step 1 is pointless, right? Because the current system doesn’t seem to be working as you are implying. I’m not saying that information is not important, I am saying how that information is taught and how that knowledge is measured is antiquated.
Click to expand...

No, I don't agree, because the problem isn't necessarily the source material- it's the method in which it was taught. Perhaps when most people were cramming there wasn't a clinical correlate that made the information stick. Besides, most students who take Step I can't say with any real certainty which specialty they're going into or what kind of future research tracks they're interested in, thus the education has to be broad. The Krebs cycle may not be that important to anesthesiologists- but you may get a different story if you talk to people who went into endocrinology or genetics.

Not to mention, I worry that your argument may be prone to a reductio ab absurdum where piece by piece we do away with all the "irrelevant" knowledge until we become Nurses+ instead of physician scientists.
 
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