Step 1 P/F: Decision

[gamerEMdoc]

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Possible indirect consequences? Place your bets:

More students wanting a competitive specialty start taking a year off between M2 and M3 for research. Since everyone can’t do this, med schools are forced to create a research track based on grades, grant funding, lottery, etc. This track makes med school 5 years long, costing an extra year of tuition.

More Med schools convert to the 1.5 year pre-clinical curriculum, giving students more research or clinical time.

More medical students pursue dual degrees.

First-Aid revamps the Step 2 CK book series, one book, 800 pages.

Book sales for FA Step 1 stay the same due to paranoia of not passing.

Step 2 CK starts testing more basic science content.

Students focus so much on Step 2 CK during 3rd year, they read FA and see less patients.

Residences focus more on Step 2 CK score, research, publications.

Residencies start asking for NBME scores from preclinical years.

I dont think it's unreasonable to believe some fields won't create their own standardized test to have students take somehow. No idea how it would work. But I could see it happen for the fields that are uber-competitive that their isn't an shelf exam for.

 

[AnatomyGrey12]

Any ideas to pitch for how the NBME nefariously benefits from a Pass/Fail switch? Seems to me they stand to make a lot more off selling all their practice forms, and selling preclinical shelves to schools that are concerned about teaching to the step 1.

Field specific Shelf exams, making all DO's take the Shelf exams because of the new Importance on shelf exams, the creation of a new "aptitude test" like you've mentioned (hey another way to keep milking that med student cash cow right?), eventually force all DO students to take CK now (would be a large revenue increase since most don't take it).

There are many ways the NBME could generate a huge profit from this. Also, do you really think they will stop selling their practice tests?

I would not be surprised at all if schools started sending NBME shelf exam results in the MSPE. They already have that data, its easy to submit and it will be relatively objective. It also provides fields with specifics like interested in a surgical sub? how did you do on surgery shelf? Interested in OBGYN, how was the shelf?

It wouldn't surprise me if they started making additional shelf exams for specialties, essentially beating the field specific organizations to the punch with creating specialty specific entrance exams as was mentioned above.

I'd Keep up the grind, you know what the best predictor for a good step 2ck score is ? a Good Step 1 score.

While there are outliers, people don't really like to admit the fact that the people doing well on Step 1 are the people doing well on Step 2. It's not like They magically start scoring lower. The only difference is that the numbers will be visually higher. Want ortho? Better be 260+ on Step 2.

 

[gamerEMdoc]

Well according to AAMC, the difference between a 70 and 100 is no longer worth distinguishing according to them.

Got a pulse? Got a pencil? Here’s your MD.

These are the same people that thought residencies would like to have a score determined by a computer on how you answered questions to a webcam.

 

[workaholic007]

im still confused on who even benefited from this. No one did. Not the students, program directors, or anyone.

 

[gamerEMdoc]

So many possibilities of what could spur out of this decision. It's going to be the wild west for a few years while different fields scramble to come up with different ways to stratify students. There will be many students hurt while that process shakes out, I have no doubt.

 

[Lawpy]

 

[gamerEMdoc]

im still confused on who even benefited from this. No one did. Not the students, program directors, or anyone.

I barely look at board scores. In EM, I care about SLOEs above all else. I don't have a cutoff for rotations. I honestly don't care. But even I know, this is only going to hurt students, because many many many places and fields do care, and care quite a bit.

 

[ace_inhibitor111]

View attachment 295440

Ouch ouch Osler.

 

[Mass Effect]

Well according to AAMC, the difference between a 70 and 100 is no longer worth distinguishing according to them.

Got a pulse? Got a pencil? Here’s your MD.

Oh, the hysteria...

 

[BoneWizard]

View attachment 295440

How do I short Pathoma stock?

 

[ReturnToMed]

So who do we press F to pay respects to?

 

[Matthew9Thirtyfive]

I'm gonna keep it up. Who knows how long it'll actually take them to implement, what the push back will be, if the scores will retroactively be changed, etc. I have a feeling they used the specific language they did "it will be no earlier than January 2022" they don't want it to impact current students to a great extent. I think they want to try and get as many current students to take it as they can so that we go "according to plan".

Also, while step 1 info isn't ALL applicable to step 2, I think without having a good grasp of step 1 material killing step 2 would be hard.

And honestly, if you're an M1 now, you will probably take the scored version.

Depends on when they implement it. We take it in spring of third year, which is spring 2022 for me. So if they drop it right away, then I’ll probably be taking the p/f. But it’s very possible that I’ll still be taking the scored.

 

[Styrene]

I actually agree with this change. Step 1 has become a dumb competition of memorizing minutiae that is long forgotten after the test. The next step needs to be reducing the number of residencies students can apply to so that programs don't become overwhelmed with apps and require some new step 1-like metric to stratify applicants and can instead focus on the bigger picture of the applicant. My $0.02.

I definitely agree with that. I've been saying it for a while. Huge problem is that everyone just applies to tons of places. I'm guilty of it, too: I just filtered through NY and New England states and checked off every program I may ever reasonably consider attending.

And I had 250s.

 

[deleted941485]

Oh, the hysteria...

Watering down the process...one step at a time.

Like slowly boiling a frog.

 

[AnatomyGrey12]

View attachment 295440

Nah Pathoma is safe because it's so integral and bare bones. You still have to pass Step 1, and Pathoma will remain the pathology king.

 

[slowthai]

im still confused on who even benefited from this. No one did. Not the students, program directors, or anyone.

American Greed should do an episode on the NBME. I'd be the first to give an interview.
"Yeah, they took my house, they took my car...they even took my step score!"

 

[Styrene]

Whether good or bad, the consequences of this will be huge.

 

[redsox93]

View attachment 295440

I feel like pathoma would be safe. If you just have to pass step you probably only need pathoma level knowledge for path

 

[gamerEMdoc]

I definitely agree with that. I've been saying it for a while. Huge problem is that everyone just applies to tons of places. I'm guilty of it, too: I just filtered through NY and New England states and checked off every program I may ever reasonably consider attending.

And I had 250s.

Good in theory. But lets say there are 200 programs in a given field. What happens when 80% of the candidates all apply to the top 100. Then a huge portion of the candidates get only a few interviews. Having some way for students to know how competitive they are actually allows them to apply to places within their competitive window. If you have zero clue how competitive you are, how do you choose where to apply?

 

[Allosteopath]

I'm interested in FM, I'm sure it will be okay as a DO.

 

[BoneWizard]

Good in theory. But lets say there are 200 programs in a given field. What happens when 80% of the candidates all apply to the top 100. Then a huge portion of the candidates get only a few interviews. Having some way for students to know how competitive they are actually allows them to apply to places within their competitive window. If you have zero clue how competitive you are, how do you choose where to apply?

So what I'm hearing is after 2022, everyone is just going to shotgun their app to 200 programs.
🙁

 

[Cath Up]

why dont you create a thread in the x v y school to get some better opinions. This thread has some good chaotic energy that needs to remain chanelled. Its like twitter before twitter.

10 pages of thread in a single afternoon. Love it

 

[libertyyne]

So what I'm hearing is after 2022, everyone is just going to shotgun their app to 200 programs.
🙁

no, a lot of 22 people are going to either switch fields late , or they are going to end up taking a research year. Afterwards when step 2 ck becomes p/f

 

[libertyyne]

I'm interested in FM, I'm sure it will be okay as a DO.

are you ok with training in barbados?

 

[longhaul3]

Methinks not since part of this change is making Step 1 a requirement before taking Step 2

Interesting, didn't know that. That was their plan last we heard from the deans, which was about 4 months ago.

This only applies to CS. You will still be able to take CK before Step 1.

 

[libertyyne]

There was an applicant in Neurosurgery last year that churned out 80 publications in a research year, probably because he had a terrible step score.
If everything becomes pass fail, everyone is going to be that applicant.

 

[efle]

This only applies to CS. You will still be able to take CK before Step 1.

Ah, good catch. How funny that their system will be Step 2 CK --> Step 1 --> Step 2 CS when the entire premise of the Step order was that they each built off each other.

Guess it'll be a case study in whether doctors truly need to know the Step 1 basic science minutiae background first, in order to perform well on the actual clinical knowledge exam

 

[FindersFee5]

So i guess if you think about it having many small NBME shelves that get reported ,or they give you a cumulative shelf score at the end of preclinical and clinicals wouldnt be such a bad idea. It alleviates the issue with overreliance on one day of testing and spreads it out over 3 years. I dont think this might be such a bad idea.

Although problem would be that it would incentivize studying for the shelf even more. As it is, I already had classmates who were frequently agitated whenever there was any downtime on the floors because they "could be studying for the shelf at home right now."

And if school administrators thought PhD lecturers got upset about students being obsessed with a standardized test, wait until they start hearing the complaints of surgeons who are being ignored by an M3 doing anki.

 

[Lawpy]

Can curricula change to allow for Step 2 CK be taken in second year?

 

[Prehealth1011]

im still confused on who even benefited from this. No one did. Not the students, program directors, or anyone.

I expect an article from SGU this week about how DO's = Caribbean now and SGU based on it's "reputation" will prevail. This is a great time for Caribbean schools to confuse pre-meds to the island life.

 

[Styrene]

Good in theory. But lets say there are 200 programs in a given field. What happens when 80% of the candidates all apply to the top 100. Then a huge portion of the candidates get only a few interviews. Having some way for students to know how competitive they are actually allows them to apply to places within their competitive window. If you have zero clue how competitive you are, how do you choose where to apply?

Yes, I agree.

 

[libertyyne]

Although problem would be that it would incentivize studying for the shelf even more. As it is, I already had classmates who were frequently agitated whenever there was any downtime on the floors because they "could be studying for the shelf at home right now."

And if school administrators thought PhD lecturers got upset about students being obsessed with a standardized test, wait until they start hearing the complaints of surgeons who are being ignored by an M3 doing anki.

I mean you still need good evals. You need clinical evals more than you need preclinical evals.

 

[deleted941485]

There was an applicant in Neurosurgery last year that churned out 80 publications in a research year, probably because he had a terrible step score.
If everything becomes pass fail, everyone is going to be that applicant.

Yeah I’m sure he went back and forth with editors made changes or contributed anything more than a fleeting glance on these papers.

If someone had 80 pubs in 1 year, it wouldn’t be a step up it would be a red flag

 

[Phloston]

Poor and myopic decision IMHO from AMA here for several reasons:

1) Step 1 levels the playing field in the modern era. You can go to school anywhere, and as long as you work hard, you've got a shot at your dream residency. Now what? We return to a 1996, pre-internet era where institutional name matters that much more? This decision carries a thinly disguised anti-immigration mindset.

2) This won't decrease med student anxiety; it's just going to shift the focus/attention to 2CK. Now everyone will ignore Step 1 and just obsess over 2CK. In other words, 2CK will simply become what Step 1 is now. Emphasis on grades will also become greater. Rather than students fixating on boards, they'll simply fixate on their med school's out-of-touch lecture material instead.

3) Residencies will actually have less objective information available to them about qualified candidates. The layered effect of requiring numerical scores for Steps 1 + 2CK, with these exams assessing different aspects of knowledge, helps residencies evaluate candidates objectively. Grades are subjective at best and vary by institution. Without a Step 1 score, programs will look strictly at 2CK + grades. In turn, the process of applying to residency will become the same as applying to med school - i.e., everything rides on MCAT + grades; well for residency, everything will just be 2CK + grades.

4) This is probably the most important one: You're going to get doctors who are literally less educated. You cannot romanticize that 100% of the med student population is going to study their foundational concepts assiduously for fun. Most people function within the realm of practicality: "Ok, I did UWorld once and did decent. I've gotta focus on these random slides my professor put up. So, yeah, I'm done with Step 1 prep." Students will now ignore basic sciences and just study clinical material instead. You'll get MS1 students reading 2CK books without even understanding basic endocrine or pathophys anymore. Result is greater proportion of future doctors won't understand the mechanisms for the diseases they're treating.

 

[libertyyne]

Yeah I’m sure he went back and forth with editors made changes or contributed anything more than a fleeting glance on these papers.

If someone had 80 pubs in 1 year, it wouldn’t be a step up it would be a red flag

I mean the dude matched neurosurgery. Most medical students are publishing trash . This will just make it a battle of who has the largest pile of trash.

This is a great time to start a consulting business that helps medical students publish.

 

[Chibucks15]

Poor and myopic decision IMHO from AMA here for several reasons:

1) Step 1 levels the playing field in the modern era. You can go to school anywhere, and as long as you work hard, you've got a shot at your dream residency. Now what? We return to a 1996, pre-internet era where institutional name matters that much more? This decision carries a thinly disguised anti-immigration mindset.

2) This won't decrease med student anxiety; it's just going to shift the focus/attention to 2CK. Now everyone will ignore Step 1 and just obsess over 2CK. In other words, 2CK will simply become what Step 1 is now. Emphasis on grades will also become greater. Rather than students fixating on boards, they'll simply fixate on their med school's out-of-touch lecture material instead.

3) Residencies will actually have less objective information available to them about qualified candidates. The layered effect of requiring numerical scores for Steps 1 + 2CK, with these exams assessing different aspects of knowledge, helps residencies evaluate candidates objectively. Grades are subjective at best and vary by institution. Without a Step 1 score, programs will look strictly at 2CK + grades. In turn, the process of applying to residency will become the same as applying to med school - i.e., everything rides on MCAT + grades; well for residency, everything will just be 2CK + grades.

4) This is probably the most important one: You're going to get doctors who are literally less educated. You cannot romanticize that 100% of the med student population is going to study their foundational concepts assiduously for fun. Most people function within the realm of practicality: "Ok, I did UWorld once and did decent. I've gotta focus on these random slides my professor put up. So, yeah, I'm done with Step 1 prep." Students will now ignore basic sciences and just study clinical material instead. You'll get MS1 students reading 2CK books without even understanding basic endocrine or pathophys anymore. Result is greater proportion of future doctors won't understand the mechanisms for the diseases they're treating.

The anti-immigrant take is pretty bold...how SJW I’d you.

 

[gamerEMdoc]

So what I'm hearing is after 2022, everyone is just going to shotgun their app to 200 programs.
🙁

I mean this is what everyone complains about in EM. Because in EM, we use the SLOEs to determine competitiveness, not boards, but the SLOEs are blinded. So since students don't know what their SLOEs say, they over apply.

I can only imagine more P/F systems making the over-application process far worse. When students don't know where they stand, that's the natural reaction. I can't blame them either.

 

[longhaul3]

There was an applicant in Neurosurgery last year that churned out 80 publications in a research year, probably because he had a terrible step score.
If everything becomes pass fail, everyone is going to be that applicant.

The neurosurgery match is already way too much about research and is going to be 100% about research once this hits.

Can curricula change to allow for Step 2 CK be taken in second year?

There are a bunch of schools that do 1.5 years preclinical, 1 year clerkships, then Step 1, then senior electives. You take CK and CS some time during the last 14-15 months because they don't matter. They are in perfect position to just swap CK and Step 1 and keep the curriculum as is, with the caveat that you'd have to take Step 1 in enough time to pass and sign up for CS.

Or, since it won't matter anymore, just take it after the 1.5-year preclinical with no dedicated study period.

 

[FindersFee5]

I mean the dude matched neurosurgery. Most medical students are publishing trash . This will just make it a battle of who has the largest pile of trash.

This is a great time to start a consulting business that helps medical students publish.

I've been trying to figure out how to get an app off the ground that connects med students and undergrads wanting to do chart review/data analysis in exchange for authorship with researchers trying to farm out these menial tasks. Now might be the time to push forwards on that.

 

[libertyyne]

Ah, good catch. How funny that their system will be Step 2 CK --> Step 1 --> Step 2 CS when the entire premise of the Step order was that they each built off each other.

Guess it'll be a case study in whether doctors truly need to know the Step 1 basic science minutiae background first, in order to perform well on the actual clinical knowledge exam

I will say , i think my school admins knew as well. One of the clinical directors/advisors made an off handed comment to me about being hurt in a world where step goes pass fail last week. So it must have been on his mind.

 

[ciestar]

Can curricula change to allow for Step 2 CK be taken in second year?

I feel like taking this after third year really helped me prepare for this. The shelf exams and studying all of third year because stuff started making real-world sense. I was seeing what i was reading about

 

[Lawpy]

The neurosurgery match is already way too much about research and is going to be 100% about research once this hits.


There are a bunch of schools that do 1.5 years preclinical, 1 year clerkships, then Step 1, then senior electives. You take CK and CS some time during the last 14-15 months because they don't matter. They are in perfect position to just swap CK and Step 1 and keep the curriculum as is, with the caveat that you'd have to take Step 1 in enough time to pass and sign up for CS.

Or, since it won't matter anymore, just take it after the 1.5-year preclinical with no dedicated study period.

I'm trying to find a lot more room for Step 2 CK for planning purposes since Step 1 is now useless. So was thinking of getting Step 2 CK done ASAP but that would make it necessary to dramatically cut down the preclinical time since I don't know what other option would work.

I feel like taking this after third year really helped me prepare for this. The shelf exams and studying all of third year because stuff started making real-world sense. I was seeing what i was reading about

See above. I'm trying to find ways to get the clinical years done ASAP.

 

[AnatomyGrey12]

I've been trying to figure out how to get an app off the ground that connects med students and undergrads wanting to do chart review/data analysis in exchange for authorship with researchers trying to farm out these menial tasks. Now might be the time to push forwards on that.

When you sell said app for 100 million I fully expect you to pay for my tuition.

 

[FrankLake]

I wish they had a definitive date in place so I know what to plan for/expect over the next 4 years. I presume they put a lot of thought into this decision, so why not have a set date as well instead of a tentative one?

Also, like a poster mentioned here earlier, why not block the schools name from residency apps to avoid prestige bias?

 

[ReturnToMed]

I wish they had a definitive date in place so I know what to plan for/expect over the next 4 years. I presume they put a lot of thought into this decision, so why not have a set date as well instead of a tentative one?

Also, like a poster mentioned here earlier, why not block the schools name from residency apps to avoid prestige bias?

i doubt the people who championed the change are going to want their students harmed elsewhere. I think this could cause an increase in tuition at top tier schools now.

 

[libertyyne]

I'm trying to find a lot more room for Step 2 CK for planning purposes since Step 1 is now useless. So was thinking of getting Step 2 CK done ASAP but that would make it necessary to dramatically cut down the preclinical time since I don't know what other option would work.



See above. I'm trying to find ways to get the clinical years done ASAP.

you need to get accepted to medical school first.

 

[libertyyne]

I wish they had a definitive date in place so I know what to plan for/expect over the next 4 years. I presume they put a lot of thought into this decision, so why not have a set date as well instead of a tentative one?

Also, like a poster mentioned here earlier, why not block the schools name from residency apps to avoid prestige bias?

because that makes no sense. You participated in a reasearch lab in harvard for 3 years, all your LORs are from harvard faculty, and your address is listed as cambridge. Gee gosh, i wonder what school you went to.

 

[gamerEMdoc]

AAMC should block everything. Why discriminate against people that score poorly? Or don't do research? Or go to a school that isn't a top school. All apps should just say "medical student" and "passed". No name, no picture, no hobbies, no identifying information, and no means of stratification. Residencies should throw darts at apps to randomly select who to interview. This is clearly the only way to fairly select candidates.

 

[Alkaidius]

4) This is probably the most important one: You're going to get doctors who are literally less educated. You cannot romanticize that 100% of the med student population is going to study their foundational concepts assiduously for fun. Most people function within the realm of practicality: "Ok, I did UWorld once and did decent. I've gotta focus on these random slides my professor put up. So, yeah, I'm done with Step 1 prep." Students will now ignore basic sciences and just study clinical material instead. You'll get MS1 students reading 2CK books without even understanding basic endocrine or pathophys anymore. Result is greater proportion of future doctors won't understand the mechanisms for the diseases they're treating.

Spare me...a million other docs have done this in the past several decades with the Step 1 average around 200 and nobody batted an eye...a lot of docs don’t remember or care about pathophys anymore... It’s the school exams purpose to make sure students understand their basic pathophysiology. Changing Step 1 from graded to P/F does nothing to prevent med students from stressing about it. It is a difficult exam in its own right and will never be treated like CS. To begin with what distinguished high scorers from low scorers was minutiae not understanding of the concepts and not anything that made them better doctors. This has been repeated ad nauseam for years. I agree with all your other points.

 

[MedicineZ0Z]

One step in a better direction towards training better doctors. Step 2 SHOULD be more heavily emphasized.

Clinical medicine >> basic sciences (by a long mile). If you can pass step 1, you know all the basic science you could possibly need to know.