Step 1 P/F: Decision

[gulli_97]

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Gunners, we must petition

 

[ace_inhibitor111]

Ok... and how many residents would pass step 1? Attendings?
Canada doesn't have step 1 and we consider their doctors to be American equivalents. Many other Western countries don't have anything similar and produce excellent physicians as well.

I also disagree that you don't need a relatively strong knowledge base to pass the exam. Your n = 1 anecdote is just silly and the whole "I know nothing" example is even more silly. The vast majority of USMLE questions are quite difficult. Without a relatively strong knowledge base, you wouldn't pass. All those super rare zebras and detailed drug mechanisms aren't things you will even remember.


I also think it's VERY silly and borderline insanity that we spend all that time in medical school just memorizing detailed rare facts so we can do well on an exam that's just a means to an end. A proper education system would use that time to make you into a better doctor.

How many surgeons would pass Step 2 CK I wonder? Do you think they’ve still memorized CHADS2VASC or do they just use medcalc

 

[AnatomyGrey12]

I disagree

An attending/resident in any general medicine field should be able to pass Step 1. Full stop. Now an orthopid, psych, neurosurgeon, or other sub specialty field attending, whose wheelhouse is far outside the scope of really anything taught heavily in medical school then sure they might not pass. My money would be that they still do. That brings up my second point.

and

Step 1 doesn’t really require some strong knowledge base to pass. A medical student that has paid attention in pre-clinical and done a few practice questions should be able to simply pass the exam. I was already at a passing level 6 months before my test date.

 

[efle]

I mean I've met residents who scored great and laugh about how they've forgotten everything from Step 1. I had to remind my Derm resident what primary ciliary dyskinesia/kartagener's was this week, and for Step prep not only did I need to know it and what it presented with but WHAT PART of the ciliary motility mechanism the mutation was in.

Less educated docs from this? Gimme a ****ing break. I knew my stuff and scored well and I've forgotten a huge chunk already in the last year. Anyone telling themselves or others that they're going to be better doctors than someone who got 20 points lower should be ashamed.

Edit: Agree with the above sentiment that it's quite easy to Pass. A 194 is not a hard target if you passed your school's exams. But, that doesn't mean we should jack up the fail rate unless we see some data that's an inadequate standard. Remember that most of the mentors training current 250s in their residency had an average of ~200 on the Step, if they even took it. We should be seeing this as a sign that we're educated about the basic science foundations far in excess of what actually needs to be known a couple decades down the road, not that all our best academic center mentors are dangerously ignorant.

 

[ak427]

This^^ the dean at my school sits on the NBME board along with other sdner faculty. It will be reported in ERAS as P/NP. They would not let entire classes go into the match with a P and others with a score, and it’s even more unlikely they just “forgot” some schools take step 1 during 3rd year

Not sure I agree with this. They let some schools rank their students pre-clinically while other schools don’t report it. Not sure how this is different

 

[BoneWizard]

The actual date doesn't matter, so long as it's between January 1 2022 and ERAS being sent out in Autumn 2022. They can pick any deadline date they want and this will apply it to everyone in the Sept 2022-March 2023 cycle. That's probably why they worded it "no earlier than Jan 1 2022," really they'll just pick whatever date they think is best between January and September. I'd predict something like May when they do their yearly question bank update.

So this will shaft:
Current M1s
MSTPs
BS-MDs
MS2's taking a research year

 

[readmypostsMD]

Does anyone see any pros to this? All ivd read about are cons

 

[subdermallight]

The actual date doesn't matter, so long as it's between January 1 2022 and ERAS being sent out in Autumn 2022. They can pick any deadline date they want and this will apply it to everyone in the Sept 2022-March 2023 cycle. That's probably why they worded it "no earlier than Jan 1 2022," really they'll just pick whatever date they think is best between January and September. I'd predict something like May when they do their yearly question bank update.

Oh. I’m still learning about how this works. You’re saying that ERAS “reporting” is what they are referring to, rather than simply the act of “reporting” your score as either numerical or P/F. That would make sense because then the whole cycle would be consistent, if it was based on ERAS reporting. Yikes, so potentially class of 2023 would have P/F.. Damn I hope they clarify soon

 

[anbuitachi]

step 2 will now decide your futures!

 

[gulli_97]

Does anyone see any pros to this? All ivd read about are cons

All the people commenting on this thread are gung-ho about competitive residencies and a P/F step makes the process seem much less objective.

I would say the pros are for those who wish to have a more relaxed preclinical years and less emphasis on standardized exams

 

[ace_inhibitor111]

I mean I've met residents who scored great and laugh about how they've forgotten everything from Step 1. I had to remind my Derm resident what primary ciliary dyskinesia/kartagener's was this week, and for Step prep not only did I need to know it and what it presented with but WHAT PART of the ciliary motility mechanism the mutation was in.

Less educated docs from this? Gimme a ****ing break. I knew my stuff and scored well and I've forgotten a huge chunk already in the last year. Anyone telling themselves or others that they're going to be better doctors than someone who got 20 points lower should be ashamed.

These examples don’t say much. I was working with a cardiologist who didn’t remember the diagnostic criteria for pancreatitis (and that’s kinda important). People obviously forget things they don’t use. Medical school is not supposed to teach to any specific specialty but instead touches on all of them.

Also, I used to complain about how broad everything is, but it makes sense. Even if you subspecialize, you never know if you’ll be the last doctor your patient sees before **** hits the fan. You don’t want to be the orthopedist who misdiagnoses an arterial thrombus as plantar fasciitis (true story).

 

[efle]

These examples don’t say much. I was working with a cardiologist who didn’t remember the diagnostic criteria for pancreatitis (and that’s kinda important). People obviously forget things they don’t use. Medical school is not supposed to teach to any specific specialty but instead touches on all of them.

Is he a good cardiologist? Clearly he wouldn't pass step 1 right now if he doesn't even remember bread and butter, life-threatening step 2 CK stuff. I feel like this kind of thing proves the point that using step to screen for cardio fellowship is utter nonsense.

 

[cybermed2424]

Oh. I’m still learning about how this works. You’re saying that ERAS “reporting” is what they are referring to, rather than simply the act of “reporting” your score as either numerical or P/F. That would make sense because then the whole cycle would be consistent, if it was based on ERAS reporting. Yikes, so potentially class of 2023 would have P/F.. Damn I hope they clarify soon

so if rank lists are made after January are current m2s even safe???

 

[efle]

So this will shaft:
Current M1s
MSTPs
BS-MDs
MS2's taking a research year

Could potentially game this as a current MS2 interested in competitive specialties. Take step, score great? Apply. Take step, don't score great? Research year, now it's a Pass.

But yeah I believe for the 2022 ERAS everyone will be put on equal footing with all of them showing only Pass, even if they got a triple digit score years ago.

 

[efle]

so if rank lists are made after January are current m2s even safe???

Current M2s will be fine. ERAS for you will go out in 2021 showing your scores.

 

[39djdjcnd9]

Not sure I agree with this. They let some schools rank their students pre-clinically while other schools don’t report it. Not sure how this is different

This is no where near the same. RDs looking at apps with a 230,P, then a 245, and another P is not going to happen. There are some top MD schools that take step 1 third year. They have too big of a piece of the pie to let that happen. Either they will make all eras apps report numerical values or as PF

 

[efle]

This is no where near the same. RDs looking at apps with a 230,P, then a 245, and another P is not going to happen. There are some top MD schools that take step 1 third year. They have too big of a piece of the pie to let that happen. Either they will make all eras apps report numerical values or as PF

Yeah for the people saying it makes no sense to retroactively change scores...why? Any examples why it would be problematic to the NBME? The only issues I can think of would all arise from having a mixed cohort where some people got to display scores and some didn't.

 

[ace_inhibitor111]

Is he a good cardiologist? Clearly he wouldn't pass step 1 right now if he doesn't even remember bread and butter, life-threatening step 2 CK stuff. I feel like this kind of thing proves the point that using step to screen for cardio fellowship is utter nonsense.

Yes, he was amazing at what he did. It’s impossible to remember everything. Knowing what you don’t know is a strength not a weakness.

And yes, I’m pretty sure he’d pass Step 1. The questions are super obvious and will probably have 3/3 criteria for pancreatitis. I can see Step 2 putting a normal lipase just to mess with test takers.

 

[efle]

Does anyone see any pros to this? All ivd read about are cons

I mean, the big one: the test can no longer be used like it has been for screening and ranking. It was never meant to be used this way, in fact they've explicitly stated many times NOT to use it like it currently is. For the next few years things could be chaotic. But for all the future student doctors of 5+ years down the road, this is a completely necessary change. People are going to look back and laugh at how stupid it was for the way to distinguish oneself being tens or hundreds of thousands of First Aid flashcards and three Q-banks.

 

[efle]

Yes, he was amazing at what he did. It’s impossible to remember everything. Knowing what you don’t know is a strength not a weakness.

And yes, I’m pretty sure he’d pass Step 1. The questions are super obvious and will probably have 3/3 criteria for pancreatitis. I can see Step 2 putting a normal lipase just to mess with test takers.

Man you are off your rocker if you think someone who did an IM residency and forgot pancreatitis criteria, could survive step 1. It's not that rare to fail, 5% of US MS2s-MS3s fail it on their first try. He certainly doesn't sound like he could beat even 1 in 20 of us.

 

[ace_inhibitor111]

Yeah for the people saying it makes no sense to retroactively change scores...why? Any examples why it would be problematic to the NBME? The only issues I can think of would all arise from having a mixed cohort where some people got to display scores and some didn't.

So if the change is implemented onJanuary 1st 2022, applicants can submit their scores on September 15th 2021, and then all their scores will switch to Pass before ranklists comes out? Hows that going to work, and why did they pick January 1st, and not the month of ERAS opening to make that change. The timing would make more sense if all future test takers have a pass fail score.

 

[ak427]

Who knows if it’ll even be January 2022. There’s a possibility it could be mid to late 2022, which in that case, all of the applying class of 2023 (even people who take Step 1 in their 3rd year) would have real scores when the apply to residency.

 

[efle]

So if the change is implemented onJanuary 1st 2022, applicants can submit their scores on September 15th 2021, and then all their scores will switch to Pass before ranklists comes out? Hows that going to work, and why did they pick January 1st, and not the month of ERAS opening to make that change. The timing would make more sense if all future test takers have a pass fail score.

The 2021 ERAS data containing all the scores will be out before January 1st. Any programs that want to recheck people's scores to rank will have already had the data sitting there for months.

They can't just make it prospective because then people taking it at different times could fall on different sides of the deadline, but still apply together. For example schools who take it after M3, or MSTP applicants. They have to just pick a day in 2022, prior to Sept 2022, to change it all to Pass for the Sept 2022-March 2023 cycle.

 

[ace_inhibitor111]

The 2021 ERAS data containing all the scores will be out before January 1st. Any programs that want to recheck people's scores to rank will have already had the data sitting there for months.

They can't just make it prospective because then people taking it at different times could fall on different sides of the deadline, but still apply together. For example schools who take it after M3, or MSTP applicants. They have to just pick a day in 2022, prior to Sept 2022, to change it all to Pass for the Sept 2022-March 2023 cycle.

But once scores are given out, transcripts can be purchased and shared if applicants are bold enough to do so. I think retroactively taking away Step scores would result in just as much of an uproar as having them in the same cycle. It is not immediately obvious that they’d pick the former over the latter.

 

[efle]

By the way to give some numbers about what score differences mean.

The test is roughly scaled to 1 point per 1 question. Per the NBME the pass threshold is maintained at 65-70% correct, which lines up with the current 194/280 (69%).

That means a 230 vs 250 is a difference on 7% of test items. Wow, yeah, vastly superior. Even the diehard step 1 fans have always agreed that there's at least a couple questions per block of trivia, that's why religious flashcarding took hold. The idea that one student should have access to any specialty while the other is shut out of most surgical fields is absurd.

 

[ace_inhibitor111]

Man you are off your rocker if you think someone who did an IM residency and forgot pancreatitis criteria, could survive step 1. It's not that rare to fail, 5% of US MS2s-MS3s fail it on their first try. He certainly doesn't sound like he could beat even 1 in 20 of us.

Pattern recognition is easy, and that’s 90% of Step 1. Memorizing diagnostic criteria and indications/contraindications can take some brushing up

 

[efle]

But once scores are given out, transcripts can be purchased and shared if applicants are bold enough to do so. I think retroactively taking away Step scores would result in just as much of an uproar as having them in the same cycle. It is not immediately obvious that they’d pick the former over the latter.

Could make it a match violation to send external transcripts/score reports (note that on your report up in the top it explicitly says in giant letters that this does NOT count as an official means of sending score to programs). Or, could just trust PDs not to trust random screenshots or PDFs from applicants.

It seems extremely obvious to me that a mixed cohort is intolerable. It'd be a class action lawsuit in about five seconds.

 

[efle]

Pattern recognition is easy, and that’s 90% of Step 1. Memorizing diagnostic criteria and indications/contraindications can take some brushing up

Ah right, that's why the 30,000 card deck that people do several times through is for Step 2 CK, right? Come on, man.

 

[Med Ed]

Now how do @efle @Lucca @Goro @Med Ed @AnatomyGrey12 respond to this?

 

[ace_inhibitor111]

Ah right, that's why the 30,000 card deck that people do several times through is for Step 2 CK, right? Come on, man.

What are you saying here? We’re talking about passing Step 1. You don’t need to do a 30,000 card deck to pass Step 1. Lol. Maybe all this is Zanki’s fault?

 

[BoneWizard]

Could make it a match violation to send external transcripts/score reports (note that on your report up in the top it explicitly says in giant letters that this does NOT count as an official means of sending score to programs). Or, could just trust PDs not to trust random screenshots or PDFs from applicants.

It seems extremely obvious to me that a mixed cohort is intolerable. It'd be a class action lawsuit in about five seconds.

Just have it included in your MSPE

 

[efle]

At least give us your take on whether they're going to wipe scores in 2022, versus allow a mixed cohort of scored and Pass

 

[efle]

What are you saying here? We’re talking about passing Step 1. You don’t need to do a 30,000 card deck to pass Step 1. Lol. Maybe all this is Zanki’s fault?

I'm saying there's plenty of "brushing up" on details needed for Step 1 as well. Keep in mind the average and the pass threshold are separated by about 10% of test items.

 

[Gilakend]

From twitter: apparently, someone called and they will NOT retroactively make scores only pass/fail only. If you take it and get a score, that score will be reported to residencies.

 

[hormonemonster]

It seems extremely obvious to me that a mixed cohort is intolerable. It'd be a class action lawsuit in about five seconds.

Assumption: Examiners changed the test to refocus medical education away from an overemphasis on Step 1
Conclusion: If Step 1 is not scored for applicants to ERAS 2022-2023 (current M1s), then this cohort, in particular, will be disadvantaged because their entire medical curriculum right now is built to support Step 1 success. ERAS 2023-2024 would be all Pass/Fail and medical schools will have the time to make some changes to the curriculum for this new class to maximize their student's odds in the Step 1-less application cycle (ie. more clinical exposure, more time for Step 2). Therefore, I do not think they will retroactively change scores.

 

[Gilakend]

I'm saying there's plenty of "brushing up" on details needed for Step 1 as well. Keep in mind the average and the pass threshold are separated by about 10% of test items.

Don't you think one reason people need to study so much less for step 2 though is because of how well they studied for step 1? I find it hard to believe someone who got a 210 on step 1 could just study hard for a couple of weeks for step 2 and get a 260 on step 2. I feel like the basis of learning the content for step 1 really well still would help. You just wouldn't need all the minutia that is in a step 1 deck. But for a lot of step 2 decks a good portion of the cards are step 1 review.

This is from an M1, I know nothing. Just trying to learn a little more in the midst of this change.

 

[workaholic007]

From twitter: apparently, someone called and they will NOT retroactively make scores only pass/fail only. If you take it and get a score, that score will be reported to residencies.

someone else on here said their dean told them they will retroactively change it cause their dean worked with whoever changed it to pass fail in the first place

 

[Gilakend]

someone else on here said their dean told them they will retroactively change it cause their dean worked with whoever changed it to pass fail in the first place

Well, I am once again just lost in this charade

 

[efle]

Would not buy into any Twitter hearsay unless it's from some kind of medical ed faculty. Someone in the thread emailed them early and they just got a repeat of what's on the INCUS page.

Assumption: Examiners changed the test to refocus medical education away from an overemphasis on Step 1
Conclusion: If Step 1 is not scored for applicants to ERAS 2022-2023 (current M1s), then this cohort, in particular, will be disadvantaged because their entire medical curriculum right now is built to support Step 1 success. ERAS 2023-2024 would be all Pass/Fail and medical schools will have the time to make some changes to the curriculum for this new class to maximize their student's odds in the Step 1-less application cycle (ie. more clinical exposure, more time for Step 2). Therefore, I do not think they will retroactively change scores.

Again, though...if you were at a school like Penn and got told that your Step was going to show as a Pass while peers like Hopkins got to flaunt their 250s, would you take that sitting down?

 

[efle]

Don't you think one reason people need to study so much less for step 2 though is because of how well they studied for step 1? I find it hard to believe someone who got a 210 on step 1 could just study hard for a couple of weeks for step 2 and get a 260 on step 2. I feel like the basis of learning the content for step 1 really well still would help. You just wouldn't need all the minutia that is in a step 1 deck. But for a lot of step 2 decks a good portion of the cards are step 1 review.

This is from an M1, I know nothing. Just trying to learn a little more in the midst of this change.

No, it's more that CK didn't have nearly the same competitive pressure and overlaps a lot with what you study on your core rotations and shelves. You basically study for it for all of MS3 but with no structured UFAPS equivalent and not nearly as much pressure. I went straight out of my dedicated into my Medicine rotation, and let me tell you, knowing the Step 1 content is NOT enough to easily make your way through UWorld Step 2.

 

[bball0718]

Them selecting 1/1/2022 as this magical date makes absolutely no sense, it's completely arbitrary and doesn't line up with any time stretch pertinent to applying for residency or taking Step 1.

I'm ultimately accepting of their decision to make it P/F, but the abruptness of the announcement and the lack of clarification on whether current M1s (who--whether or not it's smart--might have chosen a school based on how well they prepare its students for the test) will be taking a scored exam or not is absolutely insane to me and doesn't really give me confidence that they've thought as much of this through as they should have.

The clear solution is to say that the class of 2024 will be the first to apply into a residency process with only P/F scores. Saves the 2023 class (sans people taking research years) from having scores wiped or from having a logistically disastrous applicant pool with both numerical and P/F scores. Also limits the change to students who have not yet started medical school yet. I suspect they will choose the outcome that screws the most of us though

 

[ak427]

Them selecting 1/1/2022 as this magical date makes absolutely no sense, it's completely arbitrary and doesn't line up with any time stretch pertinent to applying for residency or taking Step 1.

I'm ultimately accepting of their decision to make it P/F, but the abruptness of the announcement and the lack of clarification on whether current M1s (who--whether or not it's smart--might have chosen a school based on how well they prepare its students for the test) will be taking a scored exam or not is absolutely insane to me and doesn't really give me confidence that they've thought as much of this through as they should have.

this. That’s why I believe the 1/1/2022 is not actually a fixed date and it more likely will be a date later in 2022 where everyone in the Class of 2023 will have taken Step 1. This will eliminate the mixed cohort of numeric and P/F results for that class and will let the entire Class of 2024 be P/F so their curriculums can be tailored to that.

 

[bball0718]

this. That’s why I believe the 1/1/2022 is not actually a fixed date and it more likely will be a date later in 2022 where everyone in the Class of 2023 will have taken Step 1. This will eliminate the mixed cohort of numeric and P/F results for that class and will let the entire Class of 2024 be P/F so their curriculums can be tailored to that.

literally added an immediate edit that says essentially this lol, desperate minds think alike

 

[ReturnToMed]

Any advice on how to approach this as someone who is entering M1 in the fall and will be the first full class to do P/F? Advice beyond do research please ( i was already going to). I am from low tier MD. Thanks in advance.

 

[Chad12]

Any advice on how to approach this as someone who is entering M1 in the fall and will be the first full class to do P/F? Advice beyond do research ( i was already going to). I am from low tier MD.

Us current M1s don't even know how to handle it right now because we have no idea whether our residency apps will have a pass/fail on it or the score . You guys on the other hand are for sure going to have have a pass/fail on step 1 so my advice is if you have any semblance of AOA , class ranking or grading system than gun for it and do well on in house exams while stacking your resume with research. Starting M2 year I would try to use a combination of a step 1/step 2 anki deck that I believe will be released shortly by the guys over at r/ankimedicalschool(bless their hearts). Not much else you can do tbh. Maybe brown nose some attendings to build connections lol?

 

[ReturnToMed]

Us current M1s don't even know how to handle it right now because we have no idea whether our residency apps will have a pass/fail on it or the score . You guys on the other hand are for sure going to have have a pass/fail on step 1 so my advice is if you have any semblance of AOA , class ranking or grading system than gun for it and do well on in house exams while stacking your resume with research. Starting M2 year I would try to use a combination of a step 1/step 2 anki deck that I believe will be released shortly by the guys over at r/ankimedicalschool(bless their hearts). Not much else you can do tbh. Maybe brown nose some attendings to build connections lol?

thanks.... and i am not big enough of a gunner to suck up to attendings. I'll go down (or up) with honor(s).

 

[DJay4534533]

Us current M1s don't even know how to handle it right now because we have no idea whether our residency apps will have a pass/fail on it or the score . You guys on the other hand are for sure going to have have a pass/fail on step 1 so my advice is if you have any semblance of AOA , class ranking or grading system than gun for it and do well on in house exams while stacking your resume with research. Starting M2 year I would try to use a combination of a step 1/step 2 anki deck that I believe will be released shortly by the guys over at r/ankimedicalschool(bless their hearts). Not much else you can do tbh. Maybe brown nose some attendings to build connections lol?

i wouldn't say it's "for sure" for them either. the press release was vague enough to where we still don't actually know when the pass/fail will officially be implemented. without an official date, we're all just guessing...

 

[ajc009]

The repercussions from this decision will be profound.

 

[deleted600623]

i wouldn't say it's "for sure" for them either. the press release was vague enough to where we still don't actually know when the pass/fail will officially be implemented. without an official date, we're all just guessing...

Did they say when more information would be released ? Or will we just be in purgatory for the next year or so until they figure this out?

 

[Phloston]

Standard error of 6 so there is a 96% chance that a 240 would score between 228 and 252 and a 260 would score between a 248 and a 272.
Those scores are not as different as you think they are and with the same level of prepation there is a distinct possibility that their scores would overlap if administered multiple times.

I've been tutoring for over 7 years and can tell you the breadth of knowledge between a student who achieves 240 vs 260 bears no overlap.