Step 1 P/F: Decision

[Phloston]

Regardless of what people think at the end of this thread, I really think this is a big issue.

I don't actually think you need that strong of a knowledge base to pass step 1.

We took a school-administrated CBSE back in November. I am probably one of the laziest students pre-clinically. I scored in the 3rd or 4th quartile in all but one of my school's exams until that point, had only seen half of Zanki and had not done a single practice question. Oh and we still had two system blocks left at that point.

And I still passed.

I really don't think I knew anything when I took the exam, so if this is what we're going to start expecting of and producing out of the next generation of medical students, I'm genuinely worried.

To a T. Exactly.

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[sylvanthus]

DO students are gonna have a hell of a time landing more competitive specialties.

 

[Phloston]

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.

Start studying for 2CK without knowing how the heart works.

 

[Phloston]

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.

Now instead of studying for Step 3, I'll just spend 14 hours/day for the next week developing this app.

 

[Phloston]

Or do research. Which has 0 bearing at all on how good of a physician you'll be. Honestly, I could care less about board scores, but if it came down to juding a candidate for EM based on boards or research, I'd have to tell you, boards would be a better predictor on who will be good clinically. And boards suck as a predictor of clinical success in EM.

Good value here.

 

[Phloston]

Now that the Step 1 exam has been rendered useless for residency match purposes, the NBOME should see this as a new business opportunity. The NBOME could allow MD students take the COMLEX Level 1 exam. This would enable MD students to receive a standardized test score at the end of second year that they could send with their residency applications. What would be in it for the NBOME? Loads of dough—and as a bonus, thousands of MD students would be forced to study osteopathy in order to prepare for the exam, thereby pushing osteopathy into the mainstream.

Chances are this is being schemed behind the scenes and might be released as an "update" in, e.g., a year. Sort of like how some colleges accept the ACT in addition to the SAT. It's like why not.

 

[ReturnToMed]

Start studying for 2CK without knowing how the heart works.

sounds good.

doxorubicin is good for the heart right? am I doing this studying thing correctly?

 

[Phloston]

sounds good.

doxorubicin is good for the heart right? am I doing this studying thing correctly?

Trastuzumab as well. But for future students who don't need to know it's cardiotoxic bc they only need to pass, they can learn it from this comment.

 

[ahmad sharawneh]

Non us IMG numbers will be reduced. Because of that.

 

[Espressso]

SDN is absolute chaos over this news

 

[Pluto98]

Good god!

 

[Espressso]

Some morning thoughts:

I think in the long term, making S1 p/f like it originally was designed to do can be a good thing if there are other changes across the board as well. These being:

1-1.5 year preclinical with 3 or 2.5 years of clinicals. I think if you have it as a three year clinical set up like more places are moving to, you get more time for electives and AI's/Sub-Is and you could take S2CK earlier, ensuring that you know your score a decent amount of time before Sept ERAS apps go out. But this only works if all schools transition to this sooner rather than later. 3 years of clinical can also help students take more time for research, within the four year span. Another positive for students gunning for competitive specialities.

Another idea is the EM SLOEs, but for all specialities. I think this can help create a bit more standardization in regards to visiting rotations/clerkships in general. I think having a SLOE-type set up for all specialities can help. This would be difficult to do but I think leaders in each speciality and in MedEd can potentially get this moving.

Also, caps on residency apps is probably more important than we think. Obviously AAMC will fight this tooth and nail since I'd imagine a good amount of revenue is in this. But, making students be more selective in who they apply to, and do their homework (i know everyone on SDN does their homework with this topic but many students not on SDN don't)... can help with this application mania that i think was a big driver behind the step 1 mania.

Another change is to probably move the preclinical years back to the graded/rank system. At least to give some stratification between students, although with how varied preclinical ed is already, I'm not sure how much of a net positive this will bring forth. Nonetheless, I still think this would help in regards to startifying applicants more.


I'm on the fence about the p/f debate in general, I can see both sides. But seeing DO students at my school touting how immediately great this is for everybody is a bad bad look. And I fail to realize how the NBME making this change without more significant changes coming in the near future is even possible. The worst part I think, is that the students now are basically the trial run with all of this.

 

[libertyyne]

sounds good.

doxorubicin is good for the heart right? am I doing this studying thing correctly?

It's like a vitamin for your heart.

 

[NickNaylor]

I'm completely surprised by the negative response to this. Do you guys just enjoy punishing yourself or something?

It was (is) a stupid exam that was (is) being completely misappropriated in terms of its function.

 

[Espressso]

I'm completely surprised by the negative response to this. Do you guys just enjoy punishing yourself or something?

It was (is) a stupid exam that was (is) being completely misappropriated in terms of its function.

Wait, you're surprised by the reaction of students on SDN? You don't say

 

[AnatomyGrey12]

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.

NBME can’t control what is a match violation or not.

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

One of the PD’s mentioned earlier in the thread they aren’t 100% sure it’s even legal to retroactively change a board exam score from a reported number to a P.

The more I think about it the more I think that what will happen is the actual class that applies to residency with the P/F test will be 2024, with anyone taking the test after 2022 will get a P/F score.

I just don’t really see how they can realistically retroactively change scores.

 

[Schwifty]

One of the PD’s mentioned earlier in the thread they aren’t 100% sure it’s even legal to retroactively change a board exam score from a reported number to a P.

The more I think about it the more I think that what will happen is the actual class that applies to residency with the P/F test will be 2024, with anyone taking the test after 2022 will get a P/F score.

I just don’t really see how they can realistically retroactively change scores.

I think its unlikely that they will give a numeric score to those taking the exam in 2021 but only report it as pass / fail when applying in 2023. With that said unless they do that there will be an overlap of people applying with numeric scores and p/f, so it will be interesting on how that will be handled.

As legalities go, I'm not sure if its legal or not, I think they could just do whatever they want (like change the exam to p/f lol) but I could defiantly see a law suit against them if they retroactively change scores

 

[deleted962973]

From another thread:

I agree with all of this but don’t have as much faith in the NBME to foresee what a huge disadvantage they’d be putting P/F Step takers at compared to ones with a 3-digit score. And while I agree that the fairest move would be to start sending scores to PD’s as pass/fail from 2022 onwards, that wouldn’t stop someone with a 270 from before P/F from working that score into their application or interview. If the NBME wanted to be fair, they would keep Step 1 scored until the class of 2023 is done taking the exam, and then start P/F for the class of 2024.

 

[Melchizedek]

So thinking a little bit more about it:
The USMLE process was never supposed to be a ranking system. It is first and foremost a licensing exam and developed as a way to determine If a med student could gain licensure as a physician. So to that end I can see why they would push the system into pass/fail. Either you get your license or don't.

But this leaves a vacuum where the ranking process is concerned.
Could a new test arise to help fill this need? How would adding ANOTHER exam to the already full plates of medical students, affect burn out rates? would it be evened out because there is now less pressure to perform on the USMLE exams?

discuss.

 

[Type2Fiber]

So thinking a little bit more about it:
The USMLE process was never supposed to be a ranking system. It is first and foremost a licensing exam and developed as a way to determine If a med student could gain licensure as a physician. So to that end I can see why they would push the system into pass/fail. Either you get your license or don't.

But this leaves a vacuum where the ranking process is concerned.
Could a new test arise to help fill this need? How would adding ANOTHER exam to the already full plates of medical students, affect burn out rates? would it be evened out because there is now less pressure to perform on the USMLE exams?

discuss.

I am opposed to how it is being implemented now but I think that ultimately a licensing exam should be p/f so I think this will be a good thing for future students after the system has recalibrated. Problem is, the interim is going to be chaos. Specialty specific application exams,1 year preclinical with time for more auditions, limits on applications or ideas of that type could lead to a more productive experience

I do think there needs some to be a difficult exam of some sort that students need to take to apply to residency in. The effort required to pass step 1 with the quality of resources out there now is low. I don't think its a good thing to for it to be possible to coast through pre-clinical, barely pass class & step, and then land a residency without much academic effort. I appreciate the wailing and gnashing of teeth about memorizing TSC1/TSC2 mutations but its hard to imagine putting significantly less effort into learning during pre-clinical is going to produce better physicians

 

[Cornfed101]

I don't think it is a coincidence that we have a residency merger and this happening at the same time

USMLE: Let's make Step p/f because we now have a bunch more residency spots!

COCA: Sorry guys

 

[pinguadelie]

Here's an interesting paper on the impacts of when the National Board Dental Examination (dental equivalent of USMLE) went pass fail a few years ago.

This is an editorial outlining the effects of when it went pass/fail as well.

"It is interesting to note that the National Board of Medical Examiners (NBME), medicine’s counterpart to the JCNDE, faced the same dilemma of what to do with its examinations because it also reported psychometrically unsound numerical data to candidates and schools. Its response was to acknowledge the fact, but continue to report the numerical data because medical schools and residency programs found the information so valuable."

 

[AnatomyGrey12]

But this leaves a vacuum where the ranking process is concerned.
Could a new test arise to help fill this need? How would adding ANOTHER exam to the already full plates of medical students, affect burn out rates? would it be evened out because there is now less pressure to perform on the USMLE exams?

I think it's inevitable that something fills the vacuum. For the next few years it's going to be Step 2 CK but if attendings are complaining about students on rotations now, just wait until they are completely being blown off by students to do the Dorian anki deck and UWorld on their phones during rounds. Ultimately I see Step 2 going P/F as well, with the end result being specialty specific exams that will be taken about midway through 3rd year. Now whether these will be additional Shelf like exams administered by the NBME (The NBME probably hopes so and is trying to work their way into this already), or delivered by the field specific specialty organizations who knows. Or there could be some massive aptitude test in production we don't know about that will be rolled out at some point.

The next 10 years are going to be a period of huge flux in medical education as everything gets rolled out. I am not optimistic that the downstream ramifications of this decision were throughly thought out.

 

[mdphd.234]

I agree with all of this but don’t have as much faith in the NBME to foresee what a huge disadvantage they’d be putting P/F Step takers at compared to ones with a 3-digit score. And while I agree that the fairest move would be to start sending scores to PD’s as pass/fail from 2022 onwards, that wouldn’t stop someone with a 270 from before P/F from working that score into their application or interview. If the NBME wanted to be fair, they would keep Step 1 scored until the class of 2023 is done taking the exam, and then start P/F for the class of 2024.

This doesn't seem like the best example in terms of a mixed applicant pool of Ps and numeric scores. Someone with a 270 would be exceptional compared to the entire pool, no matter if everyone else have a score or not. A 235 would be average. A 200 would be lower.

The simplest thing is just to have information be extra information. If considering fairness, it seems most unfair to students who focused on Step 1 in the pre P/F era and got a high score to the detriment of everything else, since they will be compared to students who did more research, volunteering, etc during the post-P/F era. Since PDs are going to focus more on those other things, + Step 2CK, wouldn't the people with scores have an application that overall was at a relative disadvantage to people with a P? That seems more unfair in my opinion.

In fact, by retroactively making scores P/F, you make the problem of fairness worse. I got a high Step 1 score, and am a G2 MD/PhD student, and whether or not there is a section for it in ERAS, I'm sure it will be put into my MSPE, my letters of recommendation, my CV. However, my peers who were MD/PhD, but got a lower score will be content to settle for the P if retroactively assigned. That scenario would lead to selection bias on what scores PDs are seeing.

The alternative is to have everyone who has a score have it be shown, whether its a 210 or 270. More information is just extra information. They have to judge it in context of the pre-P/F era or not.

 

[pinguadelie]

Boards to be Pass/Fail, what does this mean for residency programs?

Recently, the Joint Commission of National Dental Examination has unanimously voted to move the National Board Dental Examinations (NBDE) Part I and II to a pass/non pass format by 2010. From an email I received from one of our academic deans. Anyone heard of this? Any idea what effect it...

forums.studentdoctor.net

This is a thread from 12 years ago that's basically the dental equivalent of this thread right now...

 

[Scrubs101]

If youre not on reddit you should be, the memes are absolute FIRE

 

[ciestar]

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.

i went from a 211 to a 245..
im sure if i would have done a second pass on uworld like some people do.. i could have gotten that score. I did well on shelf exams so i think having that knowledge building up all of third year really helps

 

[ciestar]

Just have it included in your MSPE

my school actually does this so that would never work lol

 

[sargon2123]

Can someone just email them regarding current M1's?

 

[Med Ed]

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

Nothing is going to be "wiped." Even if the NBME wanted to it can't put that genie back in the bottle. Not without incurring 10,000 lawsuits, at least. You'll note that the earliest date of implementation will primarily affect students who have not yet matriculated, so they aren't changing horses midstream.

Every time there is a change it comes with a period of overlap. When the MCAT scoring scale switched we had a couple of years where some applicants had familiar scores and others had ones that were difficult to interpret. Admissions just went a little more holistic until the validity data on the new scoring scale emerged. Well, that and we tended to assume higher = better.

 

[Pluto98]

Nothing is going to be "wiped." Even if the NBME wanted to it can't put that genie back in the bottle. Not without incurring 10,000 lawsuits, at least. You'll note that the earliest date of implementation will primarily affect students who have not yet matriculated, so they aren't changing horses midstream.

Every time there is a change it comes with a period of overlap. When the MCAT scoring scale switched we had a couple of years where some applicants had familiar scores and others had ones that were difficult to interpret. Admissions just went a little more holistic until the validity data on the new scoring scale emerged. Well, that and we tended to assume higher = better.

Yes but having a mixed cohort apply to residencies would be incredibly unfair. Like someone else mentioned, imagine you are applying with a 260 from hopkins vs a Pass from Penn? Who are they going to take

 

[ciestar]

Yes but having a mixed cohort apply to residencies would be incredibly unfair. Like someone else mentioned, imagine you are applying with a 260 from hopkins vs a Pass from Penn? Who are they going to take

they probably have a similar dilemma now. Probably going to look at clinical evals and EC stuff.

 

[sargon2123]

Nothing is going to be "wiped." Even if the NBME wanted to it can't put that genie back in the bottle. Not without incurring 10,000 lawsuits, at least. You'll note that the earliest date of implementation will primarily affect students who have not yet matriculated, so they aren't changing horses midstream.

Every time there is a change it comes with a period of overlap. When the MCAT scoring scale switched we had a couple of years where some applicants had familiar scores and others had ones that were difficult to interpret. Admissions just went a little more holistic until the validity data on the new scoring scale emerged. Well, that and we tended to assume higher = better.

The issue here though is that the MCAT scale simply switched. It didn't become pass fail.

As an aside, not only will the match be affected, but the fellowship match will be too

 

[Med Ed]

Yes but having a mixed cohort apply to residencies would be incredibly unfair. Like someone else mentioned, imagine you are applying with a 260 from hopkins vs a Pass from Penn? Who are they going to take

What's in the rest of their applications?

 

[sargon2123]

Yes but having a mixed cohort apply to residencies would be incredibly unfair. Like someone else mentioned, imagine you are applying with a 260 from hopkins vs a Pass from Penn? Who are they going to take

Damn that makes me think I should get my step score, purposely take a research year, and have an edge in the match. PD's will absolutely want that 260 if all else is somewhat equal (let's be real, for 2 top school applicants it probably is). Their attitude toward step 1 has been reflected for many years in that "importance ranking list" (idk what it's called).

 

[Med Ed]

The issue here though is that the MCAT scale simply switched. It didn't become pass fail.

I was merely using a recent example of a mixed cohort.

 

[IsleyOfTheNorth]

Time to work on those soft skills....

 

[ace_inhibitor111]

Damn that makes me think I should get my step score, purposely take a research year, and have an edge in the match. PD's will absolutely want that 260 if all else is somewhat equal (let's be real, for 2 top school applicants it probably is). Their attitude toward step 1 has been reflected for many years in that "importance ranking list" (idk what it's called).

I could easily see schools adjusting to a mixed cohort by saying a 260 one Step 2 = 260 in Step 1. It’s not the same percentile but serves the same weed-out role. People with numerical Step 1 scores can have the option of using that in lieu of Step 2.

 

[deleted962973]

This doesn't seem like the best example in terms of a mixed applicant pool of Ps and numeric scores. Someone with a 270 would be exceptional compared to the entire pool, no matter if everyone else have a score or not. A 235 would be average. A 200 would be lower.

The simplest thing is just to have information be extra information. If considering fairness, it seems most unfair to students who focused on Step 1 in the pre P/F era and got a high score to the detriment of everything else, since they will be compared to students who did more research, volunteering, etc during the post-P/F era. Since PDs are going to focus more on those other things, + Step 2CK, wouldn't the people with scores have an application that overall was at a relative disadvantage to people with a P? That seems more unfair in my opinion.

In fact, by retroactively making scores P/F, you make the problem of fairness worse. I got a high Step 1 score, and am a G2 MD/PhD student, and whether or not there is a section for it in ERAS, I'm sure it will be put into my MSPE, my letters of recommendation, my CV. However, my peers who were MD/PhD, but got a lower score will be content to settle for the P if retroactively assigned. That scenario would lead to selection bias on what scores PDs are seeing.

The alternative is to have everyone who has a score have it be shown, whether its a 210 or 270. More information is just extra information. They have to judge it in context of the pre-P/F era or not.

You’re failing to consider that there are students halfway through M1 right now whose curriculums focus on Step 1, but who will be taking it after it becomes Pass/Fail. I think this is the case at Penn, Columbia, NYU, Baylor, and UCSF? They may have gotten an extraordinary Step 1 score had they taken the exam when it was graded, but since their school made them take it in 2022 when it became P/F, they aren’t going to look as impressive as someone who scored a 250+ when they took the exam back when it still had 3-digit scores. Maybe the Penn student could’ve gotten the same score, but got screwed over by timing.

Either way someone is going to be screwed over. If they retroactively convert scores to P/F, it’ll hurt the high scorers from 2021. If they report numeric and P/F scores for residency apps in 2022, it’ll hurt all the students who took the exam in 2022 and passed, when their unreported numerical grade would’ve been a 250+. That’s why the fairest situation is to start grading Step 1 as P/F only after the entire Class of 2023 has taken the exam, which would probably be around March 2022.

 

[Gilakend]

What's in the rest of their applications?

I feel like the bigger question is 260 from a new MD school vs a pass from a T20.

For T20 students, will they even be at a disadvantage for taking the P/F version?

I feel like this is a very quick roll out for such a monumental change.

 

[deleted962973]

I feel like the bigger question is 260 from a new MD school vs a pass from a T20.

For T20 students, will they even be at a disadvantage for taking the P/F version?

I feel like this is a very quick roll out for such a monumental change.

I’m almost certain they’re going to push back the 1/1/22 start date. It would be an absolute disaster considering there are schools that do Step in third year now leading to different scoring systems within a single application cycle. I don’t see how PDs are going to compare passing to getting a 250+.

 

[Pluto98]

What's in the rest of their applications?

The usual.

 

[Gilakend]

I’m almost certain they’re going to push back the 1/1/22 start date. It would be an absolute disaster considering there are schools that do Step in third year now leading to different scoring systems within a single application cycle. I don’t see how PDs are going to compare passing to getting a 250+.

I just feel like this benefits so few people. I feel like it really only benefits people who go to a top school, want a competitive specialty, and wouldn't do well on step 1. It will further make the importance of going to a top school more important, not just for the name (which will become increasingly important), but research, location, ECs, etc.

Not to mention how this will impact how people are on clinicals now that those grades will matter more and to get AOA.

 

[deleted962973]

When is the latest that students take Step 1 in schools that do Step 1 in third year?

I think for all the 1.5 year schools I interviewed at, you usually have dedicated in the beginning of January of third year and take Step 1 in February.

 

[deleted962973]

I just feel like this benefits so few people. I feel like it really only benefits people who go to a top school, want a competitive specialty, and wouldn't do well on step 1. It will further make the importance of going to a top school more important, not just for the name (which will become increasingly important), but research, location, ECs, etc.

Not to mention how this will impact how people are on clinicals now that those grades will matter more and to get AOA.

I agree, it’s incredibly unfair for people who would’ve aced Step 1 at lower tier schools and could’ve used that to boost their chances for a top specialty. This was such a pointless move. If they wanted to make residency applications less stressful, they should have placed a cap on number of programs you can apply to.

 

[deleted962973]

Okay so likely if this change is implemented, it would happen March 2022 at the earliest? Do you think, since students in the class of 2023 still need to take it

Honestly I have no clue, I’m just an M1 speculating on what I think would make the most sense. But yeah I feel like making it P/F starting March ‘22 would even the playing field for the students in the Class of 23 who take Step 1 in February ‘22. There’s still the question of how they’re going to deal with MD/PhD scores, so it’s not a perfect solution.

 

[Goro]

Yes but having a mixed cohort apply to residencies would be incredibly unfair. Like someone else mentioned, imagine you are applying with a 260 from hopkins vs a Pass from Penn? Who are they going to take

Life's not fair.

 

[deleted962973]

But there’s still step 2 still right, to differentiate people?

Yeah but it’s a huge change to make that shift from Step 1 to Step 2 in two application cycles, especially considering some schools are set up so you don’t even take Step 2 until after you apply to residency.

No one truly knows whether Step 2 will replace Step 1 as the biggest factor in residency apps, or whether other things like research, connections, and prestige will take its place instead.

 

[7331poas]

Life's not fair.

Thats the exact response I would expect from a PhD med school faculty member.

 

[deleted962973]

Thats the exact response I would expect from a PhD med school faculty member.

The ignore function can be useful if someone produces continually unhelpful responses.

If anything, I would expect the faculty at schools affected by this change to make a racket so that the NBME comes up with a better plan of implementation before 2022. All hope isn’t lost.