Step 1 P/F: Decision

[libertyyne]

Not looking to be dramatic but as an incoming M1 at a "lower-tier" MD, I should withdraw my application and leave medicine as a career permanently?

One should never go to medical school unless they would be content with going into primary care. any tier of medical school.

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[Jappa]

One should never go to medical school unless they would be content with going into primary care. any tier of medical school.

Yeah it was more of a joke lol. But regardless, if being at a lower tier MD stops you from trying to pursue those more competitive residencies, I'll be pissed. Before it was "MD opens all doors" against DO's, now it's "mid-top tier MDs opens all doors".

The school I'll more than likely be attending has a great match list in terms of competitive specialties and even competitive programs, but not sure if step 1 score has a huge part in this (which I'm sure it does).

 

[hormonemonster]

The wording is that after January of 2022 Step 1 scores will be reported as P/F. For anyone in class of 2023, if I were you, I would assume this means that anyone applying to residency in 2022 will only have a score reported as a P until explicitly stated otherwise.

"Reported as" which means if you take the test in 2021, it will read 2XX when you log on to see your score. If you take it in 2022, when you log on to see your score, it will read "Pass". Highly unlikely that your score report would change from 2XX to Pass retroactively. Think about it, applicants could say "Ya I got a 260 but it's changed to Pass following January of this year. Check out this screenshot". What a can of worms.

 

[Lawpy]

I still don't get the point of changing Step 1 to pass/fail and keeping Step 2 CK scored. I feel it makes more sense to keep both scored, both quartiles or both pass/fail.

Also why does Step 3 continue to exist as a scored exam?

 

[NotAProgDirector]

So it seems that at least M2's will be safe. I guess the question is whether or not they will retroactively change scores to P/F after 2022. This may impact peoples decisions on whether or not to take a gap year if that is the case...

They almost certainly won't change old transcripts. Not sure that's even legal to do.

Lmao exactly. If anyone thinks anything is going to change at all then they have another thing coming. “Step 1 mania” will now become “Step 2 mania”. Oh and add on the stress of ever more important clinical grades, which are extremely subjective, and the fact that Step 2 is taken right before residency apps and you have the recipe for a complete disaster lol.

I agree. Now you'll have to have a S2 score on 9/15. This will only drive the insanity to S2. Ultimately S2 will be P/F

My prediction:
I think the specialties will just make their own exams. That's what I'd do. Make an IM exam, and have everyone take it prior to applications. Each specialty can make their own exam and put whatever they want on it. Surgery could have you tie knots if they want. We'd be in control of the exam, no one could make it P/F (except us).

Unfortunately, this would mostly be bad for students. It's another exam, with additional cost. You'd be taking it right before applications. Whether you can only take it once, vs as many times as you want, leads to problems. The only "win" for students is that the exam is focused in what you're interested in, and presumably is more clinically relevant. All fields have an In Training exam -- I'd just use that.

 

[AnatomyGrey12]

edited due to comments above.

 

[Professional Student]

The wording is that after January of 2022 Step 1 scores will be reported as P/F. For anyone in class of 2023, if I were you, I would assume this means that anyone applying to residency in 2022 will only have a score reported as a P until explicitly stated otherwise.

I think the reporting in 2022 is referring to results given to the test taker, and thus results reported during residency applications would match what score you were given. So the class of 2023 that takes the exam in 2021 will get numerical scores that they then use to apply to residency. The class of 2024 gets P/F scores when they take the exam in 2022 which is what they use to apply to residency. This is similar to how MCAT scores were reported a couple years after that scoring system changed.

It wouldn't make sense to give everyone numerical scores for the next 2 years only to change those scores to P/F when those students are applying to residency. It's two different systems.

 

[deleted957830]

This is my logic.

This is going to displace the emphasis of Step 1 onto Step 2. Therefore, what is to stop them from retroactively reporting ALL step 1 scores as P/F to eliminate bias?

This may not be the "dream" for students in Top 20's. If anything, it may breed laziness and/or lack of motivation. I think about the student I would be if I knew this thing would be P/F...but perhaps that explains why I'm not at a top 20 LOL

But then again, if they were going to retroactively report scores as PF, wouldn't they just do it now?

 

[Lawpy]

They almost certainly won't change old transcripts. Not sure that's even legal to do.


I agree. Now you'll have to have a S2 score on 9/15. This will only drive the insanity to S2. Ultimately S2 will be P/F

My prediction:
I think the specialties will just make their own exams. That's what I'd do. Make an IM exam, and have everyone take it prior to applications. Each specialty can make their own exam and put whatever they want on it. Surgery could have you tie knots if they want. We'd be in control of the exam, no one could make it P/F (except us).

Unfortunately, this would mostly be bad for students. It's another exam, with additional cost. You'd be taking it right before applications. Whether you can only take it once, vs as many times as you want, leads to problems. The only "win" for students is that the exam is focused in what you're interested in, and presumably is more clinically relevant. All fields have an In Training exam -- I'd just use that.

Thanks for this. But why does Step 3 still exist and why is it a scored exam?

 

[libertyyne]

They almost certainly won't change old transcripts. Not sure that's even legal to do.


I agree. Now you'll have to have a S2 score on 9/15. This will only drive the insanity to S2. Ultimately S2 will be P/F

My prediction:
I think the specialties will just make their own exams. That's what I'd do. Make an IM exam, and have everyone take it prior to applications. Each specialty can make their own exam and put whatever they want on it. Surgery could have you tie knots if they want. We'd be in control of the exam, no one could make it P/F (except us).

Unfortunately, this would mostly be bad for students. It's another exam, with additional cost. You'd be taking it right before applications. Whether you can only take it once, vs as many times as you want, leads to problems. The only "win" for students is that the exam is focused in what you're interested in, and presumably is more clinically relevant. All fields have an In Training exam -- I'd just use that.

Do you think C/O 21 should be taking Step 2 CK earlier ? Would it influence cycles before the change in any drastic fashion in your opinion?

 

[bball0718]

absolute insanity that they would make this decision and be so completely vague about what happens to those who take Step 1 when it's scored and then apply to residency after 1/1/2022. at the end of the day things will work out for all of us but this is extremely frustrating and will inevitably just make everything more stressful for students

 

[Doctoscope]

How will this affect carib grads? Curious to see how those schools will spin this as something that will help them instead...


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[ReturnToMed]

Can you all explain what is considered low vs mid tier? Top tier is clearly top25.

 

[Lawpy]

absolute insanity that they would make this decision and be so completely vague about what happens to those who take Step 1 when it's scored and then apply to residency after 1/1/2022. at the end of the day things will work out for all of us but this is extremely frustrating and will inevitably just make everything more stressful for students

Drunk twisted Lawpy plots: what if this is all a plan to dramatically reduce the number of med school applications??

 

[Lawpy]

Can you all explain what is considered low vs mid tier? Top tier is clearly top25.

It doesn't matter since the prestige bias refers to top school name and its resources and connections

 

[Cath Up]

Step 1 is dead, long live Step 1 2ck!


This is merely a bandaid to the problem.Filters will just be placed on CK. Now PDs and applicants will have to rely on a test that is administered later in medical school , and people will have to change plans very near to the end because their step 2 ck didnt work out.

I dont think this will change anything around the decline of preclinical education and lack of participation in class. People will now just be streaming bnb step 2 ck edition.

On a separate note
Someone should do a study on the rate of increase in publishing case reports and other low quality research papers after the conversion to P/F.

Of course, a medical student should do the study.

 

[ChymeofPassion]

Can you all explain what is considered low vs mid tier? Top tier is clearly top25.

Based on my understanding Top Tier is T25, Mid-Tier is 25-50ish (some people may say up to 60), low tier below that.

 

[ReturnToMed]

It doesn't matter since the prestige bias refers to top school name and its resources and connections

ah so it's top25 vs the world.... Nice

 

[gopher1997]

How will this affect carib grads? Curious to see how those schools will spin this as something that will help them instead...


Sent from my iPhone using SDN mobile

step 1 was the only thing that they could barely rely on to just match into FM or the sorts...... with it gone - RIP.

 

[Lawpy]

Of course, a medical student should do the study.

I doubt they'll have the time if it's now the meta to panic over clinical years and Step 2, but some med education attendings and deans can explore this

 

[dinguskhan]

What confuses me is that even for current M1s, some of us (like those at Yale/UPenn) take step 1 during M3. So in 2023 how will PD compare the M4s with Pass with the M4s with a score?

 

[Lawpy]

ah so it's top25 vs the world.... Nice

It's always like this even across any field. Some make an argument that HMS >>> rest of top schools >>>>>>> everyone else, so i fully expect HMS getting flooded with more apps from people desperately wanting that hot Harvard name

 

[ReturnToMed]

Which rankings are used?

Based on my understanding Top Tier is T25, Mid-Tier is 25-50ish (some people may say up to 60), low tier below that.

 

[deleted407021]

Whatever

 

[NicMouse64]

The wording is that after January of 2022 Step 1 scores will be reported as P/F. For anyone in class of 2023, if I were you, I would assume this means that anyone applying to residency in 2022 will only have a score reported as a P until explicitly stated otherwise.

so....if I bomb step 1....just take a research year then? Lol what a mess.

 

[Lawpy]

What confuses me is that even for current M1s, some of us (like those at Yale/UPenn) take step 1 during M3. So in 2023 how will PD compare the M4s with Pass with the M4s with a score?

If you go to Yale or Penn, you wouldn't have to worry about any of this. For everyone else, no one knows how the comparison would work since it's vague

 

[ChymeofPassion]

Which rankings are used?

When people refer to rankings at all, its US News Medical School: Research ranking. How much those matter is up for debate...

 

[CuriousMDStudent]

Which rankings are used?

People use US News Rankings. It's controversial but that's my experience here

 

[Fencer]

They will not be able to hide a MSTP student's score from earlier cycles.

 

[LTMCUSN]

So we don’t know what this will mean for the current M1s yet, in other words?
I’m gonna wait until the dust settles before I go out and buy a STEP 2 review book...

 

[Cath Up]

They almost certainly won't change old transcripts. Not sure that's even legal to do.


I agree. Now you'll have to have a S2 score on 9/15. This will only drive the insanity to S2. Ultimately S2 will be P/F

My prediction:
I think the specialties will just make their own exams. That's what I'd do. Make an IM exam, and have everyone take it prior to applications. Each specialty can make their own exam and put whatever they want on it. Surgery could have you tie knots if they want. We'd be in control of the exam, no one could make it P/F (except us).

Unfortunately, this would mostly be bad for students. It's another exam, with additional cost. You'd be taking it right before applications. Whether you can only take it once, vs as many times as you want, leads to problems. The only "win" for students is that the exam is focused in what you're interested in, and presumably is more clinically relevant. All fields have an In Training exam -- I'd just use that.

You're here!!

 

[Lawpy]

They will not be able to hide a MSTP student's score from earlier cycles.

Is the prestige bias magnified for MSTP even more? Which means does it suggest it's impractical to go for a low tier non-MSTP MD/PhD program and just go MD?

 

[Actinium24]

as a premed, should this affect how you decide which school to attend? I figure now that if one has a chance to go to Stanford/Harvard/Hopkins vs staying at the local state university for free tuition, they SHOULD choose the former? with no step1 scores, and no step2ck taken by the time you apply, how are people going to determine if you deserve to match in Neurosurg/Derm/Ortho/RadOnc?

as a premed-I think you should focus on getting into a medical school first

 

[deleted854547]

step 1 was the only thing that they could barely rely on to just match into FM or the sorts...... with it gone - RIP.

This what folks on this forum have been warning those who choose to attend Carib schools about...

 

[Fencer]

In MD/PhD programs, MSTP vs non-MSTP might be important, but it will be more important to have great research productivity (manuscripts and grants), appropriate rotations, AOA, and Step 2 CK score.

 

[deleted854547]

as a premed-I think you should focus on getting into a medical school first

glad i'm not the only one who took issue with his presumption lol

 

[Actinium24]

glad i'm not the only one who took issue with his presumption lol

Not just that, but this person also assumes he/she is already getting into Harvard, Stanford, and Hopkins and is actually worried that this change alone will desecrate his chances at a ROAD specialty. Like seriously.......

 

[Lawpy]

Hmm i forgot about AOA. That could get a lot uglier

 

[inode]

For MSTPs and other MD/PhDs, I created a thread in the physician-scientist forum: How will USMLE Step 1 Changing to Pass/Fail impact current and future MD/PhDs?

@Fencer: Would be great for you to comment some of your thoughts there?

 

[Lawpy]

glad i'm not the only one who took issue with his presumption lol

Not just that, but this person also assumes he/she is already getting into Harvard, Stanford, and Hopkins and is actually worried that this change alone will desecrate his changes at a ROAD specialty. Like seriously.......

Welcome to SDN!

 

[deleted957830]

It was inevitable, not only because of the damage Step 1 Mania was causing to preclinical education, but because the theoretical and statistical validity for the use of Step 1 in this way simply wasn't there. It was built from the ground up to be a test of minimum knowledge for licensure, with good discrimination around the 65-70% pass mark, and should have been Pass/Fail to begin with like the bar exam. Treating it like an aptitude test to favor 250s over 230s for residency placement was a bastardization that sparked a pointless arms race.

I have to say though, I don't like the immediate implications here. Keeping Step 2 CK as a triple digit score is just going to lead to all residency programs requiring a Step 2 CK to apply and treating it exactly the same way.

Also going to be curious to see how people handle the relatively imminent potential implementation (January 2022). That's close enough that anyone who wanted a competitive surgical specialty, and did poorly on Step 1, could consider a couple of research years to have a brand new shot...

Well said and I completely agree.

This needed to happen. But this is in no way removing the 'burden' or 'stress' from students shoulders. They are simply moving the problem to a different location. There needs to be a complete reform if there is going to be any reform, and this just seems premature and not well thought out.

I think limiting the # of residency apps a person can place (minus couples match perhaps) would have been more beneficial to the immediate future than a non-strategic step 1 change. That way, LSU-Shreveport Peds or whatever isn't getting 260+ apps from 1000K students.

 

[Lawpy]

Well said and I completely agree.

This needed to happen. But this is in no way removing the 'burden' or 'stress' from students shoulders. They are simply moving the problem to a different location. There needs to be a complete reform if there is going to be any reform, and this just seems premature and not well thought out.

I think limiting the # of residency apps a person can place (minus couples match perhaps) would have been more beneficial to the immediate future than a non-strategic step 1 change.

Yeah i agree this would be better. I'm glad Step 1 mania is now dead since i absolutely HATED it with a burning passion. Unfortunately, now that got replaced with a burning hatred for Step 2 mania and clinical years chaos...

And people wonder why we get stressed and depressed all the time...

 

[Actinium24]

Guys, Step 1 should've been changed to quartiles at least as a compromise of sorts. But oh man, MS3 and Step 2 mania are going to be a disaster.

But hey, at least the T5 guys are happy!

I agree step 2 mania will be the result of this. In the end I think they will eventually make step 2 ck pass/fail as well sometime after this change gets implemented. The former emphasis on step scores will just be transferred to other areas of residency applications. Though what those areas are I really can’t say.

 

[CheGuevaraMD]

Well said and I completely agree.

This needed to happen. But this is in no way removing the 'burden' or 'stress' from students shoulders. They are simply moving the problem to a different location. There needs to be a complete reform if there is going to be any reform, and this just seems premature and not well thought out.

I think limiting the # of residency apps a person can place (minus couples match perhaps) would have been more beneficial to the immediate future than a non-strategic step 1 change. That way, LSU-Shreveport Peds or whatever isn't getting 260+ apps from 1000K students.

Technically this change could reduce stress at the med school level, since many students will be resigned to their fate (i.e. no sense in trying for certain specialties if you're at rank<X). High schoolers and undergrads may be more stressed though.

This is how they do it in Europe -- you're tracked very early on in your life, so you have very little hope of a high outcome if you're on a low track. Low stress but highly depressing. Also increases inequality and classism.

 

[Alkaidius]

I still don't get the point of changing Step 1 to pass/fail and keeping Step 2 CK scored. I feel it makes more sense to keep both scored, both quartiles or both pass/fail.

Also why does Step 3 continue to exist as a scored exam?

I bet it’s a cushion. Removing both would basically short out the system. This way residencies still have something to go on. It’s not a complete solution, but with how preclinical education is set up right now...it’s at least a step in the right direction once people directly affected by the transition get past it.

Any stepmania sucks, but at least Step 2 is actual medicine...

 

[Lawpy]

I agree step 2 mania will be the result of this. In the end I think they will eventually make step 2 ck pass/fail as well sometime after this change gets implemented. The former emphasis on step scores will just be transferred to other areas of residency applications. Though what those areas are I really can’t say.

It's likely going to be prestige and AOA... which stinks...

 

[Lawpy]

I bet it’s a cushion. Removing both would basically short out the system. This way residencies still have something to go on. It’s not a complete solution, but with how preclinical education is set up right now...it’s at least a step in the right direction once people directly affected by the transition get past it.

Any stepmania sucks, but at least Step 2 is actual medicine...

Yeah but Step 2 is taken right after clinical years with little time to prepare for something competitive. The only way to fix this is to drastically reduce preclinical to 1 year and have 3 years for clinical.

 

[Govols22]

So for the class of 2022, will this not make a difference considering that they will start applying to programs by fall of 2021?

 

[ciestar]

So for the class of 2022, will this not make a difference considering that they will start applying to programs by fall of 2021?

probably not

 

[Lawpy]

Also i have a sinking feeling that med admins will use the opportunity to spam more useless wellness lectures...