Step 1 P/F: Decision

[Matthew9Thirtyfive]

It's certainly not everyone but it was definitely a significant number of people, especially as we got further into M2 year. I know the prevailing sentiment on this forum is "ignore everything that isn't Anki/Step 1" until you take Step 1, which I suppose does make sense given how it's currently probably the most important part of your application. And there are obviously very real problems with how a lot of pre-clinical content is delivered and structured but I'm hopeful that we can eventually figure out a medical school model where the first two years aren't just a distraction form studying flashcards from a review book.

Wow. Yeah almost everyone in my class really enjoys our clinical reasoning sessions. I also can’t imagine just ignoring them and doing zanki considering there are like 6 of us and a physician faculty member. That would be rude as ****.

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[bananafish94]

Wow. Yeah almost everyone in my class really enjoys our clinical reasoning sessions. I also can’t imagine just ignoring them and doing zanki considering there are like 6 of us and a physician faculty member. That would be rude as ****.

Oh this would never happen if there were that few people. I'm talking about like 25 people.

 

[longhaul3]

I absolutely agree. Studying yourself up to the level to comfortably Pass step 1 will mean learning a ton of things you do need. What I'd urge everyone to consider is that they'd probably know these pimp answers regardless of whether they score 230s or 250s.

Put another way: Do two people who answer 82% correct and 87% have fundamentally different abilities to reason through human physio and patho? I'd say no. The fact that their CIs overlap would seem to agree. Yet, we treat 235 and 250 like they're a world apart in residency applications, which makes no sense.

Both 235 and 250 are above the national mean. I don't think these are the kind of performances that people will be putting up once the test is p/f. Most people studying to pass Step 1 in a p/f world will not get there, or, I fear, anywhere close. I do believe there is a fundamental difference in abilities to reason through human physiology and pathology between someone who scores 215 (which we will be seeing a lot more of, just called "P" instead of 215) and someone who scores 250.

People who score 215 are not rotating with us on service these days. It doesn't matter to me what our attendings did 20+ years ago—I do believe that people will turn out fine in the end, but I think it's a good thing today's med students know more Step 1 material than our predecessors. No reason to celebrate reverting to the past.

Edit: and people scoring 215 on Step 1 are going to have a much harder time scoring 260 on Step 2 CK.

 

[Lawpy]

Tbh if Step 1 is P/F, so should Step 2 CK and Step 3. I don't see how the problems Step 1 had won't apply to Step 2 CK.

 

[longhaul3]

Tbh if Step 1 is P/F, so should Step 2 CK and Step 3. I don't see how the problems Step 1 had won't apply to Step 2 CK.

I've been suspicious ever since they announced Step 1 p/f that the plan is to make CK p/f once things smooth out a little.

 

[Matthew9Thirtyfive]

Oh this would never happen if there were that few people. I'm talking about like 25 people.

Oh okay. Yeah our sessions are 6-8 people tops.

 

[Lawpy]

I've been suspicious ever since they announced Step 1 p/f that the plan is to make CK p/f once things smooth out a little.

what about Step 3?

 

[Lawpy]

Now that I've had some time to sit with this for awhile I guess I basically come down on the side of this being a good idea. I just feel like the whole Step 1 thing got so wildly out of control that something had to be done. All incoming students would talk about is Step 1. The expectation became memorizing tens of thousands of flashcards starting from Day 1 at the expense of literally everything else. I obviously don't blame people for this because it's rational behavior considering how important it is in the residency process, but it was a little disheartening for me to be in small groups discussing challenging concepts in anatomy or pathophysiology, or having actual physicians talk to us about physical diagnosis, etc. only to see people completely ignore everything and do Anki. Again, I completely understand because that's what the system wants, but I think there should be a middle ground.

That said, the obvious concern is that the madness will just shift to Step 2 and nothing will change, except for students from "prestigious" schools getting a more disproportionate share of opportunity. I still feel like the best way to go about this in the long term is to actually address the underlying cause which is the ridiculous amount of applications we have to send that forces programs to make hard Step 1 cutoffs, which causes a death spiral. Maybe that means an application cutoff, or an early decision type of program, or something. But the Step 1 madness is definitely a symptom of a greater problem so I'm not optimistic anything will be fixed until that is addressed.

why not change the curriculum to be entirely PBL with small groups of like 6 people?

 

[efle]

Both 235 and 250 are above the national mean. I don't think these are the kind of performances that people will be putting up once the test is p/f. Most people studying to pass Step 1 in a p/f world will not get there, or, I fear, anywhere close. I do believe there is a fundamental difference in abilities to reason through human physiology and pathology between someone who scores 215 (which we will be seeing a lot more of, just called "P" instead of 215) and someone who scores 250.

People who score 215 are not rotating with us on service these days. It doesn't matter to me what our attendings did 20+ years ago—I do believe that people will turn out fine in the end, but I think it's a good thing today's med students know more Step 1 material than our predecessors. No reason to celebrate reverting to the past.

Edit: and people scoring 215 on Step 1 are going to have a much harder time scoring 260 on Step 2 CK.

The life-consuming Step focus with hundreds of thousands of flashcards and multiple qbanks is really only the case for people who are aiming for above average scores. Hence why it's the norm on SDN or for people going surgical.

The fact is that one of those above-average students has much reduced residency prospects compared to the other, based on about a dozen Qs on this single test. There are absolutely that many Qs on Step of First Aid Fun Facts. And that's messed up!

 

[Ho0v-man]

I can’t imagine how hard it would suck to try to grind like a current M2 all through M3 on top of rotations from a knowledge base that correlates to the 210-220 step1 range but that’s gonna be the new normal in a few years.

Furthermore, just a huge LOL at anyone who thinks med students are going to start actually caring about class or clinical skills lectures now. In the era of P/F everything until 3rd year, students are just going to use the same resources we have now but at a much lower intensity. They’ll still blow off class because it hasn’t mattered in years. Just step now doesn’t matter either and pathoma and sketchy have basically handed a pass out to everyone on a silver platter. They might publish more since they have a less demanding study schedule. That’s about it.

 

[Mass Effect]

The study relating to intelligence and workforce performance makes note of the fact that different jobs have different cognitive demands (end of page 264). That said, 62% of U.S. jobs were classified as medium complexity and the r value used (0.51) corresponded to those jobs. 62% is a LOT and some jobs have even more cognitive demands. It is safe to say that the relationship between intelligence and workplace performance holds for the workplace in general

No, it isn't. You may be able to make the argument that a correlation exists between intelligence and jobs that require higher education, but this in no way expands to the workplace in general. It's an incredibly tenuous relationship at best.

this is sort of built in to my argument. A plumber wouldn’t need an SAT score to find a job or get into trade school.

my argument is that colleges should use SAT for evaluating applicants because SAT will in general predict future quality as an employee, the assumption being that that person - having made a huge investment in college - is going on to perform a mid to high complexity job that generally pays more, ie accounting, marketing, actuary, web design, engineer, finance, manager... altho I know plumbers get paid a lot

No, it won't. That's the point. There is no data to suggest that a plumber who did well on the SAT is a better employee than the plumber who didn't do well on the SAT.

I’m just saying that overall, SAT is important for college admissions because it helps select for smart people that then go into professions, or hopefully go onto professions, in which being smart is critical

The SAT also selects for people who have paid thousands for someone to tutor them to beat the test. College is also self-selective and it's generally those who are actually smart who attend. There is no evidence that if colleges stopped using the SAT, they'll suddenly be inundated with dunces struggling with astrophysics.

also, I think we should make high school applicants to college also take an IQ test in addition to the SAT

And where do we draw the line? Do those with below average intelligence not get to go to college?

 

[ak427]

After just finishing M1, ignoring everything else and focusing on board resources made my life significantly less stressful and I feel bad for people who have to rely on professors and small groups to learn during M1 and M2 year going forward if that's what happens. I tried the whole lecture, participate in groups, etc. the first half of M1 year, and I almost burned out just from that. The stress from Step 1 might go down, but the day to day stress during the first two years might go up for a lot of students if they have to rely on their school, which is not a tradeoff I personally would enjoy.

 

[Anonymous Lurker]

No, it isn't. You may be able to make the argument that a correlation exists between intelligence and jobs that require higher education, but this in no way expands to the workplace in general. It's an incredibly tenuous relationship at best.

The Hunter study had a database that "included over 32,000 employees in 515 widely diverse civillian jobs". Furthermore the r=0.51 number was for medium complexity jobs that included skilled blue collar jobs and mid level white collar jobs. The jobs for which the correlation holds included 62% of the workforce, a majority. It's not a tenuous relationship for the general workforce.

 

[altblue]

After just finishing M1, ignoring everything else and focusing on board resources made my life significantly less stressful and I feel bad for people who have to rely on professors and small groups to learn during M1 and M2 year going forward if that's what happens. I tried the whole lecture, participate in groups, etc. the first half of M1 year, and I almost burned out just from that. The stress from Step 1 might go down, but the day to day stress during the first two years might go up for a lot of students if they have to rely on their school, which is not a tradeoff I personally would enjoy.

You can still rely on board resources for NBME exams, and some select school-written exams as long as you look at your school's lectures. It's hard to score above a 92% or so on an NBME without going to your school's lectures because the professors find low yield questions from the NBME bank that aren't emphasized in First Aid/B&B, or at least that's how it is at my program, but it's definitely doable to pass.

Hell I'd say boards prep material is something we can all agree on as a net positive.

 

[bananafish94]

why not change the curriculum to be entirely PBL with small groups of like 6 people?

I'd more or less be in favor but I don't know how many schools would have enough faculty willing to frequently take multiple hours out of their clinical schedule to accommodate that many small groups.

 

[ak427]

You can still rely on board resources for NBME exams, and some select school-written exams as long as you look at your school's lectures. It's hard to score above a 92% or so on an NBME without going to your school's lectures because the professors find low yield questions from the NBME bank that aren't emphasized in First Aid/B&B, or at least that's how it is at my program, but it's definitely doable to pass.

Hell I'd say boards prep material is something we can all agree on as a net positive.

Ehh, I didn't so much as open a school lecture once we switched to NBME exams in organ systems and I was able to pull 90+ on those exams. Granted every school is different, so my experience is anecdotal. For me though, I would be studying all day if I used board resources AND school material and it would have driven me insane.

 

[Mass Effect]

The Hunter study had a database that "included over 32,000 employees in 515 widely diverse civillian jobs". Furthermore the r=0.51 number was for medium complexity jobs that included skilled blue collar jobs and mid level white collar jobs. The jobs for which the correlation holds included 62% of the workforce, a majority. It's not a tenuous relationship for the general workforce.

You're not going to convince me there's correlation between quality of the general workforce and high SAT. It's just not going to happen. Time to move on.

 

[readmypostsMD]

Ironically, this story just broke:

University of California Will End Use of SAT and ACT in Admissions (Published 2020)

The change is expected to accelerate the momentum of American colleges away from the tests, amid concern that they are unfair to poor, black and Hispanic students.

www.nytimes.com

“...The decision, however, ran counter to a recommendation from the system’s faculty senate, which voted in April to keep the SAT and ACT. A faculty task force commissioned to study the impact of standardized tests found that they predict college success within the University of California system more effectively than high school grades or other measures.”

this is borderline frightening and a symptom of a deeper obsession with equality of outcome over equality of opportunity, egalitarian doctrine, and far left progressive politics. Soon enough people will eliminate high school grades because they are “mean and unfair.” If anything, it seems like high school grades would be far more unfair than the sat

This is like me saying that it’s unfair that short people can’t be in the NBA and forcing the nba to allow short people into teams. I wonder how the Cavs would fair with a bunch of 5’6” dudes unqualified for the game

also, it’s pretty offensive to the groups the article points out. It’s basically implying that those minorities are incapable of scoring as high as other groups, so the entire test needs to be eliminated. How would it feel to be told that you can’t compete with students from other groups?

It also especially hurts low income Asians who gain academic advantage with high scores through hard work and natural abilities

Im totally lost on why a university system would do this. I can’t wrap my head around this. It blows my mind.

 

[altblue]

this is borderline frightening and a symptom of a deeper obsession with equality of outcome over equality of opportunity. Soon enough people will eliminate high school grades because they are “mean and unfair.”

This is like me saying that it’s unfair that short people can’t be in the NBA and forcing the nba to allow short people into teams. I wonder how the Cavs would fair with a bunch of 5’6” dudes unqualified for the game

also, it’s pretty offensive to the groups the article points out. It’s basically implying that those minorities are incapable of scoring as high as other groups, so the entire test needs to be eliminated. How would it feel to be told that you can’t compete with students from other groups?

It also especially hurts low income Asians who gain academic advantage with high scores through hard work and natural abilities

Im totally lost on why a university system would do this. I can’t wrap my head around this

"Those minorities"

Yikes

To the substance of it, there's a set of experiences that SES and racially privileged (i.e. upper middle class and white) people overwhelmingly get that others don't Children of these backgrounds overwhelmingly have a better English and Math education from kindergarten to 12th grade, adding a discrete advantage on the SAT over less privileged children that muddies a precise measurement of aptitude. I don't doubt the correlation between SAT and ACT and academic ability, but it's difficult to say x person is better than y person on the basis of score alone, because there are so many factors that go into a score like background that make individual use difficult. It's then hard to fill a class with the best and brightest, or with people who just all around would benefit the school and society, when that issue persists. That's a good deal the reason why the university system ignores the metric altogether.

 

[altblue]

Hell, put this more familiar terms. There are some very, very smart people who score a 500 to 510, but they might score this modestly for a variety of reasons, like speaking English as a second language, family obligations, low reading experience, limited time, or a weaker STEM background. Doesn't mean they can't kill it med school or become awesome physicians.

To be certain, I'm neutral to ignoring the SAT and I oppose ignoring the MCAT, but there's value deemphasizing scores to an extent since it allows us to see the full context behind a score.

 

[Matthew9Thirtyfive]

To everyone, this is a warning because I see where this is going. This thread is not going to turn into a thread about race or racism or anything like that. It’s about step 1 being P/F and topics related to that.

If it goes down that path, I will turn this car right the **** around so help me.

 

[readmypostsMD]

To everyone, this is a warning because I see where this is going. This thread is not going to turn into a thread about race or racism or anything like that. It’s about step 1 being P/F and topics related to that.

If it goes down that path, I will turn this car right the **** around so help me.

I've been censored

all I’ll say is that eliminating the SAT Bc of perceived unfairness sets huge precedent

 

[Lawpy]

why is Step 3 still scored? what purpose does the exam have?@longhaul3

 

[efle]

why is Step 3 still scored? what purpose does the exam have?@longhaul3

Theres no impetus to get rid of a score that nobody cares about. Step 1 was only changed because of the consequences that were becoming more and more manifest every year

 

[Lawpy]

Theres no impetus to get rid of a score that nobody cares about. Step 1 was only changed because of the consequences that were becoming more and more manifest every year

who wants to take another step in residency though

 

[Matthew9Thirtyfive]

who wants to take another step in residency though

No one cares about Step 3. 2 months of prep for Step 1, 2 weeks for Step 2, #2 pencil for Step 3.

 

[longhaul3]

why is Step 3 still scored? what purpose does the exam have?@longhaul3

I dunno, the same purpose as the rest of the USMLE portfolio, I guess. There are some clinical scenarios that are more intern-level stuff than on the other exams. People in EM/IM/FM don't have to worry about it because it's their bread and butter, but anyone in a subspecialty should take it quickly so you never have to hear about fetal heart tracings again.

I've heard that the score matters for fellowship match in some specialties, probably the ones with short residencies, but it doesn't matter at all in mine except that I've heard tell of residents getting fired at one of the more malignant programs for not passing it on time.

 

[7331poas]

Not my complaint at all. My complaint is that those 20-30/280 questions have become the major focus and primary determinant of who does well on this test, because that's the gap from average to 250s-260s.

I think it's awesome that we have to take USMLE Step 1 and score a 70% or better to become licensed physicians. Many of the questions are great reasoning-based ones on issues we really will encounter. But the 20 Q's that separate a 240 from 260? Gimme a freakin break, those will never make you a better clerk or resident or attending.

My issue has never been with Step 1 existing and needing to be passed with a high percentage correct. That's wonderful. I just hate how the small handful of trivia Qs have become a major mechanism of distinguishing oneself.

How many questions separate high scoring MCAT takers? Is it not equally ridiculous that those questions separate who can become a doctor at all? Why are we going after Step 1 and not the MCAT under that logic?

Yet, we treat 235 and 250 like they're a world apart in residency applications, which makes no sense.

Then let the residency directors reach that conclusion.

 

[Mass Effect]

To everyone, this is a warning because I see where this is going. This thread is not going to turn into a thread about race or racism or anything like that. It’s about step 1 being P/F and topics related to that.

If it goes down that path, I will turn this car right the **** around so help me.

Glad I read all the posts before hitting that reply button. You would have loved my doozy of a reply.

 

[Matthew9Thirtyfive]

Glad I read all the posts before hitting that reply button. You would have loved my doozy of a reply.

Thanks for not posting it!

 

[efle]

How many questions separate high scoring MCAT takers? Is it not equally ridiculous that those questions separate who can become a doctor at all? Why are we going after Step 1 and not the MCAT under that logic?



Then let the residency directors reach that conclusion.

If MCAT prep began consuming the college education experience to the same degree, was as statistically sloppy, was also NOT designed to be used for this function, and we convened a giant stakeholder group and decided it was best to use the AAMC recommendation of 500+ being the same and changed to Pass/Fail? Then yes, I'd view it similarly too.

Let's not pretend PDs are perfect rational actors with our best interests at heart. They need a method to sort us and thin the pile. Whether that method is a sensible, valid one is an afterthought. Caps are the answer, if we expect good app review we have to first make it possible for them to read them thoroughly. Remember that PDs ignored step scores for more than a decade until our higher and higher applications per capita started to force this behavior.

 

[Med Ed]

If MCAT prep began consuming the college education experience to the same degree, was as statistically sloppy, was also NOT designed to be used for this function, and we convened a giant stakeholder group and decided it was best to use the AAMC recommendation of 500+ being the same and changed to Pass/Fail? Then yes, I'd view it similarly too.

If USMLE stopped designating results as P/F, and instead let the state medical boards determine their own thresholds for minimum acceptable scores, the situation would also be more analogous.

 

[sunshinefl]

Yeah they expect us to know stuff too. But I read all over the place in here that you’re not expected to know anything and if you know where the bathroom is you’re good.

Yeah everyone says they don’t expect students to know anything, but they 100% do. I read the same thing about new interns, and I’m sure that’s not true either.

Wow. Yeah almost everyone in my class really enjoys our clinical reasoning sessions. I also can’t imagine just ignoring them and doing zanki considering there are like 6 of us and a physician faculty member. That would be rude as ****.

We definitely had people doing it (zanki, UWorld, etc) even when working in small groups of 6-8 with a physician faculty member in clinical reasoning type sessions.

 

[efle]

People def used small group time to get through part of their daily anki regardless of group size at my school too. Which makes sense, because who wants to sit through the sessions just to go home and have hours of flashcarding to do? It was clearly reaching a point of either/or instead of supplementation, and Step 1 was winning every time

 

[DrRiker]

I’ve been out of touch with this conversation for a while. People have tossed around the idea of including MCAT in applications. Any truth in this? Or a load of nonsense?

 

[efle]

I’ve been out of touch with this conversation for a while. People have tossed around the idea of including MCAT in applications. Any truth in this? Or a load of nonsense?

I vaguely recall hearing once that our college GPA and MCAT were still visible to PDs but nobody cares enough to look/weight them

 

[Matthew9Thirtyfive]

Yeah everyone says they don’t expect students to know anything, but they 100% do. I read the same thing about new interns, and I’m sure that’s not true either.



We definitely had people doing it (zanki, UWorld, etc) even when working in small groups of 6-8 with a physician faculty member in clinical reasoning type sessions.

People def used small group time to get through part of their daily anki regardless of group size at my school too. Which makes sense, because who wants to sit through the sessions just to go home and have hours of flashcarding to do? It was clearly reaching a point of either/or instead of supplementation, and Step 1 was winning every time

That’s insane for so many reasons.

 

[efle]

That’s insane for so many reasons.

Yes, theres a reason faculty were overwhelmingly in favor of this change, and it isnt jealousy that we replaced them with Spacebar

 

[throwaway1000000]

People def used small group time to get through part of their daily anki regardless of group size at my school too. Which makes sense, because who wants to sit through the sessions just to go home and have hours of flashcarding to do? It was clearly reaching a point of either/or instead of supplementation, and Step 1 was winning every time

even with step 1 going p/f, you will see similar attendance at schools and use of anki'ing/studying other resources instead of school curriculum.
The most important change that everyone conveniently ignores is needing to change quality of the lectures and the curriculum.
Better to rephrase this argument as online resources were winning every time over the school curriculum.
I think there's amazing ways to restructure the curriculum to make students better clinicians and more prepared for clinicals now that Step is P/F. Will schools do this is a big question mark.

 

[efle]

even with step 1 going p/f, you will see similar attendance at schools and use of anki'ing/studying other resources instead of school curriculum.
The most important change that everyone conveniently ignores is needing to change quality of the lectures and the curriculum.
Better to rephrase this argument as online resources were winning every time over the school curriculum.
I think there's amazing ways to restructure the curriculum to make students better clinicians and more prepared for clinicals now that Step is P/F. Will schools do this is a big question mark.

Well, I do think "lecture" in 2030 will mean something like Boards & Beyond instead of various professor slide decks.

But I dont think students in 2030 will be grinding a 30,000 flashcard deck in their small groups

 

[ciestar]

I vaguely recall hearing once that our college GPA and MCAT were still visible to PDs but nobody cares enough to look/weight them

None of this was on my ERAs and I didnt post it on my CV either.

 

[efle]

None of this was on my ERAs and I didnt post it on my CV either.

Maybe I'm thinking of a thread about specific programs asking for it

 

[Matthew9Thirtyfive]

Maybe I'm thinking of a thread about specific programs asking for it

Yeah I remember that thread. It was a specific program.

 

[Matthew9Thirtyfive]

Yes, theres a reason faculty were overwhelmingly in favor of this change, and it isnt jealousy that we replaced them with Spacebar

Like the other poster said, I know even if it’s p/f for me (and I don’t know if it will be because I take it February 2020) I will still be doing BnB and zanki because I learn way better using those resources than most of my schools lectures. And I think most people are like that.

But I don’t do anki during small group sessions already because those are actually really great at my school and we learn a lot.

 

[Ho0v-man]

I absolutely agree. Studying yourself up to the level to comfortably Pass step 1 will mean learning a ton of things you do need. What I'd urge everyone to consider is that they'd probably know these pimp answers regardless of whether they score 230s or 250s.

Put another way: Do two people who answer 82% correct and 87% have fundamentally different abilities to reason through human physio and patho? I'd say no. The fact that their CIs overlap would seem to agree. Yet, we treat 235 and 250 like they're a world apart in residency applications, which makes no sense.

I actually don’t know anyone who scored in the 230s. The classmates who’s scores I know either scored >240 or <220 so I’ll let others confirm or refute that claim. I think on test day, you’re probably right. But six months later, the cat with a 250 is much more likely to still know that stuff. I know personally that my understanding of pathophysiology, pharmacology,etc (things that matter) seemed almost exponentially different every ~10 points I climbed in my predicted score. So treating them like a world apart does make sense to me. There’s always gonna be outliers, but the majority of people fall in pretty close to their predicted scores. Don’t hear too many tales of people getting a 235 uwsa2 and then getting a 250 a week later.

As for the stuff we both agree is stupid, why not get rid of it? Like seriously, why doesn’t Step 1 test on diagnostic criteria of an AKI? Why is penicillin the correct answer for how you treat syphyllis on step 1 no matter what and much more complicated on step 2? Who knows but at least we all know N2 is sleep spindles and k complexes and HbC=lysine for no reason.


But I guess neither of our opinions matter because the decision has been made. We’re not going to move from the laser focus of high yield to do well to focusing on what’s necessary to become a good clinician. We’re going to go to high yield enough to get by and the knowledge base of a 235 will become a rare phenomenon. I hope I’m wrong.

 

[Chibucks15]

I actually don’t know anyone who scored in the 230s. The classmates who’s scores I know either scored >240 or <220 so I’ll let others confirm or refute that claim. I think on test day, you’re probably right. But six months later, the cat with a 250 is much more likely to still know that stuff. I know personally that my understanding of pathophysiology, pharmacology,etc (things that matter) seemed almost exponentially different every ~10 points I climbed in my predicted score. So treating them like a world apart does make sense to me. There’s always gonna be outliers, but the majority of people fall in pretty close to their predicted scores. Don’t hear too many tales of people getting a 235 uwsa2 and then getting a 250 a week later.

As for the stuff we both agree is stupid, why not get rid of it? Like seriously, why doesn’t Step 1 test on diagnostic criteria of an AKI? Why is penicillin the correct answer for how you treat syphyllis on step 1 no matter what and much more complicated on step 2? Who knows but at least we all know N2 is sleep spindles and k complexes and HbC=lysine for no reason.


But I guess neither of our opinions matter because the decision has been made. We’re not going to move from the laser focus of high yield to do well to focusing on what’s necessary to become a good clinician. We’re going to go to high yield enough to get by and the knowledge base of a 235 will become a rare phenomenon. I hope I’m wrong.

This exactly. If not getting rid of it, at least trim down the nonsense that nobody ever needs to actually know. Since its P/F now, (or whenever it will be) why not actually make it a useful exam and get rid of the minutiae used to differentiate scorers. Yes these intricate biochemical pathways are necessary if you're in research but everyone forgets them unless they're relevant to your field where you relearn them anyway. Nobody is coming out of fellowship remembering small derivations of some catabolism pathway.

In my mind, making the focus of the exam actual clinically-relevant medicine makes the P/F that much more valuable because it shows the people who actually know their stuff to be as useful as possible on the wards. I've never been pimped on 2/3rds of the crap I had to learn for step 1 and it never came up again.

 

[AnatomyGrey12]

Yes, theres a reason faculty were overwhelmingly in favor of this change, and it isnt jealousy that we replaced them with Spacebar

No, it’s because they have been replaced completely by cheap, online alternatives that do their job infinitely better.

Since its P/F now, (or whenever it will be) why not actually make it a useful exam and get rid of the minutiae used to differentiate scorers. Yes these intricate biochemical pathways are necessary if you're in research but everyone forgets them unless they're relevant to your field where you relearn them anyway. Nobody is coming out of fellowship remembering small derivations of some catabolism pathway.

You missed the part where it wasn’t even refuted that this type of minutiae might make up a total of 20 questions on the entire test. The vast majority of the test is directly clinically useful. There is a reason the Step 2 killers are usually the ones that killed Step 1.

 

[Chibucks15]

No, it’s because they have been replaced completely by cheap, online alternatives that do their job infinitely better.


You missed the part where it wasn’t even refuted that this type of minutiae might make up a total of 20 questions on the entire test. The vast majority of the test is directly clinically useful. There is a reason the Step 2 killers are usually the ones that killed Step 1.

Idk I remember a ton of the stuff I had to study, plus my test seemed kinda out there. Maybe I'm wrong though. I'm never denying the people who do well on one do well on the other, I attributed that more to serving the anki gods. I have respect for the people willing to do that but holy hell I ain't one of em. Probably why I'm super average but I'll take it haha

Even having those 20 something questions removed I think would make a difference, at least mentally and in prep-related stress. Now there really isn't a point to even have them in there. If that were the case, I woulda spent a lot more time on stuff that actually matters instead of drawing out biochem cycles constantly for months

 

[Mass Effect]

even with step 1 going p/f, you will see similar attendance at schools and use of anki'ing/studying other resources instead of school curriculum.
The most important change that everyone conveniently ignores is needing to change quality of the lectures and the curriculum.
Better to rephrase this argument as online resources were winning every time over the school curriculum.
I think there's amazing ways to restructure the curriculum to make students better clinicians and more prepared for clinicals now that Step is P/F. Will schools do this is a big question mark.

My biggest issue with Step 1 is that it's convinced generations of med students that THAT'S what's relevant to practice medicine and their school curriculums are BS.

The post above demonstrates this. No one can change the quality of lectures because every school is different and every lecturer is different. At my school, we had some outstanding lecturers and some that were below mediocre. I thought like you did -- my school's curriculum sucks and why wouldn't I just learn from Anki? The answer, in case you're wondering, is that I've found (and a few colleagues I've spoke to from other schools agree) that actually, our school's curriculum was just fine. Just because they didn't teach to Step 1 doesn't mean the curriculum was substandard. To this day, as an attending, I reflect on things I learned in med school when it comes to things outside my specialty and when I look it up on UpToDate, I'm building on the foundation I got in school. I never, ever reflect on flashcards or Anki or UWorld. Ever.

I, for one, think it's a positive that Step 1 is moving to P/F. I think it's important to standardize the bare minimum you need to know to practice and it should be a licensing exam. That's it though. People shouldn't sacrifice their school's education to focus solely on Step 1. And PDs shouldn't ignore everything else and focus on it either. The 220 Step person is just as good a doctor (and might even be better) than the 270.

 

[7331poas]

Each top 10 student and graduated attending trying to tell us that this change that clearly harms most of us is in fact good. Hmm

If I didn't care about our terrible curriculum before, I definitely won't care about it now. I will just continue doing anki, then move on to the step 2 decks. All these people talking about "becoming a better clinician". Here is an idea, if I want to preform better on my surgery clerkship, I will skip listening to the PhDs and I will spend that time reading De Virgilio. And for the record, just because you brought a MD down to do a "small group", does not make that time valuable to the individual student.