Step 1 P/F: Decision

[slowthai]

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.

Could not agree more. For many of us, it's about maximizing our time. We will relentlessly put our time and energy into what will get us closer to our goals. Why would I spend one second of my time on low yield stuff (lectures, small groups, mandatory anything, etc) that I could spend doing more boards studying, more research, working out, relaxing, or literally anything else that will contribute to my success? It just doesn't make sense.

School lectures are NOT the foundation, they're just not. We are no longer bound to the low yield due to the advent of superior resources. Boards preparation is in fact the foundation, as some of the posters in this thread have already shown. As long as preclinical grades continue to be irrelevant, school lectures will continue to get pushed to the side, aggressively. The question that naturally follows is "Well what are you paying for then?" The answer is, exactly, what am I paying for? I'm paying for the ability to take the steps and to get a diploma, end of story.

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[throwaway1000000]

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.

There are even better resources now than when you graduated. I can confidently say boards and beyond was better than most of my lectures but the thing is there are better ways to teach than by obsolete lectures.
Take a look at some of the internal medicine or emergency medicine podcasts like clinical problem solvers, curbsiders, morning report, EMCrit, Internet book of Critical Care and tons of others. They are done by experienced clinicians who are masters of internal and emergency medicine and very interactive.
This is the format that should be replicated for the pre-clinical years of course with different content. With the resources academic MD medical schools have, it is not hard to find excellent clinicians to teach pre-clinical in an effective manner.
I am not arguing against step 1 p/f. I think it's a good move but the big problem is are you going to correct the underlying curriculum that made students shift to online resources? I know you found class lectures useful but I am guessing you didn't have boards and beyond when you were studying. When free podcasts are able to dish out excellent material, there is no reason med schools with millions of dollars should be producing sub-standard curriculum.
It is time med schools and these online resources form partnerships. Students can watch a boards and beyond video on basics of heart failure and can come to class with a internist or cardiologist teaching how to elicit various heart failure exam findings, landmark trials in HF, critiquing those trials, interactive cases on working through dyspnea, non-invasive ventilation for HF patients, diuretic dosing, doing point of care u/s exams, and the list can go on and on.
I can also pretty confidently say making step 1 p/f is not going to bring students back to the classrooms or stop using boards and beyond and other resources if the underlying curriculum doesn't change. It is very convenient to blame step 1 for why students are ignoring class, but it's not the not only reason.

 

[efle]

Jesus, do you guys really feel like an hour of Zanki is worth more than an hour of your subspecialized faculty working closely with you on their area of expertise? I'm fully on board with 2x streaming of lectures at home in your underwear, but that's extreme. Flashcards are never going to teach me to read basic imaging as well as a radiologist working through cases in small groups can.

I also find it strange when someone talks about Step being a test of mostly basic reasoning, yet their primary study method was to slam hundreds of thousands of flashcards. Can't have it both ways. You can tell me you don't need to know any obscure facts for a >250 until you're blue in the face, but your behavior paints a different picture.

 

[efle]

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.

I have friends with all range of scores from so low they won't tell anyone, to 270s. I believe they are all going to be excellent physicians. To privately believe I was a better clerk or had exponentially better mastery of medicine than someone who answered 10-15 Q's differently on my form strikes me as preposterous.

Edit: This would also imply that my entire class of '21 is exponentially above the entire classes of '19 and '18 based on our step distributions. Same curriculum, same types of students. It just doesn't add up, we didn't get exponentially better than a couple years ago.

 

[Matthew9Thirtyfive]

Why would I spend one second of my time on low yield stuff (lectures, small groups, mandatory anything, etc) that I could spend doing more boards studying, more research, working out, relaxing, or literally anything else that will contribute to my success?

It sucks that those things are low yield at your school. Our lectures are not great for most modules, but our small group clinical reasoning and skills classes are great. We literally have specialists and subspecialists come in and go into just enough of the basic science so they can help guide us through working up patients with whatever the complaint is for that session. I can do tons of flashcards on dysphagia but that’s just not the same.

 

[bananafish94]

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.

I'd be more inclined to say that any correlation between high scorers is attributable to high scorers being better test takers. I'm sure there's also a correlation between Step 2 and the MCAT and ACT and shelf exams regardless of how clinically relevant they are.

 

[slowthai]

It sucks that those things are low yield at your school. Our lectures are not great for most modules, but our small group clinical reasoning and skills classes are great. We literally have specialists and subspecialists come in and go into just enough of the basic science so they can help guide us through working up patients with whatever the complaint is for that session. I can do tons of flashcards on dysphagia but that’s just not the same.

That's good, and I wish that was the norm at most schools. Like if you're forced to attend these things, you should at least get something out of it.

 

[NeuResurgens]

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.

Jesus, do you guys really feel like an hour of Zanki is worth more than an hour of your subspecialized faculty working closely with you on their area of expertise? I'm fully on board with 2x streaming of lectures at home in your underwear, but that's extreme. Flashcards are never going to teach me to read basic imaging as well as a radiologist working through cases in small groups can.

I also find it strange when someone talks about Step being a test of mostly basic reasoning, yet their primary study method was to slam hundreds of thousands of flashcards. Can't have it both ways. You can tell me you don't need to know any obscure facts for a >250 until you're blue in the face, but your behavior paints a different picture.

I won't lie, a significant amount of our lectures in preclinical were from non-clinical PhD faculty who taught us basic science and included a lot of their own research. It was even less useful than knowing the Kreb's cycle. People aren't just going to online resources because of step 1, a lot of it is because these resources do, in fact, teach us more clinically useful stuff than our school's lectures do. Many schools somehow manage to both teach a lot of non-clinically-relevant basic science AND not teach to step 1. Like M9TF, our clinical sessions were some of the most useful parts of our education during preclinical - noone was doing anki in those as our mentors were practicing clinicians who taught us extremely well.

 

[ace_inhibitor111]

Jesus, do you guys really feel like an hour of Zanki is worth more than an hour of your subspecialized faculty working closely with you on their area of expertise? I'm fully on board with 2x streaming of lectures at home in your underwear, but that's extreme. Flashcards are never going to teach me to read basic imaging as well as a radiologist working through cases in small groups can.

I also find it strange when someone talks about Step being a test of mostly basic reasoning, yet their primary study method was to slam hundreds of thousands of flashcards. Can't have it both ways. You can tell me you don't need to know any obscure facts for a >250 until you're blue in the face, but your behavior paints a different picture.

I personally never used Zanki and don’t think it’s better than any other resource. But the reason it might be useful for some is that it is a form of active learning, where they are forced to pay attention to the details, as opposed to lectures where most really won’t remember anything.

There isn’t any evidence to show Zanki is any better than FireCracker or QBanks or any other active learning resource. If you take the 2020 and 2019 Step surveys and filter by Zanki use, the average scores are the same as those who used First Aid alone. Those who used Kaplan QBanks and USMLE RX qbanks on the other hand have better scores. This is the same for any standardized reasoning test, the more questions you do the better, and Step 1 isn’t a pure aptitude or pure achievement test but a mixture of both.

Anyway, pattern recognition is important so I wouldn’t necessarily call doing flash cards a bad thing, although inefficient and time consuming. If you’ve seen the presentation of endocarditis 100 times hopefully it makes you a little better at recognizing it. As with most things in medicine, if you don’t use it you lose it.

 

[efle]

Is step 1 still expected to be p/f for class of 2024?

Yeah they havent budged from early 2022 as first potential implementation.

 

[brickcity]

Any predictions on if step 1 will be reported as P/F for class of 2023?

Sorry if this has been talked about already - I didn't want to review 30 pages.

 

[slowthai]

There isn’t any evidence to show Zanki is any better than FireCracker or QBanks or any other active learning resource. If you take the 2020 and 2019 Step surveys and filter by Zanki use, the average scores are the same as those who used First Aid alone. Those who used Kaplan QBanks and USMLE RX qbanks on the other hand have better scores. This is the same for any standardized reasoning test, the more questions you do the better, and Step 1 isn’t a pure aptitude or pure achievement test but a mixture of both.

Anyway, pattern recognition is important so I wouldn’t necessarily call doing flash cards a bad thing, although inefficient and time consuming. If you’ve seen the presentation of endocarditis 100 times hopefully it makes you a little better at recognizing it. As with most things in medicine, if you don’t use it you lose it.

I mean, Zanki alone never did, and never will cut it. It gives you the ability to maximize your use of qbanks, which I fall into the "the more the better" camp for maximizing your score.

 

[DrRiker]

Jesus, do you guys really feel like an hour of Zanki is worth more than an hour of your subspecialized faculty working closely with you on their area of expertise? I'm fully on board with 2x streaming of lectures at home in your underwear, but that's extreme. Flashcards are never going to teach me to read basic imaging as well as a radiologist working through cases in small groups can.

I also find it strange when someone talks about Step being a test of mostly basic reasoning, yet their primary study method was to slam hundreds of thousands of flashcards. Can't have it both ways. You can tell me you don't need to know any obscure facts for a >250 until you're blue in the face, but your behavior paints a different picture.

To be fair, this is why we use UWorld, Kaplan, and AMBOSS. And then make more flash cards.

 

[slowthai]

To be fair, this is why we use UWorld, Kaplan, and AMBOSS. And then make more flash cards.

And flashcards don't prohibit basic reasoning unless you allow it to. It's the responsibility of the Zanki user to make sure that they aren't just blindly memorizing.

 

[efle]

And flashcards don't prohibit basic reasoning unless you allow it to. It's the responsibility of the Zanki user to make sure that they aren't just blindly memorizing.

Def true that zanki and Step are not just memorization. But it's enough obscure memorization that you have to cram it all in there to be confident you'll score well. We're never, ever going to see a deck of countless thousands of cards become the #1 way to prep for the MCAT, LSAT, GMAT, GRE, ACT, SAT, or any other test that's actually designed to be about aptitude/reasoning. It's probably the worst defense of the test of them all, because everyone is out here behaving in a way that would be completely inappropriate for such a test.

 

[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

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

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.

but if all Steps are designed to be basic competency exams, why are they even scored in the first place? why not make all Steps P/F?

 

[efle]

but if all Steps are designed to be basic competency exams, why are they even scored in the first place? why not make all Steps P/F?

The original idea was to let students and their schools see how comfortably people had passed. If many of your students are narrowly passing vs all of them easily passing, you might need to change things up.

The whole bastardization into a mock Residency Aptitude Score didn't get going until some 15 years later

 

[Lawpy]

The original idea was to let students and their schools see how comfortably people had passed. If many of your students are narrowly passing vs all of them easily passing, you might need to change things up.

The whole bastardization into a mock Residency Aptitude Score didn't get going until some 15 years later

So why can't the NBME switch all Steps back to P/F now? Is it inertia and politics?

 

[efle]

So why can't the NBME switch all Steps back to P/F now? Is it inertia and politics?

I think they're going to, they just have to do it real sneaky one at a time so the PDs don't riot

 

[slowthai]

Jesus, do you guys really feel like an hour of Zanki is worth more than an hour of your subspecialized faculty working closely with you on their area of expertise? I'm fully on board with 2x streaming of lectures at home in your underwear, but that's extreme. Flashcards are never going to teach me to read basic imaging as well as a radiologist working through cases in small groups can.

Like I've said before, if we were allowed to just eeny meeny miny moe our way into whatever field we wanted, then we wouldn't feel the tremendous pressure to be so laser focused on the high yield. We'd feel free to leisurely take everything in. You wouldn't have Anki Lords ignoring your favorite PBL facilitator everyday. Competition has to cease to exist in order for it to be this way.

 

[Lawpy]

I think they're going to, they just have to do it real sneaky one at a time so the PDs don't riot

I guess it's interesting that the system was working fine for decades until like 90s when Steps switched from P/F to scored and then got badly bastardized and ruined few years ago. It's a clear lesson that the shift from P/F to scored was in fact a bad idea.

Also isn't CS being required for US MD a recent thing? It was meant to be an IMG screening tool iirc. Seems like the med educators in 90s were making bad calls!

 

[Ho0v-man]

I have friends with all range of scores from so low they won't tell anyone, to 270s. I believe they are all going to be excellent physicians. To privately believe I was a better clerk or had exponentially better mastery of medicine than someone who answered 10-15 Q's differently on my form strikes me as preposterous.

Edit: This would also imply that my entire class of '21 is exponentially above the entire classes of '19 and '18 based on our step distributions. Same curriculum, same types of students. It just doesn't add up, we didn't get exponentially better than a couple years ago.

I’m not saying they won’t be excellent physicians. I’m saying that at the beginning of third year, the lower scoring folks knew less. It’s not everything that goes into it though. Also, none of us know how many questions separate these scores. Could be 10. Could be 40.

You said in previous posts that your schools scores went up because everyone bucked the curriculum and focused on board resources. My analysis is that those students hit the wards knowing more basic medical science. But obviously the powers that be don’t agree with me.

 

[Lawpy]

Thinking about it more, i think having a standardized exam and metrics is important but misusing the Steps is a bad idea.

 

[ExcitatorySynapse]

Def true that zanki and Step are not just memorization. But it's enough obscure memorization that you have to cram it all in there to be confident you'll score well. We're never, ever going to see a deck of countless thousands of cards become the #1 way to prep for the MCAT, LSAT, GMAT, GRE, ACT, SAT, or any other test that's actually designed to be about aptitude/reasoning. It's probably the worst defense of the test of them all, because everyone is out here behaving in a way that would be completely inappropriate for such a test.

I agree that step doesn't measure critical thinking terribly well, but how relevant is high level critical thinking vs just knowing a lot of ideas down cold for clinical practice? This is a genuine question, by the way, since I haven't had rotations. For me, so far, med school has been a downgrade in terms of intellectual rigor. It's more taxing because of the volume, but most of the ideas are not actually that hard and it doesn't demand a lot of creativity. If there is no utility to testing reasoning, then the test simply asking obscure facts makes sense to me.

Honestly, although the change does not help me, I kind of see how the test itself is not a great thing to center education and residency prospects around.

 

[slowthai]

I agree that step doesn't measure critical thinking terribly well, but how relevant is high level critical thinking vs just knowing a lot of ideas down cold for clinical practice? This is a genuine question, by the way, since I haven't had rotations. For me, so far, med school has been a downgrade in terms of intellectual rigor. It's more taxing because of the volume, but most of the ideas are not actually that hard and it doesn't demand a lot of creativity. If there is no utility to testing reasoning, then the test simply asking obscure facts makes sense to me.

I've learned that knowledge is the currency of clinical medicine. Intellectual creativity and higher level critical thinking tend to thrive more in the research and innovation aspects of medicine. So designing medical devices or surgical approaches is where you might be able to flex those muscles.

Edit: Just as an aside, if you want to use creativity in your clinical practice, think about plastic surgery. It's one of the most innovative fields in medicine.

 

[7331poas]

I guess it's interesting that the system was working fine for decades until like 90s when Steps switched from P/F to scored and then got badly bastardized and ruined few years ago. It's a clear lesson that the shift from P/F to scored was in fact a bad idea.

Also isn't CS being required for US MD a recent thing? It was meant to be an IMG screening tool iirc. Seems like the med educators in 90s were making bad calls!

You claim it was working fine you mean.

Back then you could waltz into a neurosurgery residency. Today, the secret is out. If getting a 270 in order to get into neurosurgery isnt possible, then its going to force everyone to take research years instead.

 

[7331poas]

It sucks that those things are low yield at your school. Our lectures are not great for most modules, but our small group clinical reasoning and skills classes are great. We literally have specialists and subspecialists come in and go into just enough of the basic science so they can help guide us through working up patients with whatever the complaint is for that session. I can do tons of flashcards on dysphagia but that’s just not the same.

Or I could skip that and just read the de Virgilio chapter on their sub-specialty.

Most small groups consist of just listening to my classmates talk about what they think is the answer to the question.

 

[ExcitatorySynapse]

I've learned that knowledge is the currency of clinical medicine. Intellectual creativity and higher level critical thinking tend to thrive more in the research and innovation aspects of medicine. So designing medical devices or surgical approaches is where you might be able to flex those muscles.
Edit: Just as an aside, if you want to use creativity in your clinical practice, think about plastic surgery. It's one of the most innovative fields in medicine.

This fits with what I've heard, and that's why I don't think you can really fault step for going to obscure facts to distinguish between students. Given the nature of the field (knowledge based) and the ever present rat race, I'm unsure how feasible it is to come up with a "better" test to stratify students based on preclinical knowledge.

Having recognized, objective, stratification capable metrics is important from a justice standpoint, IMO, so maybe specialty specific exams and evaluations are the best way to go when it comes to residency application. For earlier phases of study, like college or med school admissions, specialization doesn't make sense, but at this stage it does.

I definitely agree about research being the exciting field intellectually, and am really looking forward to my summer research.

 

[Matthew9Thirtyfive]

Or I could skip that and just read the de Virgilio chapter on their sub-specialty.

Most small groups consist of just listening to my classmates talk about what they think is the answer to the question.

Sorry your school apparently sucks. Our small groups are nothing like that. I get way more out of participating than I would from just reading a book. It’s just not the same, but I guess if your sessions suck then that’s not true.

 

[efle]

Hot take: I have no problem with a research year being the norm for a neurosurg match instead of a high Step. Everyone's app this days screams "I love research I can't wait to be an academic doctor forever." Well, how better to walk the walk?

 

[bobjonesbob]

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.

What's in med schools' preclinical curriculums that's not tested on step 1 that you think is so important? My experience is that there's way too much emphasis on low yield gross anatomy, histology, embryology, and esoteric pathology that's in Robbins but never shows up on boards. My school's exams had way more obscure facts than step 1. I think that's pretty standard for schools that don't use NBME qbanks for exams and don't heavily teach to the boards.

 

[bobjonesbob]

Hot take: I have no problem with a research year being the norm for a neurosurg match instead of a high Step. Everyone's app this days screams "I love research I can't wait to be an academic doctor forever." Well, how better to walk the walk?

Further incentivizing medical students to churn out overwhelmingly worthless publications is a brilliant idea

 

[slowthai]

Hot take: I have no problem with a research year being the norm for a neurosurg match instead of a high Step. Everyone's app this days screams "I love research I can't wait to be an academic doctor forever." Well, how better to walk the walk?

I would rather not delay my career another year, thank you. Lol

 

[efle]

Further incentivizing medical students to churn out overwhelmingly worthless publications is a brilliant idea

I would rather not delay my career another year, thank you. Lol

Are gap years, frequently for research, at other times equally offensive to y'all? There are more gap years than traditional matriculants to med school nowadays, and also lots of research time built into some academic centers' surgical residencies.

 

[AnatomyGrey12]

Everyone's app this days screams "I love research I can't wait to be an academic doctor forever."

You seeing this is purely because of selection bias because of where you go to school. The vast majority of residency applications these days are NOT screaming "academic medicine for lyfe." Making research years basically a requirement for any specialty is dumb and would only increase the already huge amount of worthless med student research output.

Are gap years, frequently for research, at other times equally offensive to y'all?

If someone has no interest in academic, research based medical practice then yes. Gap years before medical school aren't the same, as many student literally couldn't be a doctor at all if they didn't do them. Research years in residency are also different and not the same. Most people in research heavy programs are there because they chose to be there. Even in neurosurgery there are residency programs that are not research heavy.

 

[7331poas]

Are gap years, frequently for research, at other times equally offensive to y'all? There are more gap years than traditional matriculants to med school nowadays, and also lots of research time built into some academic centers' surgical residencies.

There should be more traditional matriculants. Not more research years for residency applicants.

In other countries you enter medical school from high school. Why do I need to be 35 before I can become a doctor here in the united states?

 

[slowthai]

Are gap years, frequently for research, at other times equally offensive to y'all? There are more gap years than traditional matriculants to med school nowadays, and also lots of research time built into some academic centers' surgical residencies.

There's nothing wrong with taking gap years, for research or for whatever reason. I just don't want to do any, lol. The field I'm interested in (ortho) has no gap/research years included unless you're on a research track or at a 6 year program (rare).

 

[efle]

You seeing this is purely because of selection bias because of where you go to school. The vast majority of residency applications these days are NOT screaming "academic medicine for lyfe." Making research years basically a requirement for any specialty is dumb and would only increase the already huge amount of worthless med student research output.


If someone has no interest in academic, research based medical practice then yes. Gap years before medical school aren't the same, as many student literally couldn't be a doctor at all if they didn't do them. Research years in residency are also different and not the same. Most people in research heavy programs are there because they chose to be there. Even in neurosurgery there are residency programs that are not research heavy.

No it's not selection bias, look at the averages in the NRMP documents. The totally middle of the road Average Joe has over a dozen papers/posters/presentations now for things like nsurg, plastics etc

 

[slowthai]

No it's not selection bias, look at the averages in the NRMP documents. The totally middle of the road Average Joe has over a dozen papers/posters/presentations now for things like nsurg, plastics etc

Yeah, but those apps are screaming "I want to match into this field so I'll continue to pump out meaningless papers", not "I'm in love with academia"

 

[Matthew9Thirtyfive]

Yeah, but those apps are screaming "I want to match into this field so I'll continue to pump out meaningless papers", not "I'm in love with academia"

This is totally unrelated but I downloaded the cheesy ly deck today and love it.

 

[M&L]

This is totally unrelated but I downloaded the cheesy ly deck today and love it.

I’ve been using it for a while now - if I could marry that deck I would

 

[slowthai]

This is totally unrelated but I downloaded the cheesy ly deck today and love it.

Interesting. How are you going to incorporate it? Keep up with the Zanki reviews of what you've done so far and finish out the rest of your prep with Lightyear?

 

[NeuResurgens]

Like I've said before, if we were allowed to just eeny meeny miny moe our way into whatever field we wanted, then we wouldn't feel the tremendous pressure to be so laser focused on the high yield. We'd feel free to leisurely take everything in. You wouldn't have Anki Lords ignoring your favorite PBL facilitator everyday. Competition has to cease to exist in order for it to be this way.

That last sentence is key. Competition will never cease as long as there are more applicants than spots, and you can never match up the number of people who want to do something and the number of spots available to do it on a macro level like in medicine.

Hot take: I have no problem with a research year being the norm for a neurosurg match instead of a high Step. Everyone's app this days screams "I love research I can't wait to be an academic doctor forever." Well, how better to walk the walk?

I would rather not delay my career another year, thank you. Lol

Yeah I can speak as someone going into NS, I DO want to do academics, and research productivity has been very high on my priority list during all of med school precisely so that I could avoid taking a research year. I already started med school a bit later than average and a research year as a med student is absolutely nothing like the built in research years as a resident. During a student research year you work on papers to get your name out there and prove you can actually do *something*, but much of it won't be high impact. It has some utility if you have interest in basic science (which I do not), since those projects take longer to produce anything.

During resident research years, you have a bit more clout to get your research out there, PIs are more likely to prioritize your work and trust you with bigger projects, and you're eligible for bigger awards than as a med student. You can also do enfolded fellowships at many programs, dual degrees, or tailored clinical rotations based on your interests, and you're approaching the research with the mind of a resident with years of clinical experience instead of the mind of a student who just wants to boost their app. Why delay a year to go to residency (and delay of potential attending pay and time as a faculty) if you already know you want to do it, and would rather get going on the process of building your academic credentials?

tl;dr med student research years shouldn't become the norm for any specialty imo

 

[slowthai]

That last sentence is key. Competition will never cease as long as there are more applicants than spots, and you can never match up the number of people who want to do something and the number of spots available to do it on a macro level like in medicine.




Yeah I can speak as someone going into NS, I DO want to do academics, and research productivity has been very high on my priority list during all of med school precisely so that I could avoid taking a research year. I already started med school a bit later than average and a research year as a med student is absolutely nothing like the built in research years as a resident. During a student research year you work on papers to get your name out there and prove you can actually do *something*, but much of it won't be high impact. It has some utility if you have interest in basic science (which I do not), since those projects take longer to produce anything.

During resident research years, you have a bit more clout to get your research out there, PIs are more likely to prioritize your work and trust you with bigger projects, and you're eligible for bigger awards than as a med student. You can also do enfolded fellowships at many programs, dual degrees, or tailored clinical rotations based on your interests, and you're approaching the research with the mind of a resident with years of clinical experience instead of the mind of a student who just wants to boost their app. Why delay a year to go to residency (and delay of potential attending pay and time as a faculty) if you already know you want to do it, and would rather get going on the process of building your academic credentials?

tl;dr med student research years shouldn't become the norm for any specialty imo

Totally agree with everything you've said. The problem is, with the out of control expansion of schools and all the steps eventually (most likely) going to pass/fail, it'll only be a matter of time before they become an unwritten requirement. I've seen an uptick in the frequency of research years taken in both plastics and ortho. Same thing with the number of away rotations. It's an arms race.

 

[AnatomyGrey12]

No it's not selection bias, look at the averages in the NRMP documents. The totally middle of the road Average Joe has over a dozen papers/posters/presentations now for things like nsurg, plastics etc

People jumping through hoops to get into a specialty doesn't mean they are pretending they want to do academic medicine.

 

[efle]

People jumping through hoops to get into a specialty doesn't mean they are pretending they want to do academic medicine.

Come on dude. It's to look like they'll carry the torch and continue to power the paper mill as residents, fellows, and beyond.

The wording in the PD survey is "Demonstrated involvement and interest in research" for which 76% of nsurg PD said it's important with mean 4.6/5, the same as Step 1 and LORs.

Dunno how to make it any more apparent than that

 

[Yankees27]

Yeah, but those apps are screaming "I want to match into this field so I'll continue to pump out meaningless papers", not "I'm in love with academia"

And you know this, how..........

 

[Matthew9Thirtyfive]

Interesting. How are you going to incorporate it? Keep up with the Zanki reviews of what you've done so far and finish out the rest of your prep with Lightyear?

I don’t even take step until halfway through third year. I likely wasn’t going to keep up with zanki reviews during a year of clerkship while I’m also studying for shelf exams and doing the Dorian deck, so I haven’t been keeping up with them anyway. I’m probably just going to switch.

 

[Matthew9Thirtyfive]

Maybe my medical school is not as good as yours, but I don’t see how there are enough physicians available to sit in small groups and talk about each topic specific to their specialty. Many of my groups have nephrologists tackling GI cases, emergency medicine docs handling neurology, etc. Even if my school wanted to there certainly aren’t enough urologists, cardiologists, or orthopods in town to have close to a “small group” experience for everyone except for one day sort of deals. My school has small group sessions 4x a week. They’re nice, but definitely not efficient, not a replacement for patient care, and greatly bump up the price in my opinion.

That certainly makes it less fruitful. We had a rheumatologist for the rheum stuff, a cardiologist for heart stuff, an IM or a pulm doc for lungs, a nephrologist for kidneys, a neurologist for neuro, now we have GI docs for GI. We do them once a week for most modules and we tackle one chief complaint where we get little aliquots of information at a time and have to create and reorder a differential as we go, saying what tests and stuff we’d want. It’s really fun.

We also had a series on reading rads studies related to common things and life threatening diagnoses that were led by radiologists. That was super fun.

I just assumed most schools did it like this, but it sounds like at most places it’s not done this way.

 

[Mass Effect]

What's in med schools' preclinical curriculums that's not tested on step 1 that you think is so important? My experience is that there's way too much emphasis on low yield gross anatomy, histology, embryology, and esoteric pathology that's in Robbins but never shows up on boards. My school's exams had way more obscure facts than step 1. I think that's pretty standard for schools that don't use NBME qbanks for exams and don't heavily teach to the boards.

I didn't say it wasn't tested on Step 1 necessarily (I honestly don't remember Step 1 at this point). I said they didn't teach to the boards. I feel like they went in greater depth, but the depth wasn't useless come to find out. I didn't learn CHF with flashcards. My school's exams almost never tested memory. If you memorized (which I did for the first two blocks and ask me how I did lol), you failed. They taught what they thought was important while covering topics on Step 1 (I do have to add that most of our professors were clinical faculty, with the exception of embryo, microbiology, anatomy, and biochem). So when it came to studying for Step 1, I was behind because it was just a different way of learning the material and I blamed my school for that. Come to find out, I learned the subject matter pretty well and it gave me a good foundation for actually being a doctor. There's a reason only med students and pre meds are up in arms about this subject.

There should be more traditional matriculants. Not more research years for residency applicants.

In other countries you enter medical school from high school. Why do I need to be 35 before I can become a doctor here in the united states?

God no. The last thing we need is more 26 year olds who've never worked a day in their life hitting the wards as "doctor." In many cases, it's quite obvious who's young and inexperienced and who's not and it has nothing to do with how they look. I realized it as a resident, but it's become way more obvious to me as an attending.