Step 1 P/F: Decision

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aProgDirector said:
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.
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Brb making a Zanki-style anki deck from orthobullets
 
alkaidius said:
Definitely new info to me. I’m still struggling to comprehend how it’s possible, but I’ll look into it.
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Yo it's not that crazy lol. Think about how much BS your school has you do during first year, especially with anatomy and mandatory activities. Now imagine eliminating all that fluff. Bam, you have one year.
 
Here's what will happen:
Residencies use CK as as a vetting metric.
CK average around 240 since people generally perform better on the test.
Exponential increase in applications to more competitive specialties without a backup.
Less applications to primary care specialties.
More unmatched applicants.
Increase in primary care shortage.
Way to go USMLE. But hey, some med students didn't have to try too hard in the beginning, so you solved that problem. Good thing the real world will be all sunshine and rainbows.
 
studentdocftw said:
Assuming everything else remains the same, the most obvious ramifications are:
-anytime you remove an objective metric, the process becomes more subjective. Now LORs from big names, aways, clinical evals and school prestige become more important.
-the most important board exam will now be taken the year you apply to residency, giving the applicant who does poorly no time to prepare their app for a different field.
-M1 and M2 will become less standardized and more school specific. Now schools can teach what they want in whatever detail they choose.
-step 2 is the new step 1. Stress will simply move from summer of M2 to summer of M3...but now you get one shot to do well with no shot at redemption.
-DOs and IMGs will get shafted. Some residencies explicitly write that competitive DOs and IMGs should have steps >250...now one of those board exams are gone, and should step 2 become p/f, options will become very limited for these applicants.
-the MCAT becomes more important. Board exams are a tool low tier MDs, DOs and IMGs use to open doors to highly competitive places...now it becomes even more important to attend a top medical school by doing very well on the MCAT.

Just a few thoughts.
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Amen. With this and the merger DOs, IMGs, and even "lower tier MDs" are just prepping for primary care specialties more than ever. Can't sully the ivory towers.
 
Espressso said:
Yo it's not that crazy lol. Think about how much BS your school has you do during first year, especially with anatomy and mandatory activities. Now imagine eliminating all that fluff. Bam, you have one year.
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Don’t get me wrong, I get there’s fluff. But a lot of “fluff” is classified as such because it’s not “on Step1”. I’ve always been of the opinion that medicine needs to get “intuitive” and you don’t get that without repetition over time as you add more systems into your repertoire of knowledge, which, after reading about some of these 1-1.5 year curriculums is exactly what they’re cutting out.

I’m also someone of the opinion that students need to be competent at clinical stuff before they’re thrown into clinicals. Medicine has both knowledge and physical components to it and I have yet to meet a preceptor that didn’t complain about how we’re severely lacking in the latter....
 
Capping the #of residency apps would have alleviated much more stress than a mindless step 1 change.

-Students: “I don’t have to compete with people using this place as ANOTHER safety or a quick vacation destination”

-Programs: “I don’t have to sit here and sift through thousands of apps submitted by people who would never want to go here”

A win win. But that’s too easy. Apps = money.
 
Dirachlet_Dirac said:
Is there anyone I can message about this? I am an incoming MS1 and am deciding medical schools. I am hoping to see how this would factor in.
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If you're an incoming MS1, I'd suggest you give more weight to selecting the most prestigious school since that is likely to play a bigger role in your future residency options.
 
DokterMom said:
If you're an incoming MS1, I'd suggest you give more weight to selecting the most prestigious school since that is likely to play a bigger role in your future residency options.
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Honestly, if you can't live with family med as a strong possibility, I would re-take the MCAT to aim for a middle tier MD
 
Slimpickins said:
Here's what will happen:
Residencies use CK as as a vetting metric.
CK average around 240 since people generally perform better on the test.
Exponential increase in applications to more competitive specialties without a backup.
Less applications to primary care specialties.
More unmatched applicants.
Increase in primary care shortage.
Way to go USMLE. But hey, some med students didn't have to try too hard in the beginning, so you solved that problem. Good thing the real world will be all sunshine and rainbows.
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You do realize that primary care specialties (like everywhere else) fill every year right?

All this means is that more people will SOAP into it
 
can't you distinguish yourself through other ways outside the step exam? Like AOA, rotations, pre-clinical grades.

this is a big hit - but at someone at a low ranked med school I'm not gonna let this prevent me from doing what I want to do in the future (whatever that might be)
 
hormonemonster said:
I don't think they will alter the score for Class of 2023 exam takers. I think this will be the last class to receive a reported score. Residency programs might try new evaluation and interview tactics to suss out how to handle this policy change.
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doesn't this depend on when your class takes Step 1?
I'm Class of 2023, but we don't take Step until after we finish our rotations.
 
There are many issues with USMLE going pass fail for all DO students and mid/low tier MDs going into ANY field, especially competitive specialties and programs.

Random thoughts/predictions I have

- Every DO student effectively has to take USMLE Step 2 CK to maximize their residency prospects.

- DO and mid/low tier MD students have little to no school name brand, limited access to prestigious LORs, limited access to large academic departments + research. They must find a way to overcome these hurdles.

- Personal connections will play a much larger role in getting key audition rotations, interviews and matching. Prestigious personal connections are astronomically more difficult to get at DO or mid/low tier MD schools.

- The great equalizer, the USMLE step 1 score, was the opportunity for students at DO and mid/low tier MD schools to demonstrate their equivalency and/or superiority to students at top MD schools. That opportunity to overcome your school's lack of prestige/pedigree is now gone. It will be harder to get audition rotations and interviews from smaller schools.

- USMLE Step 1 scores come out after second year, giving students a year to game plan their audition rotations, LORs, research projects, and target programs based on their competitiveness. That is now gone, as most students will receive their Step 2 CK score after third year. Students lives will be more uncertain now and they will have little to no time to create a plan of action to maximize their chances to match to their dream programs. What if you score a 235-240 on Step 2 CK but have already set up 4 aways in Derm, started 4 research projects, etc? You will now have only 1-2 months to create a new game plan on where to do audition rotations, whether or not you want to apply to a back up, take a year off for research, etc.

- Objective metrics are important and have a place in education. While the USMLE step 1 scores were definitely overemphasized, the solution should not have been to eliminate the last remaining objective metric programs have, but rather to create additional standardized objective metrics through which programs could assess candidates in addition to STEP scores.

- USMLE Step 1 mania will now become Step 2 mania, I predict that schools will shorten preclinical education, start clinicals in second year, move Step 2 CK to beginning of third year and focus more overall on content tested on Step 2 CK. Hopefully clinical rotation grading, preclinical grading, Deans letters, and LORs become more objective and standardized so that programs have some type of metrics beyond just the Step 2 CK score to gauge academic/clinical acumen of applicants.

- This adds uncertainty for nearly all DO and mid/low tier MD students, making mental health more complicated moving forward. Now students will likely obsess over intangibles and subjective things like networking, LORs, research connections, etc. (again all of which disproportionately benefit elite MD schools/students). Students can no longer rely on themselves to perform well enough on STEP 1 to enhance their opportunities.

- The MCAT is now an extremely important exam for the future of a student. In the absence of LCME/COCA creating new objective academic metrics for program directors, medical schools will become more like law schools where prestige is an extremely important factor in determining where you end up post graduation.

In short, USMLE pass/fail solves little to nothing, complicating matters for students at smaller medical schools while shifting most of the problem to USMLE Step 2 CK

Moving forward

If you are running a DO or mid/low tier MD school, I would change curriculum so that preclinical education is compacted into year one, clinicals begin second year, and everyone takes USMLE Step 2 CK end of second year. I would also invest heavily in GME creation in both specialty and primary care , wet lab creation for research, research funding, creating partnerships/contracts with local universities to enhance research access.

If I was LCME/COCA I would develop standards and elements that create standardized objective metrics (standardized grading for preclincial and clinical years across all schools in country, standardized Deans letters, etc.) so that a student's competitiveness is based on a greater number of objective variables instead of just one (Step 2 CK).
 
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Two predictions on some ambiguous areas:
  • They are going to retroactively apply this and make your Sept 2022 ERAS say "Pass." The alternative, allowing some people to apply with numerical/percentiles while others in the same cycle are forced to apply only with a Pass, is asking for trouble.
    • Lmao at people saying they're going to send PDs a screenshot of their score report. I could make an identical screenshot with a different number substituted using Microsoft Paint in about 30 seconds. If they want this Pass/Fail for the Sept 2022 ERAS and Match, they're going to only show Pass on ERAS, and PDs are going to treat it as Pass.
  • They are also aware that Step 2 CK could just become the new screening tool. They're planning to make Step 2 CK into Pass/Fail just like Step 2 CS and Step 1. They're just easing everyone into it by not changing them both at once, and by not changing anything immediately.
 
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efle said:
They are also aware that Step 2 CK could just become the new screening tool. They're planning to make Step 2 CK into Pass/Fail just like Step 2 CS and Step 1. They're just easing everyone into it by not changing them both at once, and by not changing anything immediately.
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That's pretty much what the head of NBME stated on the podcast released today (Skip to 7:20):
 
Professional Student said:
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.
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It didn't make sense to suddenly change Step 1 to P/F without another system in place but here we are.
 
M3 / 2021 here, I'm f---ing pissed, I grinded hard for two years and ACED step 1, now I have to start all over again and ace step 2 which I was planning on taking after applying to residency. I'm going into medicine so it hardly matters for this match, but my fellowship match in 2024 may not even report the 263 that I earned over two years.

In the long run it makes more sense to emphasize step 2 but for ANYONE in the medical pipeline at this moment, it's gonna be a gigantic mess. I really feel bad for the FMGs who just lost their only way to distinguish themselves and earn a life in this country.
 
workaholic007 said:
can't you distinguish yourself through other ways outside the step exam? Like AOA, rotations, pre-clinical grades.

this is a big hit - but at someone at a low ranked med school I'm not gonna let this prevent me from doing what I want to do in the future (whatever that might be)
Click to expand...
There are always lower ranked programs in competitive specialties. A high step and decent app otherwise would have opened doors at the top end, if everything goes p/f you are out of luck .
AOA, rotations, and preclinical are all different at different schools and there is no apples to apples comparison.
 
Morc said:
Instead of starting Anki when school starts this fall, I will practice my obedience and cookie-baking in preparation for clinicals
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Ahahaha.

Yes. And also start going to the gym. We are no longer med students but professional butt kissers lol!
 
internetcat said:
What would the end result of p/f for step 2 CK be? All decisions based on largely arbitrary EC's? When did scored tests become non-PC.
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Well, was securing a match in the 1990s all arbitrary? Like someone said on the first page, we're heading back towards a system that functioned just fine for decades before the rise of the Step exams, not towards some uncharted chaos where nobody can identify good residents
 
efle said:
Well, was securing a match in the 1990s all arbitrary? Like someone said on the first page, we're heading back towards a system that functioned just fine for decades before the rise of the Step exams, not towards some uncharted chaos where nobody can identify good residents
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That seems like a false equivalency. There are a lot more students vying for the same amount of seats today versus 30 years ago.
 
harrislakers123 said:
There are many issues with USMLE going pass fail for all DO students and mid/low tier MDs going into ANY field, especially competitive specialties and programs.

Random thoughts/predictions I have

- Every DO student effectively has to take USMLE Step 2 CK to maximize their residency prospects.

- DO and mid/low tier MD students have little to no school name brand, limited access to prestigious LORs, limited access to large academic departments + research. They must find a way to overcome these hurdles.

- Personal connections will play a much larger role in getting key audition rotations, interviews and matching. Prestigious personal connections are astronomically more difficult to get at DO or mid/low tier MD schools.

- The great equalizer, the USMLE step 1 score, was the opportunity for students at DO and mid/low tier MD schools to demonstrate their equivalency and/or superiority to students at top MD schools. That opportunity to overcome your school's lack of prestige/pedigree is now gone. It will be harder to get audition rotations and interviews from smaller schools.

- USMLE Step 1 scores come out after second year, giving students a year to game plan their audition rotations, LORs, research projects, and target programs based on their competitiveness. That is now gone, as most students will receive their Step 2 CK score after third year. Students lives will be more uncertain now and they will have little to no time to create a plan of action to maximize their chances to match to their dream programs. What if you score a 235-240 on Step 2 CK but have already set up 4 aways in Derm, started 4 research projects, etc? You will now have only 1-2 months to create a new game plan on where to do audition rotations, whether or not you want to apply to a back up, take a year off for research, etc.

- The NBOME has an opportunity to make COMLEX open to MDs. Objective metrics are important and have a place in education. While the USMLE step 1 scores were definitely overemphasized, the solution should not have been to eliminate the last remaining objective metric programs have, but rather to create additional standardized objective metrics through which programs could assess candidates in addition to STEP scores.

- USMLE Step 1 mania will now become Step 2 mania, I predict that schools will shorten preclinical education, start clinicals in second year, move Step 2 CK to beginning of third year and focus more overall on content tested on Step 2 CK. Hopefully clinical rotation grading, preclinical grading, Deans letters, and LORs become more objective and standardized so that programs have some type of metrics beyond just the Step 2 CK score to gauge academic/clinical acumen of applicants.

- This adds uncertainty for nearly all DO and mid/low tier MD students, making mental health more complicated moving forward. Now students will likely obsess over intangibles and subjective things like networking, LORs, research connections, etc. (again all of which disproportionately benefit elite MD schools/students). Students can no longer rely on themselves to perform well enough on STEP 1 to enhance their opportunities.

- The MCAT is now an extremely important exam for the future of a student. In the absence of LCME/COCA creating new objective academic metrics for program directors, medical schools will become more like law schools where prestige is an extremely important factor in determining where you end up post graduation.

In short, USMLE pass/fail solves little to nothing, complicating matters for students at smaller medical schools while shifting most of the problem to USMLE Step 2 CK

Moving forward

If you are running a DO or mid/low tier MD school, I would change curriculum so that preclinical education is compacted into year one, clinicals begin second year, and everyone takes USMLE Step 2 CK end of second year. I would also invest heavily in GME creation in both specialty and primary care , wet lab creation for research, research funding, creating partnerships/contracts with local universities to enhance research access.

If I was LCME/COCA I would develop standards and elements that create standardized objective metrics (standardized grading for preclincial and clinical years across all schools in country, standardized Deans letters, etc.) so that a student's competitiveness is based on a greater number of objective variables instead of just one (Step 2 CK).
Click to expand...
I would rather put hot needles through my fingertips than take an exam that copies off the gold standard and adds psuedoscience to mix it up, with little to no discerning ability.

Step exams were never designed with the ability to discern applicants to residencies in mind the standard error on the exam is +-6. The MCAT on the other hand was designed with this in mind and the standard error on the exam is +-2.

The only solution here is a subspecialty focused tests that you can take, that are administered by each specialty. This is the logical conclusion to all of this.
 
Medical schools can now try out all the experimental curriculum they want on revolutionizing M1 and M2 curriculum because their worst critics (medical students) will now be focused on an exam that they can't be directly held accountable for which is great because I've always wanted to learn more about climate change. Acknowledging that Step 2 CK is going to be the new deciding factor makes little sense from the perspective of students and program administrators, however saves medical school personnel the hassle of dealing with the massive amount of pressure placed on them from having to actually be competent at enabling their students to succeed on an exam that was raising the bar with each iteration. Now if a student fails to perform on Step 2, it's completely on the student for failing to apply themselves in clinical.
 
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libertyyne said:
The only solution here is a subspecialty focused tests that you can take, that are administered by each specialty. This is the logical conclusion to all of this.
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I have said this ad nauseam to my classmates after hearing a physician say it. It's a brilliant idea and there is no true downside. People will get their money and students will get their shot.
 
dohopeful13 said:
That seems like a false equivalency. There are a lot more students vying for the same amount of seats today versus 30 years ago.
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Actually, the ratio of residency seats to USMD Seniors has gone the opposite direction for decades, and was never any lower than 1.25 seats per 1 US Senior. It's just the arms race for the tiny, highly competitive specialties that has been driving things off a cliff

 
libertyyne said:
I would rather put hot needles through my fingertips than take an exam that copies off the gold standard and adds psuedoscience to mix it up, with little to no discerning ability.

Step exams were never designed with the ability to discern applicants to residencies in mind the standard error on the exam is +-6. The MCAT on the other hand was designed with this in mind and the standard error on the exam is +-2.

The only solution here is a subspecialty focused tests that you can take, that are administered by each specialty. This is the logical conclusion to all of this.
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Two years is not enough time to implement this.

I've resigned myself to being f**ked. I already knew I'd be a zombie for the next 10 years. Just didn't expect it to be this way.
 
efle said:
Actually, the ratio of residency seats to USMD Seniors has gone the opposite direction for decades, and was never any lower than 1.25 seats per 1 US Senior. It's just the arms race for the tiny, highly competitive specialties that has been driving things off a cliff

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If you were in the mafia your nickname would be 'numbers' or 'data'. I love it.
 
Sunbodi said:
Two years is not enough time to implement this.

I've resigned myself to being f**ked. I already knew I'd be a zombie for the next 10 years. Just didn't expect it to be this way.
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I see you’re just accepted. You need to learn this sooner or later. Use this website for lots of information but take most everything here with a few tons of salt
 
ReturnToMed said:
sounds like you gotta start studying like its an in service exam before actually being in residency...
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But it wouldn't have to be 'in service' difficulty, right? Having an 'entrance exam' being a more comprehensive/longer shelf would at least let people see A)If the person actually has interest in the field, and B) Whether the person actually has a talent for the field (which depends a lot on A). That's how I think of it at least. Maybe I'm missing something though.
 
dr_stevebrule said:
Just emailed the USMLE asking them about retroactive score report changes once the new p/f reporting is implemented. Will keep you guys posted if I get a reply
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got a reply:
1581545846218.png


sounds like more information is coming.
 
libertyyne said:
I would rather put hot needles through my fingertips than take an exam that copies off the gold standard and adds psuedoscience to mix it up, with little to no discerning ability.

Step exams were never designed with the ability to discern applicants to residencies in mind the standard error on the exam is +-6. The MCAT on the other hand was designed with this in mind and the standard error on the exam is +-2.

The only solution here is a subspecialty focused tests that you can take, that are administered by each specialty. This is the logical conclusion to all of this.
Click to expand...
One extra idea to throw into the mix is the rise of a third party organization that offers some kind of Clinical Reasoning Aptitude Placement exam (CRAP exam for short). The fundamental difference between USMLE and MCAT is that the former was built to be a studyable knowledge check, while the latter is about interpreting and analyzing novel information from passages.

If someone could create a decent CRAP exam, you'd have something rivaling what we've used in high school forever: a ridiculously easy minimum bar to graduate high school/GED, and a much more useful and prep-resistant SAT.

Seems easier than trying to create something to predict who will be good at niche surgical work.
 
efle said:
One extra idea to throw into the mix is the rise of a third party organization that offers some kind of Clinical Reasoning Aptitude Placement exam (CRAP exam for short). The fundamental difference between USMLE and MCAT is that the former was built to be a studyable knowledge check, while the latter is about interpreting and analyzing novel information from passages.

If someone could create a decent CRAP exam, you'd have something rivaling what we've used in high school forever: a ridiculously easy minimum bar to graduate high school/GED, and a much more useful and prep-resistant SAT.

Seems easier than trying to create something to predict who will be good at niche surgical work.
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I'm all for this just so I can tell all of my friends and family I'm studying for CRAP
 
I think p/f step would be the right move eventually, but doing it right now is just not good timing. Would likely need to address the system of subjective clinical grading and overemphasis on med school pedigree before doing this. Now they're adding more emphasis to what a few random attendings and residents thought of you (not to mention step 2 and shelf scores). Seems like an unstable temporizing measure. Gonna be a lot of pissed off people if they retroactively report p/f too - people who had to do dedicated at the intensity of a scored exam only to get a P out of it.

Meanwhile, they keep ignoring us despite us screaming constantly to get rid of step 2 CS
 
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libertyyne said:
I would rather put hot needles through my fingertips than take an exam that copies off the gold standard and adds psuedoscience to mix it up, with little to no discerning ability.

Step exams were never designed with the ability to discern applicants to residencies in mind the standard error on the exam is +-6. The MCAT on the other hand was designed with this in mind and the standard error on the exam is +-2.

The only solution here is a subspecialty focused tests that you can take, that are administered by each specialty. This is the logical conclusion to all of this.
Click to expand...

Honestly, this is what I have supported for years. Extra costs aside, it streamlines one's focus. It's highly specific to the field and puts the pressure on you to figure out what you want to do early on. The downside is that those that are still figuring out which field they desire would have to take a "research year" or two to study for the exam if they decided on it late.
 
dr_stevebrule said:
got a reply:
View attachment 295423

sounds like more information is coming.
Click to expand...

Such a non-answer from them. It's frustrating how they release such a vague statement knowing how important this is. If you're going to do it, you should have planned out. You don't just rush it to get praise from ivory tower Twitter docs.
 
slowthai said:
Honestly, this is what I have supported for years. Extra costs aside, it streamlines one's focus. It's highly specific to the field and puts the pressure on you to figure out what you want to do early on. The downside is that those that are still figuring out which field they desire would have to take a "research year" or two to study for the exam if they decided on it late.
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Also like, nearly all of the competitive fields are surgical (or for medicine fellowships, procedural ones). There's really no way to write a multiple choice exam to help you find better surgeons. You need to hear impressions from mentors (LoRs, clinical evals) and/or see what they've got on an audition.
 
JustOnePing said:
That's pretty much what the head of NBME stated on the podcast released today (Skip to 7:20):
Click to expand...


Is there a transcript for this? I don't wanna hear his annoying, kowtowing money hungry voice. If he was to spend less time compulsively charging exorbitant amounts for licensing exams, it would positively impact med students.
 
Didn't read every single comment above, so some of this may have been repeated, and undoubtedly many will disagree with the following, but here goes:

Appreciate the sentiment behind the change, but will have unintended consequences, I feel. Will result in further consolidation of medical training, e.g. I feel med students at Ivy League or top 10 or however one defines reputation, just saying, at top programs/institutions will take even more just from their own, and vive-versa regionally/system-wise, med students from one institution will tend to stick there and get preferential treatment from their home program/hospital even more, since otherwise how can you as PD differentiate between different applicants from all over the country?

Will put exponentially more pressure on students to perform well on STEP2CK (no more, if you "bombed" or did worse than you wanted on STEP1, can make up for it by an above-average performance on STEP2), which if you traditionally still take it at your school at the end of third year (that said, lots of schools are moving to an accelerated preclinical curriculum and more clinical time, so this may accelerate a trend of taking STEP2CK earlier, I guess?), then how the hell do you plan for which specialty to apply into? You find out your score by beginning of 4th year, then you scramble for away rotations (pretty much a requirement for specialties like ortho), so that becomes even more of an application s*itshow than it already is.

Along with the fact that most every school is already Pass/Fail preclinical, lots of schools have moved to a no-ranking or loose ranking (buckets of quartiles) criteria, whereby at many institutions, that ranking is not actually determined just solely based on preclinical grades (since, well, there's no more grades), but an amalgamation of "professionalism", interpersonal skills, "peer reviews", etc., which again, how do you objectify and grade those?

And of course, we know third year grades / MSPE's are inherently subjective and vary widely between institutions (some schools, everybody is described as the next Nobel Prize laureate, but on the other end of the spectrum, I definitely have friends at DO schools where the written comments aren't filtered and are so brutally honest as to being cruel/unnecessary mean/personal and not constructive), so those grades really don't mean much either and are hard to impossible to compare school to school. And LOR's are also subjective data, and generally effusive of praise.

So... If you don't have any objective data, then you go back to an old boys system of who do you know, "networking", calling, further consolidation of training...

Not being pessimistic or cynical here, but just genuinely unsure how that can help students and employers down the line, and will just make the physician workforce more homogeneous rather than diverse and reflective of the patient population we serve.

Or, another possibility, if you need to differentiate yourself, then research becomes mega-important, students in more competitive specialities need to do an additional research year, training gets even longer...

And, finally, as a student I would find that entirely EVEN more stressful, since you're going into application season with even less data to figure out what's in and out of reach specialty-wise, which programs to apply to, and murkier/less reliable advising from your school, since entering uncharted territory.

Or, as a result, all schools realizing the above, and wanting to differentiate themselves, return to a graded 4-year system, and more emphasis on SHELF exams and ALL exams throughout the curriculum, and the end result is more stress/more focus on grades/going backwards as well...
 
workaholic007 said:
can't you distinguish yourself through other ways outside the step exam? Like AOA, rotations, pre-clinical grades.

this is a big hit - but at someone at a low ranked med school I'm not gonna let this prevent me from doing what I want to do in the future (whatever that might be)
Click to expand...

AOA and rotations are even worse (i.e. subjective) measures than step 1 is.
 
efle said:
Also like, nearly all of the competitive fields are surgical (or for medicine fellowships, procedural ones). There's really no way to write a multiple choice exam to help you find better surgeons. You need to hear impressions from mentors (LoRs, clinical evals) and/or see what they've got on an audition.
Click to expand...

Agreed. I have always said that the best metric for choosing residents is away rotations. It's the best proxy we have for clinical performance. It's extremely hard to fake all of the attributes that they're looking for in an applicant.
 
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