Step 1 P/F: Decision

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UNMedGa said:
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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my school doesnt even report shelf scores..
 
UNMedGa said:
AOA and rotations are even worse (i.e. subjective) measures than step 1 is.
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I agree - but then whats the move. Do you think they will retract the changing of pass to fail? I am not that optimistic personally even though they are receive backlash
 
This is probably one of the worst organizational decisions I have ever seen. This is going to dramatically damage the medical school system for decades. All the reasons why going to law school is terrible outside of the t14 is now happening to medical school.

Thank christ I am a M2. I am sorry for all the M1s who got bait-and-switched into this field.
 
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longtimelurker2015 said:
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...
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Direct hit. Nail. Head.
 
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.
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IMO, you still need to have a knowledge base and apititude for application of that knowledge before people can eval if you can throw in a suture. Surgical subs dont evaluate for surgical skill, because as they say , you could teach that to a monkey. Rather the letters are for discerning that you have the temperment, character and how well you can work in a team under high stress.
 
workaholic007 said:
I agree - but then whats the move. Do you think they will retract the changing of pass to fail? I am not that optimistic personally even though they are receive backlash
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No way they retract this change. They've been mulling this over for months if not years
 
ExcitatorySynapse said:
I'm MD/PhD and wonder how reporting will work if say, I apply for the match in 2025. I guess this will incentivize me even more to work hard and publish as much as possible.
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Right, if you can't differentiate based on grades/boards, then research will take potentially an outsized importance... Not necessarily a problem, BUT shifts the arms race so to say, e.g. you already are seeing some med students gunning for super competitive specialities/programs trying to get every last publication they can, submitting to predatory journals, paying exorbitant submission fees, etc. I feel if this becomes the new focus/standard, then you run the risk of further increasing applications to "top" med schools so you can have more access to research support, get in so and so's research lab, etc. More focus on who you know, etc.

Not necessarily gonna turn out that way, but feels like a legitimate possibility.
 
What about blinding schools names on eras? Instead of name, use US MD, US DO, US IMG. Yes, there is still an obvious preference, but DO takes different exams for graduation and should have comlex reported (so that failures aren’t able to slip by). That, and at the end of the day, we all chose to go where we went. It’s not perfect, but it would be a way to eliminate a lot of pedigree bias, albeit not all of it.

Just thinking out loud. Like it matters? They obviously don’t listen. They have their own agenda.
 
ciestar said:
my school doesnt even report shelf scores..
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They may start unfortunately.

workaholic007 said:
I agree - but then whats the move. Do you think they will retract the changing of pass to fail? I am not that optimistic personally even though they are receive backlash
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Yeah I highly doubt they will retract this, so unfortunately those things will become more important (even though they mean less when predicting a student's quality as a future physician) - just a bad decision they clearly didn't think through enough
 
UNMedGa said:
They may start unfortunately.



Yeah I highly doubt they will retract this, so unfortunately those things will become more important (even though they mean less when predicting a student's quality as a future physician) - just a bad decision they clearly didn't think through enough
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i just dont understand why they did this. honestly neither programs or students benefit - only maybe a small minority of the affected parties benefit. there must be some agenda behind this.

as a first year student at a bottom MD school, do you think this is gonna affect me? Im so confused and lost.

lastly, why would they have a DO merger if they are going to do this?
 
I predict a number of schools return to a fully graded and ranked pre-clinical system.

workaholic007 said:
i just dont understand why they did this. honestly neither programs or students benefit - only maybe a small minority of the affected parties benefit. there must be some agenda behind this.
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Go take a gander at who the loudest and biggest proponents were of a P/F USMLE Step 1.... Almost universally the push came from individuals associated with large, highly ranked, and well known institutions.
 
workaholic007 said:
i just dont understand why they did this. honestly neither programs or students benefit - only maybe a small minority of the affected parties benefit. there must be some agenda behind this.

as a first year student at a bottom MD school, do you think this is gonna affect me? Im so confused and lost.

lastly, why would they have a DO merger if they are going to do this?
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Plot twist, NBOME manipulated this from behind scenes so COMLEX becomes the only objective exam.
 
I imagine if you're someone who is generally low-scoring on exams and/or wants to go into Primary Care and doesn't care too much about the #prestige of residency, this is probably a great change, no matter what tier MD or DO you are.

Lower-tier MDs/DOs will become the physicians of primary care, while FMGs/Caribbean are absolutely ****ed.
 
AnatomyGrey12 said:
I predict a number of schools return to a fully graded and ranked pre-clinical system.



Go take a gander at who the loudest and biggest proponents were of a P/F USMLE Step 1.... Almost universally the push came from individuals associated with large, highly ranked, and well known institutions.
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The people who had the most to gain also had the most influence. What a joke.

That’s probably why the announcement is so vague. The brass got what they wanted, the rest will be figured out in time.
 
Type2Fiber said:
My initial reaction was that this change is not a good thing, but for M2s, the bolded might actually work out for some of us. Want to do ortho with a poor step score? Take a year off, do research and network, then apply with a P on the transcript. Not a bad option

But overall, this thing is a complete dumpster fire
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Can you imagine all the current applicants with low Step 1 taking 1-2 years off and then applying to ortho or derm? 1400 applicants for 700 spots, with a P/F Step 1... it will be a bloodbath
 
Natural Killer Cell said:
I imagine if you're someone who is generally low-scoring on exams and/or wants to go into Primary Care and doesn't care too much about the #prestige of residency, this is probably a great change, no matter what tier MD or DO you are.

Lower-tier MDs/DOs will become the physicians of primary care, while FMGs/Caribbean are absolutely ****ed.
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FMGs could probably make it if they're superstars. Caribbean guys are completely screwed however. I think this thread should be repeatedly posted in Caribbean forums and preallo to discourage everyone from considering it.
 
Would like to remind everyone that while SDN has a vocal group that views scored Step 1 as a necessary evil to let IMG and DO outliers match better, the NBME did gather a great deal of testimonials from randomly sampled students after their Step 1 exams. They even paid us for filling out the survey (only like $25, but it was still nice). I guarantee the vast majority of people had a very different take on it than the angry folks here.
 
internetcat said:
The only positive thing that I can see coming from this is that it is a sobering reminder to all incoming medical students that everything about their future career lies in the hands of unseen governing bodies that act with total impunity.
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And if you complain, they'll make your lives worse (looking at Step 2 CS)
 
efle said:
Would like to remind everyone that while SDN has a vocal group that views scored Step 1 as a necessary evil to let IMG and DO outliers match better, the NBME did gather a great deal of testimonials from randomly sampled students after their Step 1 exams. They even paid us for filling out the survey (only like $25, but it was still nice). I guarantee the vast majority of people had a very different take on it than the angry folks here.
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Lol, wonder why I didn't get to fill that out 🤔
 
efle said:
Would like to remind everyone that while SDN has a vocal group that views scored Step 1 as a necessary evil to let IMG and DO outliers match better, the NBME did gather a great deal of testimonials from randomly sampled students after their Step 1 exams. They even paid us for filling out the survey (only like $25, but it was still nice). I guarantee the vast majority of people had a very different take on it than the angry folks here.
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I mean the results of the survey was publicized, and it was 50/50 from what I recall.
 
efle said:
Would like to remind everyone that while SDN has a vocal group that views scored Step 1 as a necessary evil to let IMG and DO outliers match better, the NBME did gather a great deal of testimonials from randomly sampled students after their Step 1 exams. They even paid us for filling out the survey (only like $25, but it was still nice). I guarantee the vast majority of people had a very different take on it than the angry folks here.
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That's because people hate Step 1 mania and the overly technical crap they focus on. The test can be drastically restructured without just blindly changing it and thinking everything will be ok
 
How will this affect fellowships down the road? Will the current M2s-M4s have their numerical scores converted to P down the road? So the CK score then becomes a major determining factor for competitive fellowships?
 
AnatomyGrey12 said:
Lol, wonder why I didn't get to fill that out 🤔
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Because they wanted a random, representative sample, not a stampede of all the outliers who stood to lose or gain the most !

ace_inhibitor111 said:
I mean the results of the survey was publicized, and it was 50/50 from what I recall.
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I think you might be thinking about the mixed results on the open commentary invitation period, this was a paid survey sent to random test takers that I don't recall seeing any analysis released about
 
AnatomyGrey12 said:
The NBOME will almost assuredly follow suit. It is also irrelevant, because PD's didn't give a crap about COMLEX to begin with.
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MOST, not all, even if the preference was to Step. But yeah, it’s probably a joint venture. It would be smarter if they didn’t, because it would at least give DO friendly places more to work with, but y’know...yeah.
 
Natural Killer Cell said:
How will this affect fellowships down the road? Will the current M2s-M4s have their numerical scores converted to P down the road? So the CK score then becomes a major determining factor for competitive fellowships?
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Idk but tbh it feels it makes more sense to focus only on Step 2 CK and Step 3 at that stage given the clinical focus, according to what attendings state
 
Tbh I wish I my Step will be P/F. I'm in Class of 2022 and probably going into either FM, Peds, community/non-top academic IM, or Neuro anyway.

Ortho gunners, I wish you good fortune in the wars to come.
 
Natural Killer Cell said:
Tbh I wish I my Step will be P/F. I'm in Class of 2022 and probably going into either FM, Peds, community/non-top academic IM, or Neuro anyway.

Ortho gunners, I wish you good fortune in the wars to come.
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my step 1 was terrible.. so this wouldnt have hurt me lol (did well on CK, thought the exam was much more manageable than step 1)
I went FM anyway.
 
libertyyne said:
Step 1 is dead, long live Step 1 2ck!


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

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

On a separate note
Someone should do a study on the rate of increase in publishing case reports and other low quality research papers after the conversion to P/F.
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Wouldn't that be a good thing to change the emphasis on Step 2 ck? . I think it is a great idea.
 
Usmle_Seeker2020 said:
Wouldn't that be a good thing to change the emphasis on Step 2 ck? . I think it is a great idea.
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Potentially yes, but with the current set up? No, not at all. Because many take CK right before or as they apply, so you may not even know your CK score until right before you submit and this creates a huge problem.
 
@efle Most people can’t abstract immediate visceral feelings from weighing in logically when it comes to a high performance examination. Step 1 P/F was likely going to be implemented because there were too many parties that perceived benefit from it without really rationalizing the outcomes. Top tier medical school students, medical schools in general, mediocre to poor performing students, and students who felt unprepared taking the examination were all invested in making this exam pass/fail because they all thought they would benefit from not having to worry about actually performing while reaping the benefits of being a “performer” in soft areas like LOR, sociability, and likability (Wizard of the Wards). There are medical students who actually believe that this will hurt students from top tier medical schools due to how it was spun to them with published articles from HYPSM schools coming to mind about how P/F benefits students from minority backgrounds. I think that SDN should be lauded for seeing through the low hanging fruit of P/F when most people go for immediate satisfaction over looking at the long term implications this will have on objective decision making.
 
Assuming they do confirm retroactive change so that everyone is P/F in 2022:

>Be MS2 interested in ENT, unsure about this whole P/F step 1 thing
>Figure I should take it, if it goes fantastic I apply in 2021, if not I take a research year so it just shows up as a P in 2022
>Do just OK and take a research year
>Hundreds of other people in my situation had the same idea and did the same thing
>ENT match rate for my 2022 cycle is 50%
>soap into family med
>mfw
 
Lawper said:
It's good if clinical years started in 2nd year.
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For a few years now there have been rumblings from some schools to shorten pre-clinical education to 1.5 years
 
efle said:
Because they wanted a random, representative sample, not a stampede of all the outliers who stood to lose or gain the most !


I think you might be thinking about the mixed results on the open commentary invitation period, this was a paid survey sent to random test takers that I don't recall seeing any analysis released about
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Lol. If only USMDs got the survey then that sample is not random.

If they have evidence that most medical students that take the USMLE wanted this change then that data needs to be publicly released. If this change was truly data driven and not with an agenda then it should be published by the end of the year. Let people analyze their methods, raw data, and conclusions.
 
Usmle_Seeker2020 said:
Wouldn't that be a good thing to change the emphasis on Step 2 ck? . I think it is a great idea.
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The whole impetus was the negative culture of people relying too much on board exams for residency placement and students going ham on step one prep and avoiding everything else their school wanted to teach. Step 2 ck is not a better exam in terms of being able to objectively discern between two applicants. The standard error on the exam is 6 points so an average score of 230 really means that realistically you could be between 218- 230-242, as that is two standard errors. So think about that for a second 218 is family practice and 242 still has a shot at derm or neurosurgery. Kind of silly when you think about it.
 
efle said:
Because they wanted a random, representative sample, not a stampede of all the outliers who stood to lose or gain the most !


I think you might be thinking about the mixed results on the open commentary invitation period, this was a paid survey sent to random test takers that I don't recall seeing any analysis released about
Click to expand...
Natural Killer Cell said:
Tbh I wish I my Step will be P/F. I'm in Class of 2022 and probably going into either FM, Peds, community/non-top academic IM, or Neuro anyway.

Ortho gunners, I wish you good fortune in the wars to come.
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This is why there is frustration on this board. It is much better for those in specialties that aren't competitive or people from elite schools. People in the middle who need something to compete on are harmed. Sure, they can do well on rotations, research, network, ect but there is no way around the fact that the state school MD, and even more for DO, who wants something competitive is worse off with this
 
I'm really hoping every sentiment said here is super exaggerated and everything ends up ok in the end 🙁

I was told that an MD will open all doors for me, and having my fate decided as a PCP before I even start bothers the hell out of me. Legit the reason I didn't even apply DO, I wanted to make sure I had all options available to me.
 
Jappa said:
I'm really hoping every sentiment said here is super exaggerated and everything ends up ok in the end 🙁

I was told that an MD will open all doors for me, and having my fate decided as a PCP before I even start bothers the hell out of me. Legit the reason I didn't even apply DO, I wanted to make sure I had all options available to me.
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Your MD will still keep more doors open than the DO. Plus is in all liklihood cheaper. You should be networking with the specialties you are interested in and still studying hard in school.
 
efle said:
Would like to remind everyone that while SDN has a vocal group that views scored Step 1 as a necessary evil to let IMG and DO outliers match better, the NBME did gather a great deal of testimonials from randomly sampled students after their Step 1 exams. They even paid us for filling out the survey (only like $25, but it was still nice). I guarantee the vast majority of people had a very different take on it than the angry folks here.
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Was this survey before or after they received their Step 1 score?
 
FindersFee5 said:
I'm actually slowly working on a deck for aways - Anki isn't just a good way to learn boards material.
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if we are applying to the same specialty than ,
1581549578216.png
 
Is determining who makes a great ENT or Neurosurgeon or IM fellowships from a memorization test that many take pre-clinicals valid? I don't know, but it's a question to be asked.

I hate what this does to low-tier MDs/DOs (I'm in a DO school), but the idea of making Step 1 P/F makes sense in the long-term.
 
libertyyne said:
The whole impetus was the negative culture of people relying too much on board exams for residency placement and students going ham on step one prep and avoiding everything else their school wanted to teach. Step 2 ck is not a better exam in terms of being able to objectively discern between two applicants. The standard error on the exam is 6 points so an average score of 230 really means that realistically you could be between 218- 230-242, as that is two standard errors. So think about that for a second 218 is family practice and 242 still has a shot at derm or neurosurgery. Kind of silly when you think about it.
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This is the thing. The better decision would be to mandate that students have a Step 2 score before submission of ERAS. And if they want to de-emphasize Step 1, then average it with Step 2 CK. If you think Step 2 CK is worth more than Step 1, then do a weighted average.

But why in the world are we getting rid of step 1 altogether? Its absolutely absurd.
 
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