Step 1 P/F: Decision

Burrell College of Osteopathic Medicine
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CyrusHabs7695 said:
I saw someones comment saying its possible we might get a 3 digit score when we take the test this summer, then when we apply to residency it could just be listed as a 'P', is that accurate?
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Retroactive score change is highly unlikely. Why would they even give you a score only to change it to Pass/Fail?
 
wait so they made this change because apparently step 1 is racist...... not even for the step 1 hysteria. At what point are people going to realize that regardless of your ethnicity you still have to perform well to match into a competitive residency?
 
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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yes true, I was thinking that it is better in terms of making you a good doctor because now you are focusing more on clinical knowledge versus knowing many science details that you may not need for your future practice unless someone is going to be a both MD and Phd. But in terms of competition, might not make a difference, true.
 
ace_inhibitor111 said:
But what I’m saying is they can’t use that method since it doesn’t really affect anything. The MCAT had 230 questions and apparently a tighter interval. The only thing I can think off is the NBME estimated the variance by comparing the answers of say a 260 scorer with that of a 220 scorer, and seeing if all higher scorers got that same question correct vs all the low scorers, etc. But this would overestimate the actual variance when testing a very large body of knowledge.
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Variance depends a lot on what's being tested. Tests that attempt to get after aptitude/critical thinking tend to have very reliable performance because one's ability to reason is static (think LSAT, GRE quant, SAT, etc). A test that is primarily a knowledge check is instead trying to use 1 or 2 specific questions to assess large content areas. A lot of random chance is involved in whether I knew that particular piece of information versus dozens of others that didn't get tested, especially when they're forced to only ask for pieces that many people won't know (otherwise the test item loses discriminatory capacity)
 
Mass Effect said:
And who monitors how hard it is, the NBME? LOL. The fact is that until you're in the specialty, you shouldn't be expected to know the nitpicky nuances of the field. At the same time, if you want to stratify students, it needs to be somewhat difficult. The specialty boards aren't the ones to strike that balance and the NBME is not going to forfeit the task to them.
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ok so that means shelf exams have a much higher weight now
 
Mass Effect said:
But everyone thinks they failed before score release.
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I certainly didn't...and like I said what's the alternative? We ask people who know they have a 250+ if they want 250+'s to be visible? Ask people who know they have a 210 if they want 210s to be visible?
 
Mass Effect said:
EVERYONE should go to med school knowing that they may end up a PCP. It doesn't matter if you're at Yale or Podunk Med School. PCP is always a possibility, no matter who you are.
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There's a difference between understanding that based on your own personal ability to do well you'll end up a PCP versus having your fate sealed before walking into your first class. The latter is now the case and is what bothers me.
 
Jappa said:
There's a difference between understanding that based on your own personal ability to do well you'll end up a PCP versus having your fate sealed before walking into your first class. The latter is now the case and is what bothers me.
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How is that now the case? Talk about hysteria.
 
AnatomyGrey12 said:
So just to be clear, your argument, without knowledge of this or having seen a shred of actual data, is that the NBME is being benevolent with this? That the same people who gave us Step 2 CS are only looking out for the medical students best interests...

If they have internal data driving this they are obligated to release it. If we don’t see any published data by the end of this year then there should be a very high suspicion of an agenda, even higher than currently exists.
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Agreed. These individuals have been nothing but a self-serving monopoly from the start.
 
thissuckslol said:
wait so they made this change because apparently step 1 is racist...... not even for the step 1 hysteria. At what point are people going to realize that regardless of your ethnicity you still have to perform well to match into a competitive residency?
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um, do you want to cite your source for this?
 
Mass Effect said:
How is that now the case? Talk about hysteria.
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Because that's literally the entire thread lmao, have you read the entirety of the responses? I'm talking strictly from what I've read here
 
Fission Chips said:
My school has been working for about a year on restructuring the curriculum to 1 year preclinical and taking step 2 ck a year before step 1 (i.e. taking step 2 after your MS-2 year, step 1 after MS-3 year.) Makes me wonder if they knew this was a sure thing
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And disrupt the entire sequential order of numbers? That'll cause hysteria.
 
Fission Chips said:
My school has been working for about a year on restructuring the curriculum to 1 year preclinical and taking step 2 ck a year before step 1 (i.e. taking step 2 after your MS-2 year, step 1 after MS-3 year.) Makes me wonder if they knew this was a sure thing
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Methinks not since part of this change is making Step 1 a requirement before taking Step 2

Edit: They're only making it a requirement before Step 2 CS - a school could, if they wanted, have their students do Step 2 CK --> Step 1 --> Step 2 CS
 
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Fission Chips said:
My school has been working for about a year on restructuring the curriculum to 1 year preclinical and taking step 2 ck a year before step 1 (i.e. taking step 2 after your MS-2 year, step 1 after MS-3 year.) Makes me wonder if they knew this was a sure thing
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is your school a t-25?
 
Jappa said:
Because that's literally the entire thread lmao, have you read the entirety of the responses? I'm talking strictly from what I've read here
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Yes, I have read the thread. Have you?

Not one post suggested that everyone going to a low tier school has to be a PCP, except maybe those overreacting. You're not relegated to PCP status just because Step 1 is P/F. You just need to outshine your peers in other ways -- research, clinicals, class rank, shelf scores. Step 1 is no longer the be-all-end-all to make all your dreams come true.
 
slowthai said:
Agreed. These individuals have been nothing but a self-serving monopoly from the start.
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Any ideas to pitch for how the NBME nefariously benefits from a Pass/Fail switch? Seems to me they stand to make a lot more off selling all their practice forms, and selling preclinical shelves to schools that are concerned about teaching to the step 1.
 
efle said:
Variance depends a lot on what's being tested. Tests that attempt to get after aptitude/critical thinking tend to have very reliable performance because one's ability to reason is static (think LSAT, GRE quant, SAT, etc). A test that is primarily a knowledge check is instead trying to use 1 or 2 specific questions to assess large content areas. A lot of random chance is involved in whether I knew that particular piece of information versus dozens of others that didn't get tested, especially when they're forced to only ask for pieces that many people won't know (otherwise the test item loses discriminatory capacity)
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I mean very narrow subject matter tests are able to keep SEMs to a narrow band. The Shelf exams are SEM 4,not great but better than step.
 
efle said:
Totally agree. Though, I can't imagine any agenda that would drive the NBME to do this if it was unpopular. They only gain from Step 1 Mania.
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In exchange for making it pass/fail, they probably were offered the opportunity to raise the passing score. The more failures they get, the more money they make from it.
 
libertyyne said:
I mean very narrow subject matter tests are able to keep SEMs to a narrow band. The Shelf exams are SEM 4,not great but better than step.
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Right, it's the issue of the 2 years of content vs the 280 items. If they could go after 2 months of content instead, they'd get a fantastic SEM of 2 or something. But having us take a 3-day long test that nails down exactly how good we learned every area across 1000+ items just seems...insane
 
I also wonder, in some way, that if COMLEX remains a scored exam, if this actually could helps DOs. Like, if an MD and DO are applying for rotations and someone has a really high COMLEX score, if more competitive fields will now take that person over the P/F USMLE candidate? I just don't know otherwise how fields that put so much emphasis on Step 1 scores will choose candidates to rotate?
 
Thesimplelifeofamyloid said:
In exchange for making it pass/fail, they probably were offered the opportunity to raise the passing score. The more failures they get, the more money they make from it.
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Nobody governs where they set the pass threshold though, that's all internal to them. They could've raised it much higher and faster for the last 15+ years if that was their goal. They've kept it quite low (~4-5%) throughout.
 
Jappa said:
Because that's literally the entire thread lmao, have you read the entirety of the responses? I'm talking strictly from what I've read here
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look if you go to a low tier MD school it is unlikely that you were going to match Neurosurgery at Harvard. This change does not change that reality, just makes it even less likely. It doesnt mean that you cant match Neurosurgery at your home program or the program where you did your away, or another program that your mentor has pull with. This was the case before this change , if you were some kind of research beast, AOA, PHD, patent holder, College football celeb, you were probably going to match at a high tier before this, and you will probably match after this change.
 
after p3 said:
@efle I honestly feel like the necessity was institutional. There is no way that medical schools could keep up to the quality of services like SketchyMedical or even have similar quality lecturers to professors like Goljan, Najeeb, Ryan, Sattar, or Williams. Students have been more recently vocal about noting how much they pay for medical school compared to how little they pay for any of these online lecture services. The fact that there are memes about wellness lectures and mandatory lectures scheduled right before big block exams compared to ones glorifying services like uWorld e.g. "What did people even do before uWorld?" indicated to me that schools were under increased scrutiny especially with the primary political campaign platforms being on student loans and tuition costs.

Some adcoms have been direct that the tuition model is really appropriated for schools to fund rotations in the third year and the amount of tuition students spend for M1 and M2 is really to fund their own clinical clerkships down the road. However, the idea that students are basically paying into schools that simply raise more barriers to access education rather than reducing them is what I saw as being a large pressure to turn Step 1 into P/F in order for schools to be "let off the hook" from the mounting pressure as they were being compared to free market services that were doing their job much better for a much cheaper price. I think that a lot of student input is negligible to the overall landscape. Polls are hardly exhaustive and are a poor metric in which to pivot, but when institutional pressure is to encourage a P/F system from prestigious to "lower tier" schools then there is no reason that the changes would no go through at some point in time.
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This should be pinned. Right on the money
 
@efle @libertyyne @Angus Avagadro @everyone else

incoming m1 here who is deciding between BU and UCI. Before today I was going to take UCI because it's cheaper. Does today's news change my decision if you were me? BU has a higher ranking in USNWR and PD rankings. I am aiming for something competitive. I could really use any and all feedback.
 
gamerEMdoc said:
I just don't know otherwise how fields that put so much emphasis on Step 1 scores will choose candidates to rotate?
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They'll be forced to change their focus to other metrics, which isn't entirely a bad thing.
 
efle said:
Methinks not since part of this change is making Step 1 a requirement before taking Step 2
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Interesting, didn't know that. That was their plan last we heard from the deans, which was about 4 months ago.
 
DevinBookerMD said:
@efle @libertyyne @Angus Avagadro @everyone else

incoming m1 here who is deciding between BU and UCI. Before today I was going to take UCI because it's cheaper. Does today's news change my decision if you were me? BU has a higher ranking in USNWR and PD rankings. I am aiming for something competitive. I could really use any and all feedback.
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look at home programs of the residency you are interested. See which school has a better program or even if it does have a home residency program.
 
thissuckslol said:
www.amsa.org

AMSA's response to USMLE scoring change recommendations - AMSA

The Invitational Conference on USMLE Scoring (InCUS) recently allowed public statements from medical students in regards to the potential USMLE Step 1
www.amsa.org www.amsa.org
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AMSAs response is so foolish. We should make sure residencies look at applicants more wholistically. Sure. But when schools are P/F and tests are P/F, how exactly do you choose who to interview when you get 1000 applicants for 80 interviews? There is no "wholistic" approach when every application is exactly the same. Then it comes down to just selecting based on subjective things.
 
Why didn't they just redesign step and make it so it actually correlates with residency performance. I know that's easier said than done but surely they knew that if they made step 1 P/F than step 2 ck would become the new metric for PD evaluation of candidates. Might as well get rid of step 1 and replace it with step 2 ck completely and just beef up the material on step 2 and make it the end all be all exam like step 1 used to be.
 
libertyyne said:
look at home programs of the residency you are interested. See which school has a better program or even if it does have a home residency program.
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UCI has a good home urology department but what if I change my mind during school and want to pivot specialties? They both have home departments.
 
efle said:
Any ideas to pitch for how the NBME nefariously benefits from a Pass/Fail switch? Seems to me they stand to make a lot more off selling all their practice forms, and selling preclinical shelves to schools that are concerned about teaching to the step 1.
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I don't know, but their track record has shown that they have their own best interests at heart. They have zero incentive to be less selfish because they are the only ones providing this licensing service.
 
DevinBookerMD said:
UCI has a good home urology department but what if I change my mind during school and want to pivot specialties? They both have home departments.
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idk what to tell you, we dont know what the landscape will look like. Is the ranking difference drastic enough ?
 
libertyyne said:
do they tho? did they have the same access to primary education as well ? lets not throw this thread into more chaos.
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I won't argue with you on this one but you could say that any sort of standardized exam may benefit a certain group of folks. Whole system is flawed then I suppose
 
slowthai said:
I don't know, but their track record has shown that they have their own best interests at heart. They have zero incentive to be less selfish because they are the only ones providing this licensing service.
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they could potentially force all DO students to take CK now as well, essentially doubling income from that revenue stream because DO's werent necessitated to take it if they took step 1.
 
gamerEMdoc said:
What metric exists mid-way through 3rd year when the decisions to rotate are made?
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Depends on the field, but just off the top of my head -- research, clinical evaluations, class rank, shelf score in the field?
 
after p3 said:
@efle I honestly feel like the necessity was institutional. There is no way that medical schools could keep up to the quality of services like SketchyMedical or even have similar quality lecturers to professors like Goljan, Najeeb, Ryan, Sattar, or Williams. Students have been more recently vocal about noting how much they pay for medical school compared to how little they pay for any of these online lecture services. The fact that there are memes about wellness lectures and mandatory lectures scheduled right before big block exams compared to ones glorifying services like uWorld e.g. "What did people even do before uWorld?" indicated to me that schools were under increased scrutiny especially with the primary political campaign platforms being on student loans and tuition costs.

Some adcoms have been direct that the tuition model is really appropriated for schools to fund rotations in the third year and the amount of tuition students spend for M1 and M2 is really to fund their own clinical clerkships down the road. However, the idea that students are basically paying into schools that simply raise more barriers to access education rather than reducing them is what I saw as being a large pressure to turn Step 1 into P/F in order for schools to be "let off the hook" from the mounting pressure as they were being compared to free market services that were doing their job much better for a much cheaper price. I think that a lot of student input is negligible to the overall landscape. Polls are hardly exhaustive and are a poor metric in which to pivot, but when institutional pressure is to encourage a P/F system from prestigious to "lower tier" schools then there is no reason that the changes would no go through at some point in time.
Click to expand...
Medical school faculty do not govern the NBME. There is absolutely no way that all the admins got together and strong armed the NBME into a pass/fail change out of fear that the free market was going to replace their preclinical lecturers with superior product. Look at other cases like Step 2 CS becoming mandatory for American students and then again when they raised the failing number-having students fail is a nightmare for med school deans and yet the NBME chugged along doing what makes them money, anyways.
 
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