Step 1 P/F: Decision

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Melchizedek said:
So thinking a little bit more about it:
The USMLE process was never supposed to be a ranking system. It is first and foremost a licensing exam and developed as a way to determine If a med student could gain licensure as a physician. So to that end I can see why they would push the system into pass/fail. Either you get your license or don't.

But this leaves a vacuum where the ranking process is concerned.
Could a new test arise to help fill this need? How would adding ANOTHER exam to the already full plates of medical students, affect burn out rates? would it be evened out because there is now less pressure to perform on the USMLE exams?

discuss.
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New Test? Like a test with objective question and answer format, with adjusted grading?
 
StanleyYelnats said:
Either way someone is going to be screwed over. If they retroactively convert scores to P/F, it’ll hurt the high scorers from 2021. If they report numeric and P/F scores for residency apps in 2022, it’ll hurt all the students who took the exam in 2022 and passed, when their unreported numerical grade would’ve been a 250+. That’s why the fairest situation is to start grading Step 1 as P/F only after the entire Class of 2023 has taken the exam, which would probably be around March 2022.
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How would it affect class of 2024 then? Students in schools with 1 year/1.5 year curricula taking Step before or in March would be scored and everyone else in 2 year curricula taking it during the summer wouldn't.
 
StanleyYelnats said:
The ignore function can be useful if someone produces continually unhelpful responses.

If anything, I would expect the faculty at schools affected by this change to make a racket so that the NBME comes up with a better plan of implementation before 2022. All hope isn’t lost.
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Why would they? They still get to collect their tuition checks.
 
I read through the entire thread before i decided to ask a question. Would this be a positive or negative for those of us going after middle of the road competitiveness specialties (something like EM) and if school prestige would have influence over that now
 
StanleyYelnats said:
They do have a reason to care that their students still match at top places, even if only for selfish reasons
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No they dont lol.

If they match at top places = "look how great our students match"

If they have to match FM or IM at community programs = "Look senator, we are addressing the primary care problem in our state. Please give us more grant money."
 
7331poas said:
No they dont lol.

If they match at top places = "look how great our students match"

If they have to match FM or IM at community programs = "Look senator, we are addressing the primary care problem in our state. Please give us more grant money."
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This might apply for mid tier schools but I’m pretty sure Columbia and NYU still have a vested interest in how many of their students become subspecialty surgeons lol
 
esperanzarising9 said:
Which schools are set up this way?

Also residency programs need some kind of metric to sort through thousands of applications. It seems like they would use Step 2 scores since it’s the only metric that’s standardized across all med schools
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This is what I expect: filtering out applicants by Step 2 scores, if possible.

Slogging through multiple apps is a pain in the ass, which is why programs liked having a nice filter to block out the undesirables. If it's not Step 1, then it will be Step 2.
 
StanleyYelnats said:
I agree with all of this but don’t have as much faith in the NBME to foresee what a huge disadvantage they’d be putting P/F Step takers at compared to ones with a 3-digit score. And while I agree that the fairest move would be to start sending scores to PD’s as pass/fail from 2022 onwards, that wouldn’t stop someone with a 270 from before P/F from working that score into their application or interview. If the NBME wanted to be fair, they would keep Step 1 scored until the class of 2023 is done taking the exam, and then start P/F for the class of 2024.
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Also @AnatomyGrey12 -

This solution assumes all applicants of a given year take step in the same year too.

E.g. Hopkins students taking it 18 months ahead while Penn takes it only 6 months ahead. There is no date they can draw anywhere in the year that would prevent one school showing scores while the other shows Pass together in the same match cohort. The ONLY way to avoid a mixed cohort is to switch everyone to Pass on ERAS.
 
Thinking about it, I think (even if USMLE doesn't know it yet), this decision is going to get delayed another year. They currently have it set to take effect smack dab in the middle where either A)they screw MS1's who already took the exam retroactively changing scores or B) they screw the MS1s who take step later in the year by making them compete against scores. Would this not open them up to a lawsuit either way?
 
Med Ed said:
Nothing is going to be "wiped." Even if the NBME wanted to it can't put that genie back in the bottle. Not without incurring 10,000 lawsuits, at least. You'll note that the earliest date of implementation will primarily affect students who have not yet matriculated, so they aren't changing horses midstream.

Every time there is a change it comes with a period of overlap. When the MCAT scoring scale switched we had a couple of years where some applicants had familiar scores and others had ones that were difficult to interpret. Admissions just went a little more holistic until the validity data on the new scoring scale emerged. Well, that and we tended to assume higher = better.
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Seems to me lawsuits are just as likely if people are forced to compete against scored with only a Pass. Theres no way a Pass applicant will be treated the same as a 250+ applicant in two years. The Pass is getting indefensibly screwed here, even more so than the 250 who wouldnt get to show it off to impress PDs anymore (which is, after all, the entire point of this change)
 
I still can't believe they released this decision with so little information. Really unfair for class of 2023 to be stuck in limbo that will likely to take several months to resolve.
 
I don’t know how many schools take Step 1 after core rotations, but I imagine the vast majority take it before. So most students in Class of 2023 will take the scored Step 1. To me, it seems HIGHLY unlikely that they’ll retroactively take those scores away. That would start a riot with the vast majority of Med schools. Makes way more sense to start this with the class that has not matriculated yet.
 
pinguadelie said:
"It is interesting to note that the National Board of Medical Examiners (NBME), medicine’s counterpart to the JCNDE, faced the same dilemma of what to do with its examinations because it also reported psychometrically unsound numerical data to candidates and schools. Its response was to acknowledge the fact, but continue to report the numerical data because medical schools and residency programs found the information so valuable."
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I ****ing KNEW it. When you start looking into the origin and stats of this test, it is WILDLY inappropriate how it was being used. It's a messy, inaccurate metric that was never supposed to take this role.
 
How similar is Step 2 to Step 1?
 
efle said:
Seems to me lawsuits are just as likely if people are forced to compete against scored with only a Pass. Theres no way a Pass applicant will be treated the same as a 250+ applicant in two years. The Pass is getting indefensibly screwed here, even more so than the 250 who wouldnt get to show it off to impress PDs anymore (which is, after all, the entire point of this change)
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Applicants who don’t have a numerical Step 1 score can still take Step 2 and have their Step 2 score be used in place of a Step 1. It’s only used for screening purposes anyway. Several residencies already have a system in place where they use the higher of the two Steps.
 
There's fierce disagreement about everything, but I think we can all agree that these changes should NOT go into effect before 2024. By pushing it back, we won't have to worry about retroactive changes or cycles with mixed scored/unscored applicants. It would also give medical schools time to change their curricula and it would allow incoming medical students to plan their careers better.
 
efle said:
Also @AnatomyGrey12 -

This solution assumes all applicants of a given year take step in the same year too.

E.g. Hopkins students taking it 18 months ahead while Penn takes it only 6 months ahead. There is no date they can draw anywhere in the year that would prevent one school showing scores while the other shows Pass together in the same match cohort. The ONLY way to avoid a mixed cohort is to switch everyone to Pass on ERAS.
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You’re right, so maybe the move would be to blanket all scores under P/F if they’re sent to PDs after 2022. That’s gonna make a lot of people who got 250s in 2021 mad, and rightfully so.

either way from their announcement yesterday which addressed absolutely none of these conflicts, they need to push the P/F start date much later than 2022. Way too many kinks to work out.
 
efle said:
Seems to me lawsuits are just as likely if people are forced to compete against scored with only a Pass. Theres no way a Pass applicant will be treated the same as a 250+ applicant in two years. The Pass is getting indefensibly screwed here, even more so than the 250 who wouldnt get to show it off to impress PDs anymore (which is, after all, the entire point of this change)
Click to expand...

I really just don't see how it's plausible man. And there are numerous PD's, and now an educator, in here who are all saying the same thing. To retroactively change scores to P and only report a P for students that already received a numerical score would open them up to innumerable lawsuits and is highly unlikely. Even more so than from students with P's being compared to students with scores.
 
ace_inhibitor111 said:
It is clear from the decision page whose opinions the NBME truly values, and the AMA and AAMC are plastered on there with pride. I would trust neither organization with the future of this profession.
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Both trash organizations tbh
 
whos got all this money to pay these lawyers? damn i know uncle sam wouldnt be thrilled with me using that cash for it
 
AnatomyGrey12 said:
I mean, have you seen the demographics of where medical students come from SES wise?
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its the classic response from people of that demographic. SUE EM! lets just see where things go before getting a lawfirm on retainer
 
StanleyYelnats said:
This might apply for mid tier schools but I’m pretty sure Columbia and NYU still have a vested interest in how many of their students become subspecialty surgeons lol
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NYU and columbia are ecstatic about this change...
 
7331poas said:
NYU and columbia are ecstatic about this change...
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Did you miss the entire beginning of this conversation? NYU, Columbia, Penn etc have 1.5 year curriculums, so their current M1s will be disadvantaged because they’ll be taking the exam in 2022 as pass/fail. This is undoubtedly going to look less impressive when they apply to residency against other T20 students who took the exam before it went pass/fail and got a 255. All other things being approximately equal, is a PD going to look more favorably on a Penn student with a Pass or on a Hopkins/Harvard/Stanford student with a 260?

I’m saying the admin at those 1.5 year preclinical schools don’t want to see their students be disadvantaged in applying to the top residencies, which they probably would be if they don’t have a numerical score and other competitive students do. So they might put up a fight and potentially lead to some changes, but who really knows.
 
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CherryRedDracul said:
I'm no JD, but I expect USMLE has terms and conditions to insulate themselves from these kinds of lawsuits.
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And even if they didn't, I'm sure they have more money and better lawyers than anybody wanting to sue them
 
StanleyYelnats said:
Did you miss the entire beginning of this conversation? NYU, Columbia, Penn etc have 1.5 year curriculums, so their current M1s will be disadvantaged because they’ll be taking the exam in 2022 as pass/fail. This is undoubtedly going to look less impressive when they apply to residency against other T20 students who took the exam before it went pass/fail and got a 255. I’m saying the admin at those 1.5 year preclinical schools don’t want to see their students be disadvantaged in applying to the top residencies, which they probably would be if they don’t have a numerical score and other competitive students do. So they might put up a fight and potentially lead to some changes, but who really knows.
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I struggle to see how a handful of students from Ivy’s are more or even equally disadvantaged compared to the overwhelming majority of students who would be screwed by a retroactive change.
 
cybermed2424 said:
I struggle to see how a handful of students from Ivy’s are more or even equally disadvantaged compared to the overwhelming majority of students who would be screwed by a retroactive change.
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See this is the problem with SDN. You haven’t actually read my other responses on this thread and are replying without context. I was specifically replying to @efle’s point about top schools with step in 3rd year who won’t benefit as much from the score change as would top schools with step in 2nd year. I never said a Penn student is going to be disadvantaged in the match compared to an LSU student, only that a Penn student with a pass would be disadvantaged compared to a Hopkins student with a good score. I’ve remarked elsewhere that this move screws over students at less competitive schools the most, and said that potentially the most equitable move would be allowing the entire class of 23 to take the exam scored.
 
Regardless of the point you were trying to make the ideology that we should be more concerned about a small minority being negatively impacted compared to the majority of students seems absurd. Of course, this is assuming they don’t come up with a better cut off date than January, which seems likely given all of the issues raised here
 
cybermed2424 said:
Regardless of the point you were trying to make the ideology that we should be more concerned about a small minority being negatively impacted compared to the majority of students seems absurd. Of course, this is assuming they don’t come up with a better cut off date than January, which seems likely given all of the issues raised here
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Nobody actually said this, but ok
 
If the reasoning behind a retroactive change is that it will disadvantage students who take step later and can only report a pass, then I think it’s implied.
 
cybermed2424 said:
If the reasoning behind a retroactive change is that it will disadvantage students who take step later and can only report a pass, then I think it’s implied.
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That’s why I’m not advocating for a retroactive change. I’m advocating for pushing forward the P/F start date so that it doesn’t affect anyone in the class of 23 and so everyone applies with a numerical score. That comes with its own set of issues affecting the class of 24 though, so there’s no perfect solution.
 
StanleyYelnats said:
That’s why I’m not advocating for a retroactive change. I’m advocating for pushing forward the P/F start date so that it doesn’t affect anyone in the class of 23 and so everyone applies with a numerical score. That comes with its own set of issues affecting the class of 24 though, so there’s no perfect solution.
Click to expand...

I agree with pushing it forward, and I hope they decide to do that
 
If some programs are 1.5 preclinical and some are 2, regardless of when the change is made, some people will be p/f and some will be three digit for the first application cycle after changes are made, no? Additionally, if anyone is going to benefit from this, it is going to be people coming from programs with good reputations/ranks cause a pass from UPenn is going to look mighty impressive vs a pass from any sub Top 50 MD, DO, IMG program. The impetus of comparing students will once again emerge, whether that will take place via Step2CK, research/extracirricular nonsense, etc. will be determined over time.
 
There's no way I am reading 15 pages of this thread but from what I have skimmed it seems to me people are accurately gauging this decision as monumental.

This will drastically change how one should responsibly evaluate whether they should to go medical school at all.

If you are not going to a strong MD school: likely medical school is NOT A GOOD DECISION.

If you are going to a DO school: medical school IS NOT A GOOD DECISION.

As a resident that it is not that far from being an attending I am already terrified with the upcoming changes in medicine for physicians and I'm not 7-10 years away from it like some of you may be.
Between mid level creep, congressional bills to dramatically cut reimbursement, large medical group conglomerates expanding their reach, RAPIDLY rising tuition with no signs of slowing down, persistently criminally interest rates, and the possible barring of physician level income for loan forgiveness medicine will soon not be worth it for most.

If you are in love with the field strongly consider something else such as CRNA, NP, PA, DPT.

If you think medicine is for you because it provides the income/security that you want, this post is mostly directed at you.

It's not that it's going to be a BAD career. It is just that other fields will now probably offer better return of investment and career earnings without the years or training/studying and the massive debt burden/lost income.

If you have rich parents OR are going to a strong medical school AND willing to work hard: medical school is probably a fine decision.
 
jw3600 said:
There's no way I am reading 15 pages of this thread but from what I have skimmed it seems to me people are accurately gauging this decision as monumental.

This will drastically change how one should responsibly evaluate whether they should to go medical school at all.

If you are not going to a strong MD school: likely medical school is NOT A GOOD DECISION.

If you are going to a DO school: medical school IS NOT A GOOD DECISION.

As a resident that it is not that far from being an attending I am already terrified with the upcoming changes in medicine for physicians and I'm not 7-10 years away from it like some of you may be.
Between mid level creep, congressional bills to dramatically cut reimbursement, large medical group conglomerates expanding their reach, RAPIDLY rising tuition with no signs of slowing down, persistently criminally interest rates, and the possible barring of physician level income for loan forgiveness medicine will soon not be worth it for most.

If you are in love with the field strongly consider something else such as CRNA, NP, PA, DPT.

If you think medicine is for you because it provides the income/security that you want, this post is mostly directed at you.

It's not that it's going to be a BAD career. It is just that other fields will now probably offer better return of investment and career earnings without the years or training/studying and the massive debt burden/lost income.

If you have rich parents OR are going to a strong medical school AND willing to work hard: medical school is probably a fine decision.
Click to expand...
define strong
 
StanleyYelnats said:
Did you miss the entire beginning of this conversation? NYU, Columbia, Penn etc have 1.5 year curriculums, so their current M1s will be disadvantaged because they’ll be taking the exam in 2022 as pass/fail. This is undoubtedly going to look less impressive when they apply to residency against other T20 students who took the exam before it went pass/fail and got a 255. All other things being approximately equal, is a PD going to look more favorably on a Penn student with a Pass or on a Hopkins/Harvard/Stanford student with a 260?

I’m saying the admin at those 1.5 year preclinical schools don’t want to see their students be disadvantaged in applying to the top residencies, which they probably would be if they don’t have a numerical score and other competitive students do. So they might put up a fight and potentially lead to some changes, but who really knows.
Click to expand...

"Other top 20 students" are not going to be able to fill up any specialty. Once you hit USnews rank 50 or so, the NYU "pass" is going to start looking better than the 250s.
 
Stronk* = top 50 USMD programs. Any program you know of from a region far away from you due to positive things. Like I am from the Northeast but know about how good Chicago, WashU, U Washington, UCLA, Stanford, Mayo, Duke, Hopkins etc. are just because... well, because everyone knows.

But for real, I'm coming from a mid tier USMD program and have decent career prospects, my wife came from a mid tier USMD as a visa holder and is a resident at a mid tier academic hospital for IM with an option to subspecialize in a field of her choosing. I think if you're in the middle of the road program with average personal performance, there is still plenty of hope as long as you're being smart about what field you choose for residency/fellowship.
 
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jw3600 said:
There's no way I am reading 15 pages of this thread but from what I have skimmed it seems to me people are accurately gauging this decision as monumental.

This will drastically change how one should responsibly evaluate whether they should to go medical school at all.

If you are not going to a strong MD school: likely medical school is NOT A GOOD DECISION.

If you are going to a DO school: medical school IS NOT A GOOD DECISION.

As a resident that it is not that far from being an attending I am already terrified with the upcoming changes in medicine for physicians and I'm not 7-10 years away from it like some of you may be.
Between mid level creep, congressional bills to dramatically cut reimbursement, large medical group conglomerates expanding their reach, RAPIDLY rising tuition with no signs of slowing down, persistently criminally interest rates, and the possible barring of physician level income for loan forgiveness medicine will soon not be worth it for most.

If you are in love with the field strongly consider something else such as CRNA, NP, PA, DPT.

If you think medicine is for you because it provides the income/security that you want, this post is mostly directed at you.

It's not that it's going to be a BAD career. It is just that other fields will now probably offer better return of investment and career earnings without the years or training/studying and the massive debt burden/lost income.

If you have rich parents OR are going to a strong medical school AND willing to work hard: medical school is probably a fine decision.
Click to expand...

It’s been a while since I’ve seen this level of sensationalism, even by SDN standards. Actually snickering. I can’t even.
 
alkaidius said:
It’s been a while since I’ve seen this level of sensationalism, even by SDN standards. Actually snickering. I can’t even.
Click to expand...
I mean last time I looked DO school were like 60-80k/year (and rising) and about 20 new ones opened/opening (whats the woot woot guy's name?).
I shudder at the thought of being in the 2024 match as a DO with no USMLE and twice the amount of DO MS4 applicants as there used to be.

Obviously it's your life but the only reason why I don't consider dropping ~300K to become a DO a complete waste was my ability to do well on standardized testing and match ACGME in a specialty I wanted to.
 
jw3600 said:
Great question.

Hell if I know.

Top 40?
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*curses in rank 45
i'm deciding between a 30 and a 45 and the 45 is way cheaper so I'm kinda still leaning that way, hopefully it doesn't bit me in the ass.
 
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