Step 1 P/F: Decision

[7331poas]

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Dude, I hate to break it to you, but when you're rotating in [Insert competitive surgical subspecialty] they absolutely aren't going to be pimping you on [insert most of what you flashcarded for Step 1]

Dont worry, if you aren't at a high enough ranked institution you wont even the VSAS spot now. If there were 5 applicants for 1 ortho spot before. Now there will be 50 applicants for each ortho spot.

 

[libertyyne]

You do realize that Step2 ck is like one mega shelf? Lol That’s why it’s taken after clinicals cause the shelf exams help prepare you for step 2. Many school take step 1 after clinicals in their third year already, around the time when people take step 2ck, and you don’t see a 1000 derm applicants in these schools now do you? But again I want to emphasize that specialty specific exams is a bad idea cause med students don’t know diddly squat and we also change our minds often. Regardless, this convo is moot, you have your opinion and I have mine.


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yeah dude totally has enough Derm and ENT on that mega shelf. lol.
You dont see 1000 applicants in derm because that step 1 is still being graded and preventing 210's from applying.
Med students dont know didly squat, but maybe just maybe if they have to study for a shelf in their decided specialty they will know didly squat.

 

[BBBallIsLife]

But, the top ranking schools have always led the pack on useful wellness initiatives (like Pass/Fail grading, or not ranking in MSPE, or inflating clinical grades, or shortening preclinical to give you more time for research/electives/aways/vacation). Judging by what I hear from an old friend at the nearby U of State campus, their experience having grades and ranks and harsh Honors cutoffs and long preclinical is harder to match well and less enjoyable.

Fair, totally see where you're coming from; every school is different.

Yet, for example, if you wanted to compare costs, in-state public versus out-of-state public. Or, stay close to home at state school to be with family/spouse or go out of state/else to a different program. Even the way you feel in a community that the school is in can have an impact (safety, population).

All and all, everyone will have different personal opinions that align with values based on how we all grew up, and finding that school with that align most should be priority. Now i feel like some of that will be lost when deciding schools.

 

[efle]

Med school was always difficult. It didn't suddenly get difficult with step. Before Step 1 mania, it was class rank, AOA etc. Step 1 mania came about because the 3rd party resources became almost sure-fire ways to well on the exam, in they just explained things better than 90% of faculty. Make no mistake, this it an attempt to re-justify the high costs of medical tuition. Schools knew that their pre-curriculum were slowly becoming outdated, clunky and irrelevant in the modern era, and instead of looking at their flaws, they changed the game to buy them some time.

There is a singular emphasis placed on one's step score that is inescapably tied to feelings of intellectual inadequacy/prowess for a lot of people. If you don't believe that, maybe you just run with a chiller crowd than my school has to offer.

Again I don't think the low-yield PhDs got to tell the NBME what to do on this one. Their test wasn't built for this. What was happening was psychometrically unsound and they'd been saying it for years, falling on deaf ears.

 

[A Ryan Seacrest Type]

yeah dude totally has enough Derm and ENT on that mega shelf. lol.
You dont see 1000 applicants in derm because that step 1 is still being graded and preventing 210's from applying.
Med students dont know didly squat, but maybe just maybe if they have to study for a shelf in their decided specialty they will know didly squat.

But again I gave you the example of schools where step 1 is taken after clinicals they do just fine without having everyone apply derm despite the students getting scores so late, which would be the equivalent of step 2ck (which is graded) being used once step 1 isn’t graded in every school with a traditional curriculum.


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[efle]

yeah dude totally has enough Derm and ENT on that mega shelf. lol.
You dont see 1000 applicants in derm because that step 1 is still being graded and preventing 210's from applying.
Med students dont know didly squat, but maybe just maybe if they have to study for a shelf in their decided specialty they will know didly squat.

You do realize that Step2 ck is like one mega shelf? Lol That’s why it’s taken after clinicals cause the shelf exams help prepare you for step 2. Many school take step 1 after clinicals in their third year already, around the time when people take step 2ck, and you don’t see a 1000 derm applicants in these schools now do you? But again I want to emphasize that specialty specific exams is a bad idea cause med students don’t know diddly squat and we also change our minds often. Regardless, this convo is moot, you have your opinion and I have mine.


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Have y'all rotated in Derm? There's a reason only 5% of 250+ scorers go for it. Spending your life looking in gross oozy crevices, or doing mind-numbing Accutane followups and full body mole exams, is a steep price to sell out for.

 

[DokterMom]

Specialty exams make sense if you make them basically Uber shelves. Want to go Derm? Well, prepare for an exam absolutely loaded with immunology and skin pathology. First versions will be a toss up and no one will do well until a First Aid for Derm comes out, but it’s on a curve anyway. It’d require WAY more questions per year, but if they charge each individual specialty exam the same price as the USMLE I’m sure they’ll manage.... All of your exams would be privy to every program you apply to that way they can potentially sift out people that are trying exams for the hell of it or as backups. It would put more weight behind your choice which tells PDs a lot, as well.

Interesting idea -- especially the "make all scores visible" angle to identify backups and what-the-hecks.

 

[libertyyne]

But again I gave you the example of schools where step 1 is taken after clinicals they do just fine without having everyone apply derm despite the students getting scores so late, which would be the equivalent of step 2ck (which is graded) being used once step 1 isn’t graded in every school with a traditional curriculum.


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Please, you are telling me schools that are getting step 1 results after eras deadline? no.

 

[AnatomyGrey12]

How so? The plan moving forward is P/F, there needs to be nothing else. Rumors of this have been swirling for some time, so people in PD spots and elsewhere have been pondering how they'd approach the change already. And what "negative" consequences do you foresee?

1. Nothing changes except all the pressure gets moved to Step 2. The students that were skipping class and bailing on small group bull**** to study for Step 1 will now just be grinding for Step 2 hammering the Dorian deck and UWorld while on the wards. It truly is burying your head in the sand if you think that won't happen. 100%, despite what the NBME says right now, Step 2 CK will ultimately end up P/F as well. If they thought a bunch of PhDs were complaining hard about having their lectures skipped, just wait until the clinicians are being blown off en masse.
2. Step 2 is taken right before residency applications. You could work your butt off for a specific field only to find out that you aren't competitive for it with exceptionally little time to change course, probably on your first Sub-I.
3. There absolutely has to be a way to discriminate between residency applicants. Step 1 served that function as a standardized measure. If they wanted to move it to P/F they should have developed another standardized system before getting rid of Step 1 scoring. Without standardized measures subjective random crap takes its place like name of school, clinical grades, and research (which the majority of the time is the equivalent to monkey's throwing poop at the wall and seeing what sticks).
4. Anyone from a low tier/unranked MD or DO school gets completely shafted. The ceiling for good DO/low tier MD candidates just came crashing down. People's ability to match mid-tier programs in GS/IM/OB/Etc, is now significantly handicapped. Effectively, the ceiling to match became the very level at which you attend school. No more punching up.
5. The NBME didn't clarify anything at all with regards to its implementation and left a lot up in limbo. They have effectively increased stress to unprecedented levels at dozens of schools and classes by not clarifying what the plan is.
6. Stress will increase at every step of the medical pathway, even bleeding into the pre-med levels now since what school you go to is more important than ever before.

It's honestly very ignorant to think that none of these things will happen. There are PD's in this very thread saying as such themselves.

 

[RJ McReady]

1. Nothing changes except all the pressure gets moved to Step 2. The students that were skipping class and bailing on small group bull**** to study for Step 1 will now just be grinding for Step 2 hammering the Dorian deck and UWorld while on the wards. It truly is burying your head in the sand if you think that won't happen. 100%, despite what the NBME says right now, Step 2 CK will ultimately end up P/F as well. If they thought a bunch of PhDs were complaining hard about having their lectures skipped, just wait until the clinicians are being blown off en masse.
2. Step 2 is taken right before residency applications. You could work your butt off for a specific field only to find out that you aren't competitive for it with exceptionally little time to change course, probably on your first Sub-I.
3. There absolutely has to be a way to discriminate between residency applicants. Step 1 served that function as a standardized measure. If they wanted to move it to P/F they should have developed another standardized system before getting rid of Step 1 scoring. Without standardized measures subjective random crap takes its place like name of school, clinical grades, and research (which the majority of the time is the equivalent to monkey's throwing poop at the wall and seeing what sticks).
4. Anyone from a low tier/unranked MD or DO school gets completely shafted. The ceiling for good DO/low tier MD candidates just came crashing down. People's ability to match mid-tier programs in GS/IM/OB/Etc, is now significantly handicapped. Effectively, the ceiling to match became the very level at which you attend school. No more punching up.
5. The NBME didn't clarify anything at all with regards to its implementation and left a lot up in limbo. They have effectively increased stress to unprecedented levels at dozens of schools and classes by not clarifying what the plan is.

It's honestly very ignorant to think that none of these things will happen. There are PD's in this very thread saying as such themselves.

The sky is falling! The sky is falling!
Said the Little Red Hen ...

 

[efle]

1. Nothing changes except all the pressure gets moved to Step 2. The students that were skipping class and bailing on small group bull**** to study for Step 1 will now just be grinding for Step 2 hammering the Dorian deck and UWorld while on the wards. It truly is burying your head in the sand if you think that won't happen. 100%, despite what the NBME says right now, Step 2 CK will ultimately end up P/F as well. If they thought a bunch of PhDs were complaining hard about having their lectures skipped, just wait until the clinicians are being blown off en masse.
2. Step 2 is taken right before residency applications. You could work your butt off for a specific field only to find out that you aren't competitive for it with exceptionally little time to change course, probably on your first Sub-I.
3. There absolutely has to be a way to discriminate between residency applicants. Step 1 served that function as a standardized measure. If they wanted to move it to P/F they should have developed another standardized system before getting rid of Step 1 scoring. Without standardized measures subjective random crap takes its place like name of school, clinical grades, and research (which the majority of the time is the equivalent to monkey's throwing poop at the wall and seeing what sticks).
4. Anyone from a low tier/unranked MD or DO school gets completely shafted. The ceiling for good DO/low tier MD candidates just came crashing down. People's ability to match mid-tier programs in GS/IM/OB/Etc, is now significantly handicapped. Effectively, the ceiling to match became the very level at which you attend school. No more punching up.
5. The NBME didn't clarify anything at all with regards to its implementation and left a lot up in limbo. They have effectively increased stress to unprecedented levels at dozens of schools and classes by not clarifying what the plan is.
6. Stress will increase at every step of the medical pathway, even bleeding into the pre-med levels now since what school you go to is more important than ever before.

It's honestly very ignorant to think that none of these things will happen. There are PD's in this very thread saying as such themselves.

Bigly agree with most things except I think #4 doesn't line up with history. Tons of people from outside the top 20 MD are in all sorts of specialties. Much harder for DO and IMG now, especially with the merger, but it's not like U of State people could only do primary care in the 1990s and 2000s.

 

[Thesimplelifeofamyloid]

There is a singular emphasis placed on one's step score [MCAT SCORE] that is inescapably tied to feelings of intellectual inadequacy/prowess for a lot of people.

1. Curious, do you still agree with this statement above?

2. There's always going to be some metric in this process that is going to have a lot of weight. When you're applying to med school, it was the MCAT. Before step 1, it was class rank. And it wasn't just random PhD lecturers. Not a single faculty member in the OME could compete with sketchy micro, pathoma etc. It was 100% a factor. The only solution was to artificially cut the competition. The NBME was likely cut some sort of deal that justified them going through with that decision. Trust me, their primary motivation is profits.

 

[Ho0v-man]

why does high fructose corn syrup cause gout. just more nucleic acids? maybe they should make this step exam pass fail lol

So fructose comes in and gets immediately phosphorylated and goes to Dhap and glyceraldehyde-3-p which enters the glycolytic pathway after PFK-1 (the rate limiting step). This means you’ve got a lot of fodder to go down to pyruvate and then enter krebs. Even when you’ve got citrate backing up and inhibiting PFK-1, it won’t stop the process which comes in after that step. So you end up shunting pyruvate over to lactate. At the same time, that constant phosphorylation of fructose by is going to increase intracellular AMP which will go down the purine degradation pathway to inosine, hypoxanthine, etc to give you more uric acid. Lactate interferes with uric acid excretion so we’ll hold onto uric acid to get rid of lactate->hyperuricemia.

if that’s scary, just relax. Step 1 probably just wants you to know that etoh increases NADH, which increase lactate and can thus make gout worse that way.

 

[RJ McReady]

View attachment 295593View attachment 295594

So fructose comes in and gets immediately phosphorylated and goes to Dhap and glyceraldehyde-3-p which enters the glycolytic pathway after PFK-1 (the rate limiting step). This means you’ve got a lot of fodder to go down to pyruvate and then enter krebs. Even when you’ve got citrate backing up and inhibiting PFK-1, it won’t stop the process which comes in after that step. So you end up shunting pyruvate over to lactate. At the same time, that constant phosphorylation of fructose by is going to increase intracellular AMP which will go down the purine degradation pathway to inosine, hypoxanthine, etc to give you more uric acid. Lactate interferes with uric acid excretion so we’ll hold onto uric acid to get rid of lactate->hyperuricemia.

if that’s scary, just relax. Step 1 probably just wants you to know that etoh increases NADH, which increase lactate and can thus make gout worse that way.View attachment 295596

Dork.

 

[libertyyne]

Bigly agree with most things except I think #4 doesn't line up with history. Tons of people from outside the top 20 MD are in all sorts of specialties. Much harder for DO and IMG now, especially with the merger, but it's not like U of State people could only do primary care in the 1990s and 2000s.

a lot of this is the result of actual home programs. It will be a game of who you know. I will say it would be interesting to see before step became graded how many people from state schools ended up at barrow or MGH and how many afterwards.

It will be difficult for state school MDs to break into the upper echelons of these programs. Which is an ok price to pay I suppose ,but is definately a step back from the mertiocracy that we claim we would like to emulate.

 

[efle]

1) Curious, do you still agree with this statement above?

2) There's always going to be some metric in this process that is going to have a lot of weight. When you're applying to med school, it was the MCAT. Before step 1, it was class rank. And it wasn't just random PhD lecturers. Not a single faculty member in the OME could compete with sketchy micro, pathoma etc. It was 100% a factor. The only solution was to artificially cut the competition

At the premed level? Absolutely. You ever browse the pre-med side of SDN? People wear their LizzyM in their signature like a badge of Big D Energy to let all the other tryhard premeds know that they're coming for their HMS spot. Similarly, I saw people in college who were absolutely devastated over getting grades and MCAT scores that meant they were going to their state school, if anywhere at all. The magnitude of the effect is even bigger for Step in our Step 1 Mania climate, though. That isn't just deciding on Ivy MD vs U of State. That's deciding on whether you get to actually choose your career for the rest of your life from all the options, or only some of them.

I'll leave the tinfoil hatting about the ID PhDs somehow twisting the NBME's arm to you.

 

[RJ McReady]

The sky is falling! The sky is falling!
Said the Little Red Hen ...

oops...sorry...misquoted...
Chicken little not the Little Red Hen...

 

[A Ryan Seacrest Type]

Please, you are telling me schools that are getting step 1 results after eras deadline? no.

What? People take step 2 after eras if they have a solid step 1 without step 1 they’ll just take it before the deadline. I don’t understand what that has to do with the fact that if the only metric being used is step2ck, it means people will take the exam in their third year and apply with their step 2ck score. And if you want to know how that will go just look at medical school that take step 1 after clinicals, you don’t see everyone going derm in those schools like you claim will happen

 

[yungspleen]

Even if USMLE goes P/F... whatever. I'm still grinding. Back to doing my cards for today.

I'll throw out this argument - if USMLE goes pass fail, and I do away rotations at places I want to do my residency in, they are going to pimp me hard. If I can answer better than those who just studied enough to P step 1, then I think I'll be in good shape when interviews come around.

I scored above 260 on step 1 and miss >90% of pimping questions lol. Take your first 2 years easy so you don't burn out like I did by the time 3rd year starts..

 

[Kardio]

How are we rationalizing these two, seemingly mutually exclusive, ideas:

1. The emphasis on Step 1 will get shifted to Step 2
2. Pedigree is now (more) king

 

[libertyyne]

What? People take step 2 after eras if they have a solid step 1 without step 1 they’ll just take it before the deadline. I don’t understand what that has to do with the fact that if the only metric being used is step2ck, it means people will take the exam in their third year and apply with their step 2ck score. And if you want to know how that will go just look at medical school that take step 1 after clinicals, you don’t see everyone going derm in those schools like you claim will happen

You are missing the point. The percentage of people in neurosurgery interest group was 20 in my class , real gunners, guess how many are still even considering applying ? 3. Step one culled people. If you dont think that competitive specialties are going to have a blood bath of a match without the culling effect of a numerical score you are mistaken.

 

[ace_inhibitor111]

The sky is falling! The sky is falling!
Said the Little Red Hen ...

It's more akin to "The boy who cried wolf." Sure there are a lot of false cries, but we all know how that story ends.

 

[Thesimplelifeofamyloid]

At the premed level? Absolutely. You ever browse the pre-med side of SDN? People wear their LizzyM in their signature like a badge of Big D Energy to let all the other tryhard premeds know that they're coming for their HMS spot. Similarly, I saw people in college who were absolutely devastated over getting grades and MCAT scores that meant they were going to their state school, if anywhere at all. The magnitude of the effect is even bigger for Step in our Step 1 Mania climate, though. That isn't just deciding on Ivy MD vs U of State. That's deciding on whether you get to actually choose your career for the rest of your life from all the options, or only some of them.

I'll leave the tinfoil hatting about the ID PhDs somehow twisting the NBME's arm to you.

You're missing the point. If you look at the list of attendants to the INCUS, most of them were people heavily involved in preclinical medial education. These weren't med students who made this decision. It's not really a conspiracy. Imagine running a course and having <5% of students attend your lectures. Many schools had an incentive for this to go through, and it wasn't for your well-being.

 

[workaholic007]

You are missing the point. The percentage of people in neurosurgery interest group was 20 in my class , real gunners, guess how many are still even considering applying ? 3. Step one culled people. If you dont think that competitive specialties are going to have a blood bath of a match without the culling effect of a numerical score you are mistaken.

if you cannot understand his libertyyne's point, you must be blind. there are limited number of spots and severals times the amount of people who want these spots. everyone is a qualified physician. there has to be a method to quantify and separate people - thats just life

 

[efle]

How are we rationalizing these two, seemingly mutually exclusive, ideas:

1. The emphasis on Step 1 will get shifted to Step 2
2. Pedigree is now (more) king

I'm with AnatomyGrey that the NBME is just as aware as we are that Step 2 will start filling the void left by Step 1. I think it's inevitable that Step 1, Step 2 and Step 2 CS all become Pass/Fail. None of them should ever be conceivably used in this way.

I think the ultimate solution here is going to have to be capped residency applications.

 

[libertyyne]

I'm with AnatomyGrey that the NBME is just as aware as we are that Step 2 will start filling the void left by Step 1. I think it's inevitable that Step 1, Step 2 and Step 2 CS all become Pass/Fail. None of them should ever be conceivably used in this way.

I think the ultimate solution here is going to have to be capped residency applications.

Specialty specific shelves! Those capped residency applications are going to have a bear of a soap. and are not going to be very meritocratic.

 

[AnatomyGrey12]

How are we rationalizing these two ideas:

1. The emphasis on Step 1 will get shifted to Step 2
2. Pedigree is now (more) king

The base assumption, admittedly it is an assumption but an assumption that has a logical flow to it, is that ultimately Step 2 CK is going to go P/F too. If you look at the data Step 2 CK isn't really any better than Step 1 with regards to deciding who is stronger clinically. "Step 2 Mania" will become even bigger than Step 1 Mania because of the heightened stress it will be taking the test that is lynchpin of your entire residency app mere weeks before ERAS opens.

 

[efle]

You're missing the point. If you look at the list of attendants to the INCUS, most of them were people heavily involved in preclinical medial education. These weren't med students who made this decision. It's not really a conspiracy. Imagine running a course and having <5% of students attend your lectures. Many schools had an incentive for this to go through, and it wasn't for your well-being.

INCUS also had PDs who hated this idea and the NBME, like I said before, has a whole pile of data that none of us are privy to. I'm on the cynical side and I think the NBME is only motivated to do what benefits the NBME. If they wanted to, they could wave their hands and justify keeping it scored just like they did with the previous review of a Pass/Fail switch ten years ago (that failed). Something has changed - either their test validity was falling apart, or they see a way to make money off something coming in the future. Thinking they're noble enough to protect the role of preclinical lecturers, or the mental health of students, are both off the mark.

 

[ace_inhibitor111]

Just have medical students take the Stanford-Binet and report those scores to ERAS. That way we can have a psychometrically appropriate test to decide our specialty lol.

 

[Jappa]

So let me get this straight, people already complained about how 3rd year is the worst because of rotation times, coming home after a long shift super tired, and then having to study for shelf exams.

Now because of the shift of importance to Step 2, is 3rd year going to be even worse because we have to still do the rotations, study for shelves, AND study for step 2 like our lives depend on it?

 

[libertyyne]

So let me get this straight, people already complained about how 3rd year is the worst because of rotation times, coming home after a long shift super tired, and then having to study for shelf exams.

Now because of the shift of importance to Step 2, is 3rd year going to be even worse because we have to still do the rotations, study for shelves, AND study for step 2 like our lives depend on it?

studying for shelves is studying for step 2.

 

[Thesimplelifeofamyloid]

INCUS also had PDs who hated this idea and the NBME, like I said before, has a whole pile of data that none of us are privy to. I'm on the cynical side and I think the NBME is only motivated to do what benefits the NBME. If they wanted to, they could wave their hands and justify keeping it scored just like they did with the previous review of a Pass/Fail switch ten years ago (that failed). Something has changed - either their test validity was falling apart, or they see a way to make money off something coming in the future. Thinking they're noble enough to protect the role of preclinical lecturers, or the mental health of students, are both off the mark.

Definitely this. This time around, there's a lot more scrutiny. They make this change now, and they're in the clear for 10 years. Medical educators get what they want, and the NBME is out of scrutiny for quite some time. Win-Win for both. And, yes there may have been some opposition, but this benefits the vast majority of attendants. This makes a lot of sense considering just how quickly this was thrown together

 

[A Ryan Seacrest Type]

You are missing the point. The percentage of people in neurosurgery interest group was 20 in my class , real gunners, guess how many are still even considering applying ? 3. Step one culled people. If you dont think that competitive specialties are going to have a blood bath of a match without the culling effect of a numerical score you are mistaken.

Never said that. Again, step 2ck. an exam taken during third year after clinicals will now serve the culling purpose. This is off topic tho, I maintain specialty specific exams is not a good idea.


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[AnatomyGrey12]

I think the ultimate solution here is going to have to be capped residency applications.

I think so too, and personally I think it should have happened before a move to P/F but here we are. My only caveat is that it needs to be a number reasonable enough that low tier MD and DO students can have enough room on their application list to take some shots to places they really want to go but are reaches. I think 60 is a nice round number that would allow for broad apps but focused enough that all the programs will be places that candidate would truly consider going to.

I also think optional specialty shelves are inevitable. Too much money to be made not to be.

 

[libertyyne]

Never said that. Again, step 2ck. an exam taken during third year after clinicals will now serve the culling purpose. This is off topic tho, I maintain specialty specific exams is not a good idea.


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everyone here is saying step 2 ck will go p/f to because the logic that was used to make step 1 pf applies to step 2 ck as well. you are conveniently just glossing over that.

 

[longhaul3]

You are missing the point. The percentage of people in neurosurgery interest group was 20 in my class , real gunners, guess how many are still even considering applying ? 3. Step one culled people. If you dont think that competitive specialties are going to have a blood bath of a match without the culling effect of a numerical score you are mistaken.

Step 1 is obviously huge in neurosurgery and disqualifies a number of people, but most people end up losing interest when they find out what it's really about. Lay people, which is what pre-clinical med students are, love it because it's sexy and culturally revered (not to mention $$$). It is absolutely brutal. You have to really love it in a way that you don't have to love bones to do ortho or love skin to do derm.

Edit: Point taken regarding other specialties often lumped in alongside (ortho, derm, plastics, ophtho, whatever).

 

[A Ryan Seacrest Type]

everyone here is saying step 2 ck will go p/f to because the logic that was used to make step 1 pf applies to step 2 ck as well. you are conveniently just glossing over that.

Gloasing over what? Like I said many posts ago, people need to worry about that when and if it happens. And even if it were to happen, specialty specific exams is not the move because like I’ve been repeating, what if you fail the neurosurg exam that you’ve been studying for? Now what? There’s no time to take the other specialty exams? Like what do you do then? Also what if I study my ass off for said neurosurg exam, pay my dues and everything then decide last minute I actually love obgyn? Again am I screwed cause I didn’t prepare nor sign up for the obgyn exam? Specialty exams sound horrible

 

[jamaica jan sun princess]

Sign the Petition

Reverse the USMLE Step 1 Scoring System

www.change.org

 

[libertyyne]

Gloasing over what? Like I said many posts ago, people need to worry about that when and if it happens. And even if it were to happen, specialty specific exams is not the move because like I’ve been repeating, what if you fail the neurosurg exam that you’ve been studying for? Now what? There’s no time to take the other specialty exams? Like what do you do then? Also what if I study my ass off for said neurosurg exam, pay my dues and everything then decide last minute I actually love obgyn? Again am I screwed cause I didn’t prepare nor sign up for the obgyn exam? Specialty exams sound horrible

no because you took a core shelf. These additional shelves could just be for surgical subs and outliers like derm .
We are discussing what will eventually happen. Everyone in this thread already agrees that step 2ck will be king for while.
Specialty exams with smaller SEMs than shelf sound wonderful. If i fail the neurosurgery shelf i should probably match into the other core shelves I took. or default into primary care, kind of like what happens now in soap.

 

[surfsuncali]

I'm an M1 in an accelerated curriculum and will be starting my clinicals in spring of next year. I'm interested in surgery and think it would be better if I take step 1 before it becomes pass/fail. I'm not extremely interested in doing tons of extracurriculars or worrying my ass off over evaluations in clinicals. Could I/should I try to take it before it becomes pass/fail? Any advice is appreciated, this is kind of throwing off all my plans on how to approach school.

 

[Mad Jack]

1. Nothing changes except all the pressure gets moved to Step 2. The students that were skipping class and bailing on small group bull**** to study for Step 1 will now just be grinding for Step 2 hammering the Dorian deck and UWorld while on the wards. It truly is burying your head in the sand if you think that won't happen. 100%, despite what the NBME says right now, Step 2 CK will ultimately end up P/F as well. If they thought a bunch of PhDs were complaining hard about having their lectures skipped, just wait until the clinicians are being blown off en masse.
2. Step 2 is taken right before residency applications. You could work your butt off for a specific field only to find out that you aren't competitive for it with exceptionally little time to change course, probably on your first Sub-I.
3. There absolutely has to be a way to discriminate between residency applicants. Step 1 served that function as a standardized measure. If they wanted to move it to P/F they should have developed another standardized system before getting rid of Step 1 scoring. Without standardized measures subjective random crap takes its place like name of school, clinical grades, and research (which the majority of the time is the equivalent to monkey's throwing poop at the wall and seeing what sticks).
4. Anyone from a low tier/unranked MD or DO school gets completely shafted. The ceiling for good DO/low tier MD candidates just came crashing down. People's ability to match mid-tier programs in GS/IM/OB/Etc, is now significantly handicapped. Effectively, the ceiling to match became the very level at which you attend school. No more punching up.
5. The NBME didn't clarify anything at all with regards to its implementation and left a lot up in limbo. They have effectively increased stress to unprecedented levels at dozens of schools and classes by not clarifying what the plan is.
6. Stress will increase at every step of the medical pathway, even bleeding into the pre-med levels now since what school you go to is more important than ever before.

It's honestly very ignorant to think that none of these things will happen. There are PD's in this very thread saying as such themselves.

I like chaos, and welcome it fully.

Ultimately Step 2 wil also end up P/F. School, essays, letters, and interview performance will decide who gets the spot.

 

[Med Ed]

Is it really safe?

Yes.

"The NBME allowed students at School X to show exact numerical performance on this metric, rated the #1 most commonly cited factor in residency interview invitations despite having no demonstrated validity for this purpose. Students testing a few months later at School Y were denied the ability to show their performance beyond a Pass. Students at both School X and School Y were both able to show their exact numeric performance on a separate metric which, as of 2018, was the #4 most commonly cited factor in residency interview invitations. Residency program directors also had the usual access to students' grades, letters of recommendation, and MSPE's, which contain comparative performance data and narrative feedback. Without a significant decline in the overall match rate it is therefore extremely difficult to show any harm caused as a result of this change."

Ftfy.

 

[libertyyne]

I'm an M1 in an accelerated curriculum and will be starting my clinicals in spring of next year. I'm interested in surgery and think it would be better if I take step 1 before it becomes pass/fail. I'm not extremely interested in doing tons of extracurriculars or worrying my ass off over evaluations in clinicals. Could I/should I try to take it before it becomes pass/fail? Any advice is appreciated, this is kind of throwing off all my plans on how to approach school.

You are still going to have a full application including good evals on clinicals, research , and other ecs. even if step 1 was not pass fail . Even in the current climate you dont just waltz into a residency position with just a step score a picture of yourself wearing a surgical mask.

 

[efle]

Yes.

"The NBME allowed students at School X to show exact numerical performance on this metric, rated the #1 most commonly cited factor in residency interview invitations despite having no demonstrated validity for this purpose. Students testing a few months later at School Y were denied the ability to show their performance beyond a Pass. Students at both School X and School Y were both able to show their exact numeric performance on a separate metric which, as of 2018, was the #4 most commonly cited factor in residency interview invitations. Residency program directors also had the usual access to students' grades, letters of recommendation, and MSPE's, which contain comparative performance data and narrative feedback. Without a significant decline in the overall match rate it is therefore extremely difficult to show any harm caused as a result of this change."

Ftfy.

What's your take on Step 2 becoming Pass/Fail if it does take over this same role? Though I recall you were also a skeptic of Step 1 being Pass/Fail in 5 years, let alone 2 years.

All the other metrics were there when this decision to remove Step 1 was made. We can't pretend it isn't monumentally important to current apps. A 250+ going head to head with a Pass for interview invites seems indefensibly unfair. Given access to the data, it would not be hard to show that high scored apps received significantly more invites than Pass with the other quantitative ERAS areas held similar, which I bet would happen.

 

[Lawpy]

Yes.

"The NBME allowed students at School X to show exact numerical performance on this metric, rated the #1 most commonly cited factor in residency interview invitations despite having no demonstrated validity for this purpose. Students testing a few months later at School Y were denied the ability to show their performance beyond a Pass. Students at both School X and School Y were both able to show their exact numeric performance on a separate metric which, as of 2018, was the #4 most commonly cited factor in residency interview invitations. Residency program directors also had the usual access to students' grades, letters of recommendation, and MSPE's, which contain comparative performance data and narrative feedback. Without a significant decline in the overall match rate it is therefore extremely difficult to show any harm caused as a result of this change."

Ftfy.

Can you describe why Step 3 is scored and not pass/fail?

 

[efle]

I worked so hard for a medical school acceptance. It's mid-tier but I was willing to work hard to get where I want for residency. This news about Step 1 being pass fail makes me sick

Step 1 gave me a sense of hope before. Not anymore 🙁

Dude, chill. I guarantee your school sent people into surgical specialties for decades and decades prior to Step 1 Mania

 

[RhesusPuffs]

The MCAT didn't merely change scoring, it added an entirely new category and changed up the other three.

The wailing and gnashing of teeth on SDN then had the identical equivalent of angst and noise as you see here today.

angst and noise, fine. but completely different situations.

 

[Goro]

angst and noise, fine. but completely different situations.

The bolded is irrelevant. The point is that the pissing and moaning was the same.

Yet people are still getting into med school, CARS and Psycho/Social categories and a three digit score notwithstanding.

This too shall pass. In the mean time, I can only handle so many people projecting.

 

[Med Ed]

Can you describe why Step 3 is scored and not pass/fail?

Inertia.

 

[drducky.]

I just want to know if this will affect the class of 2023 so I can prioritize my time