Step 1 P/F: Decision

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MedicineZ0Z said:
I've taken both of them and know what's tested on both. Step 1 material doesn't in any way prepare you for managing a patient's medical problems. Step 2 material gives you a foundation of knowledge that you can apply as you accumulate clinical experience.
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That is not the purpose of step 1.
 
7331poas said:
That is not the purpose of step 1.
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Exactly. He/she implied that step 1 gives you the appropriate knowledge in that context. In reality, step 1 was intended to establish a baseline of knowledge of basic sciences.
 
Phloston said:
Then explain the myopia to not simultaneously make the 2CK P/F. Clearly people understand the importance of objective scoring to stratify out students. The bottom line is that this isn't 1996 where education is constrained to what you learn behind four walls anymore. The internet has made obsolete being physically present at an institution to get good education. Students can sit in Iceland and do three Qbanks and learn more than attending lectures every day at probably most institutions.
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I think they realize switching both is even more difficult to deal with. But if CK starts assuming the role of Step 1 I think they'll change that too. Give it 5 years. Neither of them was ever supposed to be used like that.
 
efle said:
I think they realize switching both is even more difficult to deal with. But if CK starts assuming the role of Step 1 I think they'll change that too. Give it 5 years. Neither of them was ever supposed to be used like that.
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Then what *is* supposed to be used to stratify applicants?

I feel like I am in fantasyland. None of the Bryan Carmody disciples can answer this basic question. What determines who gets a ortho/derm spot?

Their research output? Does that make them a good doctor?
Their clerkship grades? Does getting a preceptor who gives out Honors make you a good doctor?
Their school rank? Does having a higher MCAT score make you a good doctor?

Doesn't it make sense to answer this question *first*, before upending our current methods?
 
MedicineZ0Z said:
I've taken both of them and know what's tested on both. Step 1 material doesn't in any way prepare you for managing a patient's medical problems. Step 2 material gives you a foundation of knowledge that you can apply as you accumulate clinical experience.

Again, you also ignore my key question. Do you think as a surgeon, that you will just ignore your patient's ongoing medical issues once they're admitted to your service?
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Of course not, but I’m probably not going to be the one adjusting my patient’s diltiazem, if that’s what you’re asking.
 
Phloston said:
Then explain the myopia to not simultaneously make the 2CK P/F. Clearly people understand the importance of objective scoring to stratify out students. The bottom line is that this isn't 1996 where education is constrained to what you learn behind four walls anymore. The internet has made obsolete being physically present at an institution to get good education. Students can sit in Iceland and do three Qbanks and learn more than attending lectures every day at probably most institutions.
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I think you're confusing learning with memorizing and spitting out information. I'd argue that people likely "learned" more/better in 1996 than they do today.
 
7331poas said:
Then what *is* supposed to be used to stratify applicants?

I feel like I am in fantasyland. None of the Bryan Carmody disciples can answer this basic question. What determines who gets a ortho/derm spot?

Their research output? Does that make them a good doctor?
Their clerkship grades? Does getting a preceptor who gives out Honors make you a good doctor?
Their school rank? Does having a higher MCAT score make you a good doctor?

Doesn't it make sense to answer this question *first*, before upending our current methods?
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What got a derm spot in 2005?
 
ace_inhibitor111 said:
Of course not, but I’m probably not going to be the one adjusting my patient’s diltiazem, if that’s what you’re asking.
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Wait til you're an intern and on ward duty. You're not going to be calling consults for bread and butter medicine. You will be expected to handle things that pop up. In order to be a good surgeon (or a good intern), you have to be a good medical doctor and that means ordering insulin, reconciling meds and knowing obvious interactions, ability to handle blood pressure issues, ability to recognize and treat delirium (as well as looking for the causes), understanding the different etiologies of chest pain and how to work them up before you put in the cards consult, understanding how to read an EKG, recognizing the first signs of stroke, etc, etc, etc. Hell, I'm a psychiatrist and I had to do all the above intern year. Even in surgery, you will have to manage your patients on the wards, before and after you cut.
 
MedicineZ0Z said:
I've taken both of them and know what's tested on both. Step 1 material doesn't in any way prepare you for managing a patient's medical problems. Step 2 material gives you a foundation of knowledge that you can apply as you accumulate clinical experience.

Again, you also ignore my key question. Do you think as a surgeon, that you will just ignore your patient's ongoing medical issues once they're admitted to your service?
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Well, I have been consulted by surgery to make sure 'patient is on the right medications'...
 
efle said:
What got a derm spot in 2005?
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A dodge. The only strategy you people have.

Just give a straight answer. What criteria will determine who get a dermatology spot after both step exams go to pass fail?

Hope its not research output, or the need for a research year will be even more burdensome than it already is.

Hope its not clerkship grades, since I may or may not have gotten the preceptor who never hands out honors.

Hope its not away rotations, since VSAS will be impossible to compete for without a step 1 score.

Hope its not med school rank, since a low ranked MD will never be looked at favorably.

The answer is, you have nothing but deflections because you know there is no plan right now.
 
MedicineZ0Z said:
Man, you're in for a reality check in residency. Take it from us who are there now, alongside surgical residents. And we all took step 1/2.
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Dude I was just working with surgical residents a month ago. I also just took Step 1 seven months ago. Let’s just chalk it up to different experiences and leave it as that.
 
7331poas said:
A dodge. The only strategy you people have.

Just give a straight answer. What criteria will determine who get a dermatology spot after both step exams go to pass fail?

Hope its not research output, or the need for a research year will be even more burdensome than it already is.

Hope its not clerkship grades, since I may or may not have gotten the preceptor who never hands out honors.

Hope its not away rotations, since VSAS will be impossible to compete for without a step 1 score.

Hope its not med school rank, since a low ranked MD will never be looked at favorably.

The answer is, you have nothing but deflections because you know there is no plan right now.
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I'm going to go out on a limb and suggest that the snarkiness makes people less likely to engage. None of us know what PDs will use because none of us are PDs, but the possibilities have been mentioned numerous times in this thread. It's not really our fault if you haven't read/taken note of them. No one knows what's going to happen with Step 2. No one knows if shelf exams will play a bigger role. No one knows if med school subjects will all be tested with NBME exams in the future. None of us have a crystal ball, but we've all been throwing ideas around. Your frustration at not getting a concrete answer about something that hasn't happened yet and something that none of us knows is unreasonable. What we can tell you is that going by what's happening NOW, PDs will likely use Step 2.

This "the sky is falling" notion is overplayed and inconsistent with the facts, which is that residencies picked candidates before Step 1 scores and residencies will pick candidates after.
 
Lawper said:
Gunning is unavoidable. It won't be as extreme as reporting numerical scores though.
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Why wouldn’t it be? You’d still have a score (just a quartile instead of a scaled number), which means people will still be gunning just as hard to get as high as they can. Quartiles depend on how well you score relative to the curve or scale. Not gunning will just lower your chances of being in the top quartile.
 
MedicineZ0Z said:
It's not calls to authority dude. What do you think happens when you admit patients to your service? You just dismiss their dozen medical problems and just operate?

You don't yet understand the scope of your future practice and hence can't determine that step 2 knowledge isn't useful.
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You call medicine for a consult.
 
Splenda88 said:
Well, I have been consulted by surgery to make sure 'patient is on the right medications'...
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I’m on surgery now. We recently had a pt with htn the other day. Attending said “consult medicine.” The resident said “Why? They’re hypertensive bc they’re npo and can’t take their home meds. We could just give them their meds IV.” Attending: “I hope medicine figures that out.”
 
Ho0v-man said:
I’m on surgery now. We recently had a pt with htn the other day. Attending said “consult medicine.” The resident said “Why? They’re hypertensive bc they’re npo and can’t take their home meds. We could just give them their meds IV.” Attending: “I hope medicine figures that out.”
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Lol... I am sure they call us out for stupid consults as well, but boy! some consults can be ridiculous.
 
So as someone in the class of 2023 trying to get into a difficult specialty, it sounds like I should try to get into research ASAP and not take a research year? I was planning on sending some emails of interest to some research faculty today.
 
Splenda88 said:
Lol... I am sure they call us out for stupid consults as well, but boy! some consults can be ridiculous.
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Lol. No doubt. I think we’ve signed off the same patient twice now for constipation already and just got reconsulted by medicine again bc said patient vomited once overnight. Everyone is guilty of this behavior sadly.
 
I don’t get the outrage tbh. This largely just means you should decide specialty somewhat earlier so you can get pubs/ get to know people (which didn’t hurt before this change anyway). If you’re not at a top school, this is still not the end of the world. You now have to study harder for a more clinically relevant exam. The only major change is this benefits applicants with home programs in small specialties (devil you know and what not). MSTP students are somewhat shafted bc they’re applying with others that just have P while they have a numerical score, but they have PhDs... lol they’ll be fine.
 
I think there should just be "Shelf" like exams for the major pre-clinical subject matter.
1) it would help stratify students and residency program directors can focus more on the subject matter more important for that particular specialty
2) NBME would be happy cause they'd make a lot more money
3) I know each schools curriculum is different but just make it required to take the pre-clinical shelves sometime before starting rotations and leave it up to the students to take it when they feel most prepared
 
7331poas said:
A dodge. The only strategy you people have.

Just give a straight answer. What criteria will determine who get a dermatology spot after both step exams go to pass fail?

Hope its not research output, or the need for a research year will be even more burdensome than it already is.

Hope its not clerkship grades, since I may or may not have gotten the preceptor who never hands out honors.

Hope its not away rotations, since VSAS will be impossible to compete for without a step 1 score.

Hope its not med school rank, since a low ranked MD will never be looked at favorably.

The answer is, you have nothing but deflections because you know there is no plan right now.
Click to expand...
Dont really think that pointing to decades of precedent is a dodge. It's about as concrete an answer as you could possibly get. If you need it spelled out, pull up the page of "things PDs use to assign interviews" and hold your finger up to block the first item.

Though at this point youd probably develop conversion disorder and see everything else black out simultaneously.

Edit: Using any one factor can be easily attacked, because they're all flawed, just like step was. But bundle them up and you have a system that worked just fine for decades. Do well in school, do well on the wards, do some research, impress the right people and get their letters, audition if you have specific favorite targets, interview well, and match. The average U of State med school was successfully placing people into surgical subspecialties for decades before Step. I don't know why that statement pisses people off so much. You should find it reassuring.
 
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Mass Effect said:
Wait til you're an intern and on ward duty. You're not going to be calling consults for bread and butter medicine. You will be expected to handle things that pop up. In order to be a good surgeon (or a good intern), you have to be a good medical doctor and that means ordering insulin, reconciling meds and knowing obvious interactions, ability to handle blood pressure issues, ability to recognize and treat delirium (as well as looking for the causes), understanding the different etiologies of chest pain and how to work them up before you put in the cards consult, understanding how to read an EKG, recognizing the first signs of stroke, etc, etc, etcEven in surgery, you will have to manage your patients on the wards, before and after you cut.
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There's good data that shows outcomes are better for medically-complex patients when I.M. is at least consulted, if not the primary team. If it's not straightforward, or if there are competing interests to balance, it becomes more important to have other teams' input.

I would agree that every physician needs to have a broad enough base of medical knowledge to recognize when other specialties should be involved, especially for emergent issues.

Step 2 and 3 do test that knowledge, but they also include a decent amount of outpatient medicine that, while common, is pretty useless to surgeons, e.g. diabetics with hypertension should all be on an ACE inhibitor or ARB.
 
New Info from the USMLE site regarding retroactively obscuring numerical scores:

If I received a 3-digit score on my Step 1 examination, will my 3-digit score be visible on paper and ERAS transcripts after Step 1 outcomes are reported as pass/fail?
The USMLE program has not yet determined how the policy change will impact score reports and transcripts. We expect to share additional information in the coming months. As additional details become available, updates will be posted to the USMLE website and social media.

TLDR: "We realize both options will get us sued and have no idea what to do."
 
efle said:
New Info from the USMLE site regarding retroactively obscuring numerical scores:

If I received a 3-digit score on my Step 1 examination, will my 3-digit score be visible on paper and ERAS transcripts after Step 1 outcomes are reported as pass/fail?
The USMLE program has not yet determined how the policy change will impact score reports and transcripts. We expect to share additional information in the coming months. As additional details become available, updates will be posted to the USMLE website and social media.

TLDR: "We realize both options will get us sued and have no idea what to do."
Click to expand...

I'm glad they continue to be vague and useless
 
efle said:
New Info from the USMLE site regarding retroactively obscuring numerical scores:

If I received a 3-digit score on my Step 1 examination, will my 3-digit score be visible on paper and ERAS transcripts after Step 1 outcomes are reported as pass/fail?
The USMLE program has not yet determined how the policy change will impact score reports and transcripts. We expect to share additional information in the coming months. As additional details become available, updates will be posted to the USMLE website and social media.

TLDR: "We realize both options will get us sued and have no idea what to do."
Click to expand...

holy cow this is peak incompetence. I actually do think that going P/F is the right move long term but it’s so clear this was a hastily, poorly thought out decision that is going to tick a lot of people off. A plan or decision should already have been in place with the announcement and they are in a lose-lose situation no matter what the decision is.
 
ak427 said:
holy cow this is peak incompetence. I actually do think that going P/F is the right move long term but it’s so clear this was a hastily, poorly thought out decision that is going to tick a lot of people off. A plan or decision should already have been in place with the announcement and they are in a lose-lose situation no matter what the decision is.
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I dont think they really expected to have to make the change
 
Mass Effect said:
So if you were still in college and knew Step 1 would be pass/fail and you didn't get into a top med school, you wouldn't have chosen med school at all? Come on, you're not guaranteed a 260 on Step 1. You can study your ass off and still get slammed. Just ask in the Step forums. Everyone thinks they'll get that coveted score and everyone is quick to say they did, but the reality is that most people score average (which is why it's the average). SDN is the only place on Earth where 99% of the population scored over 250. Everyone needs to take a breath and realize that when the metrics change, you change your strategy. Shouting about the unfairness of it is counter-productive.



It was a stupid equalizer. It had little to do with how you'd perform in residency and was never meant to be any kind of equalizer.
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Hence the quotation marks


Sent from my iPhone using SDN mobile
 
ace_inhibitor111 said:
A student who knows that they’re taking the Step 1 when it’s Pass/Fail can significantly bolster their application with research, making connections, or early studying for the Step 2 since they do not have to study for Step 1 as hard. Is that not an advantage for them?
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The big problem is that the c/o 2023 doesn’t know whether they’re going to be taking Step 1 graded or P/F, since the changeover date isn’t set in stone. Or if we take it when it’s graded, whether it’ll be reported as P/F. So it really specifically screws us over since we have no idea what to expect.

Tho judging from today’s update on the NBME website, they don’t know what to expect either.
 
Little Green Mensch said:
There's good data that shows outcomes are better for medically-complex patients when I.M. is at least consulted, if not the primary team. If it's not straightforward, or if there are competing interests to balance, it becomes more important to have other teams' input.
Click to expand...

No one was talking about medically complex patients when it's not straight forward. The point is that the majority of what you see IS straight forward and I don't know about you, but I sure wouldn't want to be on the consulting end of calling cards to tell them you have a patient with BP 140/70.

Step 2 and 3 do test that knowledge, but they also include a decent amount of outpatient medicine that, while common, is pretty useless to surgeons, e.g. diabetics with hypertension should all be on an ACE inhibitor or ARB.
Click to expand...

Outpatient medicine is also relevant to surgery during training anyway. If you have an outpatient clinic, understanding what's going on with your patients medically is important. As a psychiatrist, I comment on laboratory values, I read my own EKGs, I sometimes evaluate my own imaging (there's always a read, obviously, but I look at it too), I send notes to PCPs if I start a patient on a psych med and tell them I'll be ordering LFTs or what to look out for in terms of side effects during their next visit, I may start propranolol for akathisia, etc etc. Basic medical knowledge is relevant to every field of medicine.
 
dienekes88 said:
If step 1 is p/f, step 2 is close behind.

A critical element of step 1 was that EVERYONE had to take it. Only a subset will be taking step 2, which makes it harder to interpret. Everyone with good CVs or anyone who suspects they might do poorly will elect to take step 2 very late.



See below.



Agree.



This.

In the old days when I took step 2, the results only came back early into the actual interview season, and after most invites went out. Way too late to make an impact on the invitation process. And I took it relatively early. Most people will just not take it except for the subset of people who absolutely need to impress. This will make step 2 harder to interpret.

If step 1 is p/f, step 2 will soon follow.
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But I'm sure almost all programs will require step 2 scores now.
 
Mad Jack said:
You'd be surprised how often routine medical stuff comes up elsewhere in medicine. Nothing worse than a surgeon that has forgotten everything about being a doctor and tries to dump patients on IM the second they're closed...
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Hmm, sounds like a field starting with ortho and ending with paedic. Hmmm, I wonder
 
efle said:
New Info from the USMLE site regarding retroactively obscuring numerical scores:

If I received a 3-digit score on my Step 1 examination, will my 3-digit score be visible on paper and ERAS transcripts after Step 1 outcomes are reported as pass/fail?
The USMLE program has not yet determined how the policy change will impact score reports and transcripts. We expect to share additional information in the coming months. As additional details become available, updates will be posted to the USMLE website and social media.

TLDR: "We realize both options will get us sued and have no idea what to do."
Click to expand...
What would the grounds for suit be? The NBME has very clearly stated for years that their scores are being used inappropriately, and they are exercising their right to have their exam used as it was meant to in their mission statement. Any lawsuit would essentially be arguing for the right to use scores as they were not meant to be in the first place, and I find it highly doubtful a win would occur
 
Mad Jack said:
What would the grounds for suit be? The NBME has very clearly stated for years that their scores are being used inappropriately, and they are exercising their right to have their exam used as it was meant to in their mission statement. Any lawsuit would essentially be arguing for the right to use scores as they were not meant to be in the first place, and I find it highly doubtful a win would occur
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If no retrograde change: SOM students who test in M2 (e.g. Hopkins) apply with Scores, and compete against students who test in M3 (e.g. Penn) that apply with Pass in the same match cycle. Penn students claim that being denied the chance to show a numerical score was an unfair disadvantage since it's the #1 most cited factor in residency interviews.

If retrograde change: Students of all schools who had a reported score claim that being denied the ability to display their score reduced their competitiveness in the match since it's the #1 most cited factor in residency interviews.

Personally I think the first case is the more indefensible one. NBME would absolutely struggle to defend allowing a mixed cohort where some applicants could show the #1 factor and others couldn't. Some other posters like MedEd seem to think the second scenario is the more problematic one, since you can't wipe or refuse to report someone's already known score.
 
efle said:
If no retrograde change: SOM students who test in M2 (e.g. Hopkins) apply with Scores, and compete against students who test in M3 (e.g. Penn) that apply with Pass in the same match cycle. Penn students claim that being denied the chance to show a numerical score was an unfair disadvantage since it's the #1 most cited factor in residency interviews.

If retrograde change: Students of all schools who had a reported score claim that being denied the ability to display their score reduced their competitiveness in the match since it's the #1 most cited factor in residency interviews.

Personally I think the first case is the more indefensible one. NBME would absolutely struggle to defend allowing a mixed cohort where some applicants could show the #1 factor and others couldn't. Some other posters like MedEd seem to think the second scenario is the more problematic one, since you can't wipe or refuse to report someone's already known score.
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You should have to indicate your med school year when applying.

The straightforward thing to do then is make it a classwide ruling. People take at least 4 years for med school. Make it so the M1s now, who are, at the earliest, going to be Class of 2023, not take it as 3 digit score. Make it so the Match for 2023 will not be using Step 1 scores. That way the M2s who take it in 2020 and the M3s who take it in 2021 will both just have it p/f. You can delay it to whatever year you want.

IMGs immigrating now have a few years to get stuff together and apply before this change. The ones coming after should be aware of the paradigm and respond appropriately by crushing CK and perhaps getting more pubs.

.
 
TheIllusionist said:
You should have to indicate your med school year when applying.

The straightforward thing to do then is make it a classwide ruling. People take at least 4 years for med school. Make it so the M1s now, who are, at the earliest, going to be Class of 2023, not take it as 3 digit score. Make it so the Match for 2023 will not be using Step 1 scores. That way the M2s who take it in 2020 and the M3s who take it in 2021 will both just have it p/f. You can delay it to whatever year you want.

IMGs immigrating now have a few years to get stuff together and apply before this change. The ones coming after should be aware of the paradigm and respond appropriately by crushing CK and perhaps getting more pubs.

.
Click to expand...
MSTP throws a kink in here. But for straight MD, yeah maybe the answer is to set it to 2024 so that everyone knows it's going to be a Pass displayed from their first day of M1.
 
efle said:
MSTP throws a kink in here. But for straight MD, yeah maybe the answer is to set it to 2024 so that everyone knows it's going to be a Pass displayed from their first day of M1.
Click to expand...

No the basis still works even for MSTP. You could say anyone matriculating medical school in X year will have a P/F score report.
 
the match cycles between 2020/21 and Step 1 going P/F are going to be so weird. Everyone has essentially agreed that we should no longer use Step 1 in a certain way, but we will probably do so anyway while everything else on the GME selection side gets figured out. Hopefully change is a little speedier than that.
 
Haven’t seen this discussed much.. What about schools that have P/F preclinicals vs grades? Will students with good grades have an advantage over students from another school with a pass for pre-clinicals?
 
efle said:
I mean the current M2 people in MSTP programs, who would still have this issue of a known score when they get to ERAS for the next ~5-6 years
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Ah I see. How big of a pool of applicants is that? Even still it seems like the "safest" option as the vast majority of medical students aren't MSTP, but still isn't great.

This just highlights the biggest problem with this decision, the way it was made. There doesn't appear to have been a single shred of foresight into the need for a plan forward.
 
Lucca said:
the match cycles between 2020/21 and Step 1 going P/F are going to be so weird. Everyone has essentially agreed that we should no longer use Step 1 in a certain way, but we will probably do so anyway while everything else on the GME selection side gets figured out. Hopefully change is a little speedier than that.
Click to expand...
I’m really frustrated after reading the updated website earlier today. The NBME has literally none of this figured out and wants to implement a drastic change in two years. Thousands of people in the M1 class don’t know what to prioritize in terms of Step studying because we don’t know how Step 1 will be scored for our class, and the leadership just says “hang on, we’ll update you several months from now with more information”?
 
slowthai said:
Hmm, sounds like a field starting with ortho and ending with paedic. Hmmm, I wonder
Click to expand...
:heckyeah:

"How much insulin do I need to give to lower this guy's BP? Oh, you'll take primary? Alright, cool"

😏

Though, to be fair, a fair chunk of the time we could manage a lot of bread and butter med issues just as well as the IM/FM teams. Once, a patient had a mag of like 1.3 and the FM resident gave em a whopping 1 gram. I proceeded to shake my head at the peeing in the ocean and ordered an additional 4g.
 
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