Step 1 Should Replace the MCAT

[rad0nc]

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Kaplan, Goljan, gunnertraining, UWorld, etc...this stuff is a lot cheaper than our curriculum and a lot more effective. That's where I learned 95% of what I've retained. School just gets in the way.

Exactly. There are very few things in life more pointless than the first two years of medical school.

 

[SpecterGT260]

can we get the current grade of people who are saying this?
It would be helpful... although I would still maintain that maybe you should have gone to a better school.... I also bought first aid recently thinking I would review it to keep things fresh before step 1. Much of the stuff in there is completely useless to me having not seen it in class. The reviews are simply that... REVIEWS. they dont do a whole lot without the ability to build on a knowledge base that already exists

 

[Instatewaiter]

The STEP 1 hasn't been used as a minimal competency exam since the day it was created. Why do you guys insist on staying in denial on its purpose? It evaluates your comprehension of basic science instruction from the first two years of medical school. It is the most important thing you do in four years of medical school and it is the single most important purpose of the first two years.

Let's investigate the idea that step 1 is not used as a minimal competency exam...

Simple question: can you practice as a doctor if you don't pass step 1?
Simple answer- No

Ipso facto, res ispa loquitor and other seemingly impressive words- you're wrong. If you don't pass step 1, you can't practice so it is in fact, used as a minimal competency exam.

The first two years are about building a strong foundation in the material needed to learn clinical medicine. Step 1 is a test of competence and readiness to move on to the clinical part of our education, the part that actually makes the M.D. There's no reason that can't be done well through other channels than a classroom.

For many people, being freed from the constant inane multiple choice tests and memorizing the useless facts you'll forget 6 months later would leave them free to focus on the larger concepts and come out of the process more prepared. This isn't about a school being good or bad, it's about being free to individualize to your own rate and style of learning.

I'm sorry if some of you take your professional pride from how long you paid tuition for instead of by what you learned and what you were required to master...

There is a flaw in your argument. People generally retain the broader concepts than the details they studied. So, if you study X deep, you retain X-1. Step 1 tests a very superficial level of knowledge which is why you can game the system by doing USMLE World and the like. If all you study is the what step 1 tests (the big concepts), you're going to know much less than if you were to go through the normal curriculum and the intricate details that requires.

When I came to the wards, I realized quickly that the stuff that step 1 focuses on is less important than the stuff learned in lectures. If you only learn what you are supposed to for step 1, you really aren't getting a good foundation.

I agree it could be streamlined. Honestly, PhDs should not be teaching medical school.

 

[Freakfarm0]

I think a big issue some people are touching on here is money. Why spend $20,000-$60,000 a year just to learn all of the material independently?

Here's why: Only a fraction of your money is going toward teacher salary. A majority of it is spent on facility upkeep, upgrading technology, and insurance (how else are they going to cover all of your screw ups when you don't know your ass from a hole in the ground?). All of which is primarily used in... wait for it... clinical rotation years! You would still be paying (almost) the same amount of money every year!

Now, if you want to cut the basic sciences years, you may as well just call us nurses.

 

[VenusinFurs]

I would argue it's very hard to practice as a doctor if you JUST pass Step 1; it is by no means IN PRACTICE being used as a minimum competency test. You don't have to be a rock star your first two years to be an average doctor, but knowing something about why you're doing the stuff you're doing will not only make you stand out, it will help you in your clinical judgement. AND YES, you aren't going to retain a lot of the first two years and you aren't going to be able to rattle off what precisely the NADPH shunt is or whatever, but having that background somewhere in there is what makes you able to do your doctor stuff.

I could maybe barely have passed step 1 if I had not had my first two years; I wouldn't have understood anything about what I was doing though.

And I would die if I had to go through three years of this clinical rotations bull. Getting in the way while other people do their work is surprisingly a lot less valuable than you would think.

 

[Instatewaiter]

You all are probably aware of the idea of necessary but not suffiicient. Step 1 is a prime example. It is necessary to show you are competent, but alone, it is not sufficient.

That is why we have the other steps. That is why we have clinical rotations and that is why we have residency.

 

[DeadCactus]

I don't know where you all come up with this fallacy that using Step 1 as an admission tests suddenly means that people will only learn the bare minimum to pass Step 1. I'm sure the 190 test takers would be rolling in the med school admission offers. Good thing we have a system to protect them from outside competition if they made it into the club.

If anything, this system would require a higher mastery of the basic sciences. Suddenly you have to learn the basic sciences beyond the minimum required for the medical school to drag you on to the next year.

The absolute only thing that would change is that people who learn better in other formats would be free to pursue that format. Just because you can't handle it doesn't invalidate other methods. If you think the 2 year basic science curriculum is so superior, you should have no complaints. Obviously all the other kiddos would never be able to score well enough on Step 1 or learn enough to do well on rotations to compete with you. 🙄

It's a country club attitude and has nothing even remotely to do with the quality of medical education...

 

[SpecterGT260]

ya that's not true

 

[KnuxNole]

I see no other reason to oppose a proposal that has no impact on you if you feel two years of basic science hand holding was more valuable to you than an extra year of clinical practice. I'm not really seeing how a system that actually presents students with the freedom to choose the educational format that works best for them is "stupid".

I agree. Keep in mind tons of med students never go to class, or actually pay attention to notes. LOL.

 

[KnuxNole]

I think too highly of this profession and my training to believe that a Kaplan course could replace 2 years of preclincal education. Maybe some of your schools aren't very good or you're not using their resources.

The only resources for any medical student is probably lectures(cause what else can help with basic sciences, lol), and for a lot of subjects, it's not something someone can tell you. Like, microbiology or histology...those are subjects where it's a matter of reading the material and understanding it. They might help to clarify some points, but there is very little to nothing that is conceptually hard.

MAYBE physiology, but that's it.

 

[link2swim06]

I find it highly unlikely that true self directed study will get you what you need. The level of non-linear thinking required in the first two years is simply absent in undergraduate courses. We basically are left with two options - make a true "pre med major" which is significantly more difficult than normal majors. For example, I have a BS in chemistry. The people I graduated with who wanted to go work for a production lab for some random company like budweiser or some cosmetic or ag company did not need nor was it very likely that they would have succeeded in a curriculum oriented around 3rd and 4th order questions. If we left undergrad the way it is the physician deficit will explode. Most text books do not put the material together in a clinically useful way. Without having heard it from a professor in medical school, what is the likelihood that you would have thought to consider, for example, splenic artery bleeds with pyloric ulcers? Its a simple example and MAYBE you would get it. but if you just go through a gross anatomy book and arent constantly tested and reminded of 3d relationships you will fail as a physician. many mid-level practitioners do this. They have extensive "name that thing" tests, and then like to talk about how they go into further detail than the med students with their anatomy curriculum. This isnt true. I dont care if you can name the 5th order branches of CNV3. That is trivial but not really useful.

The ability to name every note on every fret of every string of a guitar does not grant you the ability to make music.


as I alluded to in a previous post, we dont expect mastery of these things in undergrad. Most bachelors require a C average to pass, and most med students have a lower sGPA than cGPA. aside from the higher degree of weeding out due to using clinical basic knowledge (and it is.... USMLE will have a large amount of clinical vignettes and clinical correlations) as the entry exam we also lose roundedness which is something we look for in US medical students. Whether that is right or wrong is debatable (usually only to med students and even more by pre meds ) but if we want a step1 level knowledge at graduation then we are asking undergrads to provide a curriculum which can achieve that. I dont see this as practical



Stop it. I feel dirty whenever we agree 😀




I have to be honest with you - I would highly distrust a doctor who didn't have a good understanding of the basic medical sciences. This is my major beef with mid level practitioners entering into solo primary care. What you are suggesting is that health care providers need only memorize a string of symptoms and basically turn into diagnostic machines. Input symptoms.... calculating... calculating.... output diagnosis. This is fine for most cases, but if we lost basic sciences we would be harming the patients that don't present normally or who dont' have enough primary literature describing them to land us in the proper diagnosis. As absurd as "House" is (and with as much flak as I stand to get for using this as an exampl lol) I DO ascribe to a technique that relies more on an understanding of the anatomy, phys, and pathology, than on a memorized list of mnemonics: SMART - Shuffling gaint, Mask-like face, Akinesia, Rigidity, Tremor. Cool, parkinsons. But if this is your primary go-to for diagnosis over the basic sciences and some clinical exam tools I think you stand to miss diseases until they are obvious and late. Clinical knowledge IMO should supplement the basic sciences. EBM, IMO is an example of how our clinical knowledge falls short of basic science. By that I mean that every time EBM shows we have been doing something stupid, had we possessed the basic science knowledge it would have been avoided all together. as basic scientific understanding expands we can do our job better by being on top of it and applying what we see in the clinic



Maybe it is my own experience.... but I think the "self study" people across the board are underestimating the amount of information they get from professors either through notes provided, recorded lectures, in-person lectures, or out of class question help. In addition there is a peer teaching component that most medical students take advantage of. To say your entire basic science medical training was done solo is highly unlikely. And if you happen to be an outlier or a prodigy of sorts, you forget that many people, myself included, thrive in an environment with shorter milestones. I don't think most people would do well handling all of the material of the first 2 years with the only goal being test day. If I'm right about this then your proposed plan would only serve to slash the number of graduating doctors by an unreasonable number.

I stopped going to class 2nd month of med school. I will be done with 2nd year in 2 months.

How is this different from self-study?

How does this sound....you must take all the basic science subject NBMEs before you are allowed to sit for STEP 1? That breaks it down into obtainable steps.

I would propose you are in the minority if you go to class, most med students dont go to class.

And you really think your lecturers are more clinically relevant/better than texts like goljian rapid review?

 

[SpecterGT260]

I stopped going to class 2nd month of med school. I will be done with 2nd year in 2 months.

How is this different from self-study?

How does this sound....you must take all the basic science subject NBMEs before you are allowed to sit for STEP 1? That breaks it down into obtainable steps.

I would propose you are in the minority if you go to class, most med students dont go to class.

And you really think your lecturers are more clinically relevant/better than texts like goljian rapid review?

Have you looked at lecture handouts provided by the lecturer/school or watched lecture videos since your 2nd month of school? Looked at so much as a study guide? If so the lecturer has set the bar for each exam for you. Your education is still facilitated via milestones and checkpoints. What is being discussed here is a complete abandonment of this and tens of thousands of pre-meds hunkered down with a few textbooks and no real idea what is expected.

Im not an information machine. Some people can sit down with no background in a subject and memorize lists of crap related to the subjects (i.e. first aid). I need an understanding of the fundamentals and then many fewer factoids. I'm obviously biased but I think the walking computer type people are only good for regurgitating medical trivia but application and adaptability suffer.

 

[link2swim06]

Have you looked at lecture handouts provided by the lecturer/school or watched lecture videos since your 2nd month of school? Looked at so much as a study guide? If so the lecturer has set the bar for each exam for you. Your education is still facilitated via milestones and checkpoints. What is being discussed here is a complete abandonment of this and tens of thousands of pre-meds hunkered down with a few textbooks and no real idea what is expected.

Im not an information machine. Some people can sit down with no background in a subject and memorize lists of crap related to the subjects (i.e. first aid). I need an understanding of the fundamentals and then many fewer factoids. I'm obviously biased but I think the walking computer type people are only good for regurgitating medical trivia but application and adaptability suffer.

Watched videos no...but looked at lecture handouts sure. Here is the point, if it was even an option to skip the formal first two years there would be tons books equivalent to those note packets for sale on amazon for $89.

70% of what you learn during the first two years is you staring at notes/textbook/etc not in class. I would actually claim you are the prodigy if you can learn everything you need in lecture.

I yet to see a reason why I should pay $100,000 over 2 years to study by myself. Each NBME is about 2 months of information, you really think people couldn't motivate themselves to study for each of these subject exams without being enrolled in a formal school?

 

[SpecterGT260]

I havent taken the NBME stuff.... but it is an interesting thought..... I know that the curriculum at my school has had students outscoring the average step 1 scores for years. I'm not about to question their tactics. I know they have had small studies in the past with select students who did not go to lecture at all and did peer teaching out of supplied materials. they did well, but they were selected because of high performance indicators... they didnt want to guinea pig someone who may struggle.

I think there is also a leeriness against current schools who teach just for Step1 as the thinking is that it produces lower quality physicians. there is more to being a doctor than test scores. The first two years are also chalked full of pre-clinical training. I guess we could spend a year doing that 🙄 as that first of 3 plan......

 

[link2swim06]

I havent taken the NBME stuff.... but it is an interesting thought..... I know that the curriculum at my school has had students outscoring the average step 1 scores for years. I'm not about to question their tactics. I know they have had small studies in the past with select students who did not go to lecture at all and did peer teaching out of supplied materials. they did well, but they were selected because of high performance indicators... they didnt want to guinea pig someone who may struggle.

I think there is also a leeriness against current schools who teach just for Step1 as the thinking is that it produces lower quality physicians. there is more to being a doctor than test scores. The first two years are also chalked full of pre-clinical training. I guess we could spend a year doing that 🙄 as that first of 3 plan......

Very true....but again I would say that the NBME expected me to know the material at the same level my class exams did.

Therefore, if you are performing well on those you are learning much more than you need to know for step 1. Honestly if you are getting 99% on those you are learning everything any med school is teaching course-wise.


As far as preclinical "training" here is everything I was taught:
1) Ultrasound
2) History taking and physical exam/diagnosis

This could all be done in 3 weeks right before third year.

 

[SpecterGT260]

that is ambitious... not that the exam stuff is all that hard, but it takes some time to get to the point where the noobishness of it is not an overt hurdle for you in the clinic.

http://www.youtube.com/watch?v=V8l8_G_ce_Q&feature=related

 

[link2swim06]

that is ambitious... not that the exam stuff is all that hard, but it takes some time to get to the point where the noobishness of it is not an overt hurdle for you in the clinic.

http://www.youtube.com/watch?v=V8l8_G_ce_Q&feature=related

The reason people are bad at physical exam is because you dont know what diseases are even possible for the symptoms.


There is zero point in teaching a first year physical exam...you might as well wait till you have passed step 1 and understand all the diseases. Then its easier to know what questions to ask.

 

[JackShephard MD]

The reason people are bad at physical exam is because you dont know what diseases are even possible for the symptoms.


There is zero point in teaching a first year physical exam...you might as well wait till you have passed step 1 and understand all the diseases. Then its easier to know what questions to ask.

I agree here. Superficially learning to do things without knowledge/purpose is rapidly spreading across our medical curriculum.

 

[SpecterGT260]

We started Phys exam this semester after completing anatomy and the specific exams follow our clinical tie in course and our current Phys topics. IMO not a bad way to do it. I still suck at locating the PMI, nearly asphyxiated my partner looking for the carotid pulse, and have a 30% chance of blinding myself by not holding the ophtho scope correctly, but I understand WHY im doing these tests lol

 

[mvenus929]

OP, question: Would you remove the limit to take Step 1 once if you pass? Right now, you can take the MCAT as many times as you want, though it's discouraged in some instances. Step 1, you either pass or fail.. .if you fail, you can take it again, but you have that stigma of not being able to pass the first time...

I can see your argument, and it is potentially a useful one. After all, other medical schools in the world have 6 year programs. But, I do think that the first 'two' (getting shorter than 2 years at many schools) years of medical school do provide a lot of useful information. I was assigned a 6 person small group at the beginning of first year, and we met once a week throughout the preclinical curriculum. We grew enormously during that time, learning how to do various clinical skills, develop a differential, etc. Something that isn't explicitly taught in board review books. I don't know of any medical school that doesn't have some sort of professional development course like this... some are better than others, but I'm pretty sure they're all there. You could argue that you could spend a year prior to the traditional third year doing that sort of thing, but it's not something that takes a lot of time each week to do, so I'm not sure you could justify spending a year working on it full time, and I don't think less than a year is enough time to develop those skills.

Honestly, PhDs should not be teaching medical school.

Medical school is the only professional school in which a large portion of the education is taught by people other than those who have already been through the training.

 

[SpecterGT260]

That and Phds know the material for the pre-clinic years to a vastly greater level than practicing MDs

 

[Dave89]

Step 1 should be a public tests, open to anyone who wants to take it. Passing should be a requirement to entering medical school and the score could be used as the MCAT is now. Learning the material and studying for the exam could be done through whatever combination of college coursework, commercial review courses, and self-study the applicant wants. Medical school should then become a 3 year program of purely clinical rotations.

Agree or disagree?

I think we need to have a system which is track based from the beginning of college. Say, a five- or six-year medical program. (This could apply to anything including engineering, chemistry, etc.) In which case the MCAT would not be necessary - students incapable of handling the academics of medical school would fail out. The Steps could, of course, remain in place.

There is so much time and money wasted on undergraduate courses that have no bearing on or relevance to medical training and practice.

 

[Rothbard]

nm

 

[SlickNickMD]

Agreed.

I think it's common knowledge among those who do well in medical school that the first two years are more or less useless. Learning the material is about organizing it in a way that you can learn it and putting in a bit of hard work. We all know the best tools for this: BRS, Gojian, FA, Uworld, etc. Pick your favorites. Mandatory classes and exams just ****** this process.

Honestly, everything up to and including step 1 (including premed) should be self study. If you need lectures, then you have the option of paying for classes. The only thing that should arguably be mandatory (because it can't otherwise be tested) is an anatomy lab.

After that, give new third years a 1 month intense doctoring course before you let them loose on the floors.

Only thing I showed up to the first 2 years

 

[Charles_Carmichael]

The reason people are bad at physical exam is because you dont know what diseases are even possible for the symptoms.


There is zero point in teaching a first year physical exam...you might as well wait till you have passed step 1 and understand all the diseases. Then its easier to know what questions to ask.

I agree here. Superficially learning to do things without knowledge/purpose is rapidly spreading across our medical curriculum.

I disagree regarding learning certain physical exams. I'm an M1 and we learned the neurological exam today, for example. We finished neuroanatomy and neurophysiology last week, so we definitely have enough of a background to understand what we're testing for and why we're testing for it.

We may not be able to diagnose things specifically as Syndrome X or Syndrome Y or whatever, but we can at least localize the lesions to a general area of the nervous system, based on what we've learned in class. I think there's utility in that.

It's the same thing with when I go into the clinic with my preceptor. She taught me the basic rheum exam and, even though I don't know enough to specifically diagnose things, I've still learned enough to know how to direct my physical (in general) based on the history and what sort of signs I should be on the lookout for, etc.

I don't know how it's done at your schools, but I've really enjoyed the physical exams that I've learned so far as an M1. With that being said, we learn the majority of the various physical exams next year, as M2s. The main ones we've learned this year have been cardiac auscultation and the neurological exam, in addition to whatever else I've picked up in the clinic with my preceptor. And, to be honest, learning this stuff has been absolutely refreshing and helped motivate me to trudge through the basic science material. It's kind of like a carrot at the end of the stick. So I don't think it's a waste of time. I don't know. Maybe I'm the only one who feels that way.

 

[eyecutter]

I found the first two years of medical school to be a valuable time, and I am very thankful to have had good lecturers to help me form my foundation in medicine. Our time in the classroom is about much more than preparing for the USMLE Step 1 exam. Also, I think that such a move (which seems to have no support), might make US doctors have a much more homogenous background. It would be very difficult to major in anything other than the health sciences if one had to learn the basic sciences and medicine prior to medical school. The high level of education among our doctors is one of the things that makes medicine in this country great.

 

[Brigade4Radiant]

The flaw is the belief that Step 1 is the only purpose of the first 2 years when it's not.

Exactly. Tthis is a Doctorate degree the degree the OP is working for will just be a masters. Also it only takes my school 1.5 years to finish the preclinical curriculum even with summer break

 

[JackShephard MD]

I disagree regarding learning certain physical exams. I'm an M1 and we learned the neurological exam today, for example. We finished neuroanatomy and neurophysiology last week, so we definitely have enough of a background to understand what we're testing for and why we're testing for it.

We may not be able to diagnose things specifically as Syndrome X or Syndrome Y or whatever, but we can at least localize the lesions to a general area of the nervous system, based on what we've learned in class. I think there's utility in that.

It's the same thing with when I go into the clinic with my preceptor. She taught me the basic rheum exam and, even though I don't know enough to specifically diagnose things, I've still learned enough to know how to direct my physical (in general) based on the history and what sort of signs I should be on the lookout for, etc.

I don't know how it's done at your schools, but I've really enjoyed the physical exams that I've learned so far as an M1. With that being said, we learn the majority of the various physical exams next year, as M2s. The main ones we've learned this year have been cardiac auscultation and the neurological exam, in addition to whatever else I've picked up in the clinic with my preceptor. And, to be honest, learning this stuff has been absolutely refreshing and helped motivate me to trudge through the basic science material. It's kind of like a carrot at the end of the stick. So I don't think it's a waste of time. I don't know. Maybe I'm the only one who feels that way.

I was more referring to superficial learning, like doing PBL on pathology of a system before learning the physiology, histology, or pathology behind it.

I don't mind the physical exam, my issue is this: if it isn't practiced, it likely won't be retained. I think it would be useful more during M3/M4 when you can do these skills on a daily basis instead of a few times a month. In other words, with my exposure during pre-clinicals, I doubt I will be much further ahead of someone without exposure unless I was practicing these skills on a daily basis. Compare a semester spending a few hours a month to a 40 hr week in the clinic. Who will have better exam skills?

A final thought: I think I'm reflecting on the learning process and thinking what I would like best, as most people are. I hope to refrain from coming across like I know what's the best way to educate a physician. It is very arrogant to think as an M1/2/3/4 that you have figured out how to educate the nation's physicians when you've never practiced a day in your life. So while I think reflection is good, we should be careful as novices in thinking we've got it all figured out.

 

[adamMD]

But if they did away with the MCAT, how else would students get motivated to master organic chemistry? Kidding, I think people should just be able to take the USMLE, online, at home, and that's it. An MD shortly arrives in the mail and we can get to rolling around in huge piles of money. Everyone I know wants to go into pathology anyways. As such, clinical experience really isn't important. I mean, we aren't going to be delivering babies with a microscope? Right? I ask because I forgot everything that happened 3rd year.

 

[TheLesPaul]

but if they did away with the mcat, how else would students get motivated to master organic chemistry? Kidding, i think people should just be able to take the usmle, online, at home, and that's it. An md shortly arrives in the mail and we can get to rolling around in huge piles of money. Everyone i know wants to go into pathology anyways. As such, clinical experience really isn't important. I mean, we aren't going to be delivering babies with a microscope? Right? I ask because i forgot everything that happened 3rd year.

+1

 

[dillydally]

I'm an MS1 and I love medical school. That's about all I want to say. Oh and I'm sorry if your school's preclinical years suck. That would make me mad too.

 

[AldousHux]

I'm surprised no one else has mentioned this, but there are school that do this already. Ohio state for one. They have an individual study program where they charge less and you have completely personalized study for the first two years. You schedule your own exams, so you still have exams for the basic science, but as long as you pass you're golden. You then feed into the same program as the regular med students for your clinical years. I have a friend who is in the program, they say for specific people it works really well, but the retention rate is horrible. A lot of people who think they can self motivate find that when there is soooo much information and they are in control of when you take exams it's very hard to stay motivated, especially since you have almost no contact with any other medical students. I think this is an idea that might work for some people, but I imagine most people would try and fail...I think one of the merits of the MCAT and first two years of medical school is that they determine you can survive medical school and then give you a tremendous basis of support for 2 incredibly grueling years. People who don't get into medical school are often facing a reality check that maybe it's not the right path. Without being in school I would imagine federal loans would be out of the question, and lord knows I wouldn't survive trying to learn all this material and having a job to cover living expenses. So I'm not sure how you would propose the monetary situation during that time. A lot of people would probably end up wasting time and money to find out the same thing they would have discovered by not getting into medical school in the first place, that they're talents and skills are simply better suited to another perfectly wonderful life direction. I would certainly want to know that before taking Step 1.

Anyway, my long-winded point is while this might be an option more schools should adopt like OSU, I don't think it would be prudent or practical to get rid of the MCAT and the first two year altogether. At the least everyone should be able to choose if they want that support, at the most people should find out upfront if they have the minimum of what it takes to get through med school, which is what an MCAT and application and interview often show.

 

[Morsetlis]

Med school attendance would drop to approximately 0. I don't think anyone is motivated enough to self-study 2 years worth of med school. Frankly, I thought about dropping out in the first semester but I had already paid tuition, lol.

That's the point.

 

[mTOR]

Step 2 is more predictive of clinical competency, actually. I seriously have no problem with med school being one year -- pure clinical rotations. Right out of high school or any time for that matter. With the entrance exam being performance on Step 2.


Information and communication technologies are fundamentally uprooting every tradition-based assumption society carries on education. Most of the hoops we leap through on this path are little more than unnecessary measures of obedience and compliance with the system.

 

[adrakdavra]

Step 1 should be a public tests, open to anyone who wants to take it. Passing should be a requirement to entering medical school and the score could be used as the MCAT is now. Learning the material and studying for the exam could be done through whatever combination of college coursework, commercial review courses, and self-study the applicant wants. Medical school should then become a 3 year program of purely clinical rotations.

Agree or disagree?

I Agree and disagree, however, MCAT is huge income about $20 million per year give or take, so think about that too

 

[Robin des Bois]

Step 1 should be a public tests, open to anyone who wants to take it. Passing should be a requirement to entering medical school and the score could be used as the MCAT is now. Learning the material and studying for the exam could be done through whatever combination of college coursework, commercial review courses, and self-study the applicant wants. Medical school should then become a 3 year program of purely clinical rotations.

Agree or disagree?

Lol @ you! So we med schools applicants should be forced to self-study 2 years of intense med school curriculum while still trying to get a competitive GPA at school eventhough this will most likely end up serving no purpose for us (since most of us will end up never getting into med school)?
Easy for you to propose this stupid idea when you ain't affected by it.

 

[link2swim06]

Lol @ you! So we med schools applicants should be forced to self-study 2 years of intense med school curriculum while still trying to get a competitive GPA at school eventhough this will most likely end up serving no purpose for us (since most of us will end up never getting into med school)?
Easy for you to propose this stupid idea when you ain't affected by it.

I think the really heart of this question is why the hell do we pay nearly 100K for M1/M2 year when all the studying is done on our own, generally with outside resources.

Step 1 isn't all you learn M1/M2 year. But you could just as easy self-study each subject and take the NBMEs for each subject and end up learning everything you need.

The missed fact is the med schools would likely double M3/M4 tuition if this passed. Those basic science profs aren't getting rich off our tuition....cutting them out will not save us a lot of money.

 

[Robin des Bois]

I think we need to have a system which is track based from the beginning of college. Say, a five- or six-year medical program. (This could apply to anything including engineering, chemistry, etc.) In which case the MCAT would not be necessary - students incapable of handling the academics of medical school would fail out. The Steps could, of course, remain in place.

There is so much time and money wasted on undergraduate courses that have no bearing on or relevance to medical training and practice.

Yes, people here can get into med school straight out of CEGEP.
Also, they don't need to write the MCAT.

 

[johnmendes]

I think the really heart of this question is why the hell do we pay nearly 100K for M1/M2 year when all the studying is done on our own, generally with outside resources.

Step 1 isn't all you learn M1/M2 year. But you could just as easy self-study each subject and take the NBMEs for each subject and end up learning everything you need.

The missed fact is the med schools would likely double M3/M4 tuition if this passed. Those basic science profs aren't getting rich off our tuition....cutting them out will not save us a lot of money.

Amen. 👍

 

[Medstart108]

I agree. I could totally see pre-clinical medicine becoming something done online, or at colleges. pre-clinical medicine is really just college level material. There is no research involved, its just facts you essentially need to know. Replace the MCAT with step 1. Makes sense.

 

[jerseytrash]

Why was this thread resurrected?

 

[JP2740]

Only studied classnotes and lectures my first two years. I really feel like I have a good understanding and generally am really satisfied with that route. When I open first aid I blaze through the units- it feels like doing algebra after learning calculus (slightly bad anaology but you get the point).

 

[Didierdrogba]

I think MCAT should just test material that is more relavant to medical education. Eliminate physics, gen chem, verbal and writing, then I will have no problem with it.

 

[greg1184]

The USMLE (aka the USMAT) exams should be made into a true licensing exam.The "pass/fail" aspect of the USMAT is a facade. The so-called goals of the exam and the goals of residency programs are completely inconsistent. While the NBME's purpose of the exam is to determine minimal competency for the purposes of medical licensing, residency programs use it as an admissions test, the equivalent of the MCAT for medical schools. Only problem is... once you so-called "pass" (a pointless quality) the USMAT, that is it. You can never take it again, a wonderful "gotcha" tactic to easily screen out applicants.

It is what it is.... but as far as I am concerned either make the test a TRUE PASS/FAIL licensing exam.... or stop disguising the exam as a pass/fail exam and allow people to retake it a limited amount of times.

The MCAT can be taken multiple times, and the programs can evaluate those multiple takes their own way (average of exams, take the highest, take the latest, etc).

 

[SpecterGT260]

Lol @ you! So we med schools applicants should be forced to self-study 2 years of intense med school curriculum while still trying to get a competitive GPA at school eventhough this will most likely end up serving no purpose for us (since most of us will end up never getting into med school)?
Easy for you to propose this stupid idea when you ain't affected by it.

I can't think of anyone who I would feel confident could pass the first two years and step1 with TRUE independent study. I don't go to class either.... but the way of approaching the material is built into the curriculum and is somewhat inescapable.

Sent from my DROID RAZR using SDN Mobile

 

[Wordead]

The USMLE (aka the USMAT) exams should be made into a true licensing exam.The "pass/fail" aspect of the USMAT is a facade. The so-called goals of the exam and the goals of residency programs are completely inconsistent. While the NBME's purpose of the exam is to determine minimal competency for the purposes of medical licensing, residency programs use it as an admissions test, the equivalent of the MCAT for medical schools. Only problem is... once you so-called "pass" (a pointless quality) the USMAT, that is it. You can never take it again, a wonderful "gotcha" tactic to easily screen out applicants.

It is what it is.... but as far as I am concerned either make the test a TRUE PASS/FAIL licensing exam.... or stop disguising the exam as a pass/fail exam and allow people to retake it a limited amount of times.

The MCAT can be taken multiple times, and the programs can evaluate those multiple takes their own way (average of exams, take the highest, take the latest, etc).

I don't really see how that makes it a better admissions test. If anything, a one time do or die puts everyone on the same footing - no people taking it 4 times and asking if this or that program will take the highest of each section or whatever. MCAT should be a one time thing too, honestly.

I don't even know what you mean by "gotcha". Like anyone taking the test doesn't know it's a one time deal? If they didn't do even cursory research, well, idiocy has consequences.

 

[SpecterGT260]

I don't really see how that makes it a better admissions test. If anything, a one time do or die puts everyone on the same footing - no people taking it 4 times and asking if this or that program will take the highest of each section or whatever. MCAT should be a one time thing too, honestly.

I don't even know what you mean by "gotcha". Like anyone taking the test doesn't know it's a one time deal? If they didn't do even cursory research, well, idiocy has consequences.

For the most part, the MCAT is a one-time thing. Adcoms see every attempt and weight that accordingly. Here is the thing people are missing here: medical school is MEDICAL school. Crazy, right? They want to teach you medicine according to the way they think it should be taught (and therefore, the way they think it should be understood). If we pushed the preclinical years into nothing but rote memorization of First Aid, we might as well just name every medical school "Ross" or "AUC" and just number them.

Those saying that they taught themselves medicine the first two years are delusional. Sure... I spent most of my time studying in private to meet specific benchmarks. But who set those benchmarks? Who establishes the depth and integration of understanding required? If given the big books and told "here, just read these and I will see you in 2 years for your boards", 99.99999% of us would fail according to the standards we keep right now. Even the most motivated among us. Much of formal education is about teaching someone HOW to think, not just WHAT to think.

 

[greg1184]

I don't really see how that makes it a better admissions test. If anything, a one time do or die puts everyone on the same footing - no people taking it 4 times and asking if this or that program will take the highest of each section or whatever. MCAT should be a one time thing too, honestly.

I don't even know what you mean by "gotcha". Like anyone taking the test doesn't know it's a one time deal? If they didn't do even cursory research, well, idiocy has consequences.

It will make it like every other admissions test (MCAT, GMAT, DAT, etc). Everyone has a bad day... for whatever reason. If your NBME/UWSA practice test scores (which on this site seem to accurately predict your step score) are pointing to a particular score and you end up scoring significantly lower on the exam, you know you can do better. The "gotcha" moment is exactly that.... once you take the exam and passed, that is the end. You have potentially eliminated certain places and specialties, many of which don't pay attention to step 2 CK. If I am not mistaken, many years ago you used to be able to retake this exam.

As for the 4+ retakes... I mentioned a limited amount of times.... limit it to once or twice. Of course retakes are naturally limited by the time constraints of MS-3, the sheer amount of material, etc.

I don't know of any other pass/fail licensing exam (e.g the bar, etc) of which a score is used as a competitive entity for admission to the degree of the medical boards.

Either way, it is what it is, and this is all in hindsight since I am about to graduate.

 

[SpecterGT260]

It will make it like every other admissions test (MCAT, GMAT, DAT, etc). Everyone has a bad day... for whatever reason. If your NBME/UWSA practice test scores (which on this site seem to accurately predict your step score) are pointing to a particular score and you end up scoring significantly lower on the exam, you know you can do better. The "gotcha" moment is exactly that.... once you take the exam and passed, that is the end. You have potentially eliminated certain places and specialties, many of which don't pay attention to step 2 CK. If I am not mistaken, many years ago you used to be able to retake this exam.

As for the 4+ retakes... I mentioned a limited amount of times.... limit it to once or twice. Of course retakes are naturally limited by the time constraints of MS-3, the sheer amount of material, etc.

I don't know of any other pass/fail licensing exam (e.g the bar, etc) of which a score is used as a competitive entity for admission to the degree of the medical boards.

Either way, it is what it is, and this is all in hindsight since I am about to graduate.

Most other professions do not have the same wide degree of subspecializing that medicine has. Although there are residency programs popping up in all other facets of healthcare (dentistry, pharm, even nursing). I wouldn't be surprised if their boards also play a role in who is competitive.

 

[Anon212]

I can see multiple issues with this plan:

1) timing. The MCAT took me ~3 weeks of reviewing physics and gen chem cause I hadn't taken them in 4 years, and I studied for it a couple of hours a day max while working full time. Studying for step 1, after 2 years of instruction/ testing etc took me 5.5 weeks of studying 8-10 hours a day, and many of my classmates did way more than that. It would basically become incumbent upon pre-med students to take at least 2ish gap years to get it all done. Either that, or we'd just all have to be pre-med majors, and we'd just be moving the instruction we currently get in med school to the undergrad level- merely so that we can be in school while learning the med school material. Most people can't afford to spend a year or 2 doing nothing but studying, with no loans or jobs to support them financially. So either they do it in school (and as I said, then we're just passing the med school preclinical teaching buck onto college professors) or they prolong the torture over 2-3 years to learn it all while working full time.

I think this would be incredibly unfair to students who can't afford to be supported by mom and dad for 2 years while memorizing a bunch of factoids, who can't afford to pay for the privilege of going to an anatomy lab and seeing prosections (I suspect this wouldn't be cheap), and who can't afford 15 different prep courses to get at the material a bunch of different ways. Basically Harvard students would be a bunch of 260+ scoring rich people. Federal loans wouldn't be in there to fill the gap (I seriously doubt the government would fund your cost of living/ prep course cost/ anatomy lab costs just for the marginal chance you may go to med school someday). I don't think that's fair at all.

And because Step 1, as many have pointed out, is a test of memorization and not thinking, over 2 years you'd just keep forgetting the material over and over again. So I don't think this would work.

2) You'd be taking away all the other benefits of the first 2 years. Learning from renowned people in the field, personal anecdotal clinical correlates, the secondary classes (physical exams, ethics, etc), having classmates with whom to do group study, lab time, etc. I didn't go to lecture much either, but I took advantage of a lot of other resources my school provided, not least of which were my classmates. And also, as someone pointed out, I'm leery of making the entire purpose of the preclinical curriculum be the memorization of First Aid. I thought FA was a garbage book for learning, it's more of an outline of what you should be learning and fleshing out on your own. Sure you can supplement it with a bunch of other books, but again, learning a bunch of textbooks with no other form of instruction takes up time- time you don't have after college, at least not if you're working (not that there's a ton of jobs for fresh college grads anyway). So we're back to point 1- what do we do about the time and money it takes to learn the material?
As someone pointed out, clinical knowledge with little/no basic science background equals NP school. No thanks.

3) If you take step 1 completely out of the residency app game, you're putting way more onus on other stuff to differentiate students. Don't get me wrong, I didn't do well on step 1 so this would have actually worked in my favor, but I'm the minority. Third year is incredibly subjective, so are we gonna make your entire career/ specialty choice dependent on whether you ended up with the nice attending or the mean one? Really?? Or whether by luck of the draw you ended up in the worst service on surgery, with 16 hour days, vs the easy one that lets you out early so you can study more for the shelf?? Based on what I've seen around me as a third year, I think this would be disastrous. There is way, way too much luck involved in doing well that year already, and it makes students sufficiently cut-throat. If you take away yet more things for residencies to judge us by- however incredibly flawed Step 1/ preclinical grades/ AOA status may be- we'd all just be gunning like bloody hell for a year for that spot in the surgery clerkship that only keeps you there 8 hours. This would screw over the students who genuinely want to learn some trauma by doing trauma ICU, for example- because your shelf would matter 10x more, which means that working 16 hour days would just prevent you from doing what you want to do with your life.
Also, don't forget that if you're taking all that stuff away, one of the big differences among students would be school attended. This goes back to my first point, too. That kid whose parents were rich enough to support him for a year and a half while he got his 260+ on step 1 and got into Harvard is now gonna get the plastics spot because he's at Harvard. The kid who had to work full time because his parents couldn't support him and who got a 210 had to go to a less highly ranked school and will have to do FM because that's one of the big deciding factors- is that fair?

Right now we think about carib and to a much lesser extent DO schools this way. I.e. ok, so you weren't a super stellar student in college, maybe you didn't totally have your life together at age 19 and you got a C or 2. Now you're at, say, a carib school. Right now if you do well enough on Step 1 you still have a shot at some of the more "competitive" programs (this is far more true of DO schools than carib, but bear with me). Take that away and your entire career path is decided when you're 19.

I don't think what we have is a perfect system, far from it. But honestly, I don't think removing the preclinical curriculum fixes that at all.