Step 1 Should Replace the MCAT

[Wordead]

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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.

Agreed with pretty much all of this, although I don't know about adcoms weighing retakes accordingly across the board.

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.

There might not be another field in which a standardized test score is used as heavily in medicine, but do you really want to go away from that? If you look at jobs obtained in Law, Business, even Dental - it's pure nepotism and networking. Medicine has its fair share of "who you know", but at least there's some pretense that we care about merit over just popularity. Sure, one bad test can sink you, but it's really up to each individual person to be a big boy and delay their test if they feel like ****e. We all know how important the test is; act accordingly.

 

[Fox800]

My thoughts on this proposal:

 

[greg1184]

Agreed with pretty much all of this, although I don't know about adcoms weighing retakes accordingly across the board.



There might not be another field in which a standardized test score is used as heavily in medicine, but do you really want to go away from that? If you look at jobs obtained in Law, Business, even Dental - it's pure nepotism and networking. Medicine has its fair share of "who you know", but at least there's some pretense that we care about merit over just popularity. Sure, one bad test can sink you, but it's really up to each individual person to be a big boy and delay their test if they feel like ****e. We all know how important the test is; act accordingly.

I am perfectly fine with the Step exam being used as part of admissions. I want to go away from the one and done notion and the so-called "pass/fail" notation when the simple fact that you passed the exam means absolutely nothing. Either it is pass/fail or it is not.

I had a very disappointing score on Step 1. I wish I had a crystal ball predicting that I would make a disappointing score on the exam. Unfortunately, there are times when you simply have no idea what happened... especially considering the NBME and UWSA's scores pointing to a certain result. But hey it is a scarlet number you have to live with.

 

[SpecterGT260]

ok now this makes sense....

 

[PennDippody]

IDK - the system is set up to where we have to rely on Step 1 more than anything else to get most of us where we want to be. If it is the aim that preclinical years be about more than that, then there has to be something done to place less emphasis on a test of "minimal competance". An ideal test that graded minimal competance would be pass-fail and nothing more.

Not to mention, only in the extreme ends do preclinincal grades matter - further denouncing the imposed importance on the material we learn during that period.

 

[evilbooyaa]

I am perfectly fine with the Step exam being used as part of admissions. I want to go away from the one and done notion and the so-called "pass/fail" notation when the simple fact that you passed the exam means absolutely nothing. Either it is pass/fail or it is not.

I agree with this. I think if you're not happy with your score you should be allowed to retake it a max of 2 times (meaning 3 passing attempts total) Obviously it won't look as good if you get a 240 on your second attempt with a 220 on your first attempt as if you had just taken the test once and got a 240.

Keep the Step I score as a residency application factor. Just allow people who had a bad day on exam day (for whatever reason) to do better on a subsequent attempt.

I read the OP and first few posts before I realized the post was from 2012. To the original post (and not the poster who I quoted), that is the stupidest thing I've ever heard. The entire world is stupider for hearing your ideas. I award you no points, and may god have mercey on your soul.

 

[Wordead]

When do you envision people retaking step1? You're not going to be able to study efficiently for step 1 while on rotations - even family med is pretty draining, and you have shelfs to study for. So either you delay your clinical rotations or take a year off or something? It's just not feasible.

Not to mention that taking the test again soon after you take it the first time would be a HUGE advantage to retakers.

 

[Instatewaiter]

Also, one can have very high step 1 scores with very little understanding of what's going on as it is seen on daily basis on the wards.

We see this all the time on the wards.

Step 1 is necessary but not sufficient so just studying for step 1 is necessary but not sufficient. There is value in the other "junk" you learn.

You'll realize how basic the steps are and how little they mirror practice once you get through residency.

Step 1 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.

It is not the most important thing unless you think the reason you go to med school is to get good grades, rather than learn ****.

 

[Cali2]

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.

Would like to point out that perfecting history taking and physical exam is a career-long pursuit. There is a heavy component of the art of medicine here. I promise you did not, and can not, master it in 3 weeks. In the very least, longitudinal exposure over the first two years improves your ability to interact with patients with relative ease at the start of M3.

 

[alpinism]

If medical school is like cooking dinner, memorizing only things on Step 1 is like making $hitty ramen.

Not even good ramen.

 

[Doctopus]

This thread reminds me of how just how much the med school admissions process selects for conformity and why medicine perpetuates bad ideas institutionally seemingly in perpetuity. (Translation: this proposal is a good one, or at the very least, very worthy of discussion/consideration, and yet everyone just gut replies that it's crazy without dealing with any of the pertinent issues raised.)

 

[Mass Effect]

This thread reminds me of how just how much the med school admissions process selects for conformity and why medicine perpetuates bad ideas institutionally seemingly in perpetuity. (Translation: this proposal is a good one, or at the very least, very worthy of discussion/consideration, and yet everyone just gut replies that it's crazy without dealing with any of the pertinent issues raised.)

Actually, I think everyone IS dealing with the issues raised, even the ones that aren't pertinent. Read the thread and you'll see discussion/consideration in every single post and a number of reasons why posters think this is a bad idea. Furthermore, phrasing your sentence in such a way that you believe it needs a translation in order to be understood takes away from your point, imo.

 

[Instatewaiter]

Would like to point out that perfecting history taking and physical exam is a career-long pursuit. There is a heavy component of the art of medicine here. I promise you did not, and can not, master it in 3 weeks. In the very least, longitudinal exposure over the first two years improves your ability to interact with patients with relative ease at the start of M3.

Agree

This thread reminds me of how just how much the med school admissions process selects for conformity and why medicine perpetuates bad ideas institutionally seemingly in perpetuity. (Translation: this proposal is a good one, or at the very least, very worthy of discussion/consideration, and yet everyone just gut replies that it's crazy without dealing with any of the pertinent issues raised.)

Or perhaps it is a ****ty idea that doesn't warrant discussion.

You wouldn't get this as a med student who I'm guessing hasn't taken step 1, but when you are a resident you will realize just how worthless the step 1 knowledge is. It seems like it is important because it is found on an important test but the other stuff you learn during your preclinical years is markedly more important. This is nicely highlighted by the douchenozzles who scored well on step 1 and think they are the masters of clinical medicine and are utterly clueless on the wards. Don't be a douchenozzle

 

[jerseytrash]

Agree



Or perhaps it is a ****ty idea that doesn't warrant discussion.

You wouldn't get this as a med student who I'm guessing hasn't taken step 1, but when you are a resident you will realize just how worthless the step 1 knowledge is. It seems like it is important because it is found on an important test but the other stuff you learn during your preclinical years is markedly more important. This is nicely highlighted by the douchenozzles who scored well on step 1 and think they are the masters of clinical medicine and are utterly clueless on the wards. Don't be a douchenozzle

+10

Step 1 certainly provided an excellent scientific basis upon which to think about clinical problems, but it is by and large NOT a predictor of how good you are clinically - if anything Step 2 has been shown to be better in that regard (and not really by much, as with any standardized test).

 

[greg1184]

When do you envision people retaking step1? You're not going to be able to study efficiently for step 1 while on rotations - even family med is pretty draining, and you have shelfs to study for. So either you delay your clinical rotations or take a year off or something? It's just not feasible.

Not to mention that taking the test again soon after you take it the first time would be a HUGE advantage to retakers.

That is the main reason why it would be difficult for students to take step 1 4+ times.... it is a natural barrier.... unless they take a year off, but then the applicant has to report any interruptions of their education on ERAS and why.... I am sure that PDs would take that into consideration. Limiting it to 2-3 times is basically the ideal for me in hindsight.

Interesting discussion even though it was a minor threadjack. 😀

As for step 1 replacing the MCAT... I don't think that is a solution for anything.

 

[Doctopus]

"While I agree that clinical training is gaining ground, preclinical knowledge is the foundation of everything. Entrusting it to thousands of college or, worse, Kaplan seems to be fairly risky."

Riskier than entrusting it to crusty old PhDs who lecture AT you on minutiae

"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."

In other words, replacing MCAT with Step1 selects for the type of person who will be motivated to stay up to date in medicine, has the willpower to self-organize and self-teach (aka not be "behind the times" 10 yrs out of residency)

"Caribbean students with comparable or higher Step 1 scores don't perform as well in the match as US MD students."
Correlation does not equal causation. Carribean students are the students who didn't get into American medical schools = a lower caliber of student on net.

"The flaw is the belief that Step 1 is the only purpose of the first 2 years when it's not."
Nobody claimed this. What they claimed was that the knowledge that is supposed to be gained from preclinical coursework can be gained without the song and dance of med-school-arranged learning/"clinical experiences"/etc.

"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."
Between FC, Kap, RX, Pathoma, Goljan, BRS, FA, etc etc you can learn and understand far more than you ever will from your disorganized preclinical teachers.

Heh, I can't finish this post because I'm being forced to engage in some lame in-class activity

 

[evilbooyaa]

When do you envision people retaking step1? You're not going to be able to study efficiently for step 1 while on rotations - even family med is pretty draining, and you have shelfs to study for. So either you delay your clinical rotations or take a year off or something? It's just not feasible.

Not to mention that taking the test again soon after you take it the first time would be a HUGE advantage to retakers.

Say you took Step 1 originally in June at the end of M2, just before start of M3. You get the score back in July (after you've started clinical rotations), and you got a 205. Sucks for you, cause you wanna do Ortho. You complete the rotation you're currently on, then skip the next one that is short (like 6 weeks) to re-take Step I, and make it up at the end of M3. This would lead to the exact same timeline as those who deferred their first block of M3 so they could study more for Step 1 in the first place, which is already happening.

I will compromise and say that most people who re-take the exam would probably only put themselves through that kind of hell one additional time. If I got a 205 then a 210, I'd say screw it cause another 6 weeks is going to screw with my away rotations, plus I'm not going to do much better than a 210 anyways. But I think leaving people the option of re-taking it at least once isn't that crazy. 2 points make a line.

 

[Guillemot]

I do like the idea of replacing ****ty professor lecture notes with standardized published material. It would make learning the same material significantly less work. This will never happen though as the egos of faculty will not allow them to believe that they do an inferior job compared to notes put together by multiple educators and proof read for correctness. 🙄

 

[Wordead]

Say you took Step 1 originally in June at the end of M2, just before start of M3. You get the score back in July (after you've started clinical rotations), and you got a 205. Sucks for you, cause you wanna do Ortho. You complete the rotation you're currently on, then skip the next one that is short (like 6 weeks) to re-take Step I, and make it up at the end of M3. This would lead to the exact same timeline as those who deferred their first block of M3 so they could study more for Step 1 in the first place, which is already happening.

I will compromise and say that most people who re-take the exam would probably only put themselves through that kind of hell one additional time. If I got a 205 then a 210, I'd say screw it cause another 6 weeks is going to screw with my away rotations, plus I'm not going to do much better than a 210 anyways. But I think leaving people the option of re-taking it at least once isn't that crazy. 2 points make a line.

That seems sound, I suppose. I'm just loathe to change the system back to what I see as a MCAT-level arms race, where people with 34s are retaking it because they weren't happy. And you know that will definitely be the case - how many "Got a 240, want derm, should I retake" threads would pop up? I like the system as it is now - everyone is on the same footing, you get one do-or-die chance to shine. Once you change the timelines, the score has a lot less meaning - it's like an IMG that had a year to study. Sure, he/she got a 270. But is that really better than someone who had 5 weeks of dedicated study time and got even a 250? Not in my mind.

 

[evilbooyaa]

That seems sound, I suppose. I'm just loathe to change the system back to what I see as a MCAT-level arms race, where people with 34s are retaking it because they weren't happy. And you know that will definitely be the case - how many "Got a 240, want derm, should I retake" threads would pop up? I like the system as it is now - everyone is on the same footing, you get one do-or-die chance to shine. Once you change the timelines, the score has a lot less meaning - it's like an IMG that had a year to study. Sure, he/she got a 270. But is that really better than someone who had 5 weeks of dedicated study time and got even a 250? Not in my mind.

I see your point. However, I think PDs will take into account which attempt it is. Thing with the current system is that you can't tell how long people have studied for the exam. If someone told me I would have 3 weeks to study but if I got a 230 that would look as good as a 250, I'd take that wager in a heart beat.

Honestly, if people want to retake it with a 240 and think they're going to do substantially better, than good for them. I know I would be happy with a 240. Probably. What this will possibly do is inflate the average, thus rendering the whole exercise kind of moot. Especially if everyone gets over their first test jitters and actually does better the second time.

And yes, there would be a whole bunch of ******ed questions. (Un)Fortunately I don't frequent Pre-Allo, so I don't have to deal with that crap. For SDN, there would probably have to be a separate sub-forum for all the "OMG I have a 240 but I wanna get into MGH IM, should I retake?"

As for changing the timelines, we've already done that. Deferring the first block of M3 is changing the time line. It turns 5 weeks of dedicated study time into 11+ weeks. I personally would put a bullet through my head rather than study for 11 weeks hardcore for step 1, but it's still there.

Of course, this point is all moot for the next 10+ years, or until current SDN med students become program directors and/or have influence on the NBME. I'm sure the NBME wouldn't mind collecting more exorbitant test fees for people to voluntarily re-take the test.

 

[KnuxNole]

"While I agree that clinical training is gaining ground, preclinical knowledge is the foundation of everything. Entrusting it to thousands of college or, worse, Kaplan seems to be fairly risky."

Riskier than entrusting it to crusty old PhDs who lecture AT you on minutiae

"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."

In other words, replacing MCAT with Step1 selects for the type of person who will be motivated to stay up to date in medicine, has the willpower to self-organize and self-teach (aka not be "behind the times" 10 yrs out of residency)

"Caribbean students with comparable or higher Step 1 scores don't perform as well in the match as US MD students."
Correlation does not equal causation. Carribean students are the students who didn't get into American medical schools = a lower caliber of student on net.

"The flaw is the belief that Step 1 is the only purpose of the first 2 years when it's not."
Nobody claimed this. What they claimed was that the knowledge that is supposed to be gained from preclinical coursework can be gained without the song and dance of med-school-arranged learning/"clinical experiences"/etc.

"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."
Between FC, Kap, RX, Pathoma, Goljan, BRS, FA, etc etc you can learn and understand far more than you ever will from your disorganized preclinical teachers.

Heh, I can't finish this post because I'm being forced to engage in some lame in-class activity

Not every school has poorly disorganized lectures 😕

After all, the point of pre-clinicals are to teach you biochemistry, physiology, microbiology, path, pharm, etc. The point of pre-clinicals are NOT to only prep for Step 1. That's just an atherthought. So of course there will be a ton of material you'll never see on Step 1. And when you study for Step 1, there will be some topics you haven't covered in lecture, but can easily read up about it.

That's also why it's good to study alongside review books. If the lectures are vague, supplements are quite handy 😀