Step 1 vs Step 2

[Umyo]

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I know Step 1 is very heavily looked at when matching, but why is it so much more important to do better on Step 1 than any other Steps?

Why is Step 1 looked at more heavily than the rest?

 

[rodmichael82]

I know Step 1 is very heavily looked at when matching, but why is it so much more important to do better on Step 1 than any other Steps?

Why is Step 1 looked at more heavily than the rest?

That's not necessarily always true. Even though Step 1 is thought of being the heaviest there are different and changing attitudes by some program directors. We had a couple program directors from decent Radiology program and Rad-Onc program come in and say that they consider Step 2 to be more important because it's more clinically based compared to step 1 which is more based on details and minutia. It's really a subjective thing. I think it's best to just do well in all the steps and put in maximum effort in all of them instead of thinking that one is more important than the other.

Another reason why Step 1 might be considered more important is because when students apply to residency not all of them have taken Step 2 yet. So it's hard to gauge on a standardized exam that has not been universally taken by all students.

 

[JJMrK]

Another reason why Step 1 might be considered more important is because when students apply to residency not all of them have taken Step 2 yet. So it's hard to gauge on a standardized exam that has not been universally taken by all students.

This. Also, it takes a lot more work to get a high score on step 1 than it does for step 2. Likely this is because everybody takes step 1 at the same time, has 6 or 8 weeks off to study, and wants to do well. In other words, the scale is less forgiving because you're essentially competing against every highly motivated student in the country. The scale is much friendlier for step 2, and its probably because many people (including those applying for some of the most competitive specialties and those who got good scores on step 1 and don't feel the need to prove themselves again) take the test late and don't study much.

Having said that, IMO there is reason to believe that step 2 is going to become more important. More and more programs in specialties that have historically not cared about step 2 are starting to require it before ranking candidates (or in some cases even before offering interviews). Eventually I think this will translate into people taking the test earlier and studying longer, and I think we'll see more people with good step 1 scores putting more work into step 2.

Bottom line, IMO: Historically step 1 was a better equalizer because everyone took it under the same relative conditions. It's now seemingly becoming more important, and I think in the short-term this will result in a bunch of really high step 2 scores. Eventually, though, I bet the average will drift down to around the step 1 average as most people start to take this during the beginning of 4th year: "playing field" evens out and the scale is adjusted appropriately.

 

[swamprat]

Also I don't know if this was said but Step 2 is so much easier than Step 1. Its basically a long shelf exam with easier questions. Step 1 was much more difficult and even though it is an hour shorter it felt longer because each question required the highest level of concentration because basic science is so much more abstract. From what I have heard from PDs and being around the past several years playing the game, step 1 is still most important and step 2 is now more essential to have in by the time programs rank their lists rather than give out interviews etc. So obviously waiting on step 2 and doing poorly on it later on may not bode well for you come list ranking time.

 

[Umyo]

Thanks for the responses and clearing everything up!

 

[Gut Shot]

I know Step 1 is very heavily looked at when matching, but why is it so much more important to do better on Step 1 than any other Steps?

Why is Step 1 looked at more heavily than the rest?

1. Everyone takes Step 1 before applying to residency. Historically the timing of Step 2 has been more variable.

2. Theoretically, students taking Step 1 at different institutions have a fairly standardized experience. In general they have all completed a preclinical curriculum and had some time to prepare for the exam. When a PD looks at a 220 from School X and a 240 from School Y it is therefore easy for him/her to ascribe the 20 point gap to the students rather than anything else.

Also I don't know if this was said but Step 2 is so much easier than Step 1. Its basically a long shelf exam with easier questions.

The failure rates for both exams are essentially the same, so caveat emptor.

 

[thefritz]

I know Step 1 is very heavily looked at when matching, but why is it so much more important to do better on Step 1 than any other Steps?

Why is Step 1 looked at more heavily than the rest?

Plenty of clerkship directors place more importance on step 2 than step 1 and don't like to see applicants without step 2 scores. There is no set formula for matching into residency. What certain programs will look for in applicants varies drastically. Med students get obsessed with step 1 because it's the only objective way they have of comparing themselves
with other applicants. A 230 is better than a 200. You don't need to be a oracle to figure out that it makes you more competitive. Your letters of reference, research publications, life story, personal interests, interviewing/interpersonal skills, appearance, personal statement, etc. -- Well, it's impossible to anticipate how these things will be viewed and play into your application because they are so much more subjective and while one program may absolutely hate you and never want you back in their building, another may think you're the coolest guy on earth and want to show you off as part of their program. So that means we all focus on step 1, step 1, step 1. Because the other stuff is too inconvenient to think about because it's largely out of our control. And that's what matching is all about -- things that are largely out of our control.

 

[thefritz]

Also I don't know if this was said but Step 2 is so much easier than Step 1. Its basically a long shelf exam with easier questions. Step 1 was much more difficult and even though it is an hour shorter it felt longer because each question required the highest level of concentration because basic science is so much more abstract. From what I have heard from PDs and being around the past several years playing the game, step 1 is still most important and step 2 is now more essential to have in by the time programs rank their lists rather than give out interviews etc. So obviously waiting on step 2 and doing poorly on it later on may not bode well for you come list ranking time.

I disagree. I found step 2 harder and requiring more prep. You can do well on step 1 by only reading first aid. People think step 2 is easier because it's typically taken following third year shelf exams. Well how many books did you use to prepare for all those exams? If you only used first aid to prep for step 2 after a few years for those shelf exams to become distant memory, you'd be lucky to pass. If you took step 1 years after your preclinical education and just used first aid to study, I'd wager you'd still do pretty well.

Step 1 is a memorization exam. Very little critical thinking involved. You can cram the content and buzzwords and do well.
Step 2 is a 'can you recognize the problem and figure out what to do about it exam' To do well, you need extensive experience and exposure to the material. It would be impossible to memorize every possible scenario. With enough practice cases, you can reason your way through it, but this takes more time for critical thinking -- this exam is a lot tougher timewise. This is the reason people can take step 2 fresh off the wards with 1 week of prep and do well -- they've been bathed in medicine and studying hard for a full year beforehand. If you slack third year, you'll need a lot more prep time than you needed for step 1 to do well.

Word of warning for everyone that thinks step 2 is easy. It's easy if you know your ****. If you've been checked out, don't think you can pick up first aid and cram it in a few weeks.

 

[thefritz]

Eventually I think this will translate into people taking the test earlier and studying longer, and I think we'll see more people with good step 1 scores putting more work into step 2.

Bottom line, IMO: Historically step 1 was a better equalizer because everyone took it under the same relative conditions. It's now seemingly becoming more important, and I think in the short-term this will result in a bunch of really high step 2 scores. Eventually, though, I bet the average will drift down to around the step 1 average as most people start to take this during the beginning of 4th year: "playing field" evens out and the scale is adjusted appropriately.

By the time of residency interview, step 1 is an old achievement for most applicants. Timewise, it's the same as using your PSAT score for justification for admission to college. Sweet, you were an awesome 10th grader, but how do we know your ability now? Where's that recent SAT score? Have you started smoking pot and skipping class like most of your fellow seniors? The step 1 gives residencies a picture of what you were doing 2 years ago. OF COURSE they are going to be interested in knowing how you've been doing recently. Programs are scared of getting another <insert bad resident name here>, which every program has had and still talks about who had a killer step 1 but had no social skills and a bedside manner that embarrassed the department.

Also, everyone is blowing step 1 out of the water these days. 240 used to be an astronomical score 20 years ago. Now it's the average at some schools. There's not really much difference between an applicant with a 245 and a 255. That comes down to a handful of questions right or wrong. I seriously doubt that programs are going to take the 255 guy over the 245 guy because those extra points are going to make him a better resident. Past a certain score, other stuff is going to be the deciding criteria.

Watch step 2 become the new step 1 over the next decade or so. Anybody with half a brain can figure out that showing up with a 245 step 1, a pass on CS, and a 260 step 2 is far better than showing up with a 255 step 1. The first guy has everything in the bag and has perfectly wrapped his medical school career up into a neat little package to be presented to the programs, whereas the second guy has some explaining to do about what he's been doing for the nearly 2 YEARS since he took step 1.

 

[Wordead]

By the time of residency interview, step 1 is an old achievement for most applicants. Timewise, it's the same as using your PSAT score for justification for admission to college. Sweet, you were an awesome 10th grader, but how do we know your ability now? Where's that recent SAT score? Have you started smoking pot and skipping class like most of your fellow seniors? The step 1 gives residencies a picture of what you were doing 2 years ago. OF COURSE they are going to be interested in knowing how you've been doing recently. Programs are scared of getting another <insert bad resident name here>, which every program has had and still talks about who had a killer step 1 but had no social skills and a bedside manner that embarrassed the department.

Also, everyone is blowing step 1 out of the water these days. 240 used to be an astronomical score 20 years ago. Now it's the average at some schools. There's not really much difference between an applicant with a 245 and a 255. That comes down to a handful of questions right or wrong. I seriously doubt that programs are going to take the 255 guy over the 245 guy because those extra points are going to make him a better resident. Past a certain score, other stuff is going to be the deciding criteria.

Watch step 2 become the new step 1 over the next decade or so. Anybody with half a brain can figure out that showing up with a 245 step 1, a pass on CS, and a 260 step 2 is far better than showing up with a 255 step 1. The first guy has everything in the bag and has perfectly wrapped his medical school career up into a neat little package to be presented to the programs, whereas the second guy has some explaining to do about what he's been doing for the nearly 2 YEARS since he took step 1.

Umm, clinical evals?

Also, step 2 covers so many difference subjects - which are not relevant to a lot of residencies. What would be the point of testing whether a surgical candidate knows peds outpatient management of whatever?

I'm not saying that step 2 isn't important - I think everyone should show competence in their rotations for the year - but I think you're overestimating the importance of step 2 to a program director, as it doesn't tell you anything about whether or not someone is going to be a good resident. Not that step 1 does, but step 1 does tell you where the student stands in relation to all other students nationally.

 

[calvnandhobbs68]

By the time of residency interview, step 1 is an old achievement for most applicants. Timewise, it's the same as using your PSAT score for justification for admission to college. Sweet, you were an awesome 10th grader, but how do we know your ability now? Where's that recent SAT score? Have you started smoking pot and skipping class like most of your fellow seniors? The step 1 gives residencies a picture of what you were doing 2 years ago. OF COURSE they are going to be interested in knowing how you've been doing recently. Programs are scared of getting another <insert bad resident name here>, which every program has had and still talks about who had a killer step 1 but had no social skills and a bedside manner that embarrassed the department.

Also, everyone is blowing step 1 out of the water these days. 240 used to be an astronomical score 20 years ago. Now it's the average at some schools. There's not really much difference between an applicant with a 245 and a 255. That comes down to a handful of questions right or wrong. I seriously doubt that programs are going to take the 255 guy over the 245 guy because those extra points are going to make him a better resident. Past a certain score, other stuff is going to be the deciding criteria.

Watch step 2 become the new step 1 over the next decade or so. Anybody with half a brain can figure out that showing up with a 245 step 1, a pass on CS, and a 260 step 2 is far better than showing up with a 255 step 1. The first guy has everything in the bag and has perfectly wrapped his medical school career up into a neat little package to be presented to the programs, whereas the second guy has some explaining to do about what he's been doing for the nearly 2 YEARS since he took step 1.

Your first paragraph makes no sense because you're somehow saying that one multiple choice test over another can be used to pick good residents who don't have "beside manner that embarrasses the department". If you're talking about Step 2CS, that's such a load of crap I'd have to wonder if you even know what goes on with that test (essentially a super secret random grading system that heavily depends on whether your SPs happened to like you that day or not and a score report that doesn't even tell you what you got wrong if you fail).

Your second paragraph makes no sense as the average step 2 score is typically HIGHER than the average step 1 score.

I don't even know what you mean by the last paragraph. Will this second guy not have rotation grades? Will he not be doing a Sub-I and/or away rotations? Will he not have recommendation letters? Will he not have some paper with his name on it or abstract presentations? Don't really get how he has any explaining to do just because he hasn't taken Step 2 yet.

 

[tco]

By the time of residency interview, step 1 is an old achievement for most applicants. Timewise, it's the same as using your PSAT score for justification for admission to college. Sweet, you were an awesome 10th grader, but how do we know your ability now? Where's that recent SAT score? Have you started smoking pot and skipping class like most of your fellow seniors? The step 1 gives residencies a picture of what you were doing 2 years ago. OF COURSE they are going to be interested in knowing how you've been doing recently. Programs are scared of getting another <insert bad resident name here>, which every program has had and still talks about who had a killer step 1 but had no social skills and a bedside manner that embarrassed the department.

Also, everyone is blowing step 1 out of the water these days. 240 used to be an astronomical score 20 years ago. Now it's the average at some schools. There's not really much difference between an applicant with a 245 and a 255. That comes down to a handful of questions right or wrong. I seriously doubt that programs are going to take the 255 guy over the 245 guy because those extra points are going to make him a better resident. Past a certain score, other stuff is going to be the deciding criteria.

Watch step 2 become the new step 1 over the next decade or so. Anybody with half a brain can figure out that showing up with a 245 step 1, a pass on CS, and a 260 step 2 is far better than showing up with a 255 step 1. The first guy has everything in the bag and has perfectly wrapped his medical school career up into a neat little package to be presented to the programs, whereas the second guy has some explaining to do about what he's been doing for the nearly 2 YEARS since he took step 1.

It's pretty easy for me to explain why I scored a 255 and it's been three (OMG?!?!) years since I took step 1.

1. I did an additional academic year to explore research and to gain additional knowledge about medicine.
2. I've done rotations pertinent to my future career to ensure that I want to be involved in that field for the rest of my life.
3. I needed to do my Sub-I before a certain date.
4. By interviews, I will have taken the exams, and "I'll release them to you as soon as I get them back."

If they don't like that, I don't know what to tell them. Don't take me, I guess. I'll manage to become a radiologist somewhere else.

PS - The national average for step 1 is nowhere near 240. Who cares what it is at "some schools?"...Also, the difference in score between a 245 and a 255 is greater than you suggest. You're just making stuff up, my friend.

 

[Trastuz]

It's pretty easy for me to explain why I scored a 255 and it's been three (OMG?!?!) years since I took step 1.

1. I did an additional academic year to explore research and to gain additional knowledge about medicine.
2. I've done rotations pertinent to my future career to ensure that I want to be involved in that field for the rest of my life.
3. I needed to do my Sub-I before a certain date.
4. By interviews, I will have taken the exams, and "I'll release them to you as soon as I get them back."

If they don't like that, I don't know what to tell them. Don't take me, I guess. I'll manage to become a radiologist somewhere else.

PS - The national average for step 1 is nowhere near 240. Who cares what it is at "some schools?"...Also, the difference in score between a 245 and a 255 is greater than you suggest. You're just making stuff up, my friend.

I interviewed at about 20 categorical positions and 5 TYs with an average of 4-5 individual interviews at each program. I got asked about my lack of step 2 one time. I responded the same way you suggested and my interviewer said "great" and we moved on. After the match I received a survey from that program that basically said "you would have matched here had you ranked us higher, please give us feedback on what we can do better."

I mention that only to illustrate the point that in radiology at least, if you're step 1 is ok, no one cares about step 2. My friends that matched in derm, rad onc, ophtho, ENT have said the same thing.

I think it DOES matter quite a bit in the less competitive specialties, and is probably becoming more important in the more standard specialties like IM, EM, etc., although I can't speak firsthand to this since I don't have experience there.

 

[dr zaius]

I don't think you can do well on step I with only first aid.

 

[Siverhideo1985]

Your score on Step 1 is predictive of your ability to pass the boards in your respective specialty.

 

[JJMrK]

By the time of residency interview, step 1 is an old achievement for most applicants. Timewise, it's the same as using your PSAT score for justification for admission to college. Sweet, you were an awesome 10th grader, but how do we know your ability now? Where's that recent SAT score? Have you started smoking pot and skipping class like most of your fellow seniors? The step 1 gives residencies a picture of what you were doing 2 years ago. OF COURSE they are going to be interested in knowing how you've been doing recently. Programs are scared of getting another <insert bad resident name here>, which every program has had and still talks about who had a killer step 1 but had no social skills and a bedside manner that embarrassed the department.

Also, everyone is blowing step 1 out of the water these days. 240 used to be an astronomical score 20 years ago. Now it's the average at some schools. There's not really much difference between an applicant with a 245 and a 255. That comes down to a handful of questions right or wrong. I seriously doubt that programs are going to take the 255 guy over the 245 guy because those extra points are going to make him a better resident. Past a certain score, other stuff is going to be the deciding criteria.

Watch step 2 become the new step 1 over the next decade or so. Anybody with half a brain can figure out that showing up with a 245 step 1, a pass on CS, and a 260 step 2 is far better than showing up with a 255 step 1. The first guy has everything in the bag and has perfectly wrapped his medical school career up into a neat little package to be presented to the programs, whereas the second guy has some explaining to do about what he's been doing for the nearly 2 YEARS since he took step 1.

I'm trying (and failing) to figure out why you quoted my post. I agree with some of your points and disagree with others, but nothing you write seems to be directly related to what I wrote. I will say this: Step 1 gives programs an idea of what an applicant can do in a pure academic sense (i.e. sit down, shut up, study for 6 weeks and test your mettle against every student in the country). IMO that's a pretty valuable metric, and step 2 just can't give the same kind of information as historically it's been taken under very different conditions at different times of the year by different applicants. The curve is also much more generous, which is IMO at least partly due to high step 1 scorers taking it toward the end of the year and slacking off a bit. As far as judging an applicant's time since step 1, I'd argue that there are much better ways to do that (LOR, clinical grades, AOA, etc) than CK.

Having said all of this, I do think it's reasonable to take step 2 early, even if you have a good step one score, but... I don't really agree with either of these thoughts:

There's not really much difference between an applicant with a 245 and a 255. That comes down to a handful of questions right or wrong. I seriously doubt that programs are going to take the 255 guy over the 245 guy because those extra points are going to make him a better resident. Past a certain score, other stuff is going to be the deciding criteria.

For competitive specialties, a 245 may be below or right at the average for all applicants, while adding 10 points to that score is a pretty big boost.

Anybody with half a brain can figure out that showing up with a 245 step 1, a pass on CS, and a 260 step 2 is far better than showing up with a 255 step 1.

This is likely true for some specialties that put a ton of weight on CK and have low to average step 1 scores (EM, family, etc). Probably not true for others.

 

[Instatewaiter]

Radiology program and Rad-Onc program come in and say that they consider Step 2 to be more important because it's more clinically based compared to step 1 which is more based on details and minutia.

Why would radiology and rad-onc programs care about a clinical exam. That's like the pathologist being most concerned with your OSCE exams.

 

[David Hasselhof]

We had a couple program directors from decent Radiology program and Rad-Onc program come in and say that they consider Step 2 to be more important because it's more clinically based compared to step 1 which is more based on details and minutia.

I can assure you that the vast majority of radiology programs consider Step 1 to be much more important than Step 2. "Clinically based" or based on "details and minutia" - which one do you think would be more relevant to radiology?

The proof is in the charting outcomes, many applicants don't even report their Step 2 until well after interviews are complete.

 

[rocketbooster]

I'm currently applying to ophtho. Ophtho is an early match. Absolutely no one cares about Step 2. Literally no one. I have done a few away rotations, met many other med students from other schools applying to ophtho, and none of them took Step 2 in time for it to be included on their application. For ophtho, Step 2 is meaningless. The end.

 

[WaylonS]

I've had three derm program directors, independently of each other, tell me the same thing: there's no good Step 2 score

 

[link2swim06]

I think it is safe to say step 2's importance is 110% specialty dependent.

 

[Trogghunter]

Just rock both

 

[failedatlife]

1. Everyone takes Step 1 before applying to residency. Historically the timing of Step 2 has been more variable.

2. Theoretically, students taking Step 1 at different institutions have a fairly standardized experience. In general they have all completed a preclinical curriculum and had some time to prepare for the exam. When a PD looks at a 220 from School X and a 240 from School Y it is therefore easy for him/her to ascribe the 20 point gap to the students rather than anything else.

But really what does that 20 point gap even mean? Oh Dude is 20x smarter than me because he did 20 points higher. The freaking test has a SE of like 10 points. Give me a break

 

[failedatlife]

Your score on Step 1 is predictive of your ability to pass the boards in your respective specialty.

Yes, I heard that only kids with 250 and above actually pass the sub-surgical board exams. Lower than that fail. That's why only half the kids in residency go on to practice. No, not really...

 

[FindMeOnTheLinks]

Yes, I heard that only kids with 250 and above actually pass the sub-surgical board exams. Lower than that fail. That's why only half the kids in residency go on to practice. No, not really...

Gosh you're insufferable


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[Anicetus]

Yes, I heard that only kids with 250 and above actually pass the sub-surgical board exams. Lower than that fail. That's why only half the kids in residency go on to practice. No, not really...

Libraryismyhome is that you????