Step I Pass/Fail

[Iladelphia]

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'Momentous' USMLE Change: New Pass/Fail Format Stuns Medicine

Most agree the move will reduce the outsized role the test scores play in landing residencies, but many worry about how program directors will make the choice when they don't have an initial cutoff.

www.medscape.com

This is quite remarkable. This is going to have far reaching implications, especially for more competitive specialties like ophtho, rads, ent, neuro, derm, etc. I wonder how program directors will weigh this now vs. step 2 CK, which is going to keep its current score format. LOR are probably going to be huge now for ophtho residency applications. Same goes for reputation of medical school.

I'm well past this stage of my life but still would be interested in hearing people's thoughts, especially from any lurking program directors.....

 

[Openglobetrotters]

Medical students would probably take CK earlier.
PDs will have to look at other aspects of the application more closely and then use CK as a ranking tool is my guess.

I think it’s already hard for PDs with the amount of high quality applicants and average number of applications increasing each year (>60!). This will add more work initially.

 

[Rhexis]

This will hurt DO students in particular, and also those no from top-tier MD schools, as prestige of MD school will become a bigger factor in selection. I'm not a fan of the change. Even though Step 1 was one of the most stressful times of my life, it helped me go from a mid-tier medial school to a top-tier residency. I would have had no shot at had I not buckled down and crushed Step 1.

Step 2 CK will be more important obviously for selection. Trying to honor 3rd year rotations in your school will be even more of a bloodbath as that is one of the few objective measures to look at, although it varies widely from school to school. People are going to need more research to distinguish themselves as well, which is very stressful and frustrating for med students as often times you put in a ton of work and something doesn't end up getting published.

I'm glad these changes weren't made when I was in medical school. I would have been very opposed.

 

[Cawolf]

As an applicant who went through the match this year, I think it won't have that much of an impact. Ophthalmology was already very dependent on your school (top tier or good ophthalmology program), letters, and connections. Compared with other competitive specialities, I think once you cross the screening threshold there is minimal benefit to a higher Step 1 score. Therefore, I imagine the process will not change that much, other than more people entering the match without Step 1 as a bottle neck.

To address the post from @Rhexis, I agree that DO applicants and those without strong schools or programs will suffer (unfortunately) the most, but this bias was already very strong, even in the current model. I mostly met people from the same group of schools. If every interview averaged 20 people, I think 12 were from top schools/top ophtho program, 5 were home students or had done an away, and 3 were from other MD schools. There was an occasional IMG or DO. Just my observation from a single cycle as an applicant.

 

[Slide]

As an applicant who went through the match this year, I think it won't have that much of an impact. Ophthalmology was already very dependent on your school (top tier or good ophthalmology program), letters, and connections. Compared with other competitive specialities, I think once you cross the screening threshold there is minimal benefit to a higher Step 1 score. Therefore, I imagine the process will not change that much, other than more people entering the match without Step 1 as a bottle neck.

I would really have to disagree, strongly, with this statement. As an attending at an academic institution, I help screen applicants, and Step 1/2 scores were used heavily in determining who made the first pass. The understated value of Step 1 was that it also discouraged mediocre applicants from applying.

There's a good chance that a) Step 2 is the new Step 1, and now you're putting all your eggs in one basket, and b) there's going to be more shotgunning by applicants, and institution/region is going to play a much larger role. Step 1 was the great equalizer in determining an applicant's strength, and there is growing evidence that it does predict residency success (another reference) and written board pass rates (which is a big deal for residency programs). Yes, I do agree that after a certain percentile, the benefit is not as much, but it serves as a great way to cull already a growing applicant pool with similar accomplishments.