Taking step 3...day after graduation (??)

[JamesPhilly]

Hi everyone

Straight away, I will give you my bias against the standardized exams we take as medical students/pre-meds:

(1) There has been no correlation with standardized scores (including licensing exams) and pt outcomes. Yes, a person with a higher score has a better chance of matching in whatever field, and will likely do better on other tests in the future, but there is no evidence to suggest that a person with 250s in the USMLE or 800s in the comlex is a better physician than someone who barely passed. I read an article which showed the MCAT is correlated with IQ scores, but again, it correlates to USMLE scores, and hence, nothing of consequence.

(2) In particular, I hate the way COMLEX questions are asked. Anyone who's taken both exams knows exactly what I mean. You either know the answer or you don't, and I like that in the USMLE you could at least narrow things down or even figure out the answer even if you hadn't memorized one particular factoid.

So, with these premises in mind, it is my view that medical licensing exams are purely legal obstacles to be overcome and are NOT effective means to augment or enrich one's educational experience.

It follows then that if I would like to apply one of life's great axioms "don't put off for tomorrow what you can get done today", it would be best to get step 3 (comlex in my case) out of the way as quickly as possible.

I am in my 4th year at an osteopathic medical school. If I understand the COMLEX step 3 requirements, I can take the exam the day after i graduate. As fate would happen, i could book it for that date. (EDIT= intern friends have told me the date is open, i have not tried to register for the test)

The residency program I intend to go to says they will reimburse me IF I pass, which seems fair enough. The PD was slightly surprised and said that she'd never had that request before, but she understands my want to just get it over with. Also, I'm going into psychiatry and there was an unspoken understanding that my general medical knowledge would decline.

My question: Are there any good reasons to delay the test until intern year?

Also, keep in mind that I am a 4th year, and apart for my sub-internship exam and a shelf in neurology, i really don't have anything else to study for.

For the benefit of our US MD brethren, any comments about the Step 3 USMLE are welcome.

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[OveractiveBrain]

Hi everyone

Straight away, I will give you my bias against the standardized exams we take as medical students/pre-meds:

(1) There has been no correlation with standardized scores (including licensing exams) and pt outcomes. Yes, a person with a higher score has a better chance of matching in whatever field, and will likely do better on other tests in the future, but there is no evidence to suggest that a person with 250s in the USMLE or 800s in the comlex is a better physician than someone who barely passed. I read an article which showed the MCAT is correlated with IQ scores, but again, it correlates to USMLE scores, and hence, nothing of consequence.

(2) In particular, I hate the way COMLEX questions are asked. Anyone who's taken both exams knows exactly what I mean. You either know the answer or you don't, and I like that in the USMLE you could at least narrow things down or even figure out the answer even if you hadn't memorized one particular factoid.

So, with these premises in mind, it is my view that medical licensing exams are purely legal obstacles to be overcome and are NOT effective means to augment or enrich one's educational experience.

It follows then that if I would like to apply one of life's great axioms "don't put off for tomorrow what you can get done today", it would be best to get step 3 (comlex in my case) out of the way as quickly as possible.

I am in my 4th year at an osteopathic medical school. If I understand the COMLEX step 3 requirements, I can take the exam the day after i graduate. As fate would happen, i could book it for that date. (EDIT= intern friends have told me the date is open, i have not tried to register for the test)

The residency program I intend to go to says they will reimburse me IF I pass, which seems fair enough. The PD was slightly surprised and said that she'd never had that request before, but she understands my want to just get it over with. Also, I'm going into psychiatry and there was an unspoken understanding that my general medical knowledge would decline.

My question: Are there any good reasons to delay the test until intern year?

Also, keep in mind that I am a 4th year, and apart for my sub-internship exam and a shelf in neurology, i really don't have anything else to study for.

For the benefit of our US MD brethren, any comments about the Step 3 USMLE are welcome.

I took step 3 in august of intern year. I.e. the beginning. Before I had any ward time. I studied for two weeks, did half a qbank, and ended up with a 230. I had 252 on step 2 and 248 on Step 1 (which i studied long and hard for).

Personally, the longer you wait the farther out you are from every other speciality you aren't doing. For me, that was peds and ob. I did fine on medicine and surgery (since the surgery on standardized testing is medicine anyway).

If you have done well on Steps so far, in particular Step 2, and can dedicate a small amount of time to start thinking clinically and critically, a little deeper than you have been, and all you want is a pass, do it as soon as you can. If you don't fit ALL those criteria, I would not take this advice and take it later, when you can dominate your subject and read about one's other than yours.

That being said, the Qbanks are weaker, the books are poor, and the only thing I recommend you must absolutely do is the CSS cases on Uworld (see the thread just below you for why).

 

[JamesPhilly]

I took step 3 in august of intern year. I.e. the beginning...If you have done well on Steps so far, in particular Step 2, and can dedicate a small amount of time to start thinking clinically and critically, a little deeper than you have been, and all you want is a pass, do it as soon as you can. If you don't fit ALL those criteria, I would not take this advice and take it later, when you can dominate your subject and read about one's other than yours.

All my comlex/usmle results are 50-60ith percentile, so by SDN standards I'm pitiful, but I think I meet your requirements of having 'done well'. Congrats on your step scores BTW, they are outstanding!

It helps that not all psych fellowships fill, so i really don't care what score i get. I am just looking to pass as you say.

Thank you for the words of wisdom, any more thoughts (especially pertaining to the comlex) would be very much appreciated

 

[NewYorkDoctors]

(Preface: no malice, sarcasm, dry wit, or anything antagonistic in my voice)

I think there is a great deal of difference between someone who faile the USMLE and someone who scored in the 250 260 +

The test itself may not directly enrich the knowlege base of the test taker, but someone who failed probably does not understand key concepts or is unable to grasp basic tenets of patient care. (e.g. the person who is not aware of the fact that chronic COPD patients lose their hypercarbic drive and have to rely on the hypoxic drive to keep breathing... i've seen doctors oxygenate chronic COPDer's to 100% and still wonder why the patient is getting worse...)

The high score differential merely implies that the better test taker actually put real effort into being a good doctor.

Now 220s vs 250s becomes moer about how much First Aid one bothered to memorize. I'm sure plenty of average test takers become great doctors in their fields.


Anyway just my two cents

I am also interested in the Step 3 after graduation bit as I would like to be as stress free (yeah right I know) as possible in intern year

I have to essentially apply for it the day after graduation and then hope I can get a testing slot in those 1-2 months between graduation and start of intern year right?

 

[JamesPhilly]

(Like you, there's no antagonism of any sort in my post.)

The high score differential merely implies that the better test taker actually put real effort into being a good doctor.

I'm curious, why you put so much stock into step scores? If it followed that a better step score equals becoming a better clinician, then yes, a higher score would mean that the candidate "put real effort into being a good doctor." But clearly the literature doesn't support this view. Approach this like any other aspect of medicine: in terms of actual pt outcomes, these test don't mean jack.

I'm sure plenty of average test takers become great doctors in their fields.

Let's hope so, as I think us average/below average test takers represent approximately 50% of graduates! 🙂

 

[NewYorkDoctors]

(Like you, there's no antagonism of any sort in my post.)



I'm curious, why you put so much stock into step scores? If it followed that a better step score equals becoming a better clinician, then yes, a higher score would mean that the candidate "put real effort into being a good doctor." But clearly the literature doesn't support this view. Approach this like any other aspect of medicine: in terms of actual pt outcomes, these test don't mean jack.




Let's hope so, as I think us average/below average test takers represent approximately 50% of graduates! 🙂

Note how I mentioned Failed Step 1 vs top score.

If you took those two into clinical rotations, I am sure one would perform better than the other. (not that the one who failed is going to lament the day he/she could not remember the splice site change for beta thalassemia)

It's more of a reflection of the degree of hard work (as reflected by how willing one was to memorize First Aid and do Qbanks nonstop) and how that can translate.

Now are there exceptions? Definitely

Is my observation stone cold evidence? No it is anecdotal.


And I definitely agree that test scores are not everything.

yet they are something more than nothing.



and back to the final point of patient outcomes: from an anecdotal standpoint, I am inclined to agree because patietn care is so multifactorial anyway. No one cluelses medical student / intern has any final say. Along the way, they learn and get better. Plus if something bizarre happens, call a consult! Patient saved (hopefully)


I was merely referencing the capabilities of the test takers being reflected by the test.

 

[JamesPhilly]

It's more of a reflection of the degree of hard work (as reflected by how willing one was to memorize First Aid and do Qbanks nonstop)

I agree to an extent, but I think it's more complicated. It's also a reflection of how much money you spend. Kaplan, boards boot camp...if you have the money to spend thousands of dollars on prep courses, and you can follow a routine, you can be guaranteed a good score. While that does require hard work, it is a corrupt system that again does not make a difference to pts

And if we know that (empirically speaking), step scores are not tied to outcomes, then a high step score can only be viewed as a commitment on the candidate's part to their own self interests. A candidate who's trying hard to be a "good doctor" as you said in your last post would concentrate on the material itself and may do poorly without doing things like qbanks. It's of course smart and expected for people to act in their self interests, but I think it's an important distinction to make, lest we continue to believe that step scores matter

The discussion on how to sort though the thousands of applicants that PDs receive is an interesting one, and while I am highly critical of step scores, I can offer no alternative that is as easily applicable as a single number. From what I've seen in the literature, only clinical grades are correlated with pt outcomes, and that itself seems very flawed (anyone ever had a stingy attending?)

And hey, if anyone can comment on their experience taking the COMLEX step 3 early, as in before or during the first month of residency, I would appreciate it!

 

[JamesPhilly]

Just wanted to update everyone: I took COMLEX step 3 about 2 weeks after I graduated medical school and 2 days before residency started, and I passed. It's just like step 2, so study accordingly and you'll be fine.

It is such a relief that I can now focus on psychiatry which is fantastic! Good luck