the state of step 1

[Med Ed]

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They don’t want their match rate to go down.

Meh, most of them would get mopped up in the SOAP and count as matched.

 

[Med Ed]

Yeah I can definitely see this as a downside that I hadn’t considered. I don’t have a solution, and there is no perfect solution available, as some population will be upset no matter what happens.

Indeed, this is a zero sum game. In the current system the anecdotes are students who are gunning for competitive fields but do badly on Step 2. They get hurt. But every time that happens an opportunity opens up for someone else.

When Step 1 was scored I had many students who would squeak past it and then blossom in the wards, often getting respectable Step 2 scores. In spite of this, many of them remained hamstrung by their Step 1 scores in terms of specialty choice or program. Those students now benefit from the current system.

 

[eyeeye_captain]

Indeed, this is a zero sum game. In the current system the anecdotes are students who are gunning for competitive fields but do badly on Step 2. They get hurt. But every time that happens an opportunity opens up for someone else.

When Step 1 was scored I had many students who would squeak past it and then blossom in the wards, often getting respectable Step 2 scores. In spite of this, many of them remained hamstrung by their Step 1 scores in terms of specialty choice or program. Those students now benefit from the current system.

You basically described my application back in the graded days. Good preclinical grades, then a hair to two hairs below average Step 1 for the really competitive stuff, nailed the wards, and got like a 270 Step 2 (taking it as early as I possibly could). I would’ve had a much easier go if it were P/F as I’m more clinically oriented. For people who are more preclinically oriented, having a graded Step 1 where you could crush it and put Step 2 off until after apps were in was a big advantage.

The opportunity for someone still comes from a pool that was already building an application for those specialties to some degree. It’s harder to suddenly get connections and LORs later in the game.

 

[Med Ed]

You basically described my application back in the graded days. Good preclinical grades, then a hair to two hairs below average Step 1 for the really competitive stuff, nailed the wards, and got like a 270 Step 2 (taking it as early as I possibly could). I would’ve had a much easier go if it were P/F as I’m more clinically oriented. For people who are more preclinically oriented, having a graded Step 1 where you could crush it and put Step 2 off until after apps were in was a big advantage.

The opportunity for someone still comes from a pool that was already building an application for those specialties to some degree. It’s harder to suddenly get connections and LORs later in the game.

True. The simple fact of the matter is there is no universally ideal time to schedule these exams. Perhaps medical school should be 5 years.

Back in my day M3 ended in July, and there were zero electives permitted before that time. If you wanted a specialty outside the core clerkships you had to hit the ground running the moment M4 started.

 

[ceo_of_stonks]

So the dean is incompetent and the student was a fool. That's hardly a systems-level issue.


That may be true at your institution. My own experience has been quite different.

I would love to hear your own experience then

 

[Lost in Translation]

You basically described my application back in the graded days. Good preclinical grades, then a hair to two hairs below average Step 1 for the really competitive stuff, nailed the wards, and got like a 270 Step 2 (taking it as early as I possibly could). I would’ve had a much easier go if it were P/F as I’m more clinically oriented. For people who are more preclinically oriented, having a graded Step 1 where you could crush it and put Step 2 off until after apps were in was a big advantage.

The opportunity for someone still comes from a pool that was already building an application for those specialties to some degree. It’s harder to suddenly get connections and LORs later in the game.

Crazy idea just crossed my mind: have the applicant decide which Step sequence of 1 or 2 they want to be graded P/F, and the other one is graded on the standard numerical scale. Those who are aiming for competitive specialties would benefit from a numerical Step 1 (and those programs would probably "screen" applicants that way), and those who choose to have Step 1 be P/F and Step 2 be numerical can have less stress during Step 1 studying. Nothing stops the latter group from applying to competitive specialties, just like nothing stops those programs from reviewing select applicants with a P/F Step 1 and graded Step 2.

This solution allows for the hyper-competitive to distinguish themselves on a[n irrelevant] test but also lets the not-as-good test takers avoid a less-than-stellar result that, while numerically passing, would diminish their chances of matching in even a "mid-tier" program in their desired field. Or of they're still aiming for a competitive specialty, they can hedge all their bets on a killer Step 2. Best of both worlds.

This is not a serious idea. Unless...

 

[Nontrad_FL_LGBT]

Crazy idea just crossed my mind: have the applicant decide which Step sequence of 1 or 2 they want to be graded P/F, and the other one is graded on the standard numerical scale. Those who are aiming for competitive specialties would benefit from a numerical Step 1 (and those programs would probably "screen" applicants that way), and those who choose to have Step 1 be P/F and Step 2 be numerical can have less stress during Step 1 studying. Nothing stops the latter group from applying to competitive specialties, just like nothing stops those programs from reviewing select applicants with a P/F Step 1 and graded Step 2.

This solution allows for the hyper-competitive to distinguish themselves on a[n irrelevant] test but also lets the not-as-good test takers avoid a less-than-stellar result that, while numerically passing, would diminish their chances of matching in even a "mid-tier" program in their desired field. Or of they're still aiming for a competitive specialty, they can hedge all their bets on a killer Step 2. Best of both worlds.

This is not a serious idea. Unless...

I feel like this wouldn't work simply because PDs wouldn't be able to decide on which one matters most and you'd be DOA at some top programs either way. But conceptually cool idea haha.

 

[ron_johnson]

P/F school grading + no AOA makes for a better educational experience in terms of collaborative classmates that know that the rising tide lifts all ships, but I think that P/F Step 1 makes for an incentive system that the average patient would find patently insane. I have classmates grinding meaningless research and EC's 25/30 days of the block and cramming for a quiz / test the other 5 days since Step is no longer graded and they are smart enough to get the ≥70 on the test. This seems very backwards for folks that want to become doctors and treat patients, at least to me.

Totally agree I think the research stuff is crazy. The meta now for matching competitive specialties is to do enough studying to pass comfortably and then grind as many research items as possible, which is totally backward since 99% of us are in school to become clinicians and not researchers. Ik people counter this by saying that a lot of the content on step1 is just garbage (muh acute angle vs 90 deg branching hyphae), but in that case the answer is to improve curricula or just remove the crap content and shorten the degree program, not add meaningless research. Like the fact that all these people are doing research years to match ortho or whatever is pretty rich considering the vast majority of them are going to be community surgeons some day. honestly seems exploitative given the opportunity cost of delaying attendinghood.