USMLE 6 Attempt for exams ----- Unfair Policy change by the NBME/USMLE folks

[KnuxNole]

The working language of a country need not be legislated or recognized by law for people to understand that it is only right for them to master the language before coming. Instead of, say, showing up at medical facilities and requiring said facilities to have interpreters handy.

Get used to it. Especially in big cities, where there will be Spanish only speakers that don't speak one word of English that you either

A) need to find a translator phone stat
B) find a nurse/physician to help translate
C) learn Spanish

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[circulus vitios]

Get used to it. Especially in big cities, where there will be Spanish only speakers that don't speak one word of English that you either

A) need to find a translator phone stat
B) find a nurse/physician to help translate
C) learn Spanish

D) do nothing because it's not my problem

 

[Priapism4tooLong]

It was like a bad trip. It took me two blocks to get into the flow, and I felt like I was guessing on a good portion of the exam. I came out of the exam room a broken man; I feel like I passed, but I'm just hoping I break the average. But people have time and time again that everyone feels like **** after Step 1 and to trust their most recent NBME scores, so I'm hoping that rings true for me.

when i left, i had no idea how it went.. i was confused.. So i ultimately felt like i did bad but i did pretty well. =).. I'm sure you did well. Don't think about it now.

 

[Dave89]

It was like a bad trip. It took me two blocks to get into the flow, and I felt like I was guessing on a good portion of the exam. I came out of the exam room a broken man; I feel like I passed, but I'm just hoping I break the average. But people have time and time again that everyone feels like **** after Step 1 and to trust their most recent NBME scores, so I'm hoping that rings true for me.

Why are you on SDN?

You should be out doing mindless things and emptying your brain.

 

[evilbooyaa]

Lmao, what a troll thread. I'm ok with a 3-strikes policy that US MD schools institute for anyone who is going to graduate. 6 attempts per Step exam is outrageous

Why are you on SDN?

You should be out doing mindless things and emptying your brain.

I would argue that SDN is a great place to 1) do mindless things and 2) empty your brain. All he has to do is waltz over into pre-allo for an hour and his brain will be completely empty.
.

 

[Dave89]

Get used to it. Especially in big cities, where there will be Spanish only speakers that don't speak one word of English that you either

A) need to find a translator phone stat
B) find a nurse/physician to help translate
C) learn Spanish

Fortunately, I have no intention of practicing in a big city.

It's not going to be entirely up to me, of course.

 

[Psai]

I don't know where you live but a primary care doc could totally get by in Orlando without speaking english

Cool story bro. So I guess they're going to turn away all the English speaking patients, like everyone else who lives in America?

 

[colbgw02]

I can see how someone could easily fail a step exam due to poor proficiency in English, but that person also needs to have the insight and understanding of their weakness. If they continue to take and fail the exam without improving their English sufficiently, I see that as a surrogate measure of intelligence. So, in a roundabout way, I see their failure to progress as justified. Alcoves of cities where English can be totally avoided notwithstanding, it really is the onus of the candidate to learn English. The people who can practice medicine in the U.S. without English are sufficiently rare that it's unreasonable and impractical to expect the NBME and its DO equivalent to develop parallel tests in other languages. Also, let's remember that speaking English isn't just about the patients. It's about communicating with other healthcare providers, too.

 

[CherryRedDracul]

Why are you on SDN?

You should be out doing mindless things and emptying your brain.

Wish I had the time to do mindless things. I have two free days till I have to head to head to orientation for clerkships, and I officially start on Monday. Doing mindless things was what I had planned for this weekend (EDC NYC) but I had to push my exam back to that weekend. At least I made a $20 profit off selling the tickets, my minor consolation prize.

I'm doing a little housekeeping right now and carbing up before I head out to play 5+ hours of soccer this afternoon. It's gonna be awesome being sore from head-to-toe tomorrow.

 

[KnuxNole]

D) do nothing because it's not my problem

As long as you are in a suburb/rural place with English only peeps! If you are in a more bigger city, you'll be the one assigned to take care of them, and some may shout "NO ENGLISH NO ENGLISH" when you walk in the room.

Which, if you think about it, isn't rare. If you live in NYC, Chicago, LA for example, it's highly prevalent. Hell in Miami, people greet you in Spanish as the default.

 

[username456789]

As long as you are in a suburb/rural place with English only peeps! If you are in a more bigger city, you'll be the one assigned to take care of them, and some may shout "NO ENGLISH NO ENGLISH" when you walk in the room.

Easy. Just yell "NO ESPAÑOL NO ESPAÑOL" and turn around and walk out.

 

[Prodromo]

D) do nothing because it's not my problem

Just have to say that this is a horrible attitude to have as a physician. We are here for our patients. It isn't unreasonable to make a little bit of an extra effort if there are language incompatibilities.

 

[KnuxNole]

Easy. Just yell "NO ESPAÑOL NO ESPAÑOL" and turn around and walk out.

Haha, while they would be snarky, I can easily see people getting written up for that from nursing staff that the doctor isn't capable of caring for patient needs.

 

[Dave89]

Hell in Miami, people greet you in Spanish as the default.

I did not know that it was this bad in parts of the country. And it's only going to get worse.

Yay, wide open immigration policies/lack of law enforcement!

 

[deleted480308]

As long as you are in a suburb/rural place with English only peeps! If you are in a more bigger city, you'll be the one assigned to take care of them, and some may shout "NO ENGLISH NO ENGLISH" when you walk in the room.

Which, if you think about it, isn't rare. If you live in NYC, Chicago, LA for example, it's highly prevalent. Hell in Miami, people greet you in Spanish as the default.

At the clinic I volunteer with, 20% speak no English. Mostly Spanish, but pretty frequent Portuguese, Vietnamese, and Chinese. I've scrambled together enough Spanish to do the paperwork but we have a subscription to a teletranslation company for the less common languages to us


Sent from my iPad using Tapatalk

 

[atomi]

There should be no limit on the number of retakes regardless of the score of previous exams (including passing scores). What residency programs want to do with this information should be totally up to them. It should not be the prerogative of the the NBME to try and segregate applicants. That is the responsibility of individual residency programs. All the NBME should say is that a certain person was eligible to take a step exam based on status of medical schooling and here are the results. If someone is idiotic enough to attempt an exam 6 times, there should be no formal policy keeping them from wasting their money. Nor should there be any policy preventing people from attempting retakes in order to better their score.

 

[tco]

I don't know where you live but a primary care doc could totally get by in Orlando without speaking english

Annnnnd we've come full circle back to the point of the original post.

 

[Makati2008]

There should be no limit on the number of retakes regardless of the score of previous exams (including passing scores). What residency programs want to do with this information should be totally up to them. It should not be the prerogative of the the NBME to try and segregate applicants. That is the responsibility of individual residency programs. All the NBME should say is that a certain person was eligible to take a step exam based on status of medical schooling and here are the results. If someone is idiotic enough to attempt an exam 6 times, there should be no formal policy keeping them from wasting their money. Nor should there be any policy preventing people from attempting retakes in order to better their score.

Disagree. Why let someone keep taking it so much and waste their time and money on a pipe dream. Also retakes for a higher score seems like a bad ideal as well.

 

[tco]

There should be no limit on the number of retakes regardless of the score of previous exams (including passing scores). What residency programs want to do with this information should be totally up to them. It should not be the prerogative of the the NBME to try and segregate applicants. That is the responsibility of individual residency programs. All the NBME should say is that a certain person was eligible to take a step exam based on status of medical schooling and here are the results. If someone is idiotic enough to attempt an exam 6 times, there should be no formal policy keeping them from wasting their money. Nor should there be any policy preventing people from attempting retakes in order to better their score.

If this were to happen, and someone were to weasel their way into a residency after failing the step exam more than 6 times, I hope that by some freakish string of bitchin' karma you end up as this incompetent fool's patient.

 

[tco]

Oops.

 

[atomi]

Disagree. Why let someone keep taking it so much and waste their time and money on a pipe dream. Also retakes for a higher score seems like a bad ideal as well.

If this were to happen, and someone were to weasel their way into a residency after failing the step exam more than 6 times, I hope that by some freakish string of bitchin' karma you end up as this incompetent fool's patient.

Because the point of the exam is not to prevent people with more money than brains from wasting their lives chasing something that will never happen.

I also don't believe in seat belt laws, helmet laws, etc. I believe in personal responsibility. If you don't want to exercise common sense, that's your problem, not the NBME's.

I believe that there are other things at play than a USMLE score and somebody who passes on the ninth attempt isn't just going to breeze their way into a residency training program and become board certified so grandma could potentially in up in their hands the same way someone does who passes the first time. But maybe that's just me.

 

[tco]

Because the point of the exam is not to prevent people with more money than brains from wasting their lives chasing something that will never happen.

I also don't believe in seat belt laws, helmet laws, etc. I believe in personal responsibility. If you don't want to exercise common sense, that's your problem, not the NBME's.

I believe that there are other things at play than a USMLE score and somebody who passes on the ninth attempt isn't just going to breeze their way into a residency training program and become board certified so grandma could potentially in up in their hands the same way someone does who passes the first time. But maybe that's just me.

So you don't believe that a hypothetical ***** PD at a little-known program that has a son that has failed the Step exam 10 times would accept him as a resident? Naive.

I know it's a straw man, but stuff like this happens a lot in medicine..Maybe not that extreme, but regulations NEED to be in place at some point. I disagree with what you say about the NBME not being able to regulate who takes their tests and how many times. If they put a requirement of being at least a second year medical student in good standing to take the exam, they should be able to put the requirement of not having failed the exam more than X times in the past.

 

[atomi]

So you don't believe that some ***** PD that has a son that has failed the Step exam 10 times would accept him as a resident? Naive.

No, actually I don't. There is more to residency programs than a PD. And somebody who took step 1 10 times probably is going to have major problems come up during residency, fail in service exams and ultimately his boards. Having a connection may get you into a program in a few VERY LIMITED situations, but that connection surely will not keep your ignorant ass there and definitely won't ensure you pass your boards. And if that person who failed 10 times actually did get in and excel on his own, well then he was the one exception after all and proved himself. Good for him -- the system worked.

 

[tco]

No, actually I don't. There is more to residency programs than a PD. And somebody who took step 1 10 times probably is going to have major problems come up during residency, fail in service exams and ultimately his boards. Having a connection may get you into a program in a few VERY LIMITED situations, but that connection surely will not keep your ignorant ass there and definitely won't ensure you pass your boards. And if that person who failed 10 times actually did get in and excel on his own, well then he was the one exception after all and proved himself. Good for him -- the system worked.

The step exams assess a minimum level of competency expected for a given level of training. If it takes someone more than two shots to pass each individual exam, I question their competency, mainly because I've seen the quality of student that is fully capable of passing the exams on the first attempts. Anyone can have a bad day, get sick, or stress out, but you should need no more than two attempts to pass the exam. I apologize to anyone reading this that has failed more than twice.

So, what you're saying is, who cares if they kill someone in residency? Everyone makes mistakes, but it's obviously not due to competency issues...They failed the exam X times, but eventually passed it, so they MUST be competent! I completely disagree.

 

[Makati2008]

No, actually I don't. There is more to residency programs than a PD. And somebody who took step 1 10 times probably is going to have major problems come up during residency, fail in service exams and ultimately his boards. Having a connection may get you into a program in a few VERY LIMITED situations, but that connection surely will not keep your ignorant ass there and definitely won't ensure you pass your boards. And if that person who failed 10 times actually did get in and excel on his own, well then he was the one exception after all and proved himself. Good for him -- the system worked.

So are you one of those with multiple failed steps or would like to take the USMLE to improve your score? Just wondering.

 

[Wordead]

No, actually I don't. There is more to residency programs than a PD. And somebody who took step 1 10 times probably is going to have major problems come up during residency, fail in service exams and ultimately his boards. Having a connection may get you into a program in a few VERY LIMITED situations, but that connection surely will not keep your ignorant ass there and definitely won't ensure you pass your boards. And if that person who failed 10 times actually did get in and excel on his own, well then he was the one exception after all and proved himself. Good for him -- the system worked.

You know that residents take care of patients, right? Sometimes (or often, depending on the program) without attending supervision?

 

[colbgw02]

No, actually I don't. There is more to residency programs than a PD. And somebody who took step 1 10 times probably is going to have major problems come up during residency, fail in service exams and ultimately his boards. Having a connection may get you into a program in a few VERY LIMITED situations, but that connection surely will not keep your ignorant ass there and definitely won't ensure you pass your boards. And if that person who failed 10 times actually did get in and excel on his own, well then he was the one exception after all and proved himself. Good for him -- the system worked.

The person who failed a step exam many times, but still gets into a residency because of nepotism only to be kicked out, is taking a spot away from someone who probably has a decent chance of succeeding.

 

[Brain Bucket]

You almost won that one psai, so close

Initially I thought you were just trying to egg me on, but then I read some of your other posts...were you being serious perchance?

 

[Brain Bucket]

The person who failed a step exam many times, but still gets into a residency because of nepotism only to be kicked out, is taking a spot away from someone who probably has a decent chance of succeeding.

They're taking that chance away whether or not they succeed. Nepotism is wrong either way, and yet it's pervasive. Still, I probably don't have a shot without it.

 

[atomi]

The step exams assess a minimum level of competency expected for a given level of training. If it takes someone more than two shots to pass each individual exam, I question their competency, mainly because I've seen the quality of student that is fully capable of passing the exams on the first attempts. Anyone can have a bad day, get sick, or stress out, but you should need no more than two attempts to pass the exam. I apologize to anyone reading this that has failed more than twice.

So, what you're saying is, who cares if he kills someone in residency? Everyone makes mistakes, but it's obviously not due to competency issues...They failed the exam X times, but eventually passed it, so they MUST be competent! I completely disagree.

Yeah well, that's my opinion. You aren't going to get a 190 on step 1 just by taking it over and over again and guessing. You get it by studying enough to get the right answers in the limited time. If NBME is really that concerned about competency, then they should raise the minimum passing score, not limit the number of attempts. What difference does it make if it takes someone 1 time or 6 times to score a 200? I'd like to believe the minimum passing score is high enough that you can't just get it by getting lucky and not actually understanding fundamentals.

Furthermore, I have known plenty of people who have smoked the exam who were totally incompetent physicians.

I can't even really see this being an issue for any component of the exam other than step 2 CS, which is what I have a feeling spurred all this. I could totally see FMGs with limited English skills taking that exam 10-20 times until they get lucky enough to pass. But that's because it's a subjectively graded B.S. exam. The other parts aren't, and I have little worry about them. If on step 1 you score 185, 185, 185, 185, 185, 185, and then 255. Well clearly you decided to get your **** together and study that 7th time. Is that person less competent than somebody who scored 255 the first time? Well no, they both got the same score on a STANDARDIZED OBJECTIVELY GRADED exam. What it amounts to is punishing the retaker for being a lazy ass the first 6 times.

Penalties and rules in medicine are kind of like prison. Sure, you can go to prison and pay your debt to society and get out, but are you really back to square one? No. The collateral consequences of a criminal conviction screw you over for the rest of your life even after your free. For some reason the medical profession also chooses to adapt this collateral consequences model, making sure that anybody who screws up is punished forever. In other professions, as long as you can demonstrate competency, the world is your oyster. Note this is more about retakes after a barely passing score, which is more my beef than with some doofus trying to take it 6+ times.

 

[colbgw02]

They're taking that chance away whether or not they succeed. Nepotism is wrong either way, and yet it's pervasive.

Yes, but from a macro standpoint, the system wins irrespective of whether the favored or non-favored resident becomes a contributing physician. I agree that nepotism is wrong, but I was responding to a specific point.

 

[atomi]

The person who failed a step exam many times, but still gets into a residency because of nepotism only to be kicked out, is taking a spot away from someone who probably has a decent chance of succeeding.

Eh, I'd still argue that not even the most corrupt example of nepotism can get somebody into a program with 6+ failures on a single step a residency position with that person showing no other compelling evidence to warrant ranking. Show me one instance of that happening, ever.

 

[Brain Bucket]

Yes, but from a macro standpoint, the system wins irrespective of whether the favored or non-favored resident becomes a contributing physician. I agree that nepotism is wrong, but I was responding to a specific point.

Oh, nvm then. Sleep deprivation

 

[atomi]

So are you one of those with multiple failed steps or would like to take the USMLE to improve your score? Just wondering.

Yeah dude, I failed 6 times, somehow still managed to graduate med school and am whining on the internet in coherent English. Nice ad hominem.

 

[Makati2008]

Yeah dude, I failed 6 times, somehow still managed to graduate med school and am whining on the internet in coherent English. Nice ad hominem.

Give me a break with the attitude. I was only asking about taking it multiple times to raise your score(mainly). Who knows you could be an unhappy resident that was shooting for a high tier residency or Derm, Ortho etc

 

[colbgw02]

Eh, I'd still argue that not even the most corrupt example of nepotism can get somebody into a program with 6+ failures on a single step a residency position with that person showing no other compelling evidence to warrant ranking. Show me one instance of that happening, ever.

That's not the point. The point is that there's nothing that says that the whole onus to determine progression should fall to the residencies. That onus can, and is, shared at multiple levels, to include by the licensing exam boards. Are you also in favor of permitting someone to graduate from medical school regardless of the step exam performance(s), provided that they pass their clerkships and get adequate grades?

ETA: One of the benefits sharing this responsibility is that it identifies underperformers before residency, ideally maximizing the likelihood of producing a high-functioning physician.

 

[atomi]

Give me a break with the attitude. I was only asking about taking it multiple times to raise your score. Who knows you could be an unhappy resident that was shooting for a high tier residency or Derm, Ortho etc

Sorry, I'm not going to give you a break. If you didn't want a sarcastic response, you shouldn't have made a smartass post. I'm happy with where I'm at, but even if I were an unhappy resident, how would that make my opinion irrelevant? http://en.wikipedia.org/wiki/Ad_hominem

I have a major issue with the way the medical licensing bodies attempt to stratify students into medical specialties and careers based on preclinical performance on step 1. I have made this point repeatedly.

 

[tco]

Yeah well, that's my opinion. You aren't going to get a 190 on step 1 just by taking it over and over again and guessing. You get it by studying enough to get the right answers in the limited time.

You realize there is a learning process in taking exams. If you study for an exam and take it, then retake it the next day, then retake it again without studying in the interim, you will score progressively higher. This does not only apply to the exact same exam. There is a learning process in the style of exam, and the content, as well as the organization and time management. All of which have nothing to do with competency.

If NBME is really that concerned about competency, then they should raise the minimum passing score, not limit the number of attempts.

That's a good point. They have, and continue to, increase the minimum passing score.

What difference does it make if it takes someone 1 time or 6 times to score a 200? I'd like to believe the minimum passing score is high enough that you can't just get it by getting lucky and not actually understanding fundamentals.

As I said above, the knowledge base of the people that I've seen pass them on the first try is sometimes rather concerning. If it takes over 6 tries, they're someone I wouldn't take my dog to, regardless as to whether they're the superhuman lazy slacker you made up.

Furthermore, I have known plenty of people who have smoked the exam who were totally incompetent physicians.

I suppose this is unfalsifiable, however, I also know athletic fat kids and intelligent high school dropouts. However, I'm willing to bet that the average person who fails the step exam numerous times has a knowledge base that is absolutely pathetic compared to a student that passes on the first try, even though the former "still" eventually passed.

I can't even really see this being an issue for any component of the exam other than step 2 CS, which is what I have a feeling spurred all this. I could totally see FMGs with limited English skills taking that exam 10-20 times until they get lucky enough to pass. But that's because it's a subjectively graded B.S. exam. The other parts aren't, and I have little worry about them.

The truth finally comes out. Even if it is in a Freudian slip.

I'm assuming you've already taken the exam. If you have, you realize the massive amount of leniency they give in this exam. I forgot the entire PMH on one patient and still passed. Again, if someone fails this 10-20 times I absolutely do not want them as my physician. They either have no clue of the basics of a history and physical exam, or they speak so little English that they cannot effectively communicate with me or other members of the healthcare team.

If on step 1 you score 185, 185, 185, 185, 185, 185, and then 255. Well clearly you decided to get your **** together and study that 7th time. Is that person less competent than somebody who scored 255 the first time?

If you fail on a central line six times and cause six pneumos, are you less competent than someone that gets it on the first try and has no complications?

Well no, they both got the same score on a STANDARDIZED OBJECTIVELY GRADED exam. What it amounts to is punishing the retaker for being a lazy ass the first 6 times.

I thought you said that CS was the main problem? Why are we back to addressing the numerically scored objective exams?

By the way, we're all still wondering how many times you've taken these exams.

Penalties and rules in medicine are kind of like prison. Sure, you can go to prison and pay your debt to society and get out, but are you really back to square one? No. The collateral consequences of a criminal conviction screw you over for the rest of your life even after your free. For some reason the medical profession also chooses to adapt this collateral consequences model, making sure that anybody who screws up is punished forever. In other professions, as long as you can demonstrate competency, the world is your oyster. Note this is more about retakes after a barely passing score, which is more my beef than with some doofus trying to take it 6+ times.

If someone is a hard-headed, desperate, incompetent physician that eventually falls through the cracks, I'm betting that quite a few of their patients end up somewhere far worse than prison. That's why there's such severe consequences for being inadequate in this field.

 

[tco]

Eh, I'd still argue that not even the most corrupt example of nepotism can get somebody into a program with 6+ failures on a single step a residency position with that person showing no other compelling evidence to warrant ranking. Show me one instance of that happening, ever.

We don't have access to that type of information.

Show me one example of someone failing the USMLEs 6 or more times and still succeeding in residency. If you can't, this is a silly argument.

 

[Makati2008]

Sorry, I'm not going to give you a break. If you didn't want a sarcastic response, you shouldn't have made a smartass post. I'm happy with where I'm at, but even if I were an unhappy resident, how would that make my opinion irrelevant? http://en.wikipedia.org/wiki/Ad_hominem

I have a major issue with the way the medical licensing bodies attempt to stratify students into medical specialties and careers based on preclinical performance on step 1. I have made this point repeatedly.

Smh. There was nothing snide about the post but I had a bit of curiosity. If you want to continue debating let's do so with tact.

As far as step 1 oddly we are in agreement somewhat. I am a fan of a P/F USMLE sequence to stop all of the you must make 2** for residency xyz.

I do disagree with multiple attempts to raise a score or taking six attempts per step. Personally I'm a fan of 3 and out.

 

[tco]

That's not the point. The point is that there's nothing that says that the whole onus to determine progression should fall to the residencies. That onus can, and is, shared at multiple levels, to include by the licensing exam boards. Are you also in favor of permitting someone to graduate from medical school regardless of the step exam performance(s), provided that they pass their clerkships and get adequate grades?

ETA: One of the benefits sharing this responsibility is that it identifies underperformers before residency, ideally maximizing the likelihood of producing a high-functioning physician.

Also, people that are incompetent already fall through the cracks. If we begin to limit who does the screening, our quality decreases even further.

We're assuming that this magical number of "6" is the last and only thing that the NBME is going to do to try to improve the quality of new physicians. I don't think this is the case. I'm getting the sense that this is the beginning.

 

[tco]

As far as step 1 oddly we are in agreement somewhat. I am a fan of a P/F USMLE sequence to stop all of the you must make 2** for residency xyz.

I disagree with this. I would not have gotten interviews at the programs I interviewed at, and I'm betting I wouldn't have gotten into my program, if step exams were P/F. My score helped me compete with the people from elite institutions that didn't score as well as I did.

 

[atomi]

That's not the point. The point is that there's nothing that says that the whole onus to determine progression should fall to the residencies. That onus can, and is, shared at multiple levels, to include by the licensing exam boards. Are you also in favor of permitting someone to graduate from medical school regardless of the step exam performance(s), provided that they pass their clerkships and get adequate grades?

ETA: One of the benefits of identifying underperformers before residency is that it maximizes the likelihood of producing a high-functioning physician.

Are you in favor of allowing FMGs into US residencies? Because USMDs AFAIK can't graduate without passing step 1 and 2. So the "whole onus" could never really be on the residency. But for FMGs, they can graduate med school without passing any USMLE exams. We're getting all bent out of shape trying to shape a thread discussing a FMG issue into a debate that could potentially apply to US grads. The question is, do we want to allow a residency program to attempt to train a FMG who failed step 1 6 times? Why do we need a policy preventing this? What residency program in the country would take such an applicant without compelling evidence that he could graduate and pass boards? Again, show me one example of this happening, ever.

FWIW, I agree almost entirely with what you have written.

 

[Makati2008]

I disagree with this. I would not have gotten interviews at the programs I interviewed at, and I'm betting I wouldn't have gotten into my program, if step exams were P/F. My score helped me compete with the people from elite institutions that didn't score as well as I did.

quick question- so do you think that going to higher tiered programs and getting lor or sloes from them wouldn't suffice if you outperformed those same people clinically like you did via the steps?

 

[atomi]

Also, people that are incompetent already fall through the cracks. If we begin to limit who does the screening, our quality decreases even further.

We're assuming that this magical number of "6" is the last and only thing that the NBME is going to do to try to improve the quality of new physicians. I don't think this is the case. I'm getting the sense that this is the beginning.

Bingo. I would not be surprised if there are additional measures taken to try and stratify applicants by the NBME. NBME is attempting to take the decision of who gets into what residency away from the residency programs. If this is really a concern, then we need to seriously question the residency accreditation process.

Right now, the NBME is telling programs that a person who makes a 230 on their exam will be a better resident than someone who makes a 215. Is that true? Plenty of people say no. But that's how PDs use the information. It certainly makes the PDs job easier.

 

[colbgw02]

Are you in favor of allowing FMGs into US residencies? Because USMDs AFAIK can't graduate without passing step 1 and 2. So the "whole onus" could never really be on the residency. But for FMGs, they can graduate med school without passing any USMLE exams. We're getting all bent out of shape trying to shape a thread discussing a FMG issue into a debate that could potentially apply to US grads. The question is, do we want to allow a residency program to attempt to train a FMG who failed step 1 6 times? Why do we need a policy preventing this? What residency program in the country would take such an applicant without compelling evidence that he could graduate and pass boards? Again, show me one example of this happening, ever.

FWIW, I agree almost entirely with what you have written.

I think we just diagree. I understand your point, particularly about FMGs, but I just don't think that just because we have a choke point at residency selection that we couldn't also stand to have other 'system checks' on progression. I think it helps to ensure that, as training progresses, the percentage of likely-to-succeed, high-quality people in the pool increases.

 

[atomi]

Smh. There was nothing snide about the post but I had a bit of curiosity. If you want to continue debating let's do so with tact.

Are you serious? You implied I either failed the exam multiple times or had a low score and that was the basis for my post and opinion. Where's the option for passed the first time and did well? That is as snide as it comes and tact went out the window with your comment. Don't dish it out if you can't take it back.

This is an anonymous forum. Stating that I made 250+ on every step adds zero credibility to any of my posts, so I don't see why my exam performance is being repeatedly brought up. But, for what it's worth (which is NOTHING), I passed all my exams first try with plenty of room to spare.

 

[atomi]

I think we just diagree. I understand your point, particularly about FMGs, but I just don't think that just because we have a choke point at residency selection that we couldn't also stand to have other 'system checks' on progression. I think it helps to ensure that, as training progresses, the percentage of likely-to-succeed, high-quality people in the pool increases.

If that's the case, 6 times is a pretty poor "system check" How about 3 times? Or at least a time limit (e.g., you can only take the exam 3 times in 10 years) to allow people to correct for mistakes of the distant past.

 

[tco]

quick question- so do you think that going to higher tiered programs and getting lor or sloes from them wouldn't suffice if you outperformed those same people clinically like you did via the steps?

I don't know what a "sloes" is.

How do you outperform someone in watching residents read diagnostic studies? I did an away rotation at an IR program that I could contribute to and learn at (Arkansas). I would not trade that for any other experience. I was the primary operator on more procedures than most residents in a month. I also learned that I, for sure, want to do IR for my career.

What do you mean "going to high tiered programs?" Going for residency or for medical school? I wouldn't change where I went for medical school. I stayed in state and saved a boatload of money. I'll be leaving medical school with 80k in debt. I would not trade that for 300k in debt from a higher tiered program when I got, what I feel was, a tremendous education at my institution. I will argue that my step scores provide evidence that my school's education is just as good (or at least no worse than) any other program in the country. Could I have done better at Duke or MGH or Hopkins? Maybe, but we'll never know. The only thing I know is that I'm definitely competent for my level of training, and I'm confident that I can perform my duties, and I know when to ask for help if I get into trouble. The latter most is a characteristic that might not be present in a resident that takes a step exam more than 3 or 4 times.

 

[DermViser]

Just have to say that this is a horrible attitude to have as a physician. We are here for our patients. It isn't unreasonable to make a little bit of an extra effort if there are language incompatibilities.