USMLE Pass/Fail Comment Period.. Official Recommendations and Here is your chance to give feedback to USMLE

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Solodyn

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The link above has detailed recommendations on USMLE Pass/Fail issue by the decision makers.

Here is a direct link to the report... They recommended changing USMLE to Pass/Fail


The public comment period is 6 weeks, end in July 26, 2019

Use this link to leave comment InCUS Preliminary Recommendations for Public Comment
What?! Stunned that they're recommending P/F. The gradation of students by knowledge base and pursuit of excellence during the pre-clinical years is in everyone's interest from the public to students.

Yikes.
 
This seems like it would be bad news for any med student that isn’t US MD, since doing well on boards is one of our only ways to compete.
 
This seems like it would be bad news for any med student that isn’t US MD, since doing well on boards is one of our only ways to compete.
There are other ways. You can excel in research, do well on auditions or have strong clinical letters. I'm sure even US MDs aren't too happy with the idea if they are the type to get 270 and now they are on the same boat as the person with a 210
 
This seems like it would be bad news for any med student that isn’t US MD, since doing well on boards is one of our only ways to compete.

It would likely hurt MD students from low tier and even mid tier schools as well. I really don’t understand why they are trying to push this change so quickly (if they do end up changing it). I take Step 1 next summer, I’m assuming that my class would still receive a numerical score? Especially since they say final recommendations wouldn’t be put in place until late 2019/early 2020. As a DO student, I really hope they just leave the scoring in place as it is now.
 
It would likely hurt MD students from low tier and even mid tier schools as well. I really don’t understand why they are trying to push this change so quickly (if they do end up changing it). I take Step 1 next summer, I’m assuming that my class would still receive a numerical score? Especially since they say final recommendations wouldn’t be put in place until late 2019/early 2020. As a DO student, I really hope they just leave the scoring in place as it is now.

Hopefully class of 23' still receives a score too. Would be messed up for those who have already committed to a school this year to be forced to take a new exam in 2 years. Seeing how they may have chosen differently if they knew as of this moment the exact type of step 1 they would be taking.
 
Hopefully class of 23' still receives a score too. Would be messed up for those who have already committed to a school this year to be forced to take a new exam in 2 years. Seeing how they may have chosen differently if they knew as of this moment the exact type of step 1 they would be taking.
How is that messed up? Things change all the time in med school. If you are really worried, drop your spot and pretend your DO school never happened. Otherwise, get ready for the primary care CHOO CHOO baby! The trains a comin'.
 
How is that messed up? Things change all the time in med school. If you are really worried, drop your spot and pretend your DO school never happened. Otherwise, get ready for the primary care CHOO CHOO baby! The trains a comin'.

Its messed up for the exact reason I stated. People may have chosen a different school, MD or DO, had they known there would be changes to how resident applications would be reviewed.
 
I'm hoping if this pushes through they do it gradually like the merger (over 5-6 years transition period). The current generation of DO students need a break. We already have the merger to worry about. Let the next group of med students deal with this one please?
 
Stunned that they're recommending P/F.

If you look at all the articles they are all written by students at tip top schools, which are really the only ones who would benefit from a change.
This seems like it would be bad news for any med student that isn’t at a tip top US MD, since doing well on boards is one of our only ways to compete.

FTFY. This would affect a lot of MD students too.
Things change all the time in med school.

Not like this they don't.... pretending this isn't a really big deal and couldn't potentially have disastrous consequences for a ton of medical students is disingenuous.
 
And what if COMLEX doesn't go the same route? Would the numerical score there take on a little bit more consideration?

Just a thought.
 
Been thinking about this for awhile. I like this idea. I don't see why its a huge problem. Schools - esp DO schools - need to step up their game and this might be motivation to do that.

I also don't see an issue with emphasis going to Step 2 which probably has a better correlation with residency performance than step 1.
 
And what if COMLEX doesn't go the same route? Would the numerical score there take on a little bit more consideration?

Just a thought.

Why would anyone care about COMLEX? It's a completely different testing pool so no, in this scenario PDs wouldn't give any more weight to COMLEX than they currently do.
Been thinking about this for awhile. I like this idea. I don't see why its a huge problem. Schools - esp DO schools - need to step up their game and this might be motivation to do that.

What would they "step up" that would help their grads in this scenario? You can't inherently change your perceived ranking. This literally locks pretty much everyone into the tier of residency that correlates with their school.
I also don't see an issue with emphasis going to Step 2 which probably has a better correlation with residency performance than step 1.

The problem with this is that
1. Step 2 is taken right before residency applications go out, which means you can be working towards a field your whole time in medical school and then right before you apply have the rugged pulled out from under you leaving you completely SOL. There is no time to recalibrate if you don't do as well as you hoped.
2. You then put the emphasis on one singular exam, whereas currently someone can give an effort to overcome a lower Step 1 score with a better showing on Step 2. The current mania surrounding Step 1 would simply move to Step 2.
 
The problem with this is that
1. Step 2 is taken right before residency applications go out, which means you can be working towards a field your whole time in medical school and then right before you apply have the rugged pulled out from under you leaving you completely SOL. There is no time to recalibrate if you don't do as well as you hoped.
2. You then put the emphasis on one singular exam, whereas currently someone can give an effort to overcome a lower Step 1 score with a better showing on Step 2. The current mania surrounding Step 1 would simply move to Step 2.

Well, it still doesn't help that Step 1 has no correlation to resident performance. Shouldn't that be more important? As far as things not going well, everyone I know has done significantly better on step 2 - so its not impossible.
 
Step 1 has no correlation to resident performance.

This isn't quite true. And sure it's not great, but simply changing things to P/F doesn't change anything while concurrently making a lot of other things worse.
As far as things not going well, everyone I know has done significantly better on step 2 - so its not impossible.

The percentiles are very different for Step 2. Scores are generally always higher. The national mean on Step 1 is a 228-229, the national mean on Step 2 is around a 243. So going from a 225 on Step 1 to a 240 on Step 2 looks "significantly better" it is actually the same percentile (or around there, I'm not going to look up the exact numbers for each percentile).
 
Been thinking about this for awhile. I like this idea. I don't see why its a huge problem. Schools - esp DO schools - need to step up their game and this might be motivation to do that.

Yes, DOs will surely be able to "step up their game" now by taking away literally the one thing that allows them to "step up their game" and compete with US MDs....
 
Here's the list of the medical schools that the members of the InCUS committee graduated from, as well as their respective specialties:

Northwestern (pediatrics)
GW (family medicine)
UMichigan (family medicine)
WUSTL (pediatrics)
...plus a random non-physician from the FSMB with a master's degree in history

So, essentially: a group of doctors who mostly attended elite medical schools and entered uncompetitive specialties, are now telling the NBME to enact a policy that would screw over current students who aren't attending elite medical schools and are aiming to match into competitive specialties. How amazing is that.
 
Also, nowhere in those recommendations does it say directly "Pass/Fail is 100% the way to go and we are doing so."

Obviously the reports reads like they are trending that way, but it doesn't say for sure. Instead of reading our own eulogies, I would recommend anyone opposed take the survey and utilize that open feedback period.

Recommendations specific to USMLE:
  1. 1) Reduce the adverse impact of the current overemphasis on USMLE performance in residency screening and selection through consideration of changes such as pass/fail scoring.
  2. 2) Accelerate research on the correlation of USMLE performance to measures of residency performance and clinical practice.
  3. 3) Minimize racial demographic differences that exist in USMLE performance.
Recommendations to the UME-GME transition system:
1) Convene a cross-organizational panel to create solutions for the assessment and transition challenges from UME to GME, targeting an approved proposal, including scope/timelines by end of calendar year 2019.
 
Yes, DOs will surely be able to "step up their game" now by taking away literally the one thing that allows them to "step up their game" and compete with US MDs....

So here's my question for you. What do the MDs have that we don't? Not including name recognition for places like Harvard, etc.
 
Here's the list of the medical schools that the members of the InCUS committee graduated from, as well as their respective specialties:

Northwestern (pediatrics)
GW (family medicine)
UMichigan (family medicine)
WUSTL (pediatrics)
...plus a random non-physician from the FSMB with a master's degree in history

So, essentially: a group of doctors who mostly attended elite medical schools and entered uncompetitive specialties, are now telling the NBME to enact a policy that would screw over current students who aren't attending elite medical schools and are aiming to match into competitive specialties. How amazing is that.
It is not just random people from "elite" medical schools. Specialty interest groups are supportive of a big change. The way it is going now is not really good.
 
So here's my question for you. What do the MDs have that we don't? Not including name recognition for places like Harvard, etc.

They typically have a preferred advantage over us in the eyes of PDs, especially for competitive residencies. Hence the importance of the objective measure that is USMLE.
 
"The second InCUS recommendation seems laudable at first glance: to "minimize racial demographic differences in USMLE performance." Step 1 has been shown to play a role in perpetuating disparities as well as racial bias in medical education for underrepresented minorities in medicine. Few would argue with the intent of this recommendation. However, the steps that might actually be taken to achieve this goal are left largely unexplored. The USMLE simply states that it will "prioritize this line of work."

Noooooo!

It is not laudable at any glance. Just no. Underrepresented minorities do worse on average because they are poorer on average, tend to come from worse schools on average, and have decreased criteria to get in , in the first place. The test is not ****ing racist. Those who want to get rid of meritocratic criteria are racist. Fix the schools. Don't put a bandaid on it. These disparities are warning signs. Don't eliminate them, thus removing yet another incentive to fix, especially inner city and poor latinx heavy areas (many rural near the border) schools.

Tell affirmative action to a Hmong, low caste Indian, dark skinned Filipino (less East Asian kr White ancestry aka original of original inhabitants), Melenesian, or untouchable caste Japanese. They were all essentially enslaved longer than American slavery. Culture changes and private public partnership to change those areas is key. It gets corrupted like Newark blowing much of the 100 million of Zuckerberg's donation, so it has to be done carefully.
 
how can one try to appeal the decision if they do make it p/f?
 
Jesus people so many reactionaries. Think logically about this. If step 1 becomes pass fail what is the MOST LIKEY thing that will be used in it’s placed. Tier of med school or Step 2/clinical grades/ letters etc. come on it’s obvious very few PDs are gunna jump straightt to school prestige when they have multiple other better objective measure even with a P/F step 1 lol. Also Ita likely they will still reports scores in a quartile which will be even more accurate bc based on nbme data the clinical knowledge difference between two students with a score of 230-246 cannot be determine. 16 points. They literally say that’s how big the range is fore you can confidently and statistically say there’s a true distinction. The exact quote is “to assess whether the difference between two scores is statistically meaningful examiners must differ by two standard deviations”. Currently 1 SD is 8 points. A quartile system would be ideal.
 
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Plus..PDs already use school prestige...that's nothing new. If you think it is, try applying to MGH IM program next cycle.
 
I'm always a little miffed about how sdn admins get all ruffled up about sarcastic posts but consistently allow bigoted/racist posts to go through without issue. Like yes, lets talk crap about minorities on sdn bc it is allowed. @Goro @gyngyn
 
Theoretically, I actually can see some value to the idea. Right now, Step 1 is valued so much more than everything else that a lot students are spending $50K a year to mostly stay home and learn high yield facts with Anki and UWorld. If Step 1 was truly pass/fail, and you could give pre-clinical years more educational value than just cramming high yield facts inefficiently, that would be a good thing.

Before everybody jumps all over me, I get why it’s not— residencies are always going to want something to stratify applicants with, and without Step 1 that mostly leaves prestige, which would come back to bite most of us.

Just saying I wish there WAS a way to decrease the relative importance of Step 1 so you could judge candidates more (for lack of a better word) holistically while teaching pre-clinical students more clinical pearls and useful skills and fewer obscure factoids.
 
1. Top schools are the people who are pro for this. And those who scored poorly of course
2. If you are a DO in favor of this you are part of the problem
3. If it goes PF specialties would probably make a written test specific to their specialty and score it so just keep kicking the can down the road
4. Please explain to me how the test is racist. Do URM get less time per question, get harder questions, restricted access to cheap when compared to medical school resources such as first aid and uworld? Do cops come arrest them after the first block to take time away?
 
I'm always a little miffed about how sdn admins get all ruffled up about sarcastic posts but consistently allow bigoted/racist posts to go through without issue. Like yes, lets talk crap about minorities on sdn bc it is allowed. @Goro @gyngyn
Cry to mommy mods
 
I at a middle tier hate this ****. We match a lot of surgical sub specs, but it is the elite step tier crowd. You take that away, and you screw a good portion of them, especially the non AOA members (more than half of them). Our schools exams are extremely trash quality. You made AOA great again and rely on those PhD questions that are often irrelevant. You made preclinical cut throat again. Or you kicked the can down and made clinicals more cut throat. SAD. STEP1 is a uniter among everyone in a class. It is seen as a mutual enemy to be slayed. AOA is a zero sum game. The entire incentive markets will shift back to real gunnerism.

The elites are selling this as a minority and poverty help plan. BIGLY clever among the leftist elites and this coming from a liberal.

Some also got great MCAT scores and went middle tier for the money or are ORMs from competitive states that got the short end of the grievance points status aka a lot of "privilege." Nice to keep getting rewarded for success and economic sensibleness in our land of opportunity.
 
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I filled out the survey. I'm not spending my summer and my free time grinding through Anki and studying my butt off to take a P/F exam next summer. Yes, I'm learning for the benefit of my future patients, but I want to be rewarded for my hard work. The "everyone gets a trophy" model needs to stop.
 
I filled out the survey. I'm not spending my summer and my free time grinding through Anki and studying my butt off to take a P/F exam next summer. Yes, I'm learning for the benefit of my future patients, but I want to be rewarded for my hard work. The "everyone gets a trophy" model needs to stop.

I filled it out as well and am in the same boat as you. While I don’t believe our class would be affected even if there is a change implemented, the numerical scoring system needs to stay in place until there is sufficient evidence produced that another way of scoring is better yet still fair. I made sure to emphasize in my comments that only a select group of students would benefit from this, and that they are the ones who are likely pushing for it the hardest.
 
I - again - hope that everyone upset in this thread takes the time to go to the Incus web page and complete the survey because I promise you the “Elites” pushing so hard for this have already done so.

yes, do that. But I am not even sure that they will publish the result of the survey to show who is the majority supporting / opposing this and what those people want. There is also no guarantee that they will listen to what people want and do what they want to do anyway. Imho, it is better to form a united voice to oppose this P/F if you think that it is unfair and / or adversely affecting you as it would be more powerful doing as a big group to bargain / demand things than individuals.
 
Theoretically, I actually can see some value to the idea. Right now, Step 1 is valued so much more than everything else that a lot students are spending $50K a year to mostly stay home and learn high yield facts with Anki and UWorld. If Step 1 was truly pass/fail, and you could give pre-clinical years more educational value than just cramming high yield facts inefficiently, that would be a good thing.

Before everybody jumps all over me, I get why it’s not— residencies are always going to want something to stratify applicants with, and without Step 1 that mostly leaves prestige, which would come back to bite most of us.

Just saying I wish there WAS a way to decrease the relative importance of Step 1 so you could judge candidates more (for lack of a better word) holistically while teaching pre-clinical students more clinical pearls and useful skills and fewer obscure factoids.
Hahahahaha more educational value?!

Medical schools have failed to adapt and have made themselves IRRELEVANT in the preclinical years. This isn’t a ‘poor them getting us ready for step 1’ it’s that there are now much much more efficient means of learning that are available and to which ****ty lectures give no marginal benefit.

And yes, I did just pay a collective $165,000 for functionally the privilege to sit for an exam and use outside resources almost exclusively. Awesome system eh?
 
Hahahahaha more educational value?!

Medical schools have failed to adapt and have made themselves IRRELEVANT in the preclinical years. This isn’t a ‘poor them getting us ready for step 1’ it’s that there are now much much more efficient means of learning that are available and to which ****ty lectures give no marginal benefit.

And yes, I did just pay a collective $165,000 for functionally the privilege to sit for an exam and use outside resources almost exclusively. Awesome system eh?
Actually, I’m not disagreeing with you. The vast majority of schools do do a poor job of preparing us for Step 1 so we’re paying tuition to DIY; my point was that this one exam is currently overemphasized.

In a perfect world (or my version of it), Step 1 would matter less for the residency application process so while you could use these outside resources to your heart’s content, medical schools could focus on teaching you actual skills and clinical pearls, and you’d have time to learn it and care about it instead of pushing your H&P off to the side in favor of cramming in a few more tumor markers and biochemical pathways.

No, I have no idea what policies would need to go into place to make that happen, much less how to enforce them— so without that, I’m as against changing the score to P/F at this time.
 
Hahahahaha more educational value?!

Medical schools have failed to adapt and have made themselves IRRELEVANT in the preclinical years. This isn’t a ‘poor them getting us ready for step 1’ it’s that there are now much much more efficient means of learning that are available and to which ****ty lectures give no marginal benefit.

And yes, I did just pay a collective $165,000 for functionally the privilege to sit for an exam and use outside resources almost exclusively. Awesome system eh?
No One taught you how to use a stethoscope, take a history, deliver bad news, do an abdominal exam in your first two years? Really?
 
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