USMLE Remote Proctoring in 3-6 Months

[efle]

From the USMLE news post today:

United States Medical Licensing Examination | Announcements

The United States Medical Licensing Examination (USMLE) assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease.

www.usmle.org

Bolded and oranged the pertinent section:

"
Our current plans include a three-phased approach to expand testing capacity for Step 1, Step 2 CK, and Step 3.

• Phase One: Regional Testing Centers at Medical Schools
  Implementation: Early June
  Currently, there are a small number of U.S. medical schools that already have Prometric sites. We will be assessing whether these centers can expand their availability and capacity.
  Additionally, we are working to set up a small number of testing sites in medical schools using Prometric equipment. The schools were chosen based on the relative speed with which we could implement testing as well as their ability to serve as regional testing centers in different geographical locations. Initial steps to prepare the sites for testing have already begun, and we will communicate more about these sites soon.
  While many medical schools have demonstrated tremendous support and interest in participating in this type of testing set-up, the work to operationalize centers in this way is very complex. We recognize this solution will not be accessible to every student, but it is a positive development in addressing national capacity.
• Phase Two: Event-Based Testing at Medical Schools
  Implementation: Late June-August
  To more significantly expand testing capacity, our goal is to create larger scale proctored USMLE administrations at U.S. medical schools while abiding by social distancing guidelines. We are working to overcome some technological challenges to deliver testing via this method to many more medical schools compared with phase one. We will share more details about this plan within the next few weeks. This type of testing will be available no sooner than late June, and recurring events over the summer will allow for any larger testing backlogs to be addressed.
• Phase Three: Remote Proctoring
  Exploration Timing: Three to six months
  We are exploring the delivery of USMLE through remote proctoring. Although we are aggressively exploring this option, we cannot commit to it at this time as there is still a great deal of technological and feasibility work to do. We anticipate our exploration to occur over the next 3 months, at which point we will be able to make decisions about any future implementation of remote proctoring.

"

I freaking knew it. I am very, very concerned about security issues for a remote scored version of the test.

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[Lawpy]

Still better than telehealth Step 2 CS

 

[efle]

Still better than telehealth Step 2 CS

At least that one is Pass/Fail. How anybody can trust a scored Step exam I took "alone" in my apartment is beyond me. Med students are bright individuals, this test is the primary determinant of whether you can pursue entire specialties, and this gives waaaaay too much temptation and opportunity.

 

[frenchyn]

As long as they still get the money they don’t care ...step 2 CS is delayed until at least August now...imagine all the people will need to take it with this “telemedicine” test.

 

[frenchyn]

At least that one is Pass/Fail. How anybody can trust a scored Step exam I took "alone" in my apartment is beyond me. Med students are bright individuals, this test is the primary determinant of whether you can pursue entire specialties, and this gives waaaaay too much temptation and opportunity.

It says med school now...or remote proctoring does not mean your apartment.

 

[Goro]

The NBME is quite fanatic about exam security, even on expired exam questions that get used in shelf exams.

Expanding exams to be given at schools is feasible, remote exam in your home, Starbucks, or in Central Park is not.

At my school, I can envision quite a few rooms that could be used for the exam, even with social distancing. Going to play hell on us Faculty to proctor the damn things, though.

 

[Dantes]

Does remote proctoring mean virtual proctoring, or just setting up additional sites outside of Prometric and medical school campuses?

We were told there's a backlog of around 10,000 students who still need to take the exam. I wonder if the first two phases will suffice.

 

[Pluto98]

At least that one is Pass/Fail. How anybody can trust a scored Step exam I took "alone" in my apartment is beyond me. Med students are bright individuals, this test is the primary determinant of whether you can pursue entire specialties, and this gives waaaaay too much temptation and opportunity.

Yea but the risk of cheating is also tremendous. The risk of being kicked out of medicine all together is a huge deterrent.

 

[Dr.Bruh]

At least that one is Pass/Fail. How anybody can trust a scored Step exam I took "alone" in my apartment is beyond me. Med students are bright individuals, this test is the primary determinant of whether you can pursue entire specialties, and this gives waaaaay too much temptation and opportunity.

You’re high of you think this means they are letting people take it at home...

 

[7331poas]

How the hell would they prevent cheating? I could easily set up a second monitor and pull it off. I could easily had a speaker in my ear that they could not detect.

This is absurd.

 

[Lawpy]

How the hell would they prevent cheating? I could easily set up a second monitor and pull it off. I could easily had a speaker in my ear that they could not detect.

This is absurd.

They're still exploring and it may not happen?

 

[kuzy]

How the hell would they prevent cheating? I could easily set up a second monitor and pull it off. I could easily had a speaker in my ear that they could not detect.

This is absurd.

I think it would have to have some form of webcam monitoring in order to be feasible. And in that case, would anyone really risk getting kicked out of medicine just so they could tape a cheat sheet to their wall?

 

[7331poas]

I think it would have to have some form of webcam monitoring in order to be feasible. And in that case, would anyone really risk getting kicked out of medicine just so they could tape a cheat sheet to their wall?

Even with a webcam, what are they going to do, monitor my eyes? I can have an ear piece too. And yes, people absolutely would risk getting kicked out if they could ensure a 270 derm match. That score is worth 100k (or more).

 

[kuzy]

Even with a webcam, what are they going to do, monitor my eyes? I can have an ear piece too. And yes, people absolutely would risk getting kicked out if they could ensure a 270 derm match. That score is worth 100k (or more).

There are software programs that monitors your eye movements and flags you if something suspicious happens (I think wearing an ear piece would do it too). We’re using respondus lockdown browser for tests at my school which does that. The only thing is I have no idea how’d they actually review the video of all the people that get flagged, but I think just knowing that camera is watching you would deter cheating.

 

[libertyyne]

If all the exams become p/f it doesnt remain as such a high stakes exam at that point it could work.
Webcam proctoring although appropriate for NBME shelves, is probably not appropriate for anything higher stakes.

 

[efle]

Haha I'm sure we'd all be shocked how many people are willing to risk life and limb to get their choice match, let alone risk a cheating scandal. The stakes are (supposed to be) just as high for academic dishonesty on college exams or med school exams yet we see those every year without fail.

Gotta love the people pretending remote proctoring means using spare rooms at med schools. Bad news for you - that's phase 2. I absolutely 100% interpret "phase 3 remote proctoring" in this context to mean at your residence.

 

[ace_inhibitor111]

If it goes virtual, I predict residencies in the next cycle will put much less emphasis on Step 1. Many places were already pivoting away from Step 1 next cycle but the whole prometric situation will greatly accelerate that process.

 

[Lawpy]

If it goes virtual, I predict residencies in the next cycle will put much less emphasis on Step 1. Many places were already pivoting away from Step 1 next cycle but the whole prometric situation will greatly accelerate that process.

I'm a little confused by the timeline with Step 1 P/F, covid and this remote stuff since i thought P/F will somehow happen soon like by 2021

 

[Thesimplelifeofamyloid]

Your title is misleading. It says EXPLORATION. Not implementation like the other 2.

" we cannot commit to it at this time as there is still a great deal of technological and feasibility work to do "

 

[Thesimplelifeofamyloid]

I'm a little confused by the timeline with Step 1 P/F, covid and this remote stuff since i thought P/F will somehow happen soon like by 2021

No later than 2022. They've said this multiple times.

 

[efle]

Your title is misleading. It says EXPLORATION. Not implementation like the other 2.

" we cannot commit to it at this time as there is still a great deal of technological and feasibility work to do "

No later than 2022. They've said this multiple times.

Fair point. There's no doubt in my mind they want to make it happen, because it's the only option that is completely Second Wave proofed and they wouldn't announce it if they didn't expect it to be a real option. But, true, they're couching it in noncommittal language right now, so maybe I'll just pretend it isn't going to happen instead of thinking about all the easy ways that my accomplice and I could set up a second monitor in our apartment

 

[throwaway1000000]

Does cheating happen on NBME shelf exams and school exams? I mean what ways do people cheat
1) pull out their notes during the test? - smaller rooms with more proctors. Proctors are probably pretty cheap. As much as SPs? Even cheaper than SPs? With the tuition we pay per year, shouldn't be too hard. Install cameras in every room. Have a few people monitoring all the rooms on cctv at all times.
2) go to the bathroom during the test? -this is considered very suspicious activity at a prometric center and schools will do the same if someone takes a bathroom break during the test

If step is pushed to at-home testing, ya that is troublesome.

 

[Thesimplelifeofamyloid]

Fair point. There's no doubt in my mind they want to make it happen, because it's the only option that is completely Second Wave proofed and they wouldn't announce it if they didn't expect it to be a real option. But, true, they're couching it in noncommittal language right now, so maybe I'll just pretend it isn't going to happen instead of thinking about all the easy ways that my accomplice and I could set up a second monitor in our apartment

Fair point. There's no doubt in my mind they want to make it happen, because it's the only option that is completely Second Wave proofed and they wouldn't announce it if they didn't expect it to be a real option. But, true, they're couching it in noncommittal language right now, so maybe I'll just pretend it isn't going to happen instead of thinking about all the easy ways that my accomplice and I could set up a second monitor in our apartment

I think if there succesful with the first two, they won't ever even consider it. Schools are just going to have to be flexible with it. They could expand test spots. Expand test hours etc.

 

[efle]

Does cheating happen on NBME shelf exams and school exams?

I could have cheated on any of my school-proctored shelves. Easily. But there's no reason to, because we don't even have Honors cutoffs, and they're a tiny part of the overall grade.

Step 1, on the other hand? Suppose my lifelong goal has been to follow my father's footsteps in neurosurgery, but my practice scores are in the 220s? Or how about if all I really want to do is Pass the damn thing but my practice scores are in the danger zone? Or maybe I'm just an amoral bastard that wants a cushy life and knows I'll never get a Derm spot with my practice scores.

I'm sure plenty of people's fears and aspirations could beat their conscience into submission.

 

[efle]

I think if there succesful with the first two, they won't ever even consider it. Schools are just going to have to be flexible with it. They could expand test spots. Expand test hours etc.

Imagine you're the risk-averse leader and you anticipate a good chance of a second wave. Schools may have to shut down and send all their students home again and Prometric clearly can't be trusted to reliably operate even at 50% capacity.

You really won't even consider it? I would. I'd do more than consider it, I'd go after it aggressively until I could rest easy knowing that we could deploy it if we needed to.

 

[throwaway1000000]

I could have cheated on any of my school-proctored shelves. Easily. But there's no reason to, because we don't even have Honors cutoffs, and they're a tiny part of the overall grade.

Step 1, on the other hand? Suppose my lifelong goal has been to follow my father's footsteps in neurosurgery, but my practice scores are in the 220s? Or how about if all I really want to do is Pass the damn thing but my practice scores are in the danger zone? Or maybe I'm just an amoral bastard that wants a cushy life and knows I'll never get a Derm spot with my practice scores.

I'm sure plenty of people's fears and aspirations could beat their conscience into submission.

How will that cheating happen? Two ways I can see and two common sense, easy fixes:

1) pull out their notes during the test? - smaller rooms with more proctors. Proctors are probably pretty cheap. As much as SPs? Even cheaper than SPs? With the tuition we pay per year, shouldn't be too hard. Install cameras in every room. Have a few people monitoring all the rooms on cctv at all times.
2) go to the bathroom during the test? -this is considered very suspicious activity at a prometric center and schools will do the same if someone takes a bathroom break during the test

And this is what usmle has to say. You will not be taking in your in-house step with the same precautions you take a NBME shelf exam. They will ramp it up. They are setting up testing sites using prometric equipment which are much more fool-proof than my common sense fixes.

"Additionally, we are working to set up a small number of testing sites in medical schools using Prometric equipment"

If there are other ways you can cheat on your school NBME shelf exams than the 2 ways I listed above, post them. Would be happy to think about how to fix it.

 

[efle]

How will that cheating happen? Two ways I can see and two common sense, easy fixes:

1) pull out their notes during the test? - smaller rooms with more proctors. Proctors are probably pretty cheap. As much as SPs? Even cheaper than SPs? With the tuition we pay per year, shouldn't be too hard. Install cameras in every room. Have a few people monitoring all the rooms on cctv at all times.
2) go to the bathroom during the test? -this is considered very suspicious activity at a prometric center and schools will do the same if someone takes a bathroom break during the test

And this is what usmle has to say:

"Additionally, we are working to set up a small number of testing sites in medical schools using Prometric equipment"

You will not be taking in your in-house step with the same precautions you take a NBME shelf exam. They will ramp it up.

As long as they behave like a prometric site, sure, I'm fine with this.

But here's the kicker - they're already supposed to be preventing stuff like wandering eyes or unsupervised bathroom use for our NBMEs. And they aren't, at all. So you can understand my skepticism that they'll run a secure Step.

 

[Thesimplelifeofamyloid]

Imagine you're the risk-averse leader and you anticipate a good chance of a second wave. Schools may have to shut down and send all their students home again and Prometric clearly can't be trusted to reliably operate even at 50% capacity.

You really won't even consider it? I would. I'd do more than consider it, I'd go after it aggressively until I could rest easy knowing that we could deploy it if we needed to.

In a second wave, there are several different things they can do prior to that. That's why I think they're going to do some aggressive testing during the summer months[/QUOTE]

 

[Hopeful101]

I think of it as...if they do make a remote step, what percent of medical students would get expelled as a direct result of it (that wouldn't have otherwise)? I have no doubt there's a huge chunk of people who think they're smarter than the system.

 

[throwaway1000000]

As long as they behave like a prometric site, sure, I'm fine with this.

But here's the kicker - they're already supposed to be preventing stuff like wandering eyes or unsupervised bathroom use for our NBMEs. And they aren't, at all. So you can understand my skepticism that they'll run a secure Step.

I understand your skepticism but med schools have enormous money and resources to ramp security up. USMLE is already saying they are testing out medical school using prometric equipment. This is not exactly rocket science. Just following some already established protocols and implementing them in medical schools.

If something wrong does happen, then yes, that will need to be seriously looked at.

 

[efle]

I think of it as...if they do make a remote step, what percent of medical students would get expelled as a direct result of it (that wouldn't have otherwise)? I have no doubt there's a huge chunk of people who think they're smarter than the system.

If I was scoring dangerously low on practice tests, I would certainly bet on my ability to outsmart their webcam software >> risking it.

 

[Hopeful101]

I think of it as...if they do make a remote step, what percent of medical students would get expelled as a direct result of it (that wouldn't have otherwise)?

If I was scoring dangerously low on practice tests, I would certainly bet on my ability to outsmart their webcam software >> risking it.

And the fail rate for the USMLE is like 20% for everyone including carribean isn't it? I bet a lot of those guys would cheat. Who wouldn't if you had 200k on the line and no prospects of matching If you mess up. The reward is just too high. Not to mention the massive amount of people who hate medical school anyways. Wonder how the 60% dissatisfaction rate would factor in...

 

[efle]

There are a lot of creative ways to cheat. You can have an iPhone in front of your computer screen with First Aid on it. Your eyes would look like they’re reading the screen so the tracking software won’t help. You can have a friend come from behind and swipe the different pages so they won’t be detected by the onscreen camera. Not to mention, there is so much variation in people’s internet/camera quality etc. that will complicate the issue and can get innocent people in trouble or allow cheaters to get away. What would you do in case of connection or hardware issues during the test?

Doesn’t seem practical unless the NBME finds some magical solution, but I doubt it based on what I’m seeing at this point.

Dude I can think of extremely easy and versatile options with an accomplice in about 10 seconds.

Put my SO within earshot but offscreen with their laptop. Talk to myself a bunch during the test "Shoot, was it [Drug X] or [Drug Y] that can cause kidney damage?" "God, I remember that table of paraneoplastic syndroms, but was it lung or pancreas cancer that causes [specific one]" Then, have a basic signal system for them to tell you.

Unless I slip up and turn way off screen to look at something, I'm just going to look like an average joe with a nervous habit of vocalizing my thoughts as I test.

Now if I treated this cheating endeavor like a full time job for a week, researched everything I could about the proctoring software and whatnot? I could probably get away with a shocking amount

 

[BLmd2008]

What will they do for USMLE STEP 3??

 

[Pluto98]

Dude I can think of extremely easy and versatile options with an accomplice in about 10 seconds.

Put my SO within earshot but offscreen with their laptop. Talk to myself a bunch during the test "Shoot, was it [Drug X] or [Drug Y] that can cause kidney damage?" "God, I remember that table of paraneoplastic syndroms, but was it lung or pancreas cancer that causes [specific one]" Then, have a basic signal system for them to tell you.

Unless I slip up and turn way off screen to look at something, I'm just going to look like an average joe with a nervous habit of vocalizing my thoughts as I test.

Now if I treated this cheating endeavor like a full time job for a week, researched everything I could about the proctoring software and whatnot? I could probably get away with a shocking amount

Thats actually such a bad way to cheat lol. No one acts like that.

 

[Dantes]

Dude I can think of extremely easy and versatile options with an accomplice in about 10 seconds.

Put my SO within earshot but offscreen with their laptop. Talk to myself a bunch during the test "Shoot, was it [Drug X] or [Drug Y] that can cause kidney damage?" "God, I remember that table of paraneoplastic syndroms, but was it lung or pancreas cancer that causes [specific one]" Then, have a basic signal system for them to tell you.

Unless I slip up and turn way off screen to look at something, I'm just going to look like an average joe with a nervous habit of vocalizing my thoughts as I test.

Now if I treated this cheating endeavor like a full time job for a week, researched everything I could about the proctoring software and whatnot? I could probably get away with a shocking amount

Uhh don't you think talking that much would be suspicious...that would raise some red flags for me lol

I don't think remote proctoring is a good idea, but I don't know how easy it would be to effectively cheat. Time per question alone makes it difficult imo. I also hear proctoring software is pretty advanced nowadays.

 

[Dr.Bruh]

Dude I can think of extremely easy and versatile options with an accomplice in about 10 seconds.

Put my SO within earshot but offscreen with their laptop. Talk to myself a bunch during the test "Shoot, was it [Drug X] or [Drug Y] that can cause kidney damage?" "God, I remember that table of paraneoplastic syndroms, but was it lung or pancreas cancer that causes [specific one]" Then, have a basic signal system for them to tell you.

Unless I slip up and turn way off screen to look at something, I'm just going to look like an average joe with a nervous habit of vocalizing my thoughts as I test.

Now if I treated this cheating endeavor like a full time job for a week, researched everything I could about the proctoring software and whatnot? I could probably get away with a shocking amount

What kind of strange gunner status students do you have at your school that would ever make any of that seem remotely possible and not suspicious?? lol

My school did remote proctoring for their last couple preclinical exams with the software that tracks your eye movement and literally had someone (a live person) watching the whole time. You even had to walk around the entire room with your camera before hand and no breaks were allowed.
No significant %age of med students are risking their careers like that. And no school is going to risk losing accrediation over turning a blind eye to cheating. My DO gave a kid a 0% on an exam bc his phone went off in his pocket during and exam REVIEW (not even during the test). Instant fail, and DO schools arguable have more incentive to help their students to get higher board scores.

 

[Hopeful101]

What kind of strange gunner status students do you have at your school that would ever make any of that seem remotely possible and not suspicious?? lol

My school did remote proctoring for their last couple preclinical exams with the software that tracks your eye movement and literally had someone (a live person) watching the whole time. You even had to walk around the entire room with your camera before hand and no breaks were allowed.
No significant %age of med students are risking their careers like that. And no school is going to risk losing accrediation over turning a blind eye to cheating. My DO gave a kid a 0% on an exam bc his phone went off in his pocket during and exam REVIEW (not even during the test). Instant fail, and DO schools arguable have more incentive to help their students to get higher board scores.

that's messed up. Yet another reason to hate medical School. Hello remediation exam! Bunch of jerks.

 

[<L>]

The NBME is quite fanatic about exam security, even on expired exam questions that get used in shelf exams.

Expanding exams to be given at schools is feasible, remote exam in your home, Starbucks, or in Central Park is not.

At my school, I can envision quite a few rooms that could be used for the exam, even with social distancing. Going to play hell on us Faculty to proctor the damn things, though.

Yeah, ignoring the gigantic moneypit that is CS, the NBME does what they do quite well. I have doubts they go forward with any plan that doesn't have a lot of security built in.

 

[sharkbyte]

What kind of strange gunner status students do you have at your school that would ever make any of that seem remotely possible and not suspicious?? lol

My school did remote proctoring for their last couple preclinical exams with the software that tracks your eye movement and literally had someone (a live person) watching the whole time. You even had to walk around the entire room with your camera before hand and no breaks were allowed.
No significant %age of med students are risking their careers like that. And no school is going to risk losing accrediation over turning a blind eye to cheating. My DO gave a kid a 0% on an exam bc his phone went off in his pocket during and exam REVIEW (not even during the test). Instant fail, and DO schools arguable have more incentive to help their students to get higher board scores.

What is the rationale for something like this? Mind-boggling

 

[7331poas]

Thats actually such a bad way to cheat lol. No one acts like that.

I mean the easier way would be to set up your own webcam in your apartment out of the frame of the webcam procter. Then have an ear piece. That way a friend could just voice in the answers. Hell, they could even just yell the answer from your living room if they wanted.

 

[kuzy]

I mean the easier way would be to set up your own webcam in your apartment out of the frame of the webcam procter. Then have an ear piece. That way a friend could just voice in the answers. Hell, they could even just yell the answer from your living room if they wanted.

You can't wear an earpiece or have a friend yell answers when there's a webcam watching you...

Also for all these hypothetical scenarios, does anyone actually have a friend that would help them cheat so brazenly on a test as important as this to the point that they're giving you answers from another room? Maybe I'm just too naive

 

[kuzy]

What kind of strange gunner status students do you have at your school that would ever make any of that seem remotely possible and not suspicious?? lol

My school did remote proctoring for their last couple preclinical exams with the software that tracks your eye movement and literally had someone (a live person) watching the whole time. You even had to walk around the entire room with your camera before hand and no breaks were allowed.
No significant %age of med students are risking their careers like that. And no school is going to risk losing accrediation over turning a blind eye to cheating. My DO gave a kid a 0% on an exam bc his phone went off in his pocket during and exam REVIEW (not even during the test). Instant fail, and DO schools arguable have more incentive to help their students to get higher board scores.

Wow! That's...excessive 😳 My sister walked in the room the other day in the middle of an actual test so I would have been toast at your school.

 

[efle]

Guys if you think talking to yourself is an outrageous blatant attempt, then yall havent seen how ridiculous the dumb stuff is that people actually try. That's mastermind level next to what people were getting caught doing with AP and college exams just in my own experience.

Heres a different take then - small wireless mouse in my pocket/lap and a pdf of First Aid on my friend's laptop within my field of view.

Or, I think mentioned above, set up a hidden cam that can see your screen while your 250 bro tells you what they'd answer in your earpiece.

 

[Dr.Bruh]

I mean the easier way would be to set up your own webcam in your apartment out of the frame of the webcam procter. Then have an ear piece. That way a friend could just voice in the answers. Hell, they could even just yell the answer from your living room if they wanted.

What no? haha who would do any of this? An ear piece?

Guys if you think talking to yourself is an outrageous blatant attempt, then yall havent seen how ridiculous the dumb stuff is that people actually try. That's mastermind level next to what people were getting caught doing with AP and college exams just in my own experience.

Heres a different take then - small wireless mouse in my pocket/lap and a pdf of First Aid on my friend's laptop within my field of view.

Or, I think mentioned above, set up a hidden cam that can see your screen while your 250 bro tells you what they'd answer in your earpiece.

Every example you give sounds even more ridiculous than the last lol.

 

[7331poas]

You can't wear an earpiece or have a friend yell answers when there's a webcam watching you...

Also for all these hypothetical scenarios, does anyone actually have a friend that would help them cheat so brazenly on a test as important as this to the point that they're giving you answers from another room? Maybe I'm just too naive

A webcam is not going to be able to see an ear piece if it is small. Also, a webcam won't know if a friend is yelling answers to you since a webcam does not have sound input.

 

[7331poas]

Every example you give sounds even more ridiculous than the last lol.

Those examples only sound ridiculous because you wouldn't do it. But if I really really wanted to be a neurosurgeon, there are tons of ways to get the job done.

 

[Matthew9Thirtyfive]

Those examples only sound ridiculous because you wouldn't do it. But if I really really wanted to be a neurosurgeon, there are tons of ways to get the job done.

And that’s why remote proctoring is a terrible idea. Because there are unscrupulous people who would do this ****.

 

[CyrusHabs7695]

Those examples only sound ridiculous because you wouldn't do it. But if I really really wanted to be a neurosurgeon, there are tons of ways to get the job done.

not disagreeing with you, but if someone cant get a 240 on step 1 without cheating, they definitely should not operating on people's brains

 

[Mass Effect]

I can understand why people are concerned those scoring 220s on practice tests would cheat to score 270 and a derm match. I don't care about that at all, frankly.

What I'm way more concerned about is those scoring 160s on practice tests cheating to score 220s.

Step 1 tests minimal competency in the basic sciences. The students who can't reach that level have every incentive to cheat.