USMLE Step 1 -- Pass / Fail Starting Jan 2022

[ohmanwaddup]

At most MD programs, and for most non competitive residencies, over 90% end up passing/ matching. I don't think this will impact things too much, but it will take off a lot of the stress. They will probably just treat everyone as if they got a 230, which is sufficient to get into most non competitive specialties.

Why would they ever assume everyone is average?

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[DNC127]

And what about an average DO student who wants to do IM and goes to an old DO school (20+ years)? Surely i should still be able to match IM in a desired location, yes?

Probably, but your ceiling is lower than before this happened

 

[statlin98]

The question for class of 21/22 is whether this will change residency program evaluations prior to the implemented score change. Knowing this change is coming, for the next two classes are PD’s going to put less stock into step1 scores?

I suspect no, for the most part. They are likely set in their ways and will use scores until they can’t.

 

[BBQisgood4u]

Yikes good luck fellow class of 2024 and beyond! Gotta roll with the punches and adapt to whatever life throws at you.

So the game plan is to crush Step 2 and network like crazy?

 

[harrislakers123]

There are many issues with USMLE going pass fail for all DO students and mid/low tier MDs going into ANY field, especially competitive specialties and programs.

Random thoughts/predictions I have

- Every DO student effectively has to take USMLE Step 2 CK to maximize their residency prospects.

- DO and mid/low tier MD students have little to no school name brand, limited access to prestigious LORs, limited access to large academic departments + research. They must find a way to overcome these hurdles.

- Personal connections will play a much larger role in getting key audition rotations, interviews and matching. Prestigious personal connections are astronomically more difficult to get at DO or mid/low tier MD schools.

- The great equalizer, the USMLE step 1 score, was the opportunity for students at DO and mid/low tier MD schools to demonstrate their equivalency and/or superiority to students at top MD schools. That opportunity to overcome your school's lack of prestige/pedigree is now gone. It will be harder to get audition rotations and interviews from smaller schools.

- USMLE Step 1 scores come out after second year, giving students a year to game plan their audition rotations, LORs, research projects, and target programs based on their competitiveness. That is now gone, as most students will receive their Step 2 CK score after third year. Students lives will be more uncertain now and they will have little to no time to create a plan of action to maximize their chances to match to their dream programs. What if you score a 235-240 on Step 2 CK but have already set up 4 aways in Derm, started 4 research projects, etc? You will now have only 1-2 months to create a new game plan on where to do audition rotations, whether or not you want to apply to a back up, take a year off for research, etc.

- Objective metrics are important and have a place in education. While the USMLE step 1 scores were definitely overemphasized, the solution should not have been to eliminate the last remaining objective metric programs have, but rather to create additional standardized objective metrics through which programs could assess candidates in addition to STEP scores.

- USMLE Step 1 mania will now become Step 2 mania, I predict that schools will shorten preclinical education, start clinicals in second year, move Step 2 CK to beginning of third year and focus more overall on content tested on Step 2 CK. Hopefully clinical rotation grading, preclinical grading, Deans letters, and LORs become more objective and standardized so that programs have some type of metrics beyond just the Step 2 CK score to gauge academic/clinical acumen of applicants.

- This adds uncertainty for nearly all DO and mid/low tier MD students, making mental health more complicated moving forward. Now students will likely obsess over intangibles and subjective things like networking, LORs, research connections, etc. (again all of which disproportionately benefit elite MD schools/students). Students can no longer rely on themselves to perform well enough on STEP 1 to enhance their opportunities.

- The MCAT is now an extremely important exam for the future of a student. In the absence of LCME/COCA creating new objective academic metrics for program directors, medical schools will become more like law schools where prestige is an extremely important factor in determining where you end up post graduation.

In short, USMLE pass/fail solves little to nothing, complicating matters for students at smaller medical schools while shifting most of the problem to USMLE Step 2 CK

Moving forward

If you are running a DO or mid/low tier MD school, I would change curriculum so that preclinical education is compacted into year one, clinicals begin second year, and everyone takes USMLE Step 2 CK end of second year. I would also invest heavily in GME creation in both specialty and primary care , wet lab creation for research, research funding, creating partnerships/contracts with local universities to enhance research access.

If I was LCME/COCA I would develop standards and elements that create standardized objective metrics (standardized grading for preclincial and clinical years across all schools in country, standardized Deans letters, etc.) so that a student's competitiveness is based on a greater number of objective variables instead of just one (Step 2 CK).

 

[Chibucks15]

Does anyone have actual data that the sky is falling? Or no

 

[dohopeful13]

And what about an average DO student who wants to do IM and goes to an old DO school (20+ years)? Surely i should still be able to match IM in a desired location, yes?

No one knows man. These are uncharted waters. I've learned to just accept the uncertainty at this point and worry about things I can control.

 

[DNC127]

Ironically, this hurts people wanting ER, anesthesia, OB, rads, general surgery, academic IM, the most.

Ortho / ENT will be more affected by the school expansion than this because you essentially only had DO places as you options so this doesn't really effect DO ortho / ENT at all but it could create more applicants for the pool and when combined with school expansion will be brutal.

Derm, plastics, urology, optho etc will only be matched by a select few with the balls to venture out and go on a limb. Due to there hardly being any DO programs for these.


Just goes to show: going forward ANY subspecialty match or match at a University program by a DO is highly impressive. Will be interesting to see how this plays out.

 

[Magyarzorag]

I think everything is moving towards an "equalizing" mode right now, probably as a result of the everybody gets a trophy movement. I wouldn't be surprised if 20 years from now, academic grades are banned, and the only grades on transcripts are Pass and Fail, from Elementary to Graduate school

 

[cpr231]

So what residencies are still realistic for DOs?

 

[deleted859689]

Guess I’m doing IM now

 

[deleted936470]

good i'm glad, more time for wellness lectures

 

[EMDoc22]

Will the class of 2022 still have a numerical score reported? We will be applying in September 2021 so if this doesn’t go into effect until January 2022 then we should still have a numerical score associated with our apps right?

 

[Azmkv]

will this affect 2023..? I mean we technically should get score by 2021. I feel like there could be a lot of law suits if they take away the scores that they already gave us. Especially for those who scored high.

 

[radkat101]

Ironically, this hurts people wanting ER, anesthesia, OB, rads, general surgery, academic IM, the most.

Ortho / ENT will be more affected by the school expansion than this because you essentially only had DO places as you options so this doesn't really effect DO ortho / ENT at all but it could create more applicants for the pool and when combined with school expansion will be brutal.

Derm, plastics, urology, optho etc will only be matched by a select few with the balls to venture out and go on a limb. Due to there hardly being any DO programs for these.


Just goes to show: going forward ANY subspecialty match or match at a University program by a DO is highly impressive. Will be interesting to see how this plays out.

Actually, EM applicants will probably be least affected since SLOEs are given so much weight already. Perhaps more specialties will become more like EM in this regard.

 

[deleted831695]

I wonder how it'll effect Classes of 2020-2022 though when it comes time for fellowships. Will the Step 1 scores just be converted to P at that time?

 

[giguerex35]

Ironically, this hurts people wanting ER, anesthesia, OB, rads, general surgery, academic IM, the most.

Ortho / ENT will be more affected by the school expansion than this because you essentially only had DO places as you options so this doesn't really effect DO ortho / ENT at all but it could create more applicants for the pool and when combined with school expansion will be brutal.

Derm, plastics, urology, optho etc will only be matched by a select few with the balls to venture out and go on a limb. Due to there hardly being any DO programs for these.


Just goes to show: going forward ANY subspecialty match or match at a University program by a DO is highly impressive. Will be interesting to see how this plays out.

what is your rationale for why rads, ER, OB, gen surg etc will be affected the most

 

[EMDoc22]

will this affect 2023..? I mean we technically should get score by 2021. I feel like there could be a lot of law suits if they take away the scores that they already gave us. Especially for those who scored high.

When I get a numerical score after my exam this summer, you better be sure residencies will be seeing that score even if I have to report it myself. I will be printing off dozens of copies of my score report and storing them in a safe place.

 

[Dr. Anonymouss]

MD programs won't give a crap about your COMLEX score.

Well what about all the prior AOA residency programs. I imagine this will give DO students an even greater leg up over any MD applicants applying for these positions since DO students will have a numerical score while MD students will only have a pass/fail score.

 

[CoomassieBlue57]

how will I ever stand out compared to other DO/MD students?

Personal statement
Volunteering
Extra curricular activities
Letters of recommendation
Dean's letter
Awards
Research
Presentations
Patient experience
Audition rotations/Sub I's

Out of 15+ interviews, I was asked one time about my board scores. The list above is what I was asked about. I tailored my application specifically to the field I applied to, and received numerous positive comments about my application package.

 

[Dr.Bruh]

Ironically, this hurts people wanting ER, anesthesia, OB, rads, general surgery, academic IM, the most.

Ortho / ENT will be more affected by the school expansion than this because you essentially only had DO places as you options so this doesn't really effect DO ortho / ENT at all but it could create more applicants for the pool and when combined with school expansion will be brutal.

Derm, plastics, urology, optho etc will only be matched by a select few with the balls to venture out and go on a limb. Due to there hardly being any DO programs for these.


Just goes to show: going forward ANY subspecialty match or match at a University program by a DO is highly impressive. Will be interesting to see how this plays out.

ER will almost certainly be one of the least affected for DOs (other specialties I agree with you on). ER has already weighted step 2 equal to or even greater than step 1 for a while now. Step 2 will still have a number score for DOs. Also step 1 cutoffs for ER programs is low for most programs (200-210) and even many programs with no cutoffs. Also there were nearly 60 AOA EM programs that converted for the merger and a decent amount of community EM programs that are fine with comlex only. Also for ER it’s all about SLOE and audition. Basically the vast majority of the most important aspects to matching EM as a DO are unaffected by this. I do agree the change screws DOs I just wanted to add a more honest perspective to the ER aspect for any premeds who come across this.

 

[Tinyhandz]

Wow. And I am class of 2024. I didn't expect this actually passing. Guess eventually school will determine everything, like law school. Hopefully I can still land psychiatry.

 

[Schwifty]

So if the class of 2023 won't have scores reported should just quit doing Zanki now?

 

[Epilepsy365]

good i'm glad, more time for wellness lectures

Wrong. 5 more hrs per week in OMM for you.

 

[DNC127]

what is your rationale for why rads, ER, OB, gen surg etc will be affected the most

Because matching into good MD programs in these specialties was heavily reliant on being above a certain score (for GS 230
Is the cutoff) if you have below that score your outcomes deminish.

Now, DOs will all be viewed the same.

You can still match these specialties I’m sure, but the quality and ceiling will be lower than before in my opinion

 

[deleted831695]

I hope this leads to a ranking list/more apparent stratification among DO schools. With Step 1 taken out of the equation and if school brand name becomes more significant, I hope the state schools and established schools with good GMEs will promote that.

 

[shadowlightfox]

So what residencies are still realistic for DOs?

Primary care

 

[cantankerous]

Personal statement
Volunteering
Extra curricular activities
Letters of recommendation
Dean's letter
Awards
Research
Presentations
Patient experience
Audition rotations/Sub I's

Out of 15+ interviews, I was asked one time about my board scores. The list above is what I was asked about. I tailored my application specifically to the field I applied to, and received numerous positive comments about my application package.

That's all good and great for you as someone who has already made it out, but when a program director gets 1000s of applications, they now have less to filter out before looking at applications individually, which may mean a straight DO filter.

 

[shadowlightfox]

I hope this leads to a ranking list/more apparent stratification among DO schools. With Step 1 taken out of the equation and if school brand name becomes more significant, I hope the state schools and established schools with good GMEs will promote that.

I'm not sure if that's gonna happen. At least among the DO schools, this will make it easy for them to push the agenda of driving their students into primary care.

 

[JimBone905]

"The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome. A numeric score will continue to be reported for Step 2 Clinical Knowledge (CK) and Step 3. Step 2 Clinical Skills (CS) will continue to be reported as Pass/Fail. This policy will take effect no earlier than January 1, 2022 with further details to follow later this year."

The bolded should be noted. It does NOT state that on 1/1/22 step 1 will from that point on be pass/fail, but rather that 1/1/22 is the earliest point at which step 1 can be changed to pass/fail. In other words, they could refrain from actually implementing this policy change for many, many years.

Also who are they changing score reporting to, us or ERAS? its still not clear to me if we take the usmle before 2022 that it will show up as a 3 digit score through ERAS after 2022

 

[shadowlightfox]

"The USMLE program will change score reporting for Step 1 from a three-digit numeric score to reporting only a pass/fail outcome. A numeric score will continue to be reported for Step 2 Clinical Knowledge (CK) and Step 3. Step 2 Clinical Skills (CS) will continue to be reported as Pass/Fail. This policy will take effect no earlier than January 1, 2022 with further details to follow later this year."

The bolded should be noted. It does NOT state that on 1/1/22 step 1 will from that point on be pass/fail, but rather that 1/1/22 is the earliest point at which step 1 can be changed to pass/fail. In other words, they could refrain from actually implementing this policy change for many, many years.

That doesn't change the underlying issue. Delaying the implementation just means delaying the extra problems it will cause.

The issue was about such a change existing in the first place.

 

[BorntobeDO?]

I have re-thought things thanks to @Dr. Death . This is terrible for DOs.

The studs will maybe make it out? But the bottom 3 quartiles ceiling just lowered substantially.

Avoid DO if you want something competitive or an academic career. this was already sort of true but should be especially emphasized now.

DO school expansion makes this even worse of a problem.

Unless you get into osu-com, msu-com, tcom, pcom, ohio-U, rowan I would avoid DO an re-apply or just know and accept your limits. Schools like osu with protected residency spots in PC and specialties are the only decent move in regards to attending a DO school.

Having Step 2 ck doesn't help because you get your score back around the same time residency apps go out soits too risky to even rely on this helping as I foresee most MD students taking it after ERAS apps go out in order to prevent "blowing it".

sucks to suck guys

This is even more devastating for IMGs who have to get 250+ to even get a primary care spot.

Yep exactly right on step II. It is only minimally helpful cause of when it is taken and the fact that MDs take it even later.

I disagree on this being a bad thing. This is the smack down COCA deserved with their constant expansion. The schools will either improve or die.

 

[DNC127]

Yep exactly right on step II. It is only minimally helpful cause of when it is taken and the fact that MDs take it even later.

I disagree on this being a bad thing. This is the smack down COCA deserved with their constant expansion. The schools will either improve or die.

Very important point. This WILL regulate coca because there will be a large portion of DOs at the crap schools not finding a residency spot

 

[BorntobeDO?]

Yikes good luck fellow class of 2024 and beyond! Gotta roll with the punches and adapt to whatever life throws at you.

So the game plan is to crush Step 2 and network like crazy?

Network is right, away rotations are now mandatory. Crushing Step 2 was always part of the plan, but it comes out so late I could see it being very unreliable for competitive specialties. I think that if you want something like surgery or ortho, you have to do it the old way: with auditions at mostly former DO programs.

I hope this forces our schools to open more of the competitive specialties residencies. And I really hope their apps get cut by half. The Product needs to be improved.

 

[Cath Up]

Yep exactly right on step II. It is only minimally helpful cause of when it is taken and the fact that MDs take it even later.

I disagree on this being a bad thing. This is the smack down COCA deserved with their constant expansion. The schools will either improve or die.

RIP RPCCOM, WY

 

[Startingover123]

Network is right, away rotations are now mandatory. Crushing Step 2 was always part of the plan, but it comes out so late I could see it being very unreliable for competitive specialties. I think that if you want something like surgery or ortho, you have to do it the old way: with auditions at mostly former DO programs.


I hope this forces our schools to open more of the competitive specialties residencies. And I really hope their apps get cut by half. The Product needs to be improved.

Do you think admission stats to lower tier DO schools will decrease the next few years?

 

[BorntobeDO?]

Do you think admission stats to lower tier DO schools will decrease the next few years?

Yes I do unfortunately. Anyone who can avoid the bias will try to, especially next cycle.

 

[BorntobeDO?]

RIP RPCCOM, WY

Lol, this is perfect for RPCCOM, we never allowed students to take step anyway.

 

[Neopolymath]

You can thank your ***** upperclassmen for whining about this exam "stressing them out" like a bunch of babies. Ironically, I only heard people who did awful on it and planned on FM from day one wanting it pass/fail. It was effectively pass/fail for them from the get go so why did they campaign so hard for this to effect everyone else. It's no surprise given the type of people in med school these days.

Apply MD only your first cycle, premeds. Do not apply to any DO first cycle if you have a chance of MD acceptance. You can apply to the 90 DO schools the second year if you don't get in.

 

[Tinyhandz]

I am class of 2024 LOL. Just in time to be hit with this bomb. Guess, it's not too bad as I wanted primary care, well psychiatry. I assume the change will make the selection more regional than even before.

 

[ZezKaiEll]

Wow. What an absolutely monumental change. I had heard rumblings, but didn't believe them for whatever reason.

So here we are. All things must adapt or fail. What's done is done. The wisest future DO students will be the ones who most effectively adapt to this change. PDs still need to stratify applicants. Without the previously key Step 1 score, the focus shifts to the remaining things. For the competitive applications, research is at a higher premium. Connections and auditions become more helpful. Extra-curriculars become more prominent on the app. Interviews become a greater opportunity to make an impression. And of course, Step 2 CK is the new sheriff in town. Focus on the things you can actually change.

I'm not going to lie. Step 1 made me. I prioritized scoring well above all and swung that into the field I wanted, in a university/city I love. That style is for dinosaurs and isn't going to cut it anymore. No more locking yourself in your room and drilling purine salvage pathway minutiae in First Aid. Go out in the world and focus on the things that still can set you apart.

As for Step 2 CK, it now doubles up in importance and unfortunately, pressure. Step 1 is quite the weed out tool when it comes to specialty decision. Most people take Step 2 at the point that they have already invested in a specialty choice. I'm already cringing at the thought of someone spending 3+ years expecting to go into a competitive field (auditions and all) before CK crushes their dreams right as ERAS season starts. Outside of UWorld, comprehensive resources for Step 2 are quite scarce. Most either overshoot or undershoot the knowledge level of the exam, while the number of potential topics increases drastically. All of these companies churning out Step 1 resources would do well to focus on filling the current deficiency for quality CK oriented books/vids.

As far as the effect on DO applicants, too many are focusing on MDs taking our spots. What about DO vs. DO? That is where a lot of the true competition lies for many DO students, even those at traditionally MD programs. DOs will be tougher to compare to each other without Step 1 scores. Also keep in mind, this change will not only effect us. IMGs/FMGs face even more uncertainty. Even well-to-do MD students who would have used their stellar scores to compete with other prestigious MD grads may lose something in this new system. Don't forget, Step 1 has a massive influence on MD students' specialty choices as well. How many of them will tailor an app towards a field over their head w/o the previous Step 1 reality check to straighten them out? The number of spots available in those fields is not changing here. This could have unpredictable ripple effects that trickle down to the rest of us. Who can predict how the specifics of this plays out?

I'm not sure what this new world will be like, and it's not my problem anyhow. But for those who this will effect, I'd reiterate that you need to evolve. A lot of the traditional advice for DO students matching traditionally MD spots is about to be much less relevant. I do believe that it will be tougher for certain DO student populations as medical school name recognition likely will be more prominent in the future. I don't however, believe that most DO grads end up competing directly with US MDs for spots.

Focus on the things on your application you can still change. There are fewer of them now... for everyone.

 

[BorntobeDO?]

You can thank your ***** upperclassmen for whining about this exam "stressing them out" like a bunch of babies. Ironically, I only heard people who did awful on it and planned on FM from day one wanting it pass/fail. It was effectively pass/fail for them from the get go so why did they campaign so hard for this to effect everyone else. It's no surprise given the type of people in med school these days.

Apply MD only your first cycle, premeds. Do not apply to any DO first cycle if you have a chance of MD acceptance. You can apply to the 90 DO schools the second year if you don't get in.

Only 90? I think that number may be a bit conservative.

 

[cpr231]

So if you're a DO, your options are basically family medicine, internal medicine or pediatrics now?

 

[Tinyhandz]

DO’s already have a much worse clinical rotations than MD’s do. This will make things much much worse

 

[BorntobeDO?]

Lol, this is perfect for RPCCOM, we never allowed students to take step anyway.

I should follow up this. I have said in the past that RPCCOM has already been founded many times in the DO world. Well the ranks of RPCCOMs has expanded substantially with this change.

So if you're a DO, you options are basically family medicine, internal medicine or pediatrics now?

FM, community IM, Path, and low tier peds till that gets competitive. ER will still be open due to SLOEs but I expect the gunners to pivot towards EM without the opportunity to realistically do the most competitive specialties. I think those 5 will make up over 90% of most DO schools lists.

 

[shaha14310]

I should follow up this. I have said in the past that RPCCOM has already been founded many times in the DO world. Well the ranks of RPCCOMs has expanded substantially with this change.

FM, community IM, Path, and low tier peds till that gets competitive. ER will still be open due to SLOEs but I expect the gunners to pivot towards EM without the opportunity to realistically do the most competitive specialties. I think those 4 will make up over 90% of most DO schools lists.

What about psych?

 

[shadowlightfox]

What about psych?

Doesn't sound good. Psych is starting to be increasing competitive as is. This news would only make this worse.

 

[BorntobeDO?]

What about psych?

Psych isn’t as big about scores, but sadly they do care about prestige. I think your only shot in the future is by audition, and I don’t like the outlook. Psych has already increased greatly in competitiveness, and I don’t expect this to make it easier.

 

[Tinyhandz]

Psych is still not that competitive, according to the 2019 match list. I hope I get in though. I'll apply to community programs when the time comes.

 

[cpr231]

Wow, psych isn't even feasible anymore? That's depressing