USMLE Step 1 to be Pass/Fail

[Tipsy McStagger]

Home | United States Medical Licensing Examination

www.usmle.org

Starting 2022 the venerable step 1 will no longer be reported as a 3 digit numerical score.


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[RustedFox]

Wow.
Hate this.

 

[EctopicFetus]

participation trophy time

 

[ShockIndex]

Step 2 CK will just become all that more important...along with various other traits that have nothing to do with ability or achievements.

 

[deleted941485]

Everyone is a winner...here in the safe space of medical school.

 

[Dr Mantis Toboggan]

Lame.

Home | United States Medical Licensing Examination

www.usmle.org

Starting 2022 the venerable step 1 will no longer be reported as a 3 digit numerical score.


Sent from my iPhone using SDN

 

[Porfirio]

What will all those study companies do now? Those MDs might have to go back to practicing medicine and seeing patients...

 

[Tipsy McStagger]

Step 2 CK will just become all that more important...along with various other traits that have nothing to do with ability or achievements.

Right? I mean, step 1 was a bummer but it also was the great equalizer (despite, I suspect, not accurately predicting who will be a good physician or not). Regardless, it’s how you got noticed if you came from a less reputable school. Now I wonder if school name will matter above all else, which is advantageous to a few, and potentially catastrophic for others.

So now what? Is the hard working kid from small state school with the 270 going to be overlooked in lieu of someone from an Ivy who barely squeaked by? Or, like you said is all of this just going to be replaced by step 2?


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[HoosierdaddyO]

Who is the bonehead that got paid millions of dollars to come up with this new change??? I would inundate USMLE with calls and emails that this is a silly change. It waters down the medical process. It doesn’t benefit anyone other than the Millennial Med student who can’t have mommy and daddy buy him a good score!!!

Just my 2 cents

 

[longtimelurker2015]

To piggy back on some of the comments above:

Appreciate the sentiment behind the change, but will have unintended consequences, I feel. Will result in further consolidation of medical training, e.g. I feel med students at Ivy League or top 10 or however one defines reputation, just saying, at top programs/institutions will take even more just from their own, and vive-versa regionally/system-wise, med students from one institution will tend to stick there and get preferential treatment from their home program/hospital even more, since otherwise how can you as PD differentiate between different applicants from all over the country?

Will put exponentially more pressure on students to perform well on STEP2CK (no more, if you "bombed" or did worse than you wanted on STEP1, can make up for it by an above-average performance on STEP2), which if you traditionally still take it at your school at the end of third year (that said, lots of schools are moving to an accelerated preclinical curriculum and more clinical time, so this may accelerate a trend of taking STEP2CK earlier, I guess?), then how the hell do you plan for which specialty to apply into? You find out your score by beginning of 4th year, then you scramble for away rotations (pretty much a requirement for specialties like ortho), so that becomes even more of an application s*itshow than it already is.

Along with the fact that most every school is already Pass/Fail preclinical, lots of schools have moved to a no-ranking or loose ranking (buckets of quartiles) criteria, whereby at many institutions, that ranking is not actually determined just solely based on preclinical grades (since, well, there's no more grades), but an amalgamation of "professionalism", interpersonal skills, "peer reviews", etc., which again, how do you objectify and grade those?

And of course, we know third year grades / MSPE's are inherently subjective and vary widely between institutions (some schools, everybody is described as the next Nobel Prize laureate, but on the other end of the spectrum, I definitely have friends at DO schools where the written comments aren't filtered and are so brutally honest as to being cruel/unnecessary mean/personal and not constructive), so those grades really don't mean much either and are hard to impossible to compare school to school. And LOR's are also subjective data, and generally effusive of praise.

So... If you don't have any objective data, then you go back to an old boys system of who do you know, "networking", calling, further consolidation of training...

Not being pessimistic or cynical here, but just genuinely unsure how that can help students and employers down the line, and will just make the physician workforce more homogeneous rather than diverse and reflective of the patient population we serve.

Or, another possibility, if you need to differentiate yourself, then research becomes mega-important, students in more competitive specialities need to do an additional research year, training gets even longer...

And, finally, as a student I would find that entirely EVEN more stressful, since you're going into application season with even less data to figure out what's in and out of reach specialty-wise, which programs to apply to, and murkier/less reliable advising from your school, since entering uncharted territory.

Or, as a result, all schools realizing the above, and wanting to differentiate themselves, return to a graded 4-year system, and more emphasis on SHELF exams and ALL exams throughout the curriculum, and the end result is more stress/more focus on grades/going backwards as well...

 

[gamerEMdoc]

Silly move IMO, in an effort to compromise between the "boards are too stressful" and "boards are necessary to stratify students", they basically tried to take a middle ground, but ultimately I think this is worse than either situation. Either move to an all P/F system for all the boards, and just de-value boards altogether, or keep it the same. Doing this makes no sense. It won't decrease stress, now all the stress moves to a single chance exam with no second chance. And you will have to have that exam done by summer of the end of 3rd year so results are back by Sept, or you will get no interviews in many fields. This decision just makes no sense to me.

The one nice thing about this change though is, I'd imagine no one will expect DO's to take USMLE step 1 now. They will likely just be fine taking comlex 1/2, followed by USMLE step 2. Will also be interesting to see if the AOA changes the comlex score reporting now as a followup to this.

Another thing I can't wait to see how it pans out about this is 4th year rotations. How will any field decide who to let rotate? There will be no Step2 score by the time AIs are applied for. So many programs have board cutoffs for rotation. So now you can have people getting AIs at places or in fields that won't even rank them once they get their test back. Have a Step 2 score of 235 come back after you've done several Ortho AIs. What do you do now, too late to change course and do something like EM where you need SLOEs.

The unintended consequences of this decision will be fascinating to watch.

 

[CliveStaples]

I’d rather medical students who perform better on CK than Step 1 anyways (better barometer of actual clinical knowledge) so I don’t hate the P/F nature of step 1 but totally agreed that this will just push the arms race to CK instead of Step 1.

 

[Renaissance Man]

I think it might actually make for better medical school curriculum and learning. I never showed up to a single lecture as an MS2 because of my focus on step 1. The minutia and focus on obscure facts that is tested is just ridiculous.

Perhaps schools will start investing in more useful and engaging learning opportunities and there will not be as much of a worshipping at the alter of step 1 (not to mention the weeks of time off for dedicated studying). Although perhaps it will all shift towards step 2CK.

 

[gamerEMdoc]

I’d rather medical students who perform better on CK than Step 1 anyways (better barometer of actual clinical knowledge) so I don’t hate the P/F nature of step 1 but totally agreed that this will just push the arms race to CK instead of Step 1.

I do agree. Step 2 is way more clinically relevant. Step 1 knowledge is mostly minutia. But the problem is the timing of it all. It comes too late in medical school. It will throw a huge wrench in fields who use board scores heavily in the match, which will ultimately hurt students. Good luck matching Ortho if you've done 4 ortho rotations from June-Sept, only to find out you didn't get a 260 or above. The amount of pressure on that exam, knowing you have no idea whether you are competitive enough to do the field you are doing your AIs in, will be immense.

 

[Cath Up]

Silly move IMO, in an effort to compromise between the "boards are too stressful" and "boards are necessary to stratify students", they basically tried to take a middle ground, but ultimately I think this is worse than either situation. Either move to an all P/F system for all the boards, and just de-value boards altogether, or keep it the same. Doing this makes no sense. It won't decrease stress, now all the stress moves to a single chance exam with no second chance. And you will have to have that exam done by summer of the end of 3rd year so results are back by Sept, or you will get no interviews in many fields. This decision just makes no sense to me.

The one nice thing about this change though is, I'd imagine no one will expect DO's to take USMLE step 1 now. They will likely just be fine taking comlex 1/2, followed by USMLE step 2. Will also be interesting to see if the AOA changes the comlex score reporting now as a followup to this.

Another thing I can't wait to see how it pans out about this is 4th year rotations. How will any field decide who to let rotate? There will be no Step2 score by the time AIs are applied for. So many programs have board cutoffs for rotation. So now you can have people getting AIs at places or in fields that won't even rank them once they get their test back. Have a Step 2 score of 235 come back after you've done several Ortho AIs. What do you do now, too late to change course and do something like EM where you need SLOEs.

The unintended consequences of this decision will be fascinating to watch.

What would your prediction be re: PDs changing how they interview/rank applicants prior to step 1 going p/f? No changes?

 

[Tenk]

This is a good thing. Now they need to reduce the preclinical curriculum and add more clinical time. You could probably swap six months of ms1/2 into ms3. This would allow more exposure to various specialties and plenty of time to do well on step 2 ck.

 

[RustedFox]

STEP1 is supposed to be the tool by which to objectively evaluate academic horsepower. CK just doesn't do it like STEP1 does.

Guaranteed this will lead to Jenny McJennysons trying to parlay themselves as equivalent even more.

 

[gamerEMdoc]

What would your prediction be re: PDs changing how they interview/rank applicants prior to step 1 going p/f? No changes?

Well, in EM we rely heavily on SLOEs so I doubt it will change a ton. Programs that do emphasize boards will have Step 2 back by the time interviews go out. The big change will be competitive EM programs and how they decide who to let rotate. Because many places have a board cutoff for rotation/interview. So now you may be able to get a rotation at a place, but then when your score comes back, they won't interview you. There will be no way to select out people you have no intention on ranking based on their scores because the scores won't be back until after their AIs. So that really hurts the students. It would stink wasting your AIs on places that potentially won't rank you.

 

[Brigade4Radiant]

STEP1 is supposed to be the tool by which to objectively evaluate academic horsepower. CK just doesn't do it like STEP1 does.

Guaranteed this will lead to Jenny McJennysons trying to parlay themselves as equivalent even more.

nope it doesn’t do this at all. Step 1 is just a knowledge test it isn’t the MCAT.

Just make SLOEs for all rotations now.

 

[deleted941485]

Who is the bonehead that got paid millions of dollars to come up with this new change??? I would inundate USMLE with calls and emails that this is a silly change. It waters down the medical process. It doesn’t benefit anyone other than the Millennial Med student who can’t have mommy and daddy buy him a good score!!!

Just my 2 cents

I thought my opinion of medical students couldn’t possibly get any lower...then this happened.

 

[RustedFox]

nope it doesn’t do this at all. Step 1 is just a knowledge test it isn’t the MCAT.

Just make SLOEs for all rotations now.

Politely disagree.
The more knowledge you can arrest and apply, the higher your pure academic horsepower.
That's the point.

 

[DadIsFat]

So does this change any advice you all would give to an incoming M1 interested in emergency medicine? I’m starting at my state school this year. I’m a non traditional student (not sure how much that matters). EM was by far my favorite specialty to shadow and I look forward to learning more. I plan on joining my school’s specialty interest group and know I need to focus on my grades. Does step 1 moving to pass/fail change any advice anyone has? Thank you!

 

[RustedFox]

So does this change any advice you all would give to an incoming M1 interested in emergency medicine? I’m starting at my state school this year. I’m a non traditional student (not sure how much that matters). EM was by far my favorite specialty to shadow and I look forward to learning more. I plan on joining my school’s specialty interest group and know I need to focus on my grades. Does step 1 moving to pass/fail change any advice anyone has? Thank you!

Yeah.
Don't go into EM.
Go do something else.

 

[DadIsFat]

Yeah.
Don't go into EM.
Go do something else.

@RustedFox - thank you for your honesty.

 

[RustedFox]

This is a good thing. Now they need to reduce the preclinical curriculum and add more clinical time. You could probably swap six months of ms1/2 into ms3. This would allow more exposure to various specialties and plenty of time to do well on step 2 ck.

I am inclined to agree with you that the pre-clinical curriculum could be trimmed.
Where to trim it ?

I'll speculum (speculate).
I can be wrong.

We could trim biochemistry altogether. You REALLY should have this in-hand by the time you get accepted. Should be a pre-requisite, really.
We could trim a bit of immunology. Nobody really needs to painfully memorize the complement cascade to work clinically.
We could trim some of genetics. The diseases are interesting, but I've yet to encounter a case of Oldsmobile-Jaegermeister disease in my career, and probably never will. And I sure as hell don't need to memorize WHICH chromosome it's located on.

 

[RustedFox]

@RustedFox - thank you for your honesty.

I'm not being flippant, at all.
I know it could come across like that.
Felt the need to clarify.

 

[DadIsFat]

@RustedFox - no problem. And I honestly do mean thank you. I am early in this process and always appreciate any advice or the opinions of others that are further along in their career than I. Plus I get a kick out of your stories.

 

[deleted941485]

@RustedFox - no problem. And I honestly do mean thank you. I am early in this process and always appreciate any advice or the opinions of others that are further along in their career than I. Plus I get a kick out of your stories.

My 2c

The best jobs in medicine are non clinical.

 

[Cath Up]

Would anyone else that has been feeling extremely jaded lately like to discourage us from their specialty?

 

[DadIsFat]

Thank you @RadsWFA1900. Forgive my ignorance, but are you meaning non clinical as in less direct patient contact (pathology) or non clinical as in administrative? I had a short administrative stint in a clinical job a few years back - I’m a speech therapist- and quickly found out administration was not for me. At least not at that job. I appreciate your reply!

 

[TooMuchResearch]

I think it's because there aren't that many Oldsmobiles left. Otherwise we'd probably see it every day.

I am inclined to agree with you that the pre-clinical curriculum could be trimmed.
Where to trim it ?

I'll speculum (speculate).
I can be wrong.

We could trim biochemistry altogether. You REALLY should have this in-hand by the time you get accepted. Should be a pre-requisite, really.
We could trim a bit of immunology. Nobody really needs to painfully memorize the complement cascade to work clinically.
We could trim some of genetics. The diseases are interesting, but I've yet to encounter a case of Oldsmobile-Jaegermeister disease in my career, and probably never will. And I sure as hell don't need to memorize WHICH chromosome it's located on.

 

[TooMuchResearch]

Maybe. I think I probably have a better group/job than many here, and I'd still recommend against it. If you want to work with private equity, go do that, don't get owned by it.

Would anyone else that has been feeling extremely jaded lately like to discourage us from their specialty?

 

[Tenk]

I am inclined to agree with you that the pre-clinical curriculum could be trimmed.
Where to trim it ?

I'll speculum (speculate).
I can be wrong.

We could trim biochemistry altogether. You REALLY should have this in-hand by the time you get accepted. Should be a pre-requisite, really.
We could trim a bit of immunology. Nobody really needs to painfully memorize the complement cascade to work clinically.
We could trim some of genetics. The diseases are interesting, but I've yet to encounter a case of Oldsmobile-Jaegermeister disease in my career, and probably never will. And I sure as hell don't need to memorize WHICH chromosome it's located on.

You trim all the BS clinical hippy crap that nobody cares about during pre step 1 time. You can learn all that stuff on the wards.

Agree with biochemistry as well. There is absolutely no reason to memorize the Krebs cycle or glycolysis in 2020.

 

[RustedFox]

You trim all the BS clinical hippy crap that nobody cares about during pre step 1 time. You can learn all that stuff on the wards.

Brilliant.
Our DO colleagues have it far worse with their OMM Jedi magic also being crammed in during their MS1/MS2 years.

When I first moved to Florida, I lived in an apartment immediately above three DO students. I watched them go thru their M1-M4 years.
I would walk down to their place nearly every day to either watch sports, drink beer, or help out with their studying.
I was seriously their "ace in the hole". Sorry for bragging, but it's the truth.

I remember them cramming in nonsense about cranial suture manipulation and other things that don't exist.
I remember the seething look of hate on their faces.
What a waste of time.

DO students seem to come in two flavors:

1.) 99% of them state categorically that OMM is nothing but "Jedi mind tricks" and has no place in medicine.
2.) The other 1% are fanatical "true believers" and will defend to the death the benefits of OMM.

For the record, all three of these students bested my STEP-1 score (248) under my tutelage.
One is doing urology. One is doing radiology. One is doing orthopedic surgery.

I'm proud of them.

 

[Lawpy]

participation trophy time

 

[RustedFox]

You trim all the BS clinical hippy crap that nobody cares about during pre step 1 time. You can learn all that stuff on the wards.

Agree with biochemistry as well. There is absolutely no reason to memorize the Krebs cycle or glycolysis in 2020.

As an aside: I was cleaning house last month, and I threw out all of my "BRS Series" books.
I thought about donating them to the local medical school, but then I thought to myself: "Bruh, these books are so old and so many new editions are out there. Its time for these books to die."

I honestly felt a bit bad throwing out books. Like I was throwing "knowledge" into the trash.

But.

If I want a BRS physiology, I'll buy a new one. It will be full-color, and organized far better.

 

[Apollyon]

I am inclined to agree with you that the pre-clinical curriculum could be trimmed.
Where to trim it ?

I'll speculum (speculate).
I can be wrong.

We could trim biochemistry altogether. You REALLY should have this in-hand by the time you get accepted. Should be a pre-requisite, really.
We could trim a bit of immunology. Nobody really needs to painfully memorize the complement cascade to work clinically.
We could trim some of genetics. The diseases are interesting, but I've yet to encounter a case of Oldsmobile-Jaegermeister disease in my career, and probably never will. And I sure as hell don't need to memorize WHICH chromosome it's located on.

Dude - we went to the same med school. Immuno and genetics were already trim. What were they - 1 credit each? Or was immuno 2? I don't know what could be cut out, that would leave anything left!

 

[RustedFox]

Dude - we went to the same med school. Immuno and genetics were already trim. What were they - 1 credit each? Or was immuno 2? I don't know what could be cut out, that would leave anything left!

Immuno was 2.
Genetics was 1.

Still doesn't change my argument that we don't need to play games like "which chromosome is it!" or "Memorize the hole in the strange immunodeficiency!"

For the record, I took immunology in undergraduate. I went to one of the few Universities that offered an undergrad immunology course. My undergrad course was twice as deep and nuanced as the med.school version. I met my wife during that course. Number of times I've called upon my immunology knowledge in my career? Zero.

 

[sylvanthus]

View attachment 295481

Gotta be honest that **** made me laugh.

 

[Porfirio]

Gotta be honest that **** made me laugh.

Me too.

It would have been better to add in a bill for $$$ cost of the pass/fail exam.

 

[miacomet]

Wow. More sucking up to get a good residency slot, more competition in medschool, more stress, less objective data. Although I did hate Step 1.

 

[TheSingularity]

I disagree with trimming back all the pre-clinical knowledge. I DO think medical students should memorize the Kreb Cycle, learn about complement, have a good understanding of genetics, etc.

It does come up from time to time, even in EM. Knowing these topics COLD once in your life makes it easier ten years from now to recall the information and apply it.

This is part of what separates us from the Jenny McJennersons. Do you wanna be the person who says "ah yes, C3 deficiency, I remember that" or the person that says "what's a complement?" We are physicians, not technicians.

I wholly disagree with this USMLE decision. Further cheapens our trade.

 

[VA Hopeful Dr]

So something that I think is worth mentioning here. Step 1 prep has changed drastically in the last handful of years.

Best I can tell, most of the attendings here are roughly my age (graduated med school in 2010). Back then, almost no one I knew started Step 1 studying before at most January before the test in May/June. I think we had maybe 2 people start earlier than that.

These days, the kids are starting Step 1 prep the day they matriculate to med school. They're running through hundreds of review questions/flashcards every single day for 2 years. And that's on top of studying for tests and whatnot.

Now I'm not saying that this was a good of bad decision, but something had to be done as it was getting a little crazy.

Also, it seems like this decision was driven in large part by pre-clinical faculty. I'm not sure we can blame this on the kids being weak or not wanting to work hard.

 

[SamtheWise]

I'm glad it's changing, the current system is wholly unfair to the poor students who slide by and graduate bottom 1/3 of their class at a top 10 med school. Why should some gunner from a top 50 state med school take their god given slot in Urology? It's nice to see a re-emphasis on having academically peaked at age 20.

Hopefully we can get back to brand name residencies only matching people from brand name med schools. You should definitely spend the rest of your life reaping the rewards of going to a good undergrad and having your parents pay for a Princeton Review MCAT course and 2 summers of volunteering in Africa building wells.

 

[deleted1013752]

Once there was a blacksmith who made hammers. The townsfolk really needed more advanced tools like open end wrenches, sockets, and impact drivers, but this blacksmith only knew how to make hammers. So the townsfolk tried to get by with the hammers. They had a bunch of nuts they were trying to screw so they smashed them with the hammers. Some split apart, some skipped threads but were eventually secured, and every once in a while the hammer hit the nut just right that it spun perfectly and was snug. The townsfolk developed a system for using the hammers most efficiently and got very comfortable using the hammers to screw the nuts, but it was crude. When the blacksmith realized what the townsfolk were doing with the hammers, he told them, “Hey, that’s not really what hammers are for. Let’s just use them for nails.” The townsfolk freaked out about the kindler, gentler methods of using a wrench nobody knew how to make and how back in their day the nuts took their beating with a hammer and didn’t complain and every nut got screwed and the only way they knew how to decide how well a nut could get screwed was by using a bizarre ranking of hammer swinging techniques so they didn’t need a wrench and wanted the blacksmith to keep pumping out hammers so they could keep whacking away at the nuts even though numerous journal articles and the blacksmith affirmed the hammer was a poor choice for screwing nuts and that marginalized groups were disproportionately disadvantaged by the systems supporting the use of the hammers but the townsfolk ignored all that and wanted to keep their hammers thankyouverymuch. Because hammers.

 

[BoardingDoc]

Once there was a blacksmith who made hammers. The townsfolk really needed more advanced tools like open end wrenches, sockets, and impact drivers, but this blacksmith only knew how to make hammers. So the townsfolk tried to get by with the hammers. They had a bunch of nuts they were trying to screw so they smashed them with the hammers. Some split apart, some skipped threads but were eventually secured, and every once in a while the hammer hit the nut just right that it spun perfectly and was snug. The townsfolk developed a system for using the hammers most efficiently and got very comfortable using the hammers to screw the nuts, but it was crude. When the blacksmith realized what the townsfolk were doing with the hammers, he told them, “Hey, that’s not really what hammers are for. Let’s just use them for nails.” The townsfolk freaked out about the kindler, gentler methods of using a wrench nobody knew how to make and how back in their day the nuts took their beating with a hammer and didn’t complain and every nut got screwed and the only way they knew how to decide how well a nut could get screwed was by using a bizarre ranking of hammer swinging techniques so they didn’t need a wrench and wanted the blacksmith to keep pumping out hammers so they could keep whacking away at the nuts even though numerous journal articles and the blacksmith affirmed the hammer was a poor choice for screwing nuts and that marginalized groups were disproportionately disadvantaged by the systems supporting the use of the hammers but the townsfolk ignored all that and wanted to keep their hammers thankyouverymuch. Because hammers.

Can you elaborate on why you think this new change is a good idea outside of the "poorly written allegory" format?

 

[deleted109597]

Med students will be obsessive about matching. Removing Step 1 won't change that.
They'll still obsess about the next thing.


We need to separate the doctors from the non-doctors, or be assimilated.

 

[TheSingularity]

I think I good solution would be for each specialty specific medical society to create their own specialty specific basic science exam and require that before application. Each one would sort of be like a mini step 1.

And if you are deciding between town specialties like EM and Radiology, guess what you have to take both.

Sent from my Pixel 3 using SDN mobile

 

[deleted1013752]

Can you elaborate on why you think this new change is a good idea outside of the "poorly written allegory" format?

Sure, though I contend it wasn't poorly written. Shade aside, I can't say if this decision is certainly good or bad. What I can say is that my professional life focuses on performance evaluation and it's essential to have tests that provide meaningful data, and that the data are relevant to desired outcomes. So:

1. Does a better score on a single test accurately represent intelligence/dedication/capacity for learning?
2. Does a better score correlate with being a better resident, and a better physician?

Additionally, the response to this decision here and elsewhere seems to center on two main arguments:

1. I earned my way to where I'm at through blood, sweat, tears, and unsanctioned bare-knuckle boxing matches. If any aspect of the process changes after I went through it, everyone coming after me is an unqualified snowflake.
2. I get 1200 applications for 8 slots and I have absolutely no way to evaluate all of those applications. I understand that people are more complex than test scores and that high scores don't always net the best residents/physicians, but I have no other tool by which to evaluate candidates that won't take literally 7 years every application year.

Neither of these arguments really hold water. Change happens, and everyone needs to settle with that. Maybe yesterday's physicians look upon today's with disdain because everyone sub-specializes and back in their day they'd give a patient a swig of whiskey and tell them to bite down hard before amputating a leg using a spoon. Side note: if Jenny McJennyson could pass the test and get a high score, what does that say about Jenny's preparation and the test? As for the PDs/APDs, is board score stratification effective & accurate, or simply a convenient way to not look at 700 applications?

Do ABEM scores correlate to on-the-job performance? Are higher-scoring physicians better, or is everyone accepted equally because they've all passed the test and you evaluate performance based on how they actually do their jobs and not how they take tests? What if EM docs were compensated based solely on board score?

 

[TheSingularity]

Sure, though I contend it wasn't poorly written. Shade aside, I can't say if this decision is certainly good or bad. What I can say is that my professional life focuses on performance evaluation and it's essential to have tests that provide meaningful data, and that the data are relevant to desired outcomes. So:

1. Does a better score on a single test accurately represent intelligence/dedication/capacity for learning?
2. Does a better score correlate with being a better resident, and a better physician?

Additionally, the response to this decision here and elsewhere seems to center on two main arguments:

1. I earned my way to where I'm at through blood, sweat, tears, and unsanctioned bare-knuckle boxing matches. If any aspect of the process changes after I went through it, everyone coming after me is an unqualified snowflake.
2. I get 1200 applications for 8 slots and I have absolutely no way to evaluate all of those applications. I understand that people are more complex than test scores and that high scores don't always net the best residents/physicians, but I have no other tool by which to evaluate candidates that won't take literally 7 years every application year.

Neither of these arguments really hold water. Change happens, and everyone needs to settle with that. Maybe yesterday's physicians look upon today's with disdain because everyone sub-specializes and back in their day they'd give a patient a swig of whiskey and tell them to bite down hard before amputating a leg using a spoon. Side note: if Jenny McJennyson could pass the test and get a high score, what does that say about Jenny's preparation and the test? As for the PDs/APDs, is board score stratification effective & accurate, or simply a convenient way to not look at 700 applications?

Do ABEM scores correlate to on-the-job performance? Are higher-scoring physicians better, or is everyone accepted equally because they've all passed the test and you evaluate performance based on how they actually do their jobs and not how they take tests? What if EM docs were compensated based solely on board score?

1. Jenny couldn't pass the test.

2. To quote The Incredibles, "When everyone is super, no one will be."