USMLE Step 1 to be Pass/Fail

[deleted1013752]

ya

leave step 1 and CK alone

scrap CS and step 3

Fair enough. That puts you at odds with NBME & AMA, the forum that contributed to the decision, and the literature they cited in their decision. Additionally, that solution ignores the problems with the application process.

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[Listen2Savage]

Fair enough. That puts you at odds with NBME & AMA, the forum that contributed to the decision, and the literature they cited in their decision. Additionally, that solution ignores the problems with the application process.

what reason did they give for the p/f change?

 

[deleted1013752]

what reason did they give for the p/f change?

I encourage you to read about their decision yourself: United States Medical Licensing Examination | Invitational Conference on USMLE Scoring.

 

[Listen2Savage]

I encourage you to read about their decision yourself: United States Medical Licensing Examination | Invitational Conference on USMLE Scoring.

"well being"

lol, a point already made somewhere else on sdn is that this does the opposite

now instead of a chance of redemption with step 2ck if you crater step 1, it all falls on one test...ck

 

[deleted1013752]

"well being"

lol, a point already made somewhere else on sdn is that this does the opposite

now instead of a chance of redemption with step 2ck if you crater step 1, it all falls on one test...ck

And now for a more thoughtful explanation than just "well being lol"... this comes from that source:

Primary Purpose
An examinee’s USMLE scores are reported to medical licensing authorities for their use in the decision to grant a provisional license to practice in a post-graduate training program and the decision to grant an initial license for the independent practice of medicine. This is the primary intended purpose of USMLE scores.​

​

Secondary Purposes
Trends in medical education have increased examinee efforts to maximize their USMLE performance as demonstrated through the numeric score. These trends include limited residency training slots, particularly in certain specialties, as well as medical schools' adoption of pass/fail grading for foundational curricula. Because residency programs use USMLE scores as a means to screen and select applicants, examinees strive to obtain the highest possible scores.​

​

This use of the score is considered a secondary use of USMLE scores. USMLE was not designed for these purposes and the program did not envision the markedly increased reliance on numeric scores in graduate medical education. Program directors acknowledge the limitations of using USMLE scores for residency selection, but justify the practice given USMLE’s position as a nationally standardized measure of knowledge and skills and as the only common metric by which to evaluate all applicants.​

​

Medical Schools
This emphasis on maximizing USMLE scores has led medical school students to the perception of a "parallel curriculum" to the curriculum of their medical schools. Students engage in their school’s curriculum while simultaneously preparing for what is perceived to be "other material" important for achieving high scores on the USMLE assessments.​

​

In addition, medical school faculty and staff have noted potentially negative effects of preparation for high-stakes testing on student well-being."​

The debate here isn't whether step 1 should be quantitative or qualitative. That decision has been made. Sure, you could kick the ball down the road to the next scored exam, but that doesn't address the problem and there's always a very real possibility that exam will go down the same path using the same logic described above. A different solution is needed. Sure, you could sit back and complain about what already happened, or you could advocate for something better.

 

[Listen2Savage]

or you could advocate for something better.

I really dont care, not my fight any more amigo

just pointing out how obviously stupid this change is...

 

[deleted1013752]

I really dont care

I hope you reconsider if you match.

 

[Listen2Savage]

I hope you reconsider if you match.

?

Don’t put that evil on me jaggoff

 

[deleted1013752]

?

Don’t put that evil on me jaggoff

You misunderstand. It’s not a threat. I genuinely hope you will reconsider caring about how changes to the applicant pipeline impact the supply of future physicians. All applicants and physicians should care about how future physicians are educated.

FWIW, you’re a case study on why a personality inventory would be useful in the application process.

 

[Listen2Savage]

You misunderstand. It’s not a threat. I genuinely hope you will reconsider caring about how changes to the applicant pipeline impact the supply of future physicians. All applicants and physicians should care about how future physicians are educated.

FWIW, you’re a case study on why a personality inventory would be useful in the application process.

telling someone IF you match is supremely douchy

 

[RustedFox]

telling someone IF you match is supremely douchy

So is his FWIW at the end there.
But hey, that's administratiors for you.

 

[Listen2Savage]

So is his FWIW at the end there.
But hey, that's administratiors for you.

I've been working on my anger mgmt RF, so I let that slide...
but since you brought it up

probably comes from a place of jealousy
why else would they be trolling a physician forum?

 

[deleted1013752]

telling someone IF you match is supremely douchy

There's no guarantee you, or any applicant, will match. I wish all applicants the best and hope they find a good match into residency and grow to be caring, competent physicians with successful careers.

But hey, that's administratiors for you.

You're right. That last comment was beneath me, despite being accurate. I think there are meaningful ways the application process could be improved. You're an experienced physician and post here often - why not contribute some helpful ideas to this topic?

why else would they be trolling a physician forum?

I've worked in training & organizational development for nearly 15 years; in healthcare since 2012. I care about the industry, how it works, and how it could work better. I came to this thread because the topic interests me and I was/am hoping to have a thoughtful discussion on the decision and how candidates could be best evaluated. Let's elevate the level of dialogue here, please.

With that in mind, is anyone interested in discussing the idea of using other means of evaluation to assess residency applicants, now that step 1 will be qualitative?

 

[RustedFox]

You're right. That last comment was beneath me, despite being accurate. I think there are meaningful ways the application process could be improved. You're an experienced physician and post here often - why not contribute some helpful ideas to this topic?

I already have.
Making STEP-1 Pass/Fail is a mistake for all the reasons I have already listed.
Push the "GO BACK!" button on this decision.

 

[deleted1013752]

I already have.
Making STEP-1 Pass/Fail is a mistake for all the reasons I have already listed.
Push the "GO BACK!" button on this decision.

Thank you. Follow up question: Do you believe it's necessary to have a higher step 1 score for derm than for EM due to academic/intelligence reasons, or simply competitive/lifestyle reasons?

 

[RustedFox]

Thank you. Follow up question: Do you believe it's necessary to have a higher step 1 score for derm than for EM due to academic/intelligence reasons, or simply competitive/lifestyle reasons?

Competitive reasons, primarily.
Gotta have a way to objectively set the bar.
This applies to everywhere, regardless of specialty.

 

[deleted1013752]

Competitive reasons, primarily.
Gotta have a way to objectively set the bar.
This applies to everywhere, regardless of specialty.

The score to match EM has a pretty wide range, and it has been said EM PDs place greater emphasis on the SLOE than step 1 score. It seems fair to say absolute intelligence as demonstrated by test performance is not the most important aspect of being an EM doc, based on that information. Fair?

 

[deleted1013752]

In my experience, if a comment is beneath a person, they don't make it!

I don’t understand what you’re saying here.

 

[RustedFox]

The score to match EM has a pretty wide range, and it has been said EM PDs place greater emphasis on the SLOE than step 1 score. It seems fair to say absolute intelligence as demonstrated by test performance is not the most important aspect of being an EM doc, based on that information. Fair?

Fair, but also be aware that EM is a pretty unique animal to begin with. You get to talking about Ortho, Rads, etc - and the calculus changes. You need numerical and discrete data to see who can hack it in any subspecialty. Perhaps less so in EM, sure - but it's not like that across the board. Hell, Urology has their own private match.

I matched and trained years before the SLOE was even a thing.

 

[deleted1013752]

Fair, but also be aware that EM is a pretty unique animal to begin with. You get to talking about Ortho, Rads, etc - and the calculus changes. You need numerical and discrete data to see who can hack it in any subspecialty. Perhaps less so in EM, sure - but it's not like that across the board. Hell, Urology has their own private match.

I matched and trained years before the SLOE was even a thing.

I totally agree. There’s really no way to assess such a large and diverse pool without objective, universal data. What I’m wondering is if the metrics used to compare candidates could include nominal data in addition to numerical data. If there were a way to objectively evaluate applicants for traits relevant to their chosen specialty and across specialties, in addition to the knowledge-based numerical data, it seems the process would be ideal. I’m curious about how to get there and what to assess.

 

[RustedFox]

I totally agree. There’s really no way to assess such a large and diverse pool without objective, universal data. What I’m wondering is if the metrics used to compare candidates could include nominal data in addition to numerical data. If there were a way to objectively evaluate applicants for traits relevant to their chosen specialty and across specialties, in addition to the knowledge-based numerical data, it seems the process would be ideal. I’m curious about how to get there and what to assess.

Great thinking, but I don't think it's really possible. I can't help but to think of those bogus "personality inventory" tests given in high school that said that we should be forest rangers or marine biologists.

The test is only good as the data you feed it. Personality items really can't be objectively quantified.

 

[deleted1013752]

Great thinking, but I don't think it's really possible. I can't help but to think of those bogus "personality inventory" tests given in high school that said that we should be forest rangers or marine biologists.

The test is only good as the data you feed it. Personality items really can't be objectively quantified.

That sounds like the COPS exam. It's kind of silly. I remember one question was something like "Would you enjoy arranging flowers for display?" And if you say yes the results tell you to become a florist. How insightful. Maybe it has changed - I took it about 20 years ago.

Other personality inventories are more advanced, meaning the questions aren't as direct and they have solid test-retest reliability even over time. That doesn't mean every med student should take MBTI tomorrow and get arbitrarily shunted into specialties, of course. Assuming NBME doesn't reverse course, it's reasonable that some measures (or at least attempts) could be set into motion before Spring 2022.

 

[Brigade4Radiant]

Fair, but also be aware that EM is a pretty unique animal to begin with. You get to talking about Ortho, Rads, etc - and the calculus changes. You need numerical and discrete data to see who can hack it in any subspecialty. Perhaps less so in EM, sure - but it's not like that across the board. Hell, Urology has their own private match.

I matched and trained years before the SLOE was even a thing.

That’s because of Step 1 they can easily make standardized metrics for rotation performance they don’t have to be perfect or good just to stratify people in the same way the step 1 test did. It’s not hard design a format after collecting a couple of years of data.

 

[RustedFox]

That’s because of Step 1 they can easily make standardized metrics for rotation performance they don’t have to be perfect or good just to stratify people in the same way the step 1 test did. It’s not hard design a format after collecting a couple of years of data.

Sorry, bud.
Come again? I'm unclear on what you're trying to say.