USMLE Step 1 to become pass/fail in 2022

[elementaryschooleconomics]

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.

usmle.org

...no one will have to know how uncompetitive we are anymore!

---

Members don't see this ad.

 

[seper]

I feel really good for the future takers. The test got seriously misused due to this "top scores" concept, which we all on this board witnessed firsthand.

 

[FrostyHammer]

Wow, talk about making Generation Z even more entitled than they already are. If I had that setup, I wouldn't have put any effort in med school. The lack of accountability is just horrifying.

 

[scarbrtj]

Just heard the news from a med student myself. I think, and it seems some of the students think this too, the "tiering" will therefore move to Step 2, and there will be more emphasis by residencies on those scores. And you'll pretty much need a Step 2 score in hand to start a competitive-residency interview effort.

 

[elementaryschooleconomics]

Wow, talk about making Generation Z even more entitled than they already are. If I had that setup, I wouldn't have put any effort in med school. The lack of accountability is just horrifying.

Evidently they're going to keep Step 2CK as a three-digit score, which likely just means all the emphasis will switch to that exam.

 

[evilbooyaa]

Just heard the news from a med student myself. I think, and it seems some of the students think this too, the "tiering" will therefore move to Step 2, and there will be more emphasis by residencies on those scores. And you'll pretty much need a Step 2 score in hand to start a competitive-residency interview effort.

Evidently they're going to keep Step 2CK as a three-digit score, which likely just means all the emphasis will switch to that exam.

I am personally OK with this - Step 2 is more clinically relevant to being a doctor than Step 1 minutiae is. Maybe not being a rad onc, but at least being a doctor in general*

*I may be biased as I had a not great Step 1 and a much improved Step 2CK.

 

[FrostyHammer]

I am personally OK with this - Step 2 is more clinically relevant to being a doctor than Step 1 minutiae is. Maybe not being a rad onc, but at least being a doctor in general*

*I may be biased as I had a not great Step 1 and a much improved Step 2CK.

Both are awful metrics. Super odd that they're keeping one numeric and switching the other to p/f. Elementary school economics is absolutely correct that all this will do is defer the stress to a time where everyone's tired from MS3 rotations and residency apps are breathing down one's neck. Not the best time for stress as compared to the end of 2nd year...

 

[PhotonBomb]

Wow, talk about making Generation Z even more entitled than they already are. If I had that setup, I wouldn't have put any effort in med school. The lack of accountability is just horrifying.

Dude.

 

[deleted1002574]

Wow, talk about making Generation Z even more entitled than they already are. If I had that setup, I wouldn't have put any effort in med school. The lack of accountability is just horrifying.

YOU GET A TROPHY, AND YOU GET A TROPHY, AND YOU GET A TROPHY!!!

 

[HopeP]

so what are the good/bad consequences as such decision is made?

 

[elementaryschooleconomics]

so what are the good/bad consequences as such decision is made?

Honestly, I'm not in love with the decision - though it probably is a step (haha) in the right direction.

1) It will likely switch emphasis to Step 2CK as stated above
2) In the short term, it's going to hose MD-PhD students who poured their souls in Step 1 prior to entering the grad phase, then they're going to come out on the other end having to play catch-up with their MD-only classmates only to take a Step 2 exam with significantly more importance
3) It will disadvantage exceptional people coming from mid-to-low tier schools while benefiting average-to-below average students at "brand name" institutions
4) It will likely place more emphasis on research - which will worsen the already existing issue of research/papers being the "coin of the realm" and you have tons of people not really interested in doing research forced to do it and we'll continue to have literally millions of worthless "studies" published because you must do that to survive
5) There might be a proliferation of "research years off", which is a huge financial burden and will put a greater opportunity cost on being a doctor

These are just off the top of my head. This is actually fairly personal to me, as an MD-PhD from a mid-tier school who did very well on Step 1 and used that to get into an ultra-competitive RadOnc residency (back when that was a thing).

In particular, I would be utterly distraught if I was just coming off M1/M2, studied my butt off during the summer for Step 1, was mid-way through my first year in the graduate phase of the MD-PhD program and heard this news, envisioning that in ~4 years when I go back to med school I'll have to take a USMLE exam which now has the importance that Step 1 once did except I'm at a disadvantage.

Yeah...distraught would describe it. I just find this decision incredible - I dedicated two whole years of my life with the singular goal of doing well on this exam, and then using that score as a stepping stone to a lot of my future success. If this decision had been made 15 years ago my life might look drastically different.

 

[deleted1002574]

[you are right on all counts.

To retroactively do this is unfair for all the reasons you listed.

That being said, if the system had it as P/F before and then changed it to 3 digit score- that would also cause an uproar.

Even if they made step 2 pass/fail, the more salient points of “elite” schools and students with means benefitting, while average and low income people will be disadvantaged.

Despite your very reasonable concerns (would have affected me similarly), do you think a scored Step 1 / 2 is really the best thing for students and at the end, for patient care? I don’t know the answer..

Honestly, I'm not in love with the decision - though it probably is a step (haha) in the right direction.

1) It will likely switch emphasis to Step 2CK as stated above
2) In the short term, it's going to hose MD-PhD students who poured their souls in Step 1 prior to entering the grad phase, then they're going to come out on the other end having to play catch-up with their MD-only classmates only to take a Step 2 exam with significantly more importance
3) It will disadvantage exceptional people coming from mid-to-low tier schools while benefiting average-to-below average students at "brand name" institutions
4) It will likely place more emphasis on research - which will worsen the already existing issue of research/papers being the "coin of the realm" and you have tons of people not really interested in doing research forced to do it and we'll continue to have literally millions of worthless "studies" published because you must do that to survive
5) There might be a proliferation of "research years off", which is a huge financial burden and will put a greater opportunity cost on being a doctor

These are just off the top of my head. This is actually fairly personal to me, as an MD-PhD from a mid-tier school who did very well on Step 1 and used that to get into an ultra-competitive RadOnc residency (back when that was a thing).

In particular, I would be utterly distraught if I was just coming off M1/M2, studied my butt off during the summer for Step 1, was mid-way through my first year in the graduate phase of the MD-PhD program and heard this news, envisioning that in ~4 years when I go back to med school I'll have to take a USMLE exam which now has the importance that Step 1 once did except I'm at a disadvantage.

Yeah...distraught would describe it. I just find this decision incredible - I dedicated two whole years of my life with the singular goal of doing well on this exam, and then using that score as a stepping stone to a lot of my future success. If this decision had been made 15 years ago my life might look drastically different.

 

[elementaryschooleconomics]

[you are right on all counts.

To retroactively do this is unfair for all the reasons you listed.

That being said, if the system had it as P/F before and then changed it to 3 digit score- that would also cause an uproar.

Even if they made step 2 pass/fail, the more salient points of “elite” schools and students with means benefitting, while average and low income people will be disadvantaged.

Despite your very reasonable concerns (would have affected me similarly), do you think a scored Step 1 / 2 is really the best thing for students and at the end, for patient care? I don’t know the answer..

It's a great question, "how do we properly assess students and enhance patient care", and one I'm not sure we'll ever have a satisfactory answer for.

I'm of the opinion that we're at a level of knowledge and technology that we're about to - or already have - crossed the threshold of where rote memorization (so called "walking around knowledge") isn't the best/most efficient way to train doctors.

This was illustrated by the following Tweet:

Now, you can interpret that photo many different ways, but I interpret that as "core medical knowledge has at least doubled over the last two decades".

I've said this before about RadOnc's board certification process, chiefly around the oral boards, but I think moving to practical exams where mastery and application of resources is what's most important to be a "good" physician in 2020 and beyond.

Medical schools should heavily emphasize how to read and critique the literature, discern what makes good and bad studies/books/practices etc. At the medical student level, I haven't really envisioned how that process would work. At the RadOnc level, I think we should be plunked down at our normal workstation with all of our normal resources available. I think we should be thrown a mix of "zebra" and "bread-and-butter" cases and judged based on how we utilize all available resources to arrive at a treatment plan. It's a part of Neurosurgery's oral boards - they don't do theirs until 3 years after residency, and you submit all of your cases you've operated on in that time. The board examiners then look at how you've practiced medicine and grill you on your outcomes and what you could have/should have done differently etc.

Medical knowledge is only going to continue to explode and become more complicated. We literally walk around with computers in our pockets able to access the sum total of human knowledge. Me being able to memorize radiation trials from the 1970s is nowhere near as important as my ability to critically evaluate some new trial with a jacked up control arm concluding that we should utilize some $40,000,000 carbon ion treatment for Gleason 7 prostate cancer.

 

[FrostyHammer]

It's a great question, "how do we properly assess students and enhance patient care", and one I'm not sure we'll ever have a satisfactory answer for.

I'm of the opinion that we're at a level of knowledge and technology that we're about to - or already have - crossed the threshold of where rote memorization (so called "walking around knowledge") isn't the best/most efficient way to train doctors.

This was illustrated by the following Tweet:

View attachment 295432

Now, you can interpret that photo many different ways, but I interpret that as "core medical knowledge has at least doubled over the last two decades".

I've said this before about RadOnc's board certification process, chiefly around the oral boards, but I think moving to practical exams where mastery and application of resources is what's most important to be a "good" physician in 2020 and beyond.

Medical schools should heavily emphasize how to read and critique the literature, discern what makes good and bad studies/books/practices etc. At the medical student level, I haven't really envisioned how that process would work. At the RadOnc level, I think we should be plunked down at our normal workstation with all of our normal resources available. I think we should be thrown a mix of "zebra" and "bread-and-butter" cases and judged based on how we utilize all available resources to arrive at a treatment plan. It's a part of Neurosurgery's oral boards - they don't do theirs until 3 years after residency, and you submit all of your cases you've operated on in that time. The board examiners then look at how you've practiced medicine and grill you on your outcomes and what you could have/should have done differently etc.

Medical knowledge is only going to continue to explode and become more complicated. We literally walk around with computers in our pockets able to access the sum total of human knowledge. Me being able to memorize radiation trials from the 1970s is nowhere near as important as my ability to critically evaluate some new trial with a jacked up control arm concluding that we should utilize some $40,000,000 carbon ion treatment for Gleason 7 prostate cancer.

Good luck trying to get med students to learn to read and critique the literature. When your education comes from the IM and peds doctors, neither of which know squat about literature, it's like the blind leading the blind.

 

[deleted1002574]

For all the complaints of the ABR and their horrendous record, the oral exam is the single best examination I’ve ever had to study for and experienced. We need practical examinations ...

 

[PhotonBomb]

 

[BobbyHeenan]

Honestly, I'm not in love with the decision - though it probably is a step (haha) in the right direction.

1) It will likely switch emphasis to Step 2CK as stated above
2) In the short term, it's going to hose MD-PhD students who poured their souls in Step 1 prior to entering the grad phase, then they're going to come out on the other end having to play catch-up with their MD-only classmates only to take a Step 2 exam with significantly more importance
3) It will disadvantage exceptional people coming from mid-to-low tier schools while benefiting average-to-below average students at "brand name" institutions
4) It will likely place more emphasis on research - which will worsen the already existing issue of research/papers being the "coin of the realm" and you have tons of people not really interested in doing research forced to do it and we'll continue to have literally millions of worthless "studies" published because you must do that to survive
5) There might be a proliferation of "research years off", which is a huge financial burden and will put a greater opportunity cost on being a doctor

These are just off the top of my head. This is actually fairly personal to me, as an MD-PhD from a mid-tier school who did very well on Step 1 and used that to get into an ultra-competitive RadOnc residency (back when that was a thing).

In particular, I would be utterly distraught if I was just coming off M1/M2, studied my butt off during the summer for Step 1, was mid-way through my first year in the graduate phase of the MD-PhD program and heard this news, envisioning that in ~4 years when I go back to med school I'll have to take a USMLE exam which now has the importance that Step 1 once did except I'm at a disadvantage.

Yeah...distraught would describe it. I just find this decision incredible - I dedicated two whole years of my life with the singular goal of doing well on this exam, and then using that score as a stepping stone to a lot of my future success. If this decision had been made 15 years ago my life might look drastically different.

Agree very strongly with the detriment it will be to the low tier schools.

I went to a state med school (low to mid tier) because I got a scholarship. I could have gone to other better known schools, but debt would have been massive. My very high step scores opened doors against the "big name" grads.

There are definitely pit falls with Step 1, but we need an objective measure.

The same goes all the way down to high school kids. If you're from Appalachia or *insert terrible public school system* and you finish near top of the class no one cares...but combine that with a sky high SAT and people take notice.

 

[PhotonBomb]

 

[RollTideRadOnc]

I don't know about you all, but I thought that Step 1 was a rather good discriminator of my medschool classmates abilities and aptitude. When I looked at who did exceptionally well on that test, those are exactly the classmates I would want to work with in the future. And that holds true regardless of what the content is or how relevant it is. It's a hard test, that requires a ton of hard work and perseverance. Frankly, I don't care if it's testing medical minutiae or Pokemon trivia. If you do well, you've demonstrated brains and work ethic. Done.

As other have mentioned, I only think this will serve to disadvantage folks at state schools. And serves up more privilege to those at top med schools, many of which are moving away from objective evaluations anyhow in terms of grading (ala Stanford or Yale etc). This is exactly the opposite direction that we want to move in.

 

[deleted573262]

Will top school students need to take Step 2 before submitting their application? Many top 20 USMD students, at this time, do not take Step 2 CK before September 15. I don't see this changing with P/F Step 1. A low Step 2 CK will only be bad for these applicants. Students at top schools will get benefit of doubt interview invitations with assumption they did well on MCAT to get into medical school (whether or not this is true).

Bottom line, this is bad for IMGs, DOs, and unknown US MD schools. Step 1 doesn't matter. MCAT matters more. Step 2 CK matters more for non-top tier medical school students.

 

[elementaryschooleconomics]

I don't know about you all, but I thought that Step 1 was a rather good discriminator of my medschool classmates abilities and aptitude. When I looked at who did exceptionally well on that test, those are exactly the classmates I would want to work with in the future. And that holds true regardless of what the content is or how relevant it is. It's a hard test, that requires a ton of hard work and perseverance. Frankly, I don't care if it's testing medical minutiae or Pokemon trivia. If you do well, you've demonstrated brains and work ethic. Done.

As other have mentioned, I only think this will serve to disadvantage folks at state schools. And serves up more privilege to those at top med schools, many of which are moving away from objective evaluations anyhow in terms of grading (ala Stanford or Yale etc). This is exactly the opposite direction that we want to move in.

I feel like, in academic medicine, there's increasingly less incentive to "be a good doctor", which is a nebulous definition if you really examine it, but for me it means "someone who makes sound clinical decisions in the best interest of the patient from a disease/QoL/cost/etc standpoint".

Now, we have:

1) A growing number of schools with pass/fail pre-clinical curricula
2) Step 1 is pass/fail
3) Even if a school has a graded clinical curriculum, we all know (and experienced) how subjective M3 grading can be, often turning into a popularity contest instead of useful metrics (this is a gross over-generalization, I know)

Already existing:

1) Success at the resident/attending level is mostly measured by grants and papers
2) Least important for promotion/success are those individuals who pursue "being a good doctor" or "a good educator", which are metrics sometimes considered but will not elevate your career beyond a certain ceiling

So, let's say you're groomed from an early age to be a doctor, you destroy the MCAT, you get into an Ivy League med school. You can put the bare minimum effort into learning how to practice medicine, pass your classes, get looped in with good labs/projects/mentors, get papers, get into a good residency where you can leverage your existing research experience to continue to get papers/grants, continue to put bare minimum effort into medicine, graduate, and if you stay in academics you will likely significantly advance your career while never really trying to be "good at medicine".

Academic medicine has for decades (forever?) been setup like this where the powerhouse attendings spend little time in the clinic, but at least in the beginning they had to do well academically and put some effort into learning medicine. Now we can start the "powerhouse tenure track" lifestyle from Day 1 of M1.

 

[ramsesthenice]

I don't see this having a major affect on anyone or improving the evaluation of "clinical aptitude" or whatever people want to call it. Step 2 may feel more clinically relevant but its still pretty heavy on minutia. I would be a lot of money that the people acing step 1 will also ace step 2 if they have to start taking it more seriously. This just seems like moving crap from one pile to another to me.

Either that or everyone will do well on their standardized tests and residencies will have to look for other ways to rank applicants and with rampant grade inflation they will basically be left with medical school reputation and personal connections. We know what that will look like...

 

[deleted1002574]

1. It's strongly correlated with MCAT .. why not just use that? Will overlap heavily (high MCAT -> high Step 1, low MCAT -> low Step 1).

2. It may be possible that your assumptions about your classmates being strong are biased because of the scores they had. I remember hearing after the fact - "I didn't know Billy Bob was so smart!". Without meaning to say it, people equate high standardized test scores with intelligence. I'm not saying you are doing this for sure, but there is definitely the potential for bias based on scores.

3. Without changing anything else, yes, I agree with you. This may be bad for students at small schools and students with lower SES.

4. At the same time, the status quo of "Big Testing" still favors the wealthy ... and that starts from the tests you take to get into the good STEM schools and magnets. So keeping it the same not ideal...

5. Finally, though our training is not perfect, are American physicians any worse in terms of competence, compassion, and quality of care? People from around the world go to our medical schools, residencies, fellowships, and research institutions. Though improvement is needed, as a whole, our medical training is pretty solid.

I don't know about you all, but I thought that Step 1 was a rather good discriminator of my medschool classmates abilities and aptitude. When I looked at who did exceptionally well on that test, those are exactly the classmates I would want to work with in the future. And that holds true regardless of what the content is or how relevant it is. It's a hard test, that requires a ton of hard work and perseverance. Frankly, I don't care if it's testing medical minutiae or Pokemon trivia. If you do well, you've demonstrated brains and work ethic. Done.

As other have mentioned, I only think this will serve to disadvantage folks at state schools. And serves up more privilege to those at top med schools, many of which are moving away from objective evaluations anyhow in terms of grading (ala Stanford or Yale etc). This is exactly the opposite direction that we want to move in.

 

[PhotonBomb]

No one is Saying step 2 deserves to be that important either. This is just the first step (get it) to decreasing the importance of standardized tests.

Maybe some peope like thecarbonionangle think that standardized tests are the be all/end all of who is smart and who isn’t. But I don’t think that.

 

[Mandelin Rain]

I don't think it's the end all, be all. You can guess REALLY well on any multiple choice test and get 100% with no knowledge.

What it more likely indicates is that you are either really smart and pick up new concepts easily and/or you are willing to work really hard to synthesize concepts that you initially found difficult. Both are admirable qualities. Do they necessarily make you a good person or a better doctor when there is a patient in the room? No. But.... it likely means you'll be a good trainee who picks up new concepts easily or is willing to work hard to synthesize concepts you initially found difficult.

Residency is still training. High achieving undergrads typically make high achieving med students who typically make high achieving residents.