USMLE versus MCAT difficulty?

[Lawpy]

Idk man, if an HMS student with a 260 says they'd like to see the exam changed to quartiles? That would hurt more than help them, if it even affects them at all. Seems pretty stupid to tell them they can't have an opinion because they go to HMS.

The problem is that competitive residencies/specialties already have a massive favoritism for school name so even if Step scores get converted to P/F or quartiles, someone from HMS wouldn't be affected because their school/resources would still make them match wherever they want. IM already has a major inbreeding problem with top programs and someone who went to T5 with a 230 can still match really well and get those lucrative fellowships. Can't say the same can hold for someone who went to a low tier/DO etc.

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[Med Ed]

Is this not already the case for the mcat? If s1 becomes the new barrier to entry for med school I don't see how we would be aiding privileged students any more than we currently are. If students are already using free/low cost resources to obliterate step 1/mcat - I don't really see how any of the above would meaningfully shift the #'s at the top end of the curve.

To some extent you are correct, the MCAT does a reasonable job of flushing the underprivileged out of the applicant pool. Just look at the difference between all takers, applicants, and matriculants:

However, the knowledge base for the MCAT is usually obtained through taking undergraduate courses already en route to completing a bachelors degree. The knowledge base for Step 1 goes well beyond most undergraduate offerings. Most would need to go to college and then have 1-3 years of dedicated time to UFAP a score into the 240+ range. Good luck pulling that off if you're working.

 

[efle]

To some extent you are correct, the MCAT does a reasonable job of flushing the underprivileged out of the applicant pool. Just look at the difference between all takers, applicants, and matriculants:

View attachment 275688
View attachment 275689
View attachment 275690

However, the knowledge base for the MCAT is usually obtained through taking undergraduate courses already en route to completing a bachelors degree. The knowledge base for Step 1 goes well beyond most undergraduate offerings. Most would need to go to college and then have 1-3 years of dedicated time to UFAP a score into the 240+ range. Good luck pulling that off if you're working.

I feel like there would be pretty diminishing returns for dedicated periods longer than a few months. "Everything you need to know is in UFAPS" still holds up pretty well, and even at an extremely leisurely pace of ~1 question block daily and a dozen pages of FA, you'd be done in 3-4 months.

 

[Med Ed]

I feel like there would be pretty diminishing returns for dedicated periods longer than a few months. "Everything you need to know is in UFAPS" still holds up pretty well, and even at an extremely leisurely pace of ~1 question block daily and a dozen pages of FA, you'd be done in 3-4 months.

That's assuming you're not starting from scratch. The MCAT is a grain of sand on Step 1's beach and people still spend months preparing for it. Given the stakes I think a year minimum is not unreasonable. Oh, and people in this system might feel compelled to actually learn something before they roll onto the wards.

 

[AnatomyGrey12]

Look dude I got my 250+, I don't have a dog in this race. You might be able to write off one of my classmates if they made this argument with a 225 and wanted to match neurosurgery. But that ain't me, you can't use it to dismiss me, it's intellectually lazy of you.

I don’t give a crap what score you got on Step and that has no bearing on my argument. Your score in many ways doesn’t even matter by nature of where you go to school. What is intellectually dishonest is you trying to pawn off an idea that screws literally everyone over but yourself and trying to claim it’s the best thing for everyone.

And you are better than this dude. The elitist junk you’re spouting right now is pure rat crap and you know it. I didn’t bust my ass in medical school to build the app I have just to have someone at an elite school tell me how much more objective they are about this (LOL) and that it’s ok if I get screwed over because heaven forbid someone get a 230s instead of a 250s on Step and have slightly decreased chances at becoming a world renowned surgeon at MGH. No one is saying that you don’t get an opinion, but honestly the stakes are completely different for you so your opinion honestly carries less weight. There is a reason all the op-Ed articles on this have been written by students at top schools.

Give me an actual argument for why the USMLE writers are wrong, for why it's actually OK to use this test to screen out 230s and favor 250s for a surgical specialty. One that has more substance than "my classmates who bombed step are also dumb on the wards"

Actual argument? Well for starters the match rate for competitive specialties, let’s use ortho, in the 230s is a 75%. So my argument is that is if you have a 230’s then go get some pubs, get good clinical grades, and network because you still have a damn good chance of getting to do what you want if you play your cards right. This is what you don’t understand, people at low tier MD and DO schools see 75-80% and we are freaking happy about it. I’ll take 3/4 chances at the career I want any day of the week.

Someone should be able to compete for that ortho spot whether they got a 230 or a 250, yes. This is not a crazy idea, even the creators of the test itself have explicitly said it's not supposed to be used to screen out the former and favor the latter. This has literally only been a modern phenomenon in the most recent generation of docs, do you think that in 1995 when nobody gave a crap about USMLE scores, it was impossible to select for capable candidates?

Addressed above. It’s asinine to argue over this when people with 230s match competitive specialties all the time. The idea that a mid 230s score disqualifies you from anything is a myth. Step scores are important, but everything else comes into play.

The real role of the step1 right now is in allowing the latter groups (typical MD and DO schools' students) to differentiate themselves from one another, not to let them battle against the tiny handful of top-ranked grads in their match.

Exactly.

I can appreciate why this discussion has higher stakes for others but frankly I’ve done enough on this site to hopefully have a earned a little “good faith”. I’ll do whatever I have to do, I just think the current meta screws everyone over.

A sub 250 score doesn’t disqualify you for anything at all coming from a top school. I’m having a hard time seeing how those students get screwed in the current system. However getting rid of Step screws over everyone EXCEPT the people at top schools. Yeah I have a big dog in this fight because what your proposing would screw the crap out of me.

2 and 3 are debatable and just my knee jerk recommendations based on what I’ve thought about this issue. That said, I’m 10,000% confident precisely *nothing* will be done unless Step 1 scoring changes. All this talk about researching and developing the perfect exam for med students or whatever means absolutely nothing if there’s no impetus for anyone to change what they are already doing. That doesn’t mean that if scoring changes that it ought to go into effect tomorrow. But there needs to be a decision made to catalyze downstream changes in residency selection.

Changes made for the sake of change is a terrible way to do things. Imagine the people medicine would kill if we did things the way you are proposing of changing things before we studied them.

I don’t care if we change things, I really don’t, but when we are literally playing with thousands of individuals career prospects that change had better dang well be studied beforehand.

 

[907914]

The idea that $$$ can buy you a top-end MCAT or Step score is a myth that non-wealthy people tell themselves to feel less upset about their performance on the curve. I say this as someone who didn't have money for prep classes or whatever else. I paid my registration fee and Uworld subscription with some of my loan money, bought a cheap copy of first aid and an old copy of Pathoma. Anki is free.

Can confirm (at least MCAT wise...). I am an applicant on food stamps with Medicaid...so no money. Spent maybe $200 outside of official MCAT prep materials and the registration fee. Came out pretty darn well. Have a friend that spent $6,000 on an 8 week live-in prep course (why...?) and he was happy with his 506.

 

[notretired]

To some extent you are correct, the MCAT does a reasonable job of flushing underprivileged out of the applicant pool. Just look at the difference between all takers, applicants, and matriculants:

However, the knowledge base for the MCAT is usually obtained through taking undergraduate courses already en route to completing a bachelors degree. The knowledge base for Step 1 goes well beyond most undergraduate offerings. Most would need to go to college and then have 1-3 years of dedicated time to UFAP a score into the 240+ range. Good luck pulling that off if you're working.

This is based on the current data that we have; but that doesn't mean students wouldn't be able to succeed otherwise. Attending an in-person 4-year college is not required to succeed on the mcat (and by that argument s1); but med schools almost unanimously require all prereqs to be taken in person; so students likewise do so. Schools like MIT offer free open courseware - available to everyone with access to a public library. These are the exact same courses ug students take - so if someone happens to stream them (for free), and can prove via a say in-person exams/labs that they know just as much as the trad students, are they not just as competent in an academic sense?

I think all of the tools needed to breakdown the barriers in medicine for disadvantaged students already exist; but they simply aren't being utilized. I can't see the fight to resist changes in academia both at the ug and graduate levels as anything more than a money grab - which specifically hurts underprivileged students.

 

[Raryn]

To some extent you are correct, the MCAT does a reasonable job of flushing the underprivileged out of the applicant pool. Just look at the difference between all takers, applicants, and matriculants:

How does the data you cite have anything to do with the point you're trying to make?

All you've shown is that MCAT scores correlate with success in med school applications. The "underprivileged" aren't being flushed out - the unprepared or incapable are. Now, you can state that the underprivileged are less likely to have the time and money to become appropriately prepared - and I'd believe it (obviously if you're working your way through med school you have less time to study for example) - but that's nowhere near borne out in the graphs you posted.

 

[907914]

the unprepared

If you look at the average MCAT for low SES applicants it is about 5 points lower than the total average: so...yes, the underprivileged are the unprepared and they are being flushed out.

 

[efle]

I don’t give a crap what score you got on Step and that has no bearing on my argument. Your score in many ways doesn’t even matter by nature of where you go to school. What is intellectually dishonest is you trying to pawn off an idea that screws literally everyone over but yourself and trying to claim it’s the best thing for everyone.

And you are better than this dude. The elitist junk you’re spouting right now is pure rat crap and you know it. I didn’t bust my ass in medical school to build the app I have just to have someone at an elite school tell me how much more objective they are about this (LOL) and that it’s ok if I get screwed over because heaven forbid someone get a 230s instead of a 250s on Step and have slightly decreased chances at becoming a world renowned surgeon at MGH. No one is saying that you don’t get an opinion, but honestly the stakes are completely different for you so your opinion honestly carries less weight. There is a reason all the op-Ed articles on this have been written by students at top schools.


Actual argument? Well for starters the match rate for competitive specialties, let’s use ortho, in the 230s is a 75%. So my argument is that is if you have a 230’s then go get some pubs, get good clinical grades, and network because you still have a damn good chance of getting to do what you want if you play your cards right. This is what you don’t understand, people at low tier MD and DO schools see 75-80% and we are freaking happy about it. I’ll take 3/4 chances at the career I want any day of the week.





Addressed above. It’s asinine to argue over this when people with 230s match competitive specialties all the time. The idea that a mid 230s score disqualifies you from anything is a myth. Step scores are important, but everything else comes into play.


Exactly.


A sub 250 score doesn’t disqualify you for anything at all coming from a top school. I’m having a hard time seeing how those students get screwed in the current system. However getting rid of Step screws over everyone EXCEPT the people at top schools. Yeah I have a big dog in this fight because what your proposing would screw the crap out of me.




Changes made for the sake of change is a terrible way to do things. Imagine the people medicine would kill if we did things the way you are proposing of changing things before we studied them.

I don’t care if we change things, I really don’t, but when we are literally playing with thousands of individuals career prospects that change had better dang well be studied beforehand.

You are deeply, deeply biased on this issue because you worked hard for your score and it's a major distinguishing factor for you. Take a step back and look at my example HMS student with a 260. If he hits the magic button to switch scores to quartiles, he doesn't gain anything at all. Shouting at him that he has no right to hit the button because he didn't need his 260 anyways, doesn't make his reasoning any less valid. It's a hard pill to swallow that your score doesn't mean you deserve to match better than your classmates, but it's the truth, even according to the creators of the test itself.

Those 75% applying and matching are going to largely be people with good reason to expect they'll still match. For example, an HMS student with a 235 that feels pretty safe that they'll land in one of the Harvard network hospitals. The injustice to many people I'm talking about isn't the unfortunate 25% here, it's all the people who didn't even apply because they were scared off. I mean technically speaking, the majority of people applying ortho with a 220s still match, but that's a whopping 50 people in the country we're talking about. It's the hundreds and hundreds of other students from the middle of the curve that change their career aspirations rather than risk SOAPing who are getting the short end of the stick.

 

[Med Ed]

Can confirm (at least MCAT wise...). I am an applicant on food stamps with Medicaid...so no money. Spent maybe $200 outside of official MCAT prep materials and the registration fee. Came out pretty darn well. Have a friend that spent $6,000 on an 8 week live-in prep course (why...?) and he was happy with his 506.

The plural of anecdote is not data.

 

[907914]

The plural of anecdote is not data.

That is clever. I like that. You are correct, anecdotal ‘evidence’ is not really evidence. But it does work very well to compliment and reinforce confirmation bias.

 

[efle]

The plural of anecdote is not data.

There's been lots of good data that prep classes don't buy you a high score on these kinds of standardized exams, though. The college board review of whether the SAT was beatable had an n of many thousands. Wealth may do a lot to get you into college, but we can't pretend the key to raising low-income scores is providing them a Kaplan class or an extra month of study time.

 

[907914]

There's been lots of good data that prep classes don't buy you a high score on these kinds of standardized exams, though. The college board review of whether the SAT was beatable had an n of many thousands. Wealth may do a lot to get you into college, but we can't pretend the key to raising low-income scores is providing them a Kaplan class or an extra month of study time.

I think the difficulty with showing people these statistics and changing their mind lies within the ever-so American belief that everyone is in charge of their own destiny and enough hard work can get you anywhere. This belief cites the Steve Jobs and the Bill Gates of the country...not the other million like them that got left behind. It is sheer ignorance to believe that only a few ten thousand out of the millions who grow up in poverty have the “will power” to do well.

 

[Med Ed]

How does the data you cite have anything to do with the point you're trying to make?

FAP status and parental education both correlate with MCAT:

The MCAT could certainly do a better job of removing the underprivileged from serious contention, I won't argue that, but it's a start.

 

[Med Ed]

There's been lots of good data that prep classes don't buy you a high score on these kinds of standardized exams, though. The college board review of whether the SAT was beatable had an n of many thousands. Wealth may do a lot to get you into college, but we can't pretend the key to raising low-income scores is providing them a Kaplan class or an extra month of study time.

Let's back up. My point is that if you take 1,000 kids from affluent, educated families who attended good schools and have both time and money and pit them against 1,000 kids from poorer, less educated families who attended underperforming schools and have to work, therefore providing less time and money, I'm betting the former group would utterly destroy the latter group on Step 1.

 

[Med Ed]

This is based on the current data that we have; but that doesn't mean students wouldn't be able to succeed otherwise.

Some will always find a way. But that shouldn't stop us from implementing a system that makes them outliers.

 

[AnatomyGrey12]

You are deeply, deeply biased on this issue because you worked hard for your score and it's a major distinguishing factor for you.

Of course I’m biased. The difference between you and I is I will fully admit that and you sit there and tell me you are the most objective. Don’t fart in my face and try to tell me it’s wind.

It's a hard pill to swallow that your score doesn't mean you deserve to match better than your classmates, but it's the truth, even according to the creators of the test itself.

Yeah so all those thousands of medical students that match better than the level of their medical schools because they study their asses off for Step can all just shut up and get back in line. Cool story bro.

 

[efle]

Of course I’m biased. The difference between you and I is I will fully admit that and you sit there and tell me you are the most objective. Don’t fart in my face and try to tell me it’s wind.



Yeah so all those thousands of medical students that match better than the level of their medical schools because they study their asses off for Step can all just shut up and get back in line. Cool story bro.

I mean yeah, someone who doesn't depend on their step score at all is certainly in the most objective position to call it out for being nonsensical. It's the people relying on it that need to believe in it. I literally couldn't care less whether my report switches to just saying "Quartile 1" by my match, I'll match the same. I don't understand how being totally unaffected would make me biased in any direction at all. It just protects me from the bias affecting you.

We've come full circle - why should grinding anki harder dictate your match? It ****ing shouldn't. It's nonsense. Program directors are generally too old to have taken Step1 in anything resembling its current climate. They're literally using a metric they have no firsthand experience with, in direct contradiction to the advice of the test writers, out of necessity for a way to reduce their application load.

I'm not denying you worked a lot harder than your peers. You did, you worked harder and you can recite more of First Aid than they can. Me too. Neither of us would be any better at TURP or retinal surgery because of it, and pretending we would isn't the way to address discrimination against DO students.

 

[notretired]

Some will always find a way. But that shouldn't stop us from implementing a system that makes them outliers.

They aren't outliers in the current system; they don't exist. Allowing students who didn't attend a 4 year in-person institution; yet still demonstrate the academic metrics indicative of success in med school; will allow them to become outliers. I cannot see how one claim to be supportive of increasing opportunities for disadvantaged applicants in medicine while simultaneously keeping this door closed.

 

[efle]

They aren't outliers in the current system; they don't exist. Allowing students who didn't attend a 4 year in-person institution; yet still demonstrate the academic metrics indicative of success in med school; will allow them to become outliers. I cannot see how one claim to be supportive of increasing opportunities for disadvantaged applicants in medicine while simultaneously keeping this door closed.

@Med Ed There's a good number of med schools that already accept community college or online coursework, right? If it's not essential to learn biochemistry in a real classroom in college, what changes? Wouldn't students sitting at home doing their M1 biochemistry unit be the same thing?

But I think in the past you've mentioned that the M3-M4 years take the lion's share of resources to run. So maybe this doesn't really fix anything, the cost of an MD wouldn't be halved just by doing M1-M2 at home.

 

[notretired]

Let's back up. My point is that if you take 1,000 kids from affluent, educated families who attended good schools and have both time and money and pit them against 1,000 kids from poorer, less educated families who attended underperforming schools and have to work, therefore providing less time and money, I'm betting the former group would utterly destroy the latter group on Step 1.

Correct; but this is already the case re. the mcat. Only difference is that by lopping off a year (or 2) of med school you'd be saving these low SES students roughly $100k. Tell me how that is bad exactly?

 

[notretired]

@Med Ed There's a good number of med schools that already accept community college or online coursework, right? If it's not essential to learn biochemistry in a real classroom in college, what changes? Wouldn't students sitting at home doing their M1 biochemistry unit be the same thing?

But I think in the past you've mentioned that the M3-M4 years take the lion's share of resources to run. So maybe this doesn't really fix anything, the cost of an MD wouldn't be halved just by doing M1-M2 at home.

I can't think of any MD schools off hand that allow core science pre-reqs to be taken online. I imagine they are out there; but if so they are a small minority.

 

[Lawpy]

We've come full circle - why should grinding anki harder dictate your match? It ****ing shouldn't. It's nonsense.

That's why I'm pushing for Step 1 to be an aptitude test! I think revamping the exam to test both knowledge and reasoning will improve the quality and stop the Anki craze.

Like ok, if you want to get technical and state Steps should be only based on bare minimum knowledge needed to pass, having a separate exam that is standardized and heavily focused on aptitude + content knowledge like the MCAT would also be an ok solution.

 

[AnatomyGrey12]

I mean yeah, someone who doesn't depend on their step score at all is certainly in the most objective position to call it out for being nonsensical. It's the people relying on it that need to believe in it. I literally couldn't care less whether my report switches to just saying "Quartile 1" by my match, I'll match the same. I don't understand how being totally unaffected would make me biased in any direction at all. It just protects me from the bias affecting you.

I’ve never said I think USMLE is some great predictor of ability to be a doctor.

It’s ridiculous you can sit there and tell me that you are more objective. It’s pretty easy to see how this benefits students at top schools. If you don’t have to worry about Step then your match is pretty much sealed at the time of medical school acceptance. Who needs to stress about anything in medical school when all you gotta do is pass and you will land that residency of your choice? Not saying this is you specifically but have you read the op-Ed’s written by your peers? They’re all about “wellness” and “decreasing stress” and other crap that is thinly veiled “why should we have stress and have to compete when we’re at X elite medical school? We shouldn’t have to work this hard for the match we want.”

We've come full circle - why should grinding anki harder dictate your match? It ****ing shouldn't. It's nonsense.

Why should the grades you got 10 years ago as a freshman in undergrad dictate your match? It ******* shouldn’t. Because that’s what happens if you get rid of Step without a good replacement. It will have nothing to do with merit and, you know, anything that you’ve actually done in medical school; matching will become even more directly linked to the prestige of the medical school you attend. These days that is pretty much decided by if you knew you wanted to go to medical school when you matriculate into college. At that point you’re telling me the fact I turned my academic career around and now have multiple years’ worth of sustained excellence doesn’t ******** matter and my early follies as a teenager dictate my match potential.

I'm not denying you worked a lot harder than your peers. You did, you worked harder and you can recite more of First Aid than they can. Me too. Neither of us would be any better at TURP or retinal surgery because of it, and pretending we would isn't the way to address discrimination against DO students.

And what do you propose we do to discover who is better at those things? I’m not sure anything we do in medical school predicts that stuff.

Design a replacement with clearly delineated effects and we can talk about it. I’m honestly open to change if we know what that change entails. However right now you guys are sitting here wanting to blow up the whole system without having a good replacement designed, a move with significant deleterious effects for multitudes of medical students. You don’t get to use my career, and the thousands of other students’ that would be affected, as the experimental group in this hoping stuff gets better. Screw that.

That's why I'm pushing for Step 1 to be an aptitude test! I think revamping the exam to test both knowledge and reasoning will improve the quality and stop the Anki craze.

Anki is simply a learning tool. It’s only a “craze” because it is extremely effective. As long as medicine is extremely memorization driven (it always will be FYI) then Anki is here to stay. Can’t reason your way around almost all of pharm, signaling cascades, what the components of a TIMI score are, etc.

 

[Lawpy]

Wait guys quick question. What does Step 3 do? Does it have a value or can we get rid of it with Step 2 CS?

 

[Raryn]

FAP status and parental education both correlate with MCAT:

View attachment 275698

The MCAT could certainly do a better job of removing the underprivileged from serious contention, I won't argue that, but it's a start.

They correlate, for a wide variety of reasons, most absolutely out of the control of their colleges (or the med schools looking at them). Things like childhood environment and self-selection. Even still, there is substantial overlap between every single one of those box plots (much less the whiskers) - and there's tons of resources out there that are free and/or inexpensive to study for both tests. Honestly, for purposes of the MCAT, the hardest resource is *time* when there's so much else on your plate (classes, extracurriculars, potentially work).

Med schools (and residencies) need *some* kind of way to select for ability when there are more applicants than there are seats - and a standardized function that requires both ability AND preparation is ideal. Now, the MCAT does a better job of reflecting that than the USMLEs do due to actually being designed for that function.

Wait guys quick question. What does Step 3 do? Does it have a value or can we get rid of it with Step 2 CS?

All of the USMLEs serve the same purpose - to determine minimum competency for licensing. Step 3 is the most clinically oriented exam and serves as one last weed out. Is it particularly useful? No. But it's not going away either.

 

[efle]

I’ve never said I think USMLE is some great predictor of ability to be a doctor.

It’s ridiculous you can sit there and tell me that you are more objective. It’s pretty easy to see how this benefits students at top schools. If you don’t have to worry about Step then your match is pretty much sealed at the time of medical school acceptance. Who needs to stress about anything in medical school when all you gotta do is pass and you will land that residency of your choice? Not saying this is you specifically but have you read the op-Ed’s written by your peers? They’re all about “wellness” and “decreasing stress” and other crap that is thinly veiled “why should we have stress and have to compete when we’re at X elite medical school? We shouldn’t have to work this hard for the match we want.”



Why should the grades you got 10 years ago as a freshman in undergrad dictate your match? It ******* shouldn’t. Because that’s what happens if you get rid of Step without a good replacement. It will have nothing to do with merit and, you know, anything that you’ve actually done in medical school; matching will become even more directly linked to the prestige of the medical school you attend. These days that is pretty much decided by if you knew you wanted to go to medical school when you matriculate into college. At that point you’re telling me the fact I turned my academic career around and now have multiple years’ worth of sustained excellence doesn’t ******** matter and my early follies as a teenager dictate my match potential.


And what do you propose we do to discover who is better at those things? I’m not sure anything we do in medical school predicts that stuff.

Design a replacement with clearly delineated effects and we can talk about it. I’m honestly open to change if we know what that change entails. However right now you guys are sitting here wanting to blow up the whole system without having a good replacement designed, a move with significant deleterious effects for multitudes of medical students. You don’t get to use my career, and the thousands of other students’ that would be affected, as the experimental group in this hoping stuff gets better. Screw that.




Anki is simply a learning tool. It’s only a “craze” because it is extremely effective. As long as medicine is extremely memorization driven (it always will be FYI) then Anki is here to stay. Can’t reason your way around almost all of pharm, signaling cascades, what the components of a TIMI score are, etc.

You keep acting like it's always been this way. In the distant year of 1995, did all ortho surgeons come out of Harvard and Hopkins?

 

[efle]

Btw I Dont think the op Ed's are supposed to read as "waaah, why cant I be lazy and rest on my laurels"

More like "its stupid that all my classmates in this small group are doing enzyme flashcards on their phone instead of working the example cases with the expert physician in the room"

 

[907914]

More like "its stupid that all my classmates in this small group are doing enzyme flashcards on their phone instead of working the example cases with the expert physician in the room"

This x1000

 

[AnatomyGrey12]

You keep acting like it's always been this way. In the distant year of 1995, did all ortho surgeons come out of Harvard and Hopkins?

I mean we didn’t used to have a Match either so I don’t really get your point. Medicine has changed drastically in the last 20 years.

Btw I Dont think the op Ed's are supposed to read as "waaah, why cant I be lazy and rest on my laurels"

More like "its stupid that all my classmates in this small group are doing enzyme flashcards on their phone instead of working the example cases with the expert physician in the room"

Either way it sounds like a lot of entitled complaining, and I’ve read op-Ed’s that read both ways. Acting like medical students are somehow missing out on great bits of knowledge by not paying attention in small groups is asinine too. I’m pretty sure that would happen regardless of what happens with Step.

This x1000

Once again, you’re passing judgement on a study modality you have no experience with and on classmates you don’t have yet.

 

[Lawpy]

You keep acting like it's always been this way. In the distant year of 1995, did all ortho surgeons come out of Harvard and Hopkins?

Dude why are you looking at what happened decades ago? Even the MCAT medians for top schools rose drastically in the past decade

 

[efle]

I mean we didn’t used to have a Match either so I don’t really get your point. Medicine has changed drastically in the last 20 years.



Either way it sounds like a lot of entitled complaining, and I’ve read op-Ed’s that read both ways. Acting like medical students are somehow missing out on great bits of knowledge by not paying attention in small groups is asinine too. I’m pretty sure that would happen regardless of what happens with Step.



Once again, you’re passing judgement on a study modality you have no experience with and on classmates you don’t have yet.

The match goes way further back than step1 screening does. My point is that in the not very distant past, residency directors did a fine job of filling their seats with capable applicants without relying on the USMLE. Pretending its absence would cause our whole system to implode is disingenuous.

The truth is that you know the current role of the USMLE is indefensible nonsense, just like the authors of the test itself have explicitly stated. But, you'd rather see outlier DO students have a nonsensical method of identifying themselves as outliers, rather than no method at all.

I completely understand why youd feel that way, I'm sure I would too. But you cant act surprised that anyone else involved sees that as a pretty lame basis to perpetuate the nonsensical system. The reason groups at INCUS like AMA/AAMC want the system to change is because they have the 10,000ft view of how this is affecting the vast majority of typical cases, instead of protecting a few DO students' ability to match unusually well.

 

[efle]

Dude why are you looking at what happened decades ago? Even the MCAT medians for top schools rose drastically in the past decade

Like I said, I also don't think the recent emphasis on the top 1-2% of MCAT scores is very defensible. The rise of US News rankings and excessive numbers of applicants have been driving that phenomenon too, not some new meritocratic philosophy that the MCAT is the best way of finding rough diamonds in unlikely places.

 

[AnatomyGrey12]

The match goes way further back than step1 screening does. My point is that in the not very distant past, residency directors did a fine job of filling their seats with capable applicants without relying on the USMLE. Pretending its absence would cause our whole system to implode is disingenuous.

Getting rid of Step 1, in the current system would 100% cause the entire system to go into complete disarray. To deny this is straight elitist stupidity.

The truth is that you know the current role of the USMLE is indefensible nonsense, just like the authors of the test itself have explicitly stated. But, you'd rather see outlier DO students have a nonsensical method of identifying themselves as outliers, rather than no method at all.

COME UP WITH A BETTER SYSTEM. It’s that simple. Design a better system that has been studied and has clear outcomes and then implement that. You’re at Hopkins and I’m sure doing research, I know for a fact you know how changes to the status quo are made in medicine and they sure as hell aren’t made on a whim before an idea of what the outcomes from that change would be.

completely understand why youd feel that way, I'm sure I would too. But you cant act surprised that anyone else involved sees that as a pretty lame basis to perpetuate the nonsensical system. The reason groups at INCUS like AMA/AAMC want the system to change is because they have the 10,000ft view of how this is affecting the vast majority of typical cases, instead of protecting a few DO students' ability to match unusually well.

To pretend this is only DO students is blind ignorance. You know this would effect thousands of low tier MD students too. Have you really been on the ivory tower for that long? The AMA is garbage and most doctors I know see them nothing more than a liberal political group masquerading behind the shield of medicine so their opinion isn't worth much. Many PDs are fighting against the proposals at INCUS which you neglect to mention. You also neglect to mention that most of the people involved in these discussions are from elite schools, furthering the fact that the majority of people taking your stance are from the only demographic that would benefit from such proposals.

You’ve revealed a lot about your view on other medical students. The truth comes out. You don’t give a **** about any other group of students. Low tier MD students and DO students can all just shut up and get back in line, no more rising above the level of your school. Congratulations, the elitist bull**** you’re spreading everywhere is a new SDN low.

 

[907914]

Once again, you’re passing judgement on a study modality you have no experience with and on classmates you don’t have yet.

I do have experience with this study modality. Not MED school, but similar setting, topics and pace. I did 60 semester hours in six months as part of my military coursework and we had to sit for a board exam at the end. Most people just did flash cards and blah blah study for the test. It may not be MED school, but I am very familiar with it.

 

[Raryn]

Like I said, I also don't think the recent emphasis on the top 1-2% of MCAT scores is very defensible. The rise of US News rankings and excessive numbers of applicants have been driving that phenomenon too, not some new meritocratic philosophy that the MCAT is the best way of finding rough diamonds in unlikely places.

90,000 people take the MCAT in any given year. They can't all be doctors. Obviously a bunch of them self-select out of applying but there's still far more candidates than there are seats. So if you're one of the most elite of a group of already selective institutions, it's not unreasonable to pick from the ones who do the best on the test. I think it's a perfectly defensible strategy.

Only in America do we get into these arguments. In most other countries, there's no meritocratic subjective component at all. You want to get into the medical school, you take a nationally standardized test (... as a 17-18 year old usually) and the people who do the best get first pick. We have more of an emphasis on a holistic system than anywhere else I know of, which is (generally) a strength, but no one is ever satisfied.

 

[efle]

Getting rid of Step 1, in the current system would 100% cause the entire system to go into complete disarray. To deny this is straight elitist stupidity.

It would very literally just be a rollback to the system that existed a short while ago. It's a convenience for PDs to screen out with a threshold, not a requirement.

COME UP WITH A BETTER SYSTEM. It’s that simple. Design a better system that has been studied and has clear outcomes and then implement that. You’re at Hopkins and I’m sure doing research, I know for a fact you know how changes to the status quo are made in medicine and they sure as hell aren’t made on a whim before an idea of what the outcomes from that change would be.

Can you provide me any studies that support the current system? Of course not, this didn't arise because we had studies showing that Step1 scores should be used this way. Not everything in medicine works like that and not all things can be trialed first. The first schools to switch to Pass/Fail curriculums, for example, were making a leap of faith based on how nonsensical and unnecessarily stressful they viewed their grading situation to be.

To pretend this is only DO students is blind ignorance. You know this would effect thousands of low tier MD students too. Have you really been on the ivory tower for that long? The AMA is garbage and most doctors I know see them nothing more than a liberal political group masquerading behind the shield of medicine so their opinion isn't worth much. Many PDs are fighting against the proposals at INCUS which you neglect to mention. You also neglect to mention that most of the people involved in these discussions are from elite schools, furthering the fact that the majority of people taking your stance are from the only demographic that would benefit from such proposals.

You’ve revealed a lot about your view on other medical students. The truth comes out. You don’t give a **** about any other group of students. Low tier MD students and DO students can all just shut up and get back in line, no more rising above the level of your school. Congratulations, the elitist bull**** you’re spreading everywhere is a new SDN low.

Again dude, no horse in this fight. A switch to quartiles tomorrow night would have no impact on my match. I really, truly think it's a stupid way to use the test just like the tests' authors do, that's all. Most of the PDs that like the scaled scores didn't even take a Step 1 anything like we do. They just hate the idea of losing their convenient, standardized screening tool, even when the folks that made it are telling them to stop using it that way.

Sorry if I've offended you, I've always enjoyed your posts and discussions a lot. I apologize if I've come off as looking down on or disrespecting you. I do think it's ****ed up how much discrimination there is against DO students and MD students from new or unknown schools. But, I think the ever-accelerating anki and UFAPS arms race to overcome that discrimination has left us all in a position that will soon be untenable.

 

[efle]

90,000 people take the MCAT in any given year. They can't all be doctors. Obviously a bunch of them self-select out of applying but there's still far more candidates than there are seats. So if you're one of the most elite of a group of already selective institutions, it's not unreasonable to pick from the ones who do the best on the test. I think it's a perfectly defensible strategy.

Only in America do we get into these arguments. In most other countries, there's no meritocratic subjective component at all. You want to get into the medical school, you take a nationally standardized test (... as a 17-18 year old usually) and the people who do the best get first pick. We have more of an emphasis on a holistic system than anywhere else I know of, which is (generally) a strength, but no one is ever satisfied.

The modern system is a pretty extreme departure from anything in the last 50 years, though. I mean for frick's sake, there are medical schools where you need a top 1% score to be average, and top 5-10% just to be in their range.

I'm usually pretty skeptical of the D I V E R S I T Y initiative. At the same time I'm not (quite) cynical enough to agree that my MCAT score should make me more desirable than an average scorer with Americorps or TFA years. A decade ago the big names had MCAT ranges only slightly above the average, and they had their pick of the litter back then too.

 

[Lawpy]

But, I think the ever-accelerating anki and UFAPS arms race to overcome that discrimination has left us all in a position that will soon be untenable.

so make Step 1 an aptitude test!

 

[Raryn]

The modern system is a pretty extreme departure from anything in the last 50 years, though. I mean for frick's sake, there are medical schools where you need a top 1% score to be average, and top 5-10% just to be in their range.

I'm usually pretty skeptical of the D I V E R S I T Y initiative. At the same time I'm not (quite) cynical enough to agree that my MCAT score should make me more desirable than an average scorer with Americorps or TFA years. A decade ago the big names had MCAT ranges only slightly above the average, and they had their pick of the litter back then too.

I don't know what year the data in that post is from, but it's certainly more than a decade ago.

I applied to medical school in 2008 for matriculation in 2009 - so basically exactly a decade ago. I just pulled up my old spreadsheets.

The year before I applied (thus in the MSAR I used), Stanford, Harvard, Hopkins, Northwestern already had an average MCAT for matriculants of 37 (519-520). Wash U was 38 (521-522). UCSF, USC, UCSD, Sinai, Case and company were 35 (517).

That's more or less the same as it is today. Maybe one point off - which can be explained by an increase in applicants. There's probably a few more schools that have gone up to join the extreme high end folks (explained by the same), but it really hasn't changed significantly in the last 10 years.

 

[Matthew9Thirtyfive]

I mean we didn’t used to have a Match either so I don’t really get your point. Medicine has changed drastically in the last 20 years.



Either way it sounds like a lot of entitled complaining, and I’ve read op-Ed’s that read both ways. Acting like medical students are somehow missing out on great bits of knowledge by not paying attention in small groups is asinine too. I’m pretty sure that would happen regardless of what happens with Step.



Once again, you’re passing judgement on a study modality you have no experience with and on classmates you don’t have yet.

I go to a school where I would 1000% benefit from a p/f step and I actually think keeping it scored is better. Or @efle’s idea of having a p/f step 1 with a scored exam that’s more aptitude based. Maybe just revamping ck to fit that.

But I think just making step p/f with no other change is a terrible idea even though it would make my life way easier.

 

[AnatomyGrey12]

Again dude, no horse in this fight. A switch to quartiles tomorrow night would have no impact on my match. I really, truly think it's a stupid way to use the test just like the tests' authors do, that's all. Most of the PDs that like the scaled scores didn't even take a Step 1 anything like we do. They just hate the idea of losing their convenient, standardized screening tool, even when the folks that made it are telling them to stop using it that way.

I wouldn't be overly against a quintile system until we can design something better.

Sorry if I've offended you, I've always enjoyed your posts and discussions a lot. I apologize if I've come off as looking down on or disrespecting you. I do think it's ****ed up how much discrimination there is against DO students and MD students from new or unknown schools. But, I think the ever-accelerating anki and UFAPS arms race to overcome that discrimination has left us all in a position that will soon be untenable.

We're good bro. I just think you are looking from the top down without truly realizing how drastically negative a sudden change in Step 1 scoring would affect those of us on the bottom of the prestige ladder. It's not just a few outlier DOs, it would have far reaching impacts on just about every DO student, as well as most if not all low-mid tier MDs.

 

[Lawpy]

Can we please just get rid of Step 2 CS which incidentally is pass/fail?

 

[Lawpy]

Like i want to hear a valid argument from anyone on SDN regarding the benefits of keeping Step 2 CS. I saw an insanely idiotic suggestion listed from that meeting attended by medical educators and interest groups to make Step 2 CS a scored exam.

 

[AnatomyGrey12]

Like i want to hear a valid argument from anyone on SDN regarding the benefits of keeping Step 2 CS. I saw an insanely idiotic suggestion listed from that meeting attended by medical educators and interest groups to make Step 2 CS a scored exam.

I don't even think the people who design that test can give a valid argument for why it costs $1200, let alone why it should even exist.

 

[Lawpy]

I don't even think the people who design that test can give a valid argument for why it costs $1200, let alone why it should even exist.

They want money. I don't know why medical educators defend that test so passionately if some of them were making *****ic suggestions to change it to a scored exam

 

[efle]

I don't know what year the data in that post is from, but it's certainly more than a decade ago.

I applied to medical school in 2008 for matriculation in 2009 - so basically exactly a decade ago. I just pulled up my old spreadsheets.

The year before I applied (thus in the MSAR I used), Stanford, Harvard, Hopkins, Northwestern already had an average MCAT for matriculants of 37 (519-520). Wash U was 38 (521-522). UCSF, USC, UCSD, Sinai, Case and company were 35 (517).

That's more or less the same as it is today. Maybe one point off - which can be explained by an increase in applicants. There's probably a few more schools that have gone up to join the extreme high end folks (explained by the same), but it really hasn't changed significantly in the last 10 years.

I think it was 2006 data. Maybe that huge jump happened over just a couple years?

 

[Lawpy]

In case anyone was curious, was referring to this:

Pass/ Fail Step 1

Another issue with making the app "more holistic" is that is really code for pre-med style volunteer in a soup kitchen to show I'm Mother Theresa type bull****. No thanks. I didn't do it for med school apps and I'm definitely not doing that for residency apps. In fact, I would blackball anyone...

forums.studentdoctor.net

People love to fixate on Step 1 mania while allowing useless, expensive and stressful tests like Step 2 CS to continue, even to the point of making absurd suggestions to change it to a scored exam

 

[efle]

I go to a school where I would 1000% benefit from a p/f step and I actually think keeping it scored is better. Or @efle’s idea of having a p/f step 1 with a scored exam that’s more aptitude based. Maybe just revamping ck to fit that.

But I think just making step p/f with no other change is a terrible idea even though it would make my life way easier.

Would life really get easier is a big question though. Imagine trying match derm if EVERYONE could apply instead of just people scoring 240+. People would be doing away rotations left and right to try and secure an advantage somewhere

I wouldn't be overly against a quintile system until we can design something better.


We're good bro. I just think you are looking from the top down without truly realizing how drastically negative a sudden change in Step 1 scoring would affect those of us on the bottom of the prestige ladder. It's not just a few outlier DOs, it would have far reaching impacts on just about every DO student, as well as most if not all low-mid tier MDs.

Honestly there's zero chance of this affecting either of us, I just like to talk about it out of concern for posterity. Preclinical medical school in the year 2025 is going to be a nightmare. Day 1: here's your schedule to complete half a million Zanki reviews, two first aid passes, and 3 question banks prior to dedicated. Stick to it and you might be in the running for a 230!

I don't even think the people who design that test can give a valid argument for why it costs $1200, let alone why it should even exist.

Isn't the (non-politically correct) reason so that there's an excuse to keep out terribly awkward people or people that can't hold a conversation in English?