MD & DO USMLE will eventually become P/F?

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If I remember correctly, the USMLE was originally designed to be a pass/fail exam. Then they added scores for funsies. Then, of course, the scores started mattering.

I have no data to back this up-- but I remember hearing this story first or second year.
 
Pretty sure if Step exams became pass/fail, third year would become super annoying and subjective. People would be gunning for honors like crazy and the honors threshold would soar with attendings/residents being insanely picky and biased in grading.

Gunning for AOA would increase. School name would matter even more. It would make med school life miserable and residency application process a nightmare

This is why standardized tests are important to counter the impact of subjective grades and variations
 
I personally like having Step 1 as a numeric score. It encourages people to learn the material better. While a lot of it isn't very clinically relevant in practice, having a strong basic science foundation is what separates us from mid-level providers. Plus, I'll take Step 1 stratification over the subjective clinical grades any day.
 
Lawper said:
Pretty sure if Step exams became pass/fail, third year would become super annoying and subjective. People would be gunning for honors like crazy and the honors threshold would soar with attendings/residents being insanely picky and biased in grading.

Gunning for AOA would increase. School name would matter even more. It would make med school life miserable and residency application process a nightmare

This is why standardized tests are important to counter the impact of subjective grades and variations
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The bolded is already completely true as is. I couldn't even begin to imagine the new horrors of third year if we got rid of Step scores.

Either way, I would imagine that current students are safe for at least the next 3-4 years and will be able to get through Step and residency applications before any changes get implemented.

God help us all if they take away the only objective metric we have throughout 4 years of medical school. I never thought I'd say this, but thank god for Step 1.
 
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Lawper said:
Pretty sure if Step exams became pass/fail, third year would become super annoying and subjective. People would be gunning for honors like crazy and the honors threshold would soar with attendings/residents being insanely picky and biased in grading.

Gunning for AOA would increase. School name would matter even more. It would make med school life miserable and residency application process a nightmare

This is why standardized tests are important to counter the impact of subjective grades and variations
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Said exactly what I came here to say. This sounds great from an academic standpoint but it would benefit top US MDs tremendously and the expense of others. I mean, if LCME really feels like they did such a great job determining who belongs at a top school, go for it .If it wasn’t for Step 1, I wouldn’t be where I am today.

That said, if someone can come up with an objective clinical OSCE or exam that represents the true competence of a medical student that doesn’t include obscure biochemistry and anatomy details, I would be all for that. Just give us non-top MD students a fighting chance.
 
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Syncrohnize said:
Said exactly what I came here to say. This sounds great from an academic standpoint but it would benefit top US MDs tremendously and the expense of others. I mean, if LCME really feels like they did such a feat and great job determining who belongs at a top school, go for it .If it wasn’t for Step 1, I wouldn’t be where I am today.

That said, if someone can come up with an objective clinical OSCE or exam that represents the true competence of a medical student that doesn’t include obscure biochemistry and anatomy details, I would be all for that. Just give us non-top MD students a fighting chance.
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Don’t you guys also think that this will hurt DO students severely? @Goro
 
Commentators keep repeating that Step 1 cannot be used to stratify applicants based on their potential to succeed in residency, but that simply is not true. A myriad of studies, across different specialties, have shown that step 1 scores correlate with achievement on in-service and certifying exams. While these correlations are not perfect, they do provide an indicator of whether residents will succeed in residency, which PDs find helpful and which they should be able to use in their selection process.

1. An Error Occurred Setting Your User Cookie
2. Predicting Performance on the American Board of Surgery Qualifying and Certifying Examinations
3. A Multi-institutional Study USMLE Scores Predict Success in ABEM Initial Certification:
4. A Multicenter Study - The Western Journal of Emergency Medicine An Error Occurred Setting Your User Cookie
5. https://www.academicpedsjnl.net/article/S1530-1567(07)00007-X/abstract
6. Do Scores of the USMLE Step 1 and OITE Correlate with the ABOS Part I Certifying Examination?: A Multicenter Study
7. Do Residency Selection Factors Predict Radiology Resident Performance? - PubMed - NCBI
8. https://www.jaad.org/article/S0190-9622(10)00007-1/pdf

One qualification for residency selection is being able to learn large volumes of information and correctly answer questions about it. It's not the only important factor - interpersonal skills, research, etc matter also. But medical students should have a way of demonstrating their competency in the content they learned during their education. If step 1 becomes pass/fail, program directors will still want residents who can perform well on certifying exams - and will likely even more preferentially choose students from top ranked medical schools, which tend to have the highest average MCAT scores. No one is demanding that the MCAT be made pass/fail. If there are problems with the USMLEs, they should be improved. The prestige of the medical school we attend and subjective clinical evaluations should not fully determine which medical specialty we can pursue. A study has already shown that medical students want the USMLEs to remain a scored exam. Once against medical lobbyists are acting against medical students and physicians' best interest.

Numerical Versus Pass/Fail Scoring on the USMLE: What Do Medical Students and Residents Want and Why?
 
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RockMcat520 said:
Don’t you guys also think that this will hurt DO students severely? @Goro
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Not as much as IMGs, but possibly. DOs still have M3 grades/equivalent courses to US MDs whereas admins don’t know what IMG schools work at all. This would hurt everyone not from brand name schools.
 
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Aerus said:
I personally like having Step 1 as a numeric score. It encourages people to learn the material better. While a lot of it isn't very clinically relevant in practice, having a strong basic science foundation is what separates us from mid-level providers. Plus, I'll take Step 1 stratification over the subjective clinical grades any day.
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Spare me. Most of the time people learn how to take the test better, not learn the material. There’s a difference in studying for Step vs studying for retention.
 
DubbiDoctor said:
Commentators keep repeating that Step 1 cannot be used to stratify applicants based on their potential to succeed in residency, but that simply is not true. A myriad of studies, across different specialties, have shown that step 1 scores correlate with achievement on in-service and certifying exams. While these correlations are not perfect, they do provide an indicator of whether residents will succeed in residency, which PDs find helpful and which they should be able to use in their selection process.
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All the studies you posted that I was able to link to basically came down to those who do well on tests do well on tests in residency. The only one that varies slightly was the radiology one, and they still based their final results on a test of sorts (how well the resident’s initial read coincided with the attending’s is still basically a test, just not standardized). None that I read indicated how Step 1 scores correlated with overall performance as residents, which is a very different thing than continued performance on tests. Show me studies that give me that information, and I’d be more convinced.
 
It will hurt everyone but top school MD students... i doubt this will ever happen. For fun, lets say it does. How would you decide the merit of a student when looking at apps for pgy1 spots ? not everyone can rotate at the program. Letter will become increasingly more important
 
Moose A Moose said:
Spare me. Most of the time people learn how to take the test better, not learn the material. There’s a difference in studying for Step vs studying for retention.
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People learn to take the test better, regardless of whether it's P/F or a number. But because it's a number that matters, more people will inherently try to learn the material better.
 
I'd encourage everyone to learn about the Canadian matching system before vomiting out your initial thoughts on this. It works really well up there and their boards have always been pass/fail. They even take their boards much later, so they can focus on their transition from pre-clinical years to clinical years.

So what do residency directors base their decisions on? Summer between first and second year become much more important, as well as research, audition rotations (this most of all), and clinical year grades.

There's no question there would need to be more standardization of the grading in 3rd year, but the system as is has no happy ending. USLME averages for every specialty has increased, things are getting more competitive, and your entire future hinges on a single score on a single test. Some people at the ACGME want to see this changed.
 
Robotfishbrain said:
I'd encourage everyone to learn about the Canadian matching system before vomiting out your initial thoughts on this. It works really well up there and their boards have always been pass/fail. They even take their boards much later, so they can focus on their transition from pre-clinical years to clinical years.

So what do residency directors base their decisions on? Summer between first and second year become much more important, as well as research, audition rotations (this most of all), and clinical year grades.

There's no question there would need to be more standardization of the grading in 3rd year, but the system as is has no happy ending. USLME averages for every specialty has increased, things are getting more competitive, and your entire future hinges on a single score on a single test. Some people at the ACGME want to see this changed.
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Yeah good luck on standardizing those third year grades, where your future grade is decided on the mood of the surgical attending or medicine attending who may or may not “believe” in giving Honors and who thinks that “in my day, this is what we did”.

There has to be an objective standard to which we can compare folks. The USMLE step 1 is not perfect but right now it’s definitely the best we have
 
While I agree it will be difficult, I don't think being complacent with the current system is the best way to improve things. There are many ways to standardize scoring, including taking into account how frequently one gives out honors.
 
NecFasc92 said:
Someone with a Phd in biochemistry who teaches M1 students doesn't have any actual idea about residency so no idea why you tagged him
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That's Anatomy, thank you, who teaches both M1 and 2, genius.

I do know enough to listen to what my wise resident and attending colleagues have to say on the subject. For starters, be a decent human being.

I also know enough to ask people who matter. @aProgDirector @Med Ed @gyngyn what say you???

My two cents? What's a PD to do when s/he'd flooded with a sea of MSTPs and other eval assessments? I'll wager PDs start looking for something that all med students have in common (and NO, not MCAT) so there is some standard to stratify candidates.

Alternatively, PD could be conservative and stick with graduates of known feeder schools. This would hurt people from new schools.

I'd also wager that PDs who understand COMLEX would at least have a numerical score to assess DOs. My Gawd! That opens a can of worms!

Another thought is that this reminds me of the days when people first learned of the AOA/ACGME merger. Take home is that it's easier to predict the results of the 2020 presidential election.
 
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If this does happen, would this not just make things more like how they do it in Canada? They don't have any standardized exams for residency matching I believe.
 
NecFasc92 said:
Hmm that's weird, *** must of messed up your CV on their website, genius 😉.

I can link it here if you want to double check.
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I don't necessarily disagree with your original statement, but this is not cool. Comes off as immature and creepy.
 
NecFasc92 said:
Dudes an ass to everyone and I'm the tool? Lol ok buddy, thanks for the keyboard warrior contribution. And I'm not your bro.

I'll delete them so you guys can have your safespace. 🙂
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It’s ridiculously unprofessional to try to out someone on an a forum designed specifically for medical students, professors, professionals, and other interested parties to discuss topics anonymously. That’s not just calling out someone you don’t like; that’s trying to hurt someone’s career. Hopefully you act more professionally in the real world.
 
LoGo said:
If this does happen, would this not just make things more like how they do it in Canada? They don't have any standardized exams for residency matching I believe.
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Every time Canadian match comes up on these forums it's all about how everyone goes to primary care, it's a complete disaster to prove yourself, and students apparently kill themselves over it not uncommonly. I think I'll pass on that system. I haven't gotten my step score back, but I can tell you I worked hard for it whatever it is. I went to my med school (top 30, but nothing worth bragging out) not because I couldn't get in elsewhere, but because it worked for my personal life and I had faith that I would be given the opportunity to prove myself. I still want an academic career doing bench science, and that basically requires time at a top 20-esque institution fellowship. If my research career ends up boiling down to subjective evaluations by attendings... it would basically be an insult to all the work I've put in to get this far.

Anyone remember that Radiolab when they talked about that study that showed that judges gave parole 90% of the time after lunch but only 10% of the time before lunch? All those things apply to attendings and residents giving evals. I know there were a few times when I had to evaluate professors on feedback sheets. Sometimes I'd be pushing the deadline, and on those days everyone got a 4/5 on every category. Some days I'd remember earlier and do it relaxed from my bed, and on those days I left detailed feedback. If you told me after-the-fact that professors would actually have their careers affected based on my evals, I'd be the first to say it was completely BS.
 
Goro said:
I also know enough to ask people who matter. @aProgDirector @Med Ed @gyngyn what say you???
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There is no chance that USMLE will remove the numeric component of its scoring system, so this whole discussion is rather moot. The general observation on this thread is true, however, that when an element is removed from the application it forces the evaluators to (1) look for proxies, and (2) concentrate more emphasis on what remains, which may not be a good thing.
 
This is already NBME policy. the AMA is just reaffirming it. I know enough docs who protest against it. Views of the organization aren't monolithic. Also, certain concessions are made to please different members of the establishment.

Btw, I am also against this. Also, the NBME only releases these scores because residency directors demand them. Their official policy endorses the STEP1 as a pass fail licensing exam. It is NOT an excellence tool. It certainly needs reform but total elimination of scoring is really bad because that removes the only objective measure. this disproportionately favors those at top med schools. It would push medicine down the route of high finance and law, where pedigree is the mlst important thing. Unironically, the BAR is pass/fail.
 
DrMcCoyDO said:
All the studies you posted that I was able to link to basically came down to those who do well on tests do well on tests in residency. The only one that varies slightly was the radiology one, and they still based their final results on a test of sorts (how well the resident’s initial read coincided with the attending’s is still basically a test, just not standardized). None that I read indicated how Step 1 scores correlated with overall performance as residents, which is a very different thing than continued performance on tests. Show me studies that give me that information, and I’d be more convinced.
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Competency in medical knowledge test-taking is one of the skills needed for residency success. If you cannot pass the certifying exams, you are considered a failure, harming your residency's reputation. Therefore, it makes sense that an objective assessment of medical knowledge examination ability should be one of numerous factors considered in residency selection.
TheIllusionist said:
This is already NBME policy. the AMA is just reaffirming it. I know enough docs who protest against it. Views of the organization aren't monolithic. Also, certain concessions are made to please different members of the establishment.

Btw, I am also against this. Also, the NBME only releases these scores because residency directors demand them. Their official policy endorses the STEP1 as a pass fail licensing exam. It is NOT an excellence tool. It certainly needs reform but total elimination of scoring is really bad because that removes the only objective measure. this disproportionately favors those at top med schools. It would push medicine down the route of high finance and law, where pedigree is the mlst important thing. Unironically, the BAR is pass/fail.
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This is what NBME writes on the matter how USMLE scores should influence the residency selection process:

Guidelines for Use of USMLE Step Scores for Selection Decisions When comparing examinee performance, it is generally appropriate to consider Step examination scores in conjunction with other criteria such as course grades and faculty evaluations, rather than using test scores as the sole basis for decisions. Test scores should be viewed as approximate rather than exact measures of medical knowledge. Small differences in Step examination scores alone should not be used as the basis for selection decisions about examinees, and scores that are relatively old may not accurately reflect current knowledge and ability

The NBME explicitly states that step *scores* (not simply whether you pass or fail) are an appropriate selection factor, in conjunction with other factors. They state that the 3 digit scores represent an approximate measure of medical knowledge. Their language does not support the myth that step scores should only be interpreted as indicating whether examinees have demonstrated minimum competency of medical knowledge, and never as indicating whether examinees with exceptionally high scores possess more medical knowledge and reasoning skills than those who barely passed.
 
This would also **** on everyone who didn't go through primary education + college with a silver spoon.

Your family isn't rich enough to send you on "volunteering missions" to Costa Rica and other BS to fluff up your college application? There goes your chance for going to a top undergrad, which in turn weakens your chances for a top med school. Had to work 30+ hours a week during college to fund your tuition and living expenses? Again, good luck on that near 4.0 you need to have a realistic chance for getting into a top med school.

Med school proper is probably the first point in the game where everyone is on basically an even footing, since whether your parents are paying or it or you're taking loans, everyone can devote 100% of their time to it if they so choose. What is the #1 thing all your effort in med school can produce to help you during residency applications? Your Step 1 score.

If you go to a top med school you are already way ahead of everyone else due to:

1) The Name of your school.
2) The names on your letters, which correspond to the Name of your school.
3) Your research, which is highly influenced by schools with good Names having the best research opportunities

The only factor you have much control over which can equalize some of that above is your Step 1. No wonder they want to nerf it.
 
ChordaEpiphany said:
Every time Canadian match comes up on these forums it's all about how everyone goes to primary care, it's a complete disaster to prove yourself, and students apparently kill themselves over it not uncommonly. I think I'll pass on that system. I haven't gotten my step score back, but I can tell you I worked hard for it whatever it is. I went to my med school (top 30, but nothing worth bragging out) not because I couldn't get in elsewhere, but because it worked for my personal life and I had faith that I would be given the opportunity to prove myself. I still want an academic career doing bench science, and that basically requires time at a top 20-esque institution fellowship. If my research career ends up boiling down to subjective evaluations by attendings... it would basically be an insult to all the work I've put in to get this far.

Anyone remember that Radiolab when they talked about that study that showed that judges gave parole 90% of the time after lunch but only 10% of the time before lunch? All those things apply to attendings and residents giving evals. I know there were a few times when I had to evaluate professors on feedback sheets. Sometimes I'd be pushing the deadline, and on those days everyone got a 4/5 on every category. Some days I'd remember earlier and do it relaxed from my bed, and on those days I left detailed feedback. If you told me after-the-fact that professors would actually have their careers affected based on my evals, I'd be the first to say it was completely BS.
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Oh I'm not contesting the utility of having a step score to prove yourself. I'm also not saying that evals are really the best way, and in fact I agree with you that they are useless most of the time. (I also don't know exactly what the Canadian schools use for evaluating. But I do think there's something to be said for working your ass off to get to know the department/residents you want to work with, and make them like you, rather than shacking up at home for months to study for a test - ultimately its the attendings who will be the ones to vouch for you so regardless of how good your step score is if they hate you or if they know and like someone else better, you aren't interviewing.

Again, not saying step should abandon scoring - I'm just raising the possibility that maybe the step score currently counts for too much because there are systems that get by without it altogether.

I also did an MD/PhD. Step counts for absolutely nothing in the research world - you could fail it for all they care. You could argue that you need a good step to get into a good residency which will lead to a good CLINICAL job, but doing so doesn't guarantee a research faculty position. Publish or perish.
 
LoGo said:
Oh I'm not contesting the utility of having a step score to prove yourself. I'm also not saying that evals are really the best way, and in fact I agree with you that they are useless most of the time. (I also don't know exactly what the Canadian schools use for evaluating. But I do think there's something to be said for working your ass off to get to know the department/residents you want to work with, and make them like you, rather than shacking up at home for months to study for a test - ultimately its the attendings who will be the ones to vouch for you so regardless of how good your step score is if they hate you or if they know and like someone else better, you aren't interviewing.

Again, not saying step should abandon scoring - I'm just raising the possibility that maybe the step score currently counts for too much because there are systems that get by without it altogether.

I also did an MD/PhD. Step counts for absolutely nothing in the research world - you could fail it for all they care. You could argue that you need a good step to get into a good residency which will lead to a good CLINICAL job, but doing so doesn't guarantee a research faculty position. Publish or perish.
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Absolutely you are right about getting to know the department vs. shacking up for months to study. I don't think these are mutually exclusive, but certainly both represent equally important parts of your medical career. You have to go home, read, and really internalize the information necessary to complete your residency training. You still need to build a massive knowledge base. You also have to be a likeable, easy going person who is reliable if you're gonna survive in the clinical world.

As for publish or perish, I think there's something to be said for going somewhere amazing for residency/fellowship. You don't have to be at The Brigham or MGH to get a K grant, but you have to admit that it's easier to make the connections necessary to publish in top basic science journals if you're at Yale vs. UConn. I know a ton of residents from my alma mater that were able to slip into a lab, contribute a figure to an upcoming Cell paper, and continue their research careers unscathed from clinical years and even bolstered by high profile papers and connections. I just don't see many people from mid-tier med schools obtaining tenure track basic science positions anywhere unless they broke into the top tier at some point in their career. My med school is not top tier, but every new hire for these positions even here comes from an elite institution. For me, a 260 step 1 + a PhD + my best effort in clinicals felt like it might at least guarantee that I go somewhere with name brand value and good labs that could keep this crazy dream alive. However, top residencies love their own and other top schools. Why would any residency take me over a name brand student if I can't prove superiority in some fashion? It feels difficult to even plan for my future if it's all based on the subjective opinions of residents and attendings filling out evals that mean nothing to them on their lunch break.

It makes me feel hopeless, and I'm sure I'm not alone. I've seen so many people fail at this and say, "I shouldn't have even done the PhD." I don't want to be another one of those. I don't want to be starting my first true job at 40, having missed my children's early years as a resident/fellow, looking at a broken, failed attempt at a research career. I thought I at least had some sort of say in the matter. Now it seems like it's mostly just luck. The biggest determinant of clerkship grade at my school is site placement... Am I supposed to slave away for 4 years, get placed at the hospital where everyone gets a "Pass" and then watch myself get passed over for interviews anywhere that could make my career?

I was told that step 1 was important, just like everyone else. We all set out to achieve a high score. We all adjusted our lives, worked our butts off, and gave it our best shot. It may not directly test my clinical skills, but it certainly tested all of our abilities to aim for a target and hit it. To be told that all of that might not matter after going through all of this, it's rough.
 
ChordaEpiphany said:
I was told that step 1 was important, just like everyone else. We all set out to achieve a high score. We all adjusted our lives, worked our butts off, and gave it our best shot. It may not directly test my clinical skills, but it certainly tested all of our abilities to aim for a target and hit it. To be told that all of that might not matter after going through all of this, it's rough.
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If you already took step or are taking it this year I'm pretty sure you're safe. It's not like they're going to give you a numerical score and then retroactively take it away by the time ERAS comes around next year. If this change goes forward, it will only apply to people who will have been told it's pass and fail long before they take the exam.
 
Money Moniker said:
If you already took step or are taking it this year I'm pretty sure you're safe. It's not like they're going to give you a numerical score and then retroactively take it away by the time ERAS comes around next year. If this change goes forward, it will only apply to people who will have been told it's pass and fail long before they take the exam.
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I'm MD/PhD, that was the point unfortunately.
 
There are no logical reasons to make Step 1 Pass/Fail. So you don't like competitiveness? +pity+ Welcome to the rest of your life, and it is not unique to medical school.

This is an exam with a score that even ~10 years ago correlated extremely well with the efforts and abilities of every single person around me. It's not a scratch-off lottery ticket. You're an adult. Don't like your results or score? Then do something about it. Just like you would for anything else in your life.
 
First of all, the document at the top of this thread simply talks about the AMA trying to get the stakeholders together to discuss switching USMLE to pass/fail. Two major points about that:

1. I could care less what the AMA thinks about anything.
2. The major stakeholders don't want USMLE scoring to go away.

But, let's pretend for a minute that the USMLE does make scoring go away. It's not going to happen, but let's pretend it does. What next?

Well:
1. As already mentioned, in Canada scores are often not available / used. Removing scores simply shuffles the deck of what's important. Now, auditions and "who you know" become more important. Imagine needing to do away rotations at places that you want to seriously consider. Think about how expensive and inconvienent that would be. I could imagine people needing to take a gap year just to get enough experience to apply. Or it will all depend upon whom you know, how well connected your school is, etc. None of this sounds like a good plan to me.

2. If the USMLE became pass/fail, here's what really would happen: Each subspecialty would develop a high stakes exam used for applying, and all students would need to take it. The "shelf" exams could become reportable. Or, more likely, each field already has an "in training exam". We'd just take a smaller subset of questions from that and create a high stakes exam with a score. There might be some student benefit to this plan, as you could possibly retake the exam if you were unhappy with your first score (although perhaps not, and who knows how programs would look at multiple scores). But this also means multiple exams for some students (want radiology and prelim IM? Take both exams).

3. Full tinfoil hat: the high stakes exam is administered by the NBME. Now they charge you for the USMLE which is pass/fail, and then they get to charge you again for each field specific exam you take. I could imagine the NBME being very interested in making the USMLE pass/fail...
 
If it happens it is a terribly bad thing for DO students and even students from low tier MD schools. PDs have to use something to stratify applicants and if it isn’t a standardized test then it will become like dental where medical school GPA matters a ton, along with subjective clinical grades, letters, and the name brand of schools
 
I for one am 100% in favor of a p/f step score. I feel that the singular focus on step one has been a huge negative for medical education. We can’t fault students who are simply smart people doing what they must to succeed, but we can alter the system.

Yes it’s one of the few objective measures but it’s terrible! Look at what it actually measures! That doesn’t really tell residency programs much important information. APD is correct that specialties would probably develop their own exams and use those to help stratify. Personally I think this is a great idea as I feel I could design test questions to elucidate things I care about in a resident that would be much more useful than a scaled 3 digit score based off how well someone knew the Krebs cycle 2 years ago.

I’m personally optimistic that this could happen. Despite PDs liking the universal measure, enough faculty are frustrated by their students blowing off coursework to do UFAP that something has to change. Students are just too smart and efficient and will triage their time to what matters most. It really shouldn’t be some stupid test that’s sole purpose is to test if you’re ready for 3rd year (not residency).
 
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aProgDirector said:
3. Full tinfoil hat: the high stakes exam is administered by the NBME. Now they charge you for the USMLE which is pass/fail, and then they get to charge you again for each field specific exam you take. I could imagine the NBME being very interested in making the USMLE pass/fail...
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I mean I'm against having to pay the NBME even more, but wouldn't have standardized pre-clinical exams & reportable shelf exam scores be better for everyone? Someone who is a good student will consistently score well overall (a la, Derm applicants, good IMGs, etc) while some programs can focus on one important score if they want (eg. IM only caring about IM shelf score or FM caring about FM, Ob/Gyn, Peds score etc). Pre-clinical years would also count more since they will be standardized for multiple exams instead of just this mentality of Step 1 is all that matter, everything else is baloney. Can also start moving away from P/F mentality and the first 2 years can be considered important for your application just like how all of undergrad is important for applying to medical school.
 
AnatomyGrey12 said:
If it happens it is a terribly bad thing for DO students and even students from low tier MD schools. PDs have to use something to stratify applicants and if it isn’t a standardized test then it will become like dental where medical school GPA matters a ton, along with subjective clinical grades, letters, and the name brand of schools
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I wouldn't say "terribly bad". More like "Bad if you want to specialize at a really good residency program." The Program Director's guide (which is the only dtaa we have, such as it is) lets us know who will or won't accept COMLEX. Generally, the more competitive the specialty, the less they will accept a COMLEX score. Fine, we already know that's how they view DO students, period.

Oddly, PDs are more likely to take COMLEX II over COMLEX I!

I suspect that what you'd see is a more geographic distribution of when medical students end up. For example, the PDs in and around your home state know the quality of your grads, so they will take them. A PD at U FL? Not so much.
 
Goro said:
I wouldn't say "terribly bad". More like "Bad if you want to specialize at a really good residency program." The Program Director's guide (which is the only dtaa we have, such as it is) lets us know who will or won't accept COMLEX. Generally, the more competitive the specialty, the less they will accept a COMLEX score. Fine, we already know that's how they view DO students, period.
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I mean if I were a PD I wouldn’t accept COMLEX.... and I would be a DO. Even among the thousand or so practice Qs I’ve already done the difference between USMLE questions and COMLEX questions is striking. It’s just a poorly written exam and every single person I know that has taken both says the same thing. There are more than a few programs (in many specialties) that are DO friendly but not COMLEX friendly, and it’s easy to see why.

It really would be terribly bad for most DO applicants. Even people applying to very DO friendly fields like anesthesiology and IM would be hit hard. The fact that you are a DO is even more pronounced as you have nothing in your app that hints that you are as good or better than the MD applicants they are receiving. The only thing there would be subjective clinical year info and many PDs are iffy enough as it is with the clinical training at DO schools whether it’s true or not. I would hate to apply and the thing on my app that they are using to compare me to other applicants being my supposed inferior clinical training (again whether it’s true or not isn’t relevant as that’s how it’s viewed)
 
Grading step 1 as H/HP/P/LP/F would be ideal....that way we will see less "omg im one point below ortho step 1 average i failed at life im not gonna be an orthopod" threads.
 
khrisskhoras said:
Grading step 1 as H/HP/P/LP/F would be ideal....that way we will see less "omg im one point below ortho step 1 average i failed at life im not gonna be an orthopod" threads.
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That just trades one demon for another.
 
[
Goro said:
That just trades one demon for another.
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Arguably makes it worse, since PDs won't know if you're close to the honors grade or barely made high pass. If honors is 250 and high pass is 235, and you score a 248, you're be viewed the same as everyone else who gets high pass. But if the ortho step 1 average is 250 (it's a bit lower), and you score a 248, no program director would think any less of you. In general, I think giving people more information is better.
 
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DubbiDoctor said:
[

Arguably makes it worse, since PDs won't know if you're close to the honors grade or barely made high pass. If honors is 250 and high pass is 235, and you score a 248, you're be viewed as everyone else who gets high pass. But if the ortho step 1 average is 250 (it's a bit lower), and you score a 248, no program director would think any less of you. In general, I think giving people more information with is better.
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but it would better serve USMLEs purpose of PDs not using a numerical score to stratify candidates while still giving students enough incentive to study hard. Step 1 scores have a pretty large SEM too if I recall correctly.

Giving simple letter grades will make step 1 more like what it should be: only part of the initial screen for PDs to choose interview candidates, not the primary screening tool it has become.
 
khrisskhoras said:
but it would better serve USMLEs purpose of PDs not using a numerical score to stratify candidates while still giving students enough incentive to study hard. Step 1 scores have a pretty large SEM too if I recall correctly.

Giving simple letter grades will make step 1 more like what it should be: only part of the initial screen for PDs to choose interview candidates, not the primary screening tool it has become.
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Are you really that naive? Specialties/Programs that want people with 250+ will just switch their primary screen from a numerical line to whatever letter grade they want.
 
DubbiDoctor said:
[

Arguably makes it worse, since PDs won't know if you're close to the honors grade or barely made high pass. If honors is 250 and high pass is 235, and you score a 248, you're be viewed the same as everyone else who gets high pass. But if the ortho step 1 average is 250 (it's a bit lower), and you score a 248, no program director would think any less of you. In general, I think giving people more information is better.
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Let’s not forget that a 248 and a 235 are not significantly different. The NBME clearly states that two scores must differ by more than 16 points for the difference to be statistically significant and not due to scaling error. Few people know this but it’s in their published materials.

Yet another reason it’s a terrible test for startifying applicants.

Everyone freaking out that students at mid to lower tier schools would lose out, I strongly disagree. The good students would just distinguish themselves in other ways and programs would have to work harder to review apps.

For us, the top scoring applicants also tend to be some of the most impressive in other ways. My sense is that people with the chops to bang out 260+ scores typically have more time to devote to other things. The people trying to hack the system by binging UFAP aren’t typically also doing high quality research and other ECs. That’s a broad generalization but true more often than not.
 
darklabel said:
I mean I'm against having to pay the NBME even more, but wouldn't have standardized pre-clinical exams & reportable shelf exam scores be better for everyone? Someone who is a good student will consistently score well overall (a la, Derm applicants, good IMGs, etc) while some programs can focus on one important score if they want (eg. IM only caring about IM shelf score or FM caring about FM, Ob/Gyn, Peds score etc). Pre-clinical years would also count more since they will be standardized for multiple exams instead of just this mentality of Step 1 is all that matter, everything else is baloney. Can also start moving away from P/F mentality and the first 2 years can be considered important for your application just like how all of undergrad is important for applying to medical school.
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The rise of Step 1's importance has occurred in conjunction with two other phenomena: (1) the spread of P/F unranked grading systems, and (2) the marked increase in the average number of residency applications. The former has become common because there is a strong desire among institutions to minimize competition between classmates and promote a collaborative learning environment. So in essence we traded students fighting each other with students fighting a common enemy (the USMLE). The latter is multifactorial in origin, but the push by student affairs deans to draw everyone toward the sublime middle hasn't helped.

Standardized preclinical exams would be awful. They would subvert one of the core principles of academia: the faculty is in charge of the curriculum. If every test were a mini-USMLE then I imagine most schools would move toward a "teach-to-the-test" model, which would optimize scores but forgo anything resembling an authentic education. No thanks, we have enough problems with just one monolith.
 
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