USMLEs Changed to Pass/Fail

[Gabujabu]

I've heard rumors that there are potential plans to change the USMLE to a pass/fail test. If so, is this likely to affect those in the entering class of 2007 or later?

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[notdeadyet]

I've heard rumors that there are potential plans to change the USMLE to a pass/fail test. If so, is this likely to affect those in the entering class of 2007 or later?

Where did you hear this? I doubt very much it will happen. The Step 1 is pretty much like the MCAT: it's the only equalizer that residency directors can use to quantitatively compare an applicant from one school to an applicant from another. I wouldn't sweat it moving to P/F any time soon.

 

[MattD]

it's already pass/fail....

185+ is pass...
<185 is fail!

:-D

 

[Gabujabu]

Where did you hear this? I doubt very much it will happen. The Step 1 is pretty much like the MCAT: it's the only equalizer that residency directors can use to quantitatively compare an applicant from one school to an applicant from another. I wouldn't sweat it moving to P/F any time soon.

Some people were talking about it. Also, the USMLE site says this:

"There are conflicting opinions on the value of numeric versus pass/fail reporting for both the primary and secondary uses of USMLE. It is likely that this issue will not be resolved until the final recommendations of CEUP are made and the implications of those recommendations fully examined."

http://www.usmle.org/General_Information/review.html

 

[beegeforty4]

Our class president said that the Deans at our school were asking our opinion on the matter a couple of weeks ago. Nothing has been changed yet, but there could be some change if the the deans of the medical schools all agree.

 

[Law2Doc]

I've heard rumors that there are potential plans to change the USMLE to a pass/fail test. If so, is this likely to affect those in the entering class of 2007 or later?

There are several threads on this on the Step 1 board. There is going to be a meeting in January where such a proposal will be presented. The actual proposal also relates to combining some of the Steps. Beyond that, everything else is just conjecture and rumor. If implemented (and that is still a big if), it will take quite a few years to happen --there are tons of issues that need to be worked out because residencies depend on these scores to differentiate applicants, and non-US allo students require these scores to validate their credentials when applying to US residencies (eg if you were a foreign student who wanted to move to the US, there needs to be a test where you can demonstrate your competitiveness-- not just P/F, since US residencies won't know a great deal about other medical systems). I wouldn't expect anyone already in college now to be affected - this will not be a quick change. But your question might be more answerable after January, when we may see if the proposal actually has legs. So sit tight.

 

[SomeDoc]

I've heard rumors that there are potential plans to change the USMLE to a pass/fail test. If so, is this likely to affect those in the entering class of 2007 or later?

I honestly hope this does not happen.

 

[fazza3]

this could be very good.

 

[AmoryBlaine]

this could be very good.

No, it would be disasterous. As it stands, like it or not, the USMLE Step1 is a number that every applicant has on his application for comparison. If this test becomes meaningless then residency application is going to get alot more stressful.

Med school grades will become MUCH more important, gunners will probably come out of the woodwork. If you think think people behave badly now...

Research will become much more important, giving you less time to have fun.

I personally am of the opinion that there is seldom a huge gap between clinical ability and USMLE score (either step). The myth of the kid who gets 250 and is a bonehead around patients is just that - a myth. I know probably 10 people who scored in the 250s and 9//10 of them are superstars.

Fortunately most people are in the average range on scores/ability and most people get the residency of their choice. I don't think the system is horribly broken as it is.

 

[njbmd]

I am on the committee that is dealing with the best use and changes in USMLE. There have been no changes made and hundreds of proposals that we are currently evaluating. At this point, this is a non-issue for medical students.

 

[threemae]

No, it would be disasterous. As it stands, like it or not, the USMLE Step1 is a number that every applicant has on his application for comparison. If this test becomes meaningless then residency application is going to get alot more stressful.

Exactly. Anyone proposing eliminating the USMLE-1 is overindulging in the nose candy.

 

[braluk]

Even if a proposal were to pass, I couldn't imagine this being inplemented for anyone currently in medical school; that is, should any change occur, it will be for the incoming class of 2012 when they take their boards. Otherwise, thats just cruel.

I hope no change occurs. there are also many medical schools out there that grade on a P/F system where only the dean's letter reveals which quartile of the class you are in (like my school) versus a numeric ranking. This would force alot of schools to revert back to older H/HP/P systems and increase the overall competitiveness between classmates. I dont forsee any reason why it should be changed, the drawbacks seem to far outweigh the benefits

 

[Pinner Doc]

I've heard this rumor as well, but only for Step 2 CK. Step 1 is 'the great equalizer,' and could never really be made P/F, but it seems like programs just look to see if you passed CK (unless your score went way up or down from the first).

 

[RxnMan]

No, it would be disasterous. As it stands, like it or not, the USMLE Step1 is a number that every applicant has on his application for comparison. If this test becomes meaningless then residency application is going to get alot more stressful.

Med school grades will become MUCH more important, gunners will probably come out of the woodwork...

I agree. PDs will find a yardstick to compare applicants. If not the USMLE, where you are in competition with faceless students at other schools, then your grades, where you are in direct competition with your classmates.

There is a similar discussion in the MD/PhD forum talking about how this will change their training.

Thing to remember is that these changes won't happen until everyone in school now has graduated (2012 or +).

 

[Pinkertinkle]

Pray they keep it largely intact.

 

[Pinkertinkle]

I think that we are more likely to see a combining of steps than a conversion to p/f. As it stands right now, the structure of the steps make it impractical for students to get real clinical skills until after their choice of specialty may be already limited.

If students shut themselves out of specialties by not doing as well as they can on step 1 its nobody's fault but their own.

 

[AmoryBlaine]

I think that we are more likely to see a combining of steps than a conversion to p/f. As it stands right now, the structure of the steps make it impractical for students to get real clinical skills until after their choice of specialty may be already limited.

Any excellent point which I believe to be in discussion. A faculty member at my school told me last year that med school ciriculum is essestially held hostage by the fact that Step1 is after M2.

Part of the problem is the persistence of the "P=MD" nonsense. M1/2 is such a grind with clinical medicine so distant that alot of students revert to a "just get by" mentality. It then sucks to find out that they love Ophthalmology and now have a hell of a battle ahead of them trying to match.

 

[Gabujabu]

It's good to hear that they're not doing away with them immediately. I go to a pass-fail school, and I don't think I'd like the added stress of having to do a billion little extra things to try to distinguish yourself for competitive residencies. Also, this would be highly unfair to students from lower-ranked schools, as they wouldn't have any chance to prove themselves, and could make med school like law school in the sense that where you go is extremely important. The boards ultimately seem like a necessary evil.

 

[Law2Doc]

I personally am of the opinion that there is seldom a huge gap between clinical ability and USMLE score (either step). The myth of the kid who gets 250 and is a bonehead around patients is just that - a myth. I know probably 10 people who scored in the 250s and 9//10 of them are superstars.

While you are right that the top scoring people most often do fine in rotations, the disconnect tends to be with the folks at the other end of the spectrum -- a lot of us know quite a few folks who are incredibly personable and are loved by patients, staff and residents/attendings, but who really weren't superstars on tests. So to some extent there will be a good handful of folks who get great evals without impressive board numbers.

 

[Timmythemic22]

No good can come from this.

 

[keeping-it-real]

Going pass/fail on step 1 would be one of the best things to happen to medical education. The USMLE is a licensure examination, not a medical aptitude test. The role of the test is to ensure competency, but currently it has been bastardized and abused to ostensibly weed out "unqualified" applicants.

The biggest problem with using USMLE scores as screening tools is that the USMLE doesn't necessarily test any of the skills or subject matter necessary to excel in a given specialty. The best examples of this are Dermatology and Integrated Plastics. Step 1 has minimal dermatology and zero plastic surgery, yet these two specialties set extremely high minimum standards of excellence on Step 1. The same trend is true for many other specialities: Rad, Ortho, Ophtho, ENT, etc. If you didn't rock your Step 1, don't even think about applying to these fields. But if we actually analyze it, there is almost nothing on Step 1 to indicate how a person will perform in these fields. I would like to have someone justify the appropriateness of this.

Also, saying that people will be forced to do better in class and do more research is not necessarily a bad thing. People SHOULD being doing research in a field of their interest rather than focusing on complex biochemical reactions that they will never remember beyond the end of their second year.

Step 1 is filled with a fair share of useless information that you'll never remember or need to know for clincal practice, yet it is touted as this great selection tool. And ironically, Step 2 is emphasized less than step 1, despite it being much more clinically relevant. And the argument that "not everyone takes step 2" is also bunk because if programs required it, people would take. Let's not act like medical students are the most rebellious group of inidividuals; if the programs demanded it, medical students would form rank-and-file and take their good little sheep tests.

The bottom line is that programs need a way to reject people. The USMLE is nothing more than a tool to do this. Anyone who thinks it is anything more than a hoop should just remember the fact that a double-hand amputee with a 265 Step 1 score is a more competitive Integrated plastics applicant than a former masterful plastic surgeon from India who only scored 196.

And I scored very well on Step 1 so do not think I my aim is to mask insecurities.

 

[Law2Doc]

Also, saying that people will be forced to do better in class ... is not necessarily a bad thing. .

I think you weaken your argument here. You make a good point about the Step not testing the right things, but elimination of the Step simply results in focusing on coursework on those same things -- only even less targeted. Putting more weight on pre-clinical course grades (things like biochem, embryo, histo...) is the logical conclusion of eliminating a preclinical step score, and simply isn't going to be more relevant to a field like derm or plastics, which will still demand high scorers in whatever they can get scores on.

 

[keeping-it-real]

I think you weaken your argument here. You make a good point about the Step not testing the right things, but elimination of the Step simply results in focusing on coursework on those same things -- only even less targeted. Putting more weight on pre-clinical course grades (things like biochem, embryo, histo...) is the logical conclusion of eliminating a preclinical step score, and simply isn't going to be more relevant to a field like derm or plastics, which will still demand high scorers in whatever they can get scores on.

In a perfect world, these courses would follow the Step and also go pass/fail.

There is no reason that a general physician needs to have intimate knowledge of biochemistry, embryology, histology or even the depth of knowledge required to do well in anatomy. These classes should all be pass fail with a very conservative mark for passing (80%?).

Medical school has continued to remain 4 years for more than 70 years despite the extensive growth in medical information during this time period. It's not feasible nor necesssary to have intimate knowledge of medical science that we will: 1) never use in practice 2) never remember past the test/boards

 

[Law2Doc]

In a perfect world, these courses would follow the Step and also go pass/fail....

Medical school has continued to remain 4 years for more than 70 years despite the extensive growth in medical information during this time period. It's not feasible nor necesssary to have intimate knowledge of medical science that we will: 1) never use in practice 2) never remember past the test/boards

We don't live in a perfect world. And in case you missed it, much of education is not meant to be focused on what you can use. This isn't vocational school. Most of us are used to a long history of learning things that are not immediately applicable to our career goals. The prereqs for med school are not useful for med school. In fact, more and more nonsci majors are attending medical school because it has been made clear that the strict science majors are actually not all that useful background for physicians, who are better served by being well rounded. Then in med school, the basic science years material is somewhat more relevant, in that there are actually folks out there with these particular diseases, but sure, they will be more useful in some specialties than others. Schools train you to be a generalist first, to have a core base of medical knowledge. Then you go on to residency where you learn a specialty, but still generally have to study for boards and recertification on things that may not be directly related to your sub-practice. Such is life. And it's actually a system that has served us well for quite a while. The notion of broad rounded education rather than learning a finite skillset is ingrained in American education and will outlast you. And considering folks may change specialties at times, it probably isn't a bad idea for folks to come from a generalist background. But you can take heart in the fact that, a few years back the concept of internship - where you do a year of medicine (even if you are going into derm, path, etc) was largely eliminated from many residency tracks. So that's a bit less general knowledge you can avoid.

 

[NotAProgDirector]

There is a discussion thread on the USMLE site where people can discuss this, and presumably will be followed/read by those making decisions. That thread is here. If you want to voice your opinion officially, that's probably the best place.

As a PD, my opinion is this:

1. Program directors and students need a standardized, national exam to assess medical knowledge / clinical skills. As mentioned above, we have to make decisions based on something -- if the USMLE score goes away, we will make those decisions on something else which might be much less under your control. For example, going to that state school to save tuition $$ might all of a sudden be a poor choice...

2. Step 1 is really an imperfect test for this purpose. It tests the wrong things.

3. Combining Step 1 and 2 and leaving it a graded test is a fine idea, but A) student would need to be clear what's on it (i.e. just mixing current Step 1 and 2 questions would be a disaster) and B) everyone would need to take it end of year 3 / beginning of year 4 before application season -- and the USMLE would need to have the infrastructure to handle this.

4. If the USMLE goes P/F, expect the NBME shelf exams to be used instead. This isn't a terrible idea -- everyone could take whatever shelf they wanted (i.e. Medicine, Surgery, OB, etc), the NBME would provide a transcript of these results. Students could choose the shelfs that made the most sense for their careers. Specialty sociaties could then have more input into their shelf exams -- i.e. plastics could have some sort of physical aspect to their test (i.e. tie these knots, or draw how you would change this face, etc).

A system for IMG's to take shelfs would be needed. Of note, one bonus to this system is that you would be able to retake a shelf should you want to try to improve your score, unlike the USMLE.

 

[Law2Doc]

4. If the USMLE goes P/F, expect the NBME shelf exams to be used instead. This isn't a terrible idea -- everyone could take whatever shelf they wanted (i.e. Medicine, Surgery, OB, etc), the NBME would provide a transcript of these results. Students could choose the shelfs that made the most sense for their careers. Specialty sociaties could then have more input into their shelf exams -- i.e. plastics could have some sort of physical aspect to their test (i.e. tie these knots, or draw how you would change this face, etc).

A system for IMG's to take shelfs would be needed. Of note, one bonus to this system is that you would be able to retake a shelf should you want to try to improve your score, unlike the USMLE.

I guess I don't really see why having everyone report assorted shelf exams is going to be better for the NBME than the Step. It's my understanding that the whole point of moving or merging Step 1 was that they wanted to remove it from being a part of residency decisions, and get the step out of the middle of this process, being used for a purpose it was never intended. To say, ok, the step comes out, but now you have to administer all the shelves officially probably isn't their goal.

 

[keeping-it-real]

We don't live in a perfect world. And in case you missed it, much of education is not meant to be focused on what you can use. This isn't vocational school. Most of us are used to a long history of learning things that are not immediately applicable to our career goals. The prereqs for med school are not useful for med school. In fact, more and more nonsci majors are attending medical school because it has been made clear that the strict science majors are actually not all that useful background for physicians, who are better served by being well rounded. Then in med school, the basic science years material is somewhat more relevant, in that there are actually folks out there with these particular diseases, but sure, they will be more useful in some specialties than others. Schools train you to be a generalist first, to have a core base of medical knowledge. Then you go on to residency where you learn a specialty, but still generally have to study for boards and recertification on things that may not be directly related to your sub-practice. Such is life. And it's actually a system that has served us well for quite a while. The notion of broad rounded education rather than learning a finite skillset is ingrained in American education and will outlast you. And considering folks may change specialties at times, it probably isn't a bad idea for folks to come from a generalist background. But you can take heart in the fact that, a few years back the concept of internship - where you do a year of medicine (even if you are going into derm, path, etc) was largely eliminated from many residency tracks. So that's a bit less general knowledge you can avoid.

The trend of the US medical field has continued to progress towards specialization at the expense of a rounded physician. And the problem with making medical students "rouneded" is that there we currently accumulate vast libraries of basic science knowledge while refusing to expand the timeline that medical students have to learn this material.

And just because we have a history of learning impractical information does not necessarily mean anything. The rest of the world has realized that learning a bunch of extraneous information is not necessary to become a great physician. Maybe someday we will follow suit.

 

[Tiki]

Call me old fashioned, but I actually like being well-rounded. I, in no way intend, to say anything negative about mid-level providers (they do a great job, and life would be very hard without them) but I think what makes the MD degree different from a PA or NP is the fact that we learn the whole picture. Granted, some of the details of embryology may not come up in practice, but understanding the biological background of growth and development allows you to understand the pathophysiologic process better, hence making one a better physician.

But take what I say with a grain of salt, I'm a future pathologist, and therefore actually enjoyed my basic science years.

And I totally disagree with making the USMLE P/F unless there is another objective way to compare applicants.

 

[Law2Doc]

The rest of the world has realized that learning a bunch of extraneous information is not necessary to become a great physician. Maybe someday we will follow suit.

Actually, our system came later than much of "the rest of the world". So it is us who have rejected their notions as not ideal. Hard to say who has realized what. But maybe someday they will follow suit of the newer trend we started.

 

[Law2Doc]

And I totally disagree with making the USMLE P/F unless there is another objective way to compare applicants.

Considering it won't affect any of us who are already in med school, I don't feel that strongly one way or another. They can muck up the entry to the profession as much as they want as long as I (and present company are) allowed through beforehand.

 

[Tiki]

Considering it won't affect any of us who are already in med school, I don't feel that strongly one way or another. They can muck up the entry to the profession as much as they want as long as I (and present company are) allowed through beforehand.

True!!!

I'm already interviewing, so it doesn't matter to me!