What no one is talking about in p/f change to Step 1?! Limited Chances!

[wheatbar]

So I think the biggest change to step 1 is that you only have four chances to pass now, and we don't know right what the passing score will be once the change is implemented. You used to have 6 chances. This means if you don't pass on your 4th try you can never be a doctor. Period!? No buts or exceptions right? That's a big deal.

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[deleted771945]

Serious question: Who's taking Step 1 3+ times?

 

[voxveritatisetlucis]

I’m not being mean or trying to offend, but I think that if one fails twice, he or she should cut losses and move on.

What are the chances of matching with two board failures? The amount of debt is simply too much to risk in most cases.

 

[Ho0v-man]

I thought you couldn’t even get licensed in some states if you fail 3 times.

 

[Browns99]

So I think the biggest change to step 1 is that you only have four chances to pass now, and we don't know right what the passing score will be once the change is implemented. You used to have 6 chances. This means if you don't pass on your 4th try you can never be a doctor. Period!? No buts or exceptions right? That's a big deal.

If you can't pass by your 4th try....well, you don't deserve to be a physician. Sorry if that comes across harsh, but, should we hand out degrees just because?

 

[ciestar]

I thought you couldn’t even get licensed in some states if you fail 3 times.

This is also true

 

[GoSpursGo]

Many schools would also in practice often dismiss you if you fail more than twice. In practice, this change is to protect students from predatory Caribbean schools that would let you continue to take your USMLEs an infinite number of times even when you've passed any chance of ever getting a residency spot.

 

[operaman]

Yeah I think my school had a 2 attempt limit. I can’t imagine someone taking 4 attempts to pass it. Better to cut and run at that point. Its not like they’re going to suddenly get good at tests and do fine on shelf exams, and step 2, step3, inservice exams, and written and oral board exams.

 

[Dr. Anonymouss]

Yeah I don't find this as a big deal. As others have said, if someone can't pass by their 4th attempt then they don't have the pre-clinical knowledge to move on and become a doctor.

 

[Dral]

Yah, more than twice (MAAAAYBE three) is just ridiculous.

It's hard for me to imagine interviewing someone and saying...'So, I see you finally passed Step I on your fifth attempt.'.

Yeah, that wouldn't happen because the person wouldn't get an interview to begin with.

 

[Goro]

Yeah I think my school had a 2 attempt limit.

Ditto at my school.

 

[voxveritatisetlucis]

The real thing that should be talked about is the timing of the exam. If residency programs do in fact begin to use step2 ck as a benchmark, it should be moved up. After third is often too late to pivot to another specialty.

If somebody wants ent, does a ton of research, networks with faculty etc., yet then scores a 220 on CK, they aren’t getting ENT

 

[KnightDoc]

The real thing that should be talked about is the timing of the exam. If residency programs do in fact begin to use step2 ck as a benchmark, it should be moved up. After third is often too late to pivot to another specialty.

If somebody wants ent, does a ton of research, networks with faculty etc., yet then scores a 220 on CK, they aren’t getting ENT

Are these scores so disconnected from overall academic performance that they come as a total surprise? Given what is being tested, how much earlier could the test possibly be taken? It seems like if someone is shooting for the stars and falls way short on Step 2, the answer is going to be a seriously less competitive specialty or a research year, and taking the test a few months earlier wouldn't change that.

 

[JoyFairy]

The real thing that should be talked about is the timing of the exam. If residency programs do in fact begin to use step2 ck as a benchmark, it should be moved up. After third is often too late to pivot to another specialty.

If somebody wants ent, does a ton of research, networks with faculty etc., yet then scores a 220 on CK, they aren’t getting ENT

This. I’m headed to a school that’s PF preclinical and clinical so step 2 will be the only graded academic metric I have. I’m hoping to take step 2 as early as possible

 

[TelemarketingEnigma]

Are these scores so disconnected from overall academic performance that they come as a total surprise? Given what is being tested, how much earlier could the test possibly be taken? It seems like if someone is shooting for the stars and falls way short on Step 2, the answer is going to be a seriously less competitive specialty or a research year, and taking the test a few months earlier wouldn't change that.

Completely anecdotally, I know people who were shocked by their Step 1 scores (in good and bad ways) but no one who was shocked by their step 2 scores after a year of shelf exams

 

[voxveritatisetlucis]

Are these scores so disconnected from overall academic performance that they come as a total surprise? Given what is being tested, how much earlier could the test possibly be taken? It seems like if someone is shooting for the stars and falls way short on Step 2, the answer is going to be a seriously less competitive specialty or a research year, and taking the test a few months earlier wouldn't change that.

I’ve tutored a lot of people on various exams (SAT, SAT subject tests, MCAT) and have definitely seen people consistently scoring great on practice exams and then do poorly on the real thing.

Test anxiety is real. On the other hand, I’ve definitely also seen people “live up” to the moment in that they score much higher on the real thing (ie clutch gene)

I suppose step 2 could be different but I’m sure a decent amount of people underperform.

 

[Gilakend]

Is step 1 graded on a curve? Or could everyone pass?

 

[DOVinciRobot]

Are these scores so disconnected from overall academic performance that they come as a total surprise? Given what is being tested, how much earlier could the test possibly be taken? It seems like if someone is shooting for the stars and falls way short on Step 2, the answer is going to be a seriously less competitive specialty or a research year, and taking the test a few months earlier wouldn't change that.

Yes they can come as a total surprise. And it happens enough that it should be in the back or any students mind as they prepare to apply to a competitive specialty.

The issue is that it’s not like med school where you just go “oh I scored a 515 MCAT instead of 520 let me adjust my school list.” Even in the less competitive specialties they want people who want to be there. I know for a fact that if an ortho hopeful whose all screamed ortho who dropped the ball on Step 2 and last second switched to general surgery they would not get an interview at my program, even if everything was above our averages.

Switching specialties last second is not as easy as it sounds.

 

[Med Ed]

Is step 1 graded on a curve? Or could everyone pass?

It's criterion-referenced.

 

[KnightDoc]

Yes they can come as a total surprise. And it happens enough that it should be in the back or any students mind as they prepare to apply to a competitive specialty.

The issue is that it’s not like med school where you just go “oh I scored a 515 MCAT instead of 520 let me adjust my school list.” Even in the less competitive specialties they want people who want to be there. I know for a fact that if an ortho hopeful whose all screamed ortho who dropped the ball on Step 2 and last second switched to general surgery they would not get an interview at my program, even if everything was above our averages.

Switching specialties last second is not as easy as it sounds.

So, what happens? Internal medicine? Unplanned research year to change the focus of the application?

What does keeping it in the back of someone's mind accomplish if they are otherwise doing well in school? Is the idea to build a broad enough application that it doesn't scream anything, just in case?

It can't be that if an application is geared to a competitive specialty and the Step score isn't commensurate that they are relegated to become UPS drivers. Also, please correct me if I am wrong, but my understanding is that retakes are not a thing unless you fail, and that a good score after failing does not rehabilitate an application for a competitive specialty like it can with the MCAT.

 

[Dr. Anonymouss]

Yes they can come as a total surprise. And it happens enough that it should be in the back or any students mind as they prepare to apply to a competitive specialty.

The issue is that it’s not like med school where you just go “oh I scored a 515 MCAT instead of 520 let me adjust my school list.” Even in the less competitive specialties they want people who want to be there. I know for a fact that if an ortho hopeful whose all screamed ortho who dropped the ball on Step 2 and last second switched to general surgery they would not get an interview at my program, even if everything was above our averages.

Switching specialties last second is not as easy as it sounds.

I dont understand the mindest behind this. There is very limited exposure to specialties prior to the clinical years. Students are not given the luxury of enough exposure in adequate time. So I think its completely understandable that students may realize that their passion wasn't in orthopedics, but radiology for example. I think holding students to this standard that they MUST know what they want from day 1 is complete BS. If this is the standard that is to be upheld then the medical education system must change...

 

[Lawpy]

I dont understand the mindest behind this. There is very limited exposure to specialties prior to the clinical years. Students are not given the luxury of enough exposure in adequate time. So I think its completely understandable that students may realize that their passion wasn't in orthopedics, but radiology for example. I think holding students to this standard that they MUST know what they want from day 1 is complete BS. If this is the standard that is to be upheld then the medical education system must change...

This is why a 1 yr preclinical/3 yr clinical model is a good thing

 

[MDMechEngr]

This is why a 1 yr preclinical/3 yr clinical model is a good thing

Agree with this 100%.

 

[voxveritatisetlucis]

most schools probably don’t have the capacity for 3 classes doing rotations simultaneously.

Of course a school line Umich can because they have so many hospitals

 

[Billiam95]

This is why a 1 yr preclinical/3 yr clinical model is a good thing

Agree, but the current scope of info for step1 would have to be scaled back - even using only HY boards resources, I don't think the current amount of info could be learned in less than 1.5 years preclinical.

 

[Lawpy]

Agree, but the current scope of info for step1 would have to be scaled back - even using only HY boards resources, I don't think the current amount of info could be learned in less than 1.5 years preclinical.

I don’t think it’s hard to pass Step 1 even in its current form

 

[DOVinciRobot]

I dont understand the mindest behind this. There is very limited exposure to specialties prior to the clinical years. Students are not given the luxury of enough exposure in adequate time. So I think its completely understandable that students may realize that their passion wasn't in orthopedics, but radiology for example. I think holding students to this standard that they MUST know what they want from day 1 is complete BS. If this is the standard that is to be upheld then the medical education system must change...

You don’t have to know by day 1, but you do need to know by about the middle of M3. If you want a competitive specialty you have to know earlier. Look at it from the program perspective, who are you going to take, the person with an app that shows obvious dedication to that specialty who you know will be happy in that slot? Or the person who clearly wanted something else and is only applying to your specialty because they aren’t competitive enough for what they really want to do?

People seem to constantly forget residency is a job. This isn’t school anymore. It’s a job application, and some specialties get enough qualified candidates who clearly want to be there they don’t need to hire the person who obviously doesn’t. Some specialties don’t have that luxury and those people will still be fine and fill those slots, they simply won’t match into the more competitive slots in whichever specialty they end up applying to instead.

This is also one of the major reasons a good many people argued against making Step 1 P/F. There is not enough time between score reports and applications to make any significant changes to your application. With a Step 1 score you were able to calibrate and adjust as necessary a full year in advance.

I also agree there needs to be a en masse change to 1.5/2.5 model so students get more exposure earlier.

 

[DOVinciRobot]

Agree, but the current scope of info for step1 would have to be scaled back - even using only HY boards resources, I don't think the current amount of info could be learned in less than 1.5 years preclinical.

And yet there are schools that do it successfully…

 

[Med Ed]

I don’t think it’s hard to pass Step 1 even in its current form

How many struggling medical students have you tutored?

 

[voxveritatisetlucis]

Obviously at schools like Duke and Michigan, people are going to have an easier time passing the step earlier

 

[Dr. Anonymouss]

This is why a 1 yr preclinical/3 yr clinical model is a good thing

I agree, but unfortunately this isn't the standard across medical education.

 

[KnightDoc]

This is also one of the major reasons a good many people argued against making Step 1 P/F. There is not enough time between score reports and applications to make any significant changes to your application. With a Step 1 score you were able to calibrate and adjust as necessary a full year in advance.

Okay, but this just brings me back to my original question. Is Step 2 really not correlated with anything, and, is the risk really significant that a person building a compelling application for a competitive specialty for 3 years is going to be blindsided by a score that has no relation to med school performance, MCAT, or anything else.

I get that everyone on SDN seems to have a n=1 story for everything. I also know that anything is possible. But, is Step 1 really the only thing in the world that is highly correlated to Step2 (is it even?), or is the whole point just that an early Step 1 score allowed you to pivot to something less competitive and that will now be impossible due to the timing of Step 2?

If true, then what, as I asked before? People are still going to be doctors, and less competitive slots are still going to have to be filled. How much better off would someone really be having a sub par Step 1 score a year before a sub par Step 2 score? How much easier would it really be to pivot to something better than whatever someone will be "stuck" with after a disappointing Step 2 score?

 

[Med Ed]

Obviously at schools like Duke and Michigan, people are going to have an easier time passing the step earlier

Indeed, a handful of exceptionally competitive schools with sky high average metrics do manage to pull it off. But it's hard to extrapolate from them, and virtually impossible to see what they may have to do behind the scenes to get all their students over the line.

If your average medical school went this route it would have to prepare for three things: (1) everything not directly related to Step 1 would get removed from the pre-clerkship year or be utterly ignored by the students, even more so than it is now, (2) the Step 1 failure rate would increase, and (3) the number of students taking LOAs to prep for the test would increase, thus undercutting one of the major rationales for the change.

The move from 2-year pre-clerkship to 1.5 was made possible by eliminating redundancies and shortening the summer break. Beyond that you're really relying on your students having insane brain power and test-taking skills.

 

[Med Ed]

Okay, but this just brings me back to my original question. Is Step 2 really not correlated with anything, and, is the risk really significant that a person building a compelling application for a competitive specialty for 3 years is going to be blindsided by a score that has no relation to med school performance, MCAT, or anything else.

I get that everyone on SDN seems to have a n=1 story for everything. I also know that anything is possible. But, is Step 1 really the only thing in the world that is highly correlated to Step2 (is it even?), or is the whole point just that an early Step 1 score allowed you to pivot to something less competitive and that will now be impossible due to the timing of Step 2?

If true, then what, as I asked before? People are still going to be doctors, and less competitive slots are still going to have to be filled. How much better off would someone really be having a sub par Step 1 score a year before a sub par Step 2 score? How much easier would it really be to pivot to something better than whatever someone will be "stuck" with after a disappointing Step 2 score?

There is a facet to this that I think people overlook: it's a zero sum game. For every individual who is harmed by P/F Step 1, someone else will be helped.

Consider @alligator3, who in this thread is strategizing IM programs around a low Step 1 score (in spite of a 250 on Step 2). Replace the 208 on Step 1 with a "P" and all of a sudden the application becomes substantially more competitive.

Ultimately this mess is just going to continue being a mess until over-application is successfully addressed. But considering that all the handwringing over the UME-to-GME transition has produced almost no substantive change in the last two years, I'm not holding my breath.

 

[Lawpy]

Indeed, a handful of exceptionally competitive schools with sky high average metrics do manage to pull it off. But it's hard to extrapolate from them, and virtually impossible to see what they may have to do behind the scenes to get all their students over the line.

If your average medical school went this route it would have to prepare for three things: (1) everything not directly related to Step 1 would get removed from the pre-clerkship year or be utterly ignored by the students, even more so than it is now, (2) the Step 1 failure rate would increase, and (3) the number of students taking LOAs to prep for the test would increase, thus undercutting one of the major rationales for the change.

The move from 2-year pre-clerkship to 1.5 was made possible by eliminating redundancies and shortening the summer break. Beyond that you're really relying on your students having insane brain power and test-taking skills.

… i don’t think it’s that hard to pass Step 1. The pass threshold is in the 190s I think? Med schools overwhelmingly admit students with MCAT scores well north of 500, which is the score the AAMC says correlates with boards passing rates. I believe even the most struggling students in US MD schools can pass Step 1 in the 1 yr preclinical model if they use the resources and help available early on.

 

[Lawpy]

I agree, but unfortunately this isn't the standard across medical education.

And i don’t see why when incoming med students are known to be smart and hardworking

 

[voxveritatisetlucis]

Why do I never see 270 or 280 step 2 scores on this site but see 270 or 280 step 1 scores sometimes. Is there a higher ceiling for step 1 but lower floor?

 

[Med Ed]

… i don’t think it’s that hard to pass Step 1. The pass threshold is in the 190s I think? Med schools overwhelmingly admit students with MCAT scores well north of 500, which is the score the AAMC says correlates with boards passing rates. I believe even the most struggling students in US MD schools can pass Step 1 in the 1 yr preclinical model if they use the resources and help available early on.

I take it you have not worked with any struggling medical students, then.

Being human, you are making the error of over-extrapolating from your own lived experience. It's true that medical students are, in aggregate, a bright and hardworking bunch. And yet each year about 5% of US MD students fail Step 1 on the first attempt. Should you someday become a faculty member who interfaces with the Academic Support Office you will develop a new perspective on this issue. I certainly did.

 

[Med Ed]

Why do I never see 270 or 280 step 2 scores on this site but see 270 or 280 step 1 scores sometimes. Is there a higher ceiling for step 1 but lower floor?

The scoring scales are somewhat different, a feature that only a psychometrician could understand.

Both exams, however, are similar in that they are calibrated to be meaningful only around the passing threshold, and with an inconsequential number of false positives.

 

[Billiam95]

I don’t think it’s hard to pass Step 1 even in its current form

Just out of curiosity, when did you take step1?

 

[DOVinciRobot]

Okay, but this just brings me back to my original question. Is Step 2 really not correlated with anything,

Step 2 is correlated with Step 1 scores..

is the risk really significant that a person building a compelling application for a competitive specialty for 3 years is going to be blindsided by a score that has no relation to med school performance, MCAT, or anything else.

Yes it is a significant enough risk. It happens with enough frequency it should be at the back of everyone’s mind.

or is the whole point just that an early Step 1 score allowed you to pivot to something less competitive and that will now be impossible due to the timing of Step 2?

This is a big part of it. Yes having a low Step 1 a year in advance is significantly better than a low Step 2 right before apps… again, residency isn’t school. For example, if you apply to general surgery, programs will expect you to have 3 general surgery letters (or some derivative like vascular/Surg onc/etc). That is a very tall order in the month before apps come out. Much easier to do when you get that low Step 1 back but then have your entire surgery rotation and 3rd year ahead of you.

 

[Lawpy]

I take it you have not worked with any struggling medical students, then.

Being human, you are making the error of over-extrapolating from your own lived experience. It's true that medical students are, in aggregate, a bright and hardworking bunch. And yet each year about 5% of US MD students fail Step 1 on the first attempt. Should you someday become a faculty member who interfaces with the Academic Support Office you will develop a new perspective on this issue. I certainly did.

I’m starting to think there is a steep selection bias here because even the most struggling students I know and help out usually are struggling not because the subjects are hard to understand but because of pressing situational factors that are making it difficult for them to study. Once those are addressed through various strategies, they usually do very well. This is like n=1 and different schools have different classes, curricula etc

But I maintain that the AAMC put the 500 as a pass threshold for the MCAT for a reason, and I highly doubt the 5% of US MD students who failed were largely due to something intrinsic as opposed to external, situational factors. There are several instances here where people who failed once passed comfortably in retake, so I think the % of those who consistently fail Step 1 is probably close to 0, but i don’t know the exact data

I admit I’m probably overestimating the aptitude and skills of my peers because I think they’re all smart and hardworking individuals, and even those who were struggling can succeed with help and support. I just don’t like the idea of attributing difficulties to things intrinsic like limited brainpower.

 

[KnightDoc]

There is a facet to this that I think people overlook: it's a zero sum game. For every individual who is harmed by P/F Step 1, someone else will be helped.

Consider @alligator3, who in this thread is strategizing IM programs around a low Step 1 score (in spite of a 250 on Step 2). Replace the 208 on Step 1 with a "P" and all of a sudden the application becomes substantially more competitive.

Ultimately this mess is just going to continue being a mess until over-application is successfully addressed. But considering that all the handwringing over the UME-to-GME transition has produced almost no substantive change in the last two years, I'm not holding my breath.

Yes, of course. My question had nothing to do with someone else being helped if someone is being hurt.

My question was in response to a statement that Step 2 is so late, without a Step 1 preceding it, that people who blow Step 2 who want something competitive are screwed because it's too late to pivot to something else a little less competitive. I am questioning both whether this is really true, but, more importantly, whether Step 2 is really so uncorrelated to everything else that more than a tiny slice of people are really blindsided by a bad score, out of nowhere, after spending the past 3 years building a compelling application for a competitive specialty.

Do you have any thoughts on that?

 

[MDMechEngr]

LMAO. Most of the discussions above are reasons why Step 2 will go P/F eventually also.

 

[Med Ed]

Yes, of course. My question had nothing to do with someone else being helped if someone is being hurt.

It's called a tangent.

My question was in response to a statement that Step 2 is so late, without a Step 1 preceding it, that people who blow Step 2 who want something competitive are screwed because it's too late to pivot to something else a little less competitive. I am questioning both whether this is really true, but, more importantly, whether Step 2 is really so uncorrelated to everything else that more than a tiny slice of people are really blindsided by a bad score, out of nowhere, after spending the past 3 years building a compelling application for a competitive specialty.

Do you have any thoughts on that?

I do. Since Step 1 is not reverting to a scored exam this line of inquiry is pointless.

 

[DOVinciRobot]

LMAO. Most of the discussions above are reasons why Step 2 will go P/F eventually also.

It’s the inevitable conclusion.

 

[Med Ed]

I’m starting to think there is a steep selection bias here because even the most struggling students I know and help out usually are struggling not because the subjects are hard to understand but because of pressing situational factors that are making it difficult for them to study. Once those are addressed through various strategies, they usually do very well. This is like n=1 and different schools have different classes, curricula etc

But I maintain that the AAMC put the 500 as a pass threshold for the MCAT for a reason,

The MCAT doesn't have a pass threshold.

and I highly doubt the 5% of US MD students who failed were largely due to something intrinsic as opposed to external, situational factors. There are several instances here where people who failed once passed comfortably in retake, so I think the % of those who consistently fail Step 1 is probably close to 0, but i don’t know the exact data

I admit I’m probably overestimating the aptitude and skills of my peers because I think they’re all smart and hardworking individuals, and even those who were struggling can succeed with help and support. I just don’t like the idea of attributing difficulties to things intrinsic like limited brainpower.

I'm not sure where you're going with this. Suffice to say that the statement "I don’t think it’s hard to pass Step 1 even in its current form" could be construed as insulting to some individuals who do struggle with the test, regardless of the reason(s).

 

[Lawpy]

The MCAT doesn't have a pass threshold.


I'm not sure where you're going with this. Suffice to say that the statement "I don’t think it’s hard to pass Step 1 even in its current form" could be construed as insulting to some individuals who do struggle with the test, regardless of the reason(s).

What are the chances of Step 1 pass threshold being lowered in the coming years now that P/F is in effect? Because the score creep was met by a corresponding rise in pass threshold.

 

[Med Ed]

What are the chances of Step 1 pass threshold being lowered in the coming years now that P/F is in effect? Because the score creep was met by a corresponding rise in pass threshold.

The passing threshold is set using the Modified Angoff Method. I do think it's possible the threshold will go down, but one of the aspects of this method is that it "lags." Can't wait to see what the overall failure rate is this year. I'm expecting higher than usual.

 

[Ho0v-man]

It’s the inevitable conclusion.

*surprised pikachu face* /s