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

[sloop]

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

My step 2 score was better than my step 1 for some reason (though probably similar percentile wise) but it could have easily gone terribly.

I’m wondering if schools are going to start giving more dedicated for step 2 now that it is so heavily emphasized. My recollection of step 2 was that I was completely shot from my surgery clerkship and I had like a week or two of time to study max. It ****ing sucked and I felt like **** going into that exam.

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[bGMx]

It’s the inevitable conclusion.

It is the repugnant conclusion.

 

[Arsartium]

To address the original thread, the USMLE composite committee discovered that chances of becoming a board-certified physician after 4 attempts was virtually nil. I can’t seem to find the original data again though. Why prolong the agony when more attempts don’t lead to more practicing physicians?

To address the tangent, after a year of shelf exams you can get a pretty good idea where you’ll land on step 2 CK, especially based on medicine, peds, and surgery exams. Of course, that assumes that you have adequate time to study for shelf exams during clerkships. My understanding is that at many institutions you can take as long a dedicated period as you like, especially with shorter step 1 dedicated periods and earlier clerkships.

Food for thought: I wonder if institutions with greater emphasis on shelf scores for clerkship grades have higher step 2 averages.

 

[32valveMD]

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

They already threw the baby out with the bath water with making step 1 p/f. Too late! It’s sad too because step 2ck pulls largely from clinical medicine, I.e. what you experience during third year in most med schools.

 

[32valveMD]

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).

I’ll agree with you that making a statement like that is insulting for those who have to grind to succeed because of a myriad of reasons… BUT, those who struggle with passing step 1 at its current passing score of 196 likely have important deficiencies in their basic clinical knowledge, enough so that they would go on to be a danger to patients. That’s the point of the test.
There’s a reason why this has a passing threshold and the MCAT doesn’t. Nobody dies if you bomb the MCAT. Someone will die if we pass along inept clinicians in the name of XYZ reasons.

We should never lower the thresholds of clinical competency for a morally expedient solution.

 

[Billiam95]

I’ll agree with you that making a statement like that is insulting for those who have to grind to succeed because of a myriad of reasons… BUT, those who struggle with passing step 1 at its current passing score of 196 likely have important deficiencies in their basic clinical knowledge, enough so that they would go on to be a danger to patients. That’s the point of the test.
There’s a reason why this has a passing threshold and the MCAT doesn’t. Nobody dies if you bomb the MCAT. Someone will die if we pass along inept clinicians in the name of XYZ reasons.

We should never lower the thresholds of clinical competency for a morally expedient solution.

Baseless speculation, but I'd wager that minimum step1 passing score increases over time have little to do with competency and more to do with justifying the continued existence of step1. (See arguments for getting rid of step2 CS - "what's the point if nearly everyone passes?").

Better explained by the sheriff of sodium : A peek inside the USMLE sausage factory: setting the Step 1 minimum passing score

Are students who passed with a 180 in 1997 out there killing people today? Assuming the exam is more difficult now (harder questions, more info), what would a 180 in 1997 even look like today?

 

[voxveritatisetlucis]

Is it more difficult though? I know that the SAT and ACT were watered down significantly throughout the 2000s. They say that the prior to the 1990s, the SAT was arguably the best test of intelligence on the market. I assumed the effort to making exams easier applied to all standardized tests.

 

[Captain_Falcon]

Is it more difficult though? I know that the SAT and ACT were watered down significantly throughout the 2000s. They say that the prior to the 1990s, the SAT was arguably the best test of intelligence on the market. I assumed the effort to making exams easier applied to all standardized tests.

If you've taken NBME forms during school blocks you can see the type of questions thst have been retired so to speak. I took a practice NBME at school that used old questions and they were ridiculously simpler compared to the actual NBMEs and Steps

 

[Billiam95]

I'll defer to Dr. Glaucomflecken here -


But on a more serious note, the # of pages in FA have nearly tripled since the first edition came out. If you take the size of FA as an proxy for the amount of information required for the exam, the amount of knowledge to take the exam has increased substantially but the length of preclinical has not (or has deceased in some cases). Having trouble finding page count for old FA editions, I'll come back with an edit when I do.

 

[Med Ed]

If you take the size of FA as an proxy for the amount of information required for the exam, the amount of knowledge to take the exam has increased substantially but the length of preclinical has not (or has deceased in some cases).

This isn't a very good approach. When FA came out the typical study plan for Step 1 involved reviewing selected books on each subject (like the BRS series). Trust me, there was not shortage of knowledge in them. FA just provided a final pass of high yield content.

FA is obviously very different now, and I think a lot of this reflects the fact that they have to add new content each year to justify purchasing the most recent edition. As the page count increased, and they began to add photos, the utility of the book evolved into more of a companion than an ultimate review.

 

[FutureInternist]

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

Problem with that is waaayyy too many subjective grades based on whether you had heard your attendings favourite song, etc….

 

[notretired]

Is it more difficult though? I know that the SAT and ACT were watered down significantly throughout the 2000s. They say that the prior to the 1990s, the SAT was arguably the best test of intelligence on the market. I assumed the effort to making exams easier applied to all standardized tests.

The mcat, step1, and likely step2 now have all gotten more difficult. It's easy to see just based on the old practice exams which are widely available. The idea that FA has expanded as a companion vs. a HY final pass is laughable as the 2021 FA is still only a shell of what you need to know. I think most who graduated even ~10yrs ago don't realize how much these tests have bloated the difficulty level, likely because the students don't come out better prepared for wards/residency, so faculty can't understand how the tests could've gotten harder. The reality is that the time spent memorizing arcane details that have insignificant application to clinical practice is *shockingly* not effective at producing better clinicians. It's a zero sum game, even as someone who has benefited from standardized testing all my life, these tests are largely a sham, if a current attending could pass the 2022 version of step1 I'd question their priorities and why they weren't putting that time into learning actual medicine.

 

[Med Ed]

The idea that FA has expanded as a companion vs. a HY final pass is laughable as the 2021 FA is still only a shell of what you need to know.

I'm not sure what your definition of "companion" is, but many students create annotated versions of FA as they progress through the basic science years. They get carried around like high schoolers carry around infant simulators. This wasn't really a thing 20 years ago.

 

[voxveritatisetlucis]

When should we get a copy of FA then? Before first class?

 

[Med Ed]

When should we get a copy of FA then? Before first class?

Just follow the herd.

 

[Wolvvs]

When should we get a copy of FA then? Before first class?

I haven't found it to be helpful. Anking is essentially First Aid in flashcard form and B&B is essentially First Aid in video form, and both of those formats work much better for me than reading First Aid would be. Some people do really like it though and completely cover it in annotations.

 

[deleted1079620]

When should we get a copy of FA then? Before first class?

Get a pdf of the newest copy at the start of 2nd year. It’s easier to ctrl +F search for topics and saves a ton of time when looking up stuff from missed qbank questions. And you can still annotate it either in a pdf editor, or with a stylus.

 

[BBQisgood4u]

The thread reminds me of what Dr. Ryan (creator of BnB) said earlier this month:

 

[DrZoidbergDO]

I'll defer to Dr. Glaucomflecken here -


But on a more serious note, the # of pages in FA have nearly tripled since the first edition came out. If you take the size of FA as an proxy for the amount of information required for the exam, the amount of knowledge to take the exam has increased substantially but the length of preclinical has not (or has deceased in some cases). Having trouble finding page count for old FA editions, I'll come back with an edit when I do.