Why doesn't Step 2 count for more than Step 1?

[MedicineZ0Z]

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Step 2 or COMLEX II, in either case, should count for more than step 1/level 1. Simply because knowing the receptor for some protein doesn't matter quite as much as actually managing patients.

 

[Stagg737]

Step 2 or COMLEX II, in either case, should count for more than step 1/level 1. Simply because knowing the receptor for some protein doesn't matter quite as much as actually managing patients.

Up until recently, many people would not take Step 2 before applying to residency programs, so when comparing applicants PDs did not have Step 2 scores to look at for everyone. On the other hand, everyone had a Step 1 score, meaning it was a valid metric to measure and compare every applicant. It's more of a historical reason than a practical one.

 

[Redpancreas]

Step 2 or COMLEX II, in either case, should count for more than step 1/level 1. Simply because knowing the receptor for some protein doesn't matter quite as much as actually managing patients.

Also it’s still not required for interviews but usually for ranking. Also Step 1 and Step 2 have tons of overlap. Step 2 CK has so much biochemistry minutiae from Step 1.

 

[sliceofbread136]

It’s been up trending in importance. I think they may very become equal in the near future

 

[Crayola227]

eh, some of it is that Step 1 is a better weed out, and I might be *totally* wrong on this next point, I thought it had better correlation to future board scores

no matter how you slice it, docs have to memorize and know an enormous amount of minutiae, and Step 2 doesn't even touch it. It's like the bare minimum they seem to think every doc should know having absorbed from 4 years (what med do you give for gonnorhea? what are the signs of MI? etc etc)

It's almost a given that if you can do well on Step 1, you can memorize stuff and can memorize stuff in your field.

I'll tell you right now specialty board review questions are *much* more similar to Step 1 than 2 in minutiae, difficulty and complexity of thinking.

while Step 2 matters for licensing and I agree, you should know most of the stuff on that test, it's far too easy to be what I would use to pick a resident

this almost brings up back to my first ever post on SDN all those years ago

for Step 1, I did the typical thing of studying my ass off for a whole month straight
and I got a respectable score

for Step 2, I did like 200 questions out of a qbank, thought I would fail, and my score followed the typical trend after Step 1
I also frakked off all the shelfs

So no, I wouldn't use Step 2 to pick an applicant. I would pick Step 1. Not for the value of the information tested, but for the value of the test itself. Make sense?

 

[MedicineZ0Z]

eh, some of it is that Step 1 is a better weed out, and I might be *totally* wrong on this next point, I thought it had better correlation to future board scores

no matter how you slice it, docs have to memorize and know an enormous amount of minutiae, and Step 2 doesn't even touch it. It's like the bare minimum they seem to think every doc should know having absorbed from 4 years (what med do you give for gonnorhea? what are the signs of MI? etc etc)

It's almost a given that if you can do well on Step 1, you can memorize stuff and can memorize stuff in your field.

I'll tell you right now specialty board review questions are *much* more similar to Step 1 than 2 in minutiae, difficulty and complexity of thinking.

while Step 2 matters for licensing and I agree, you should know most of the stuff on that test, it's far too easy to be what I would use to pick a resident

this almost brings up back to my first ever post on SDN all those years ago

for Step 1, I did the typical thing of studying my ass off for a whole month straight
and I got a respectable score

for Step 2, I did like 200 questions out of a qbank, thought I would fail, and my score followed the typical trend after Step 1
I also frakked off all the shelfs

So no, I wouldn't use Step 2 to pick an applicant. I would pick Step 1. Not for the value of the information tested, but for the value of the test itself. Make sense?

Not really, because using less relevant things to educate & assess ourselves is why NP/PAs can get away with FAR less training and still manage patients to an acceptable point. If we actually put our focus on developing better clinicians (step 2 type material) rather than book worm test takers - we'd be ahead of where we are now.

 

[Crayola227]

Yes but as someone who hasn't done specialty board review, are you really in a position to say which test prepares you more on that front? That's what programs ultimately care about when it comes to tests.

Being better at Step 2 material doesn't represent to me that you'll be a better residency candidate choice. Why would you think so? If that material is the reason that NP/PAs can "get away" with managing patients, then why does attending more to that material put us ahead?

Actually, what I notice that I understand better than NP/PAs and allows me to make decisions where they struggle, is a more in depth understanding of biochemistry, pharmacodynamics/kinetics, drug MOA, physiology, etiology of disease, and interpreting studies in more depth. Basically, Step 1 speaks more to that than to Step 2.

Fully understanding almost all of human health from the atom up (or having the background to be able to read and quickly grasp) is where I think the power of the MD lies. I think Step 1 tests more to what makes a doctor a doctor and not a PA.

I had to work really hard to know the basis of disease for Step 1. I basically just went to med school and showed up, nothing more, and literally by "absorption" or "osmosis" learned what I needed for Step 2. Step 2 would have put me at the level of the PAs I was on rotations side by side with. Step 1 type stuff is what put me ahead of them getting pimped on rounds.

I get it, you guys are students and really want to cling to the idea that because Step 2 is more clinically relevant and Step 1 is a total PITA and does have idiotic questions, that it doesn't matter. It does.

 

[Postictal Raiden]

Because knowing the MOA of drugs and the process of diseases to the molecular level requires a higher thinking process than being familiar with guidelines.

 

[Crayola227]

Because knowing the MOA of drugs and the process of diseases to the molecular level requires a higher thinking process than being familiar with guidelines.

thank you

 

[MedicineZ0Z]

Yes but as someone who hasn't done specialty board review, are you really in a position to say which test prepares you more on that front? That's what programs ultimately care about when it comes to tests.

Being better at Step 2 material doesn't represent to me that you'll be a better residency candidate choice. Why would you think so? If that material is the reason that NP/PAs can "get away" with managing patients, then why does attending more to that material put us ahead?

Actually, what I notice that I understand better than NP/PAs and allows me to make decisions where they struggle, is a more in depth understanding of biochemistry, pharmacodynamics/kinetics, drug MOA, physiology, etiology of disease, and interpreting studies in more depth. Basically, Step 1 speaks more to that than to Step 2.

Fully understanding almost all of human health from the atom up (or having the background to be able to read and quickly grasp) is where I think the power of the MD lies. I think Step 1 tests more to what makes a doctor a doctor and not a PA.

I had to work really hard to know the basis of disease for Step 1. I basically just went to med school and showed up, nothing more, and literally by "absorption" or "osmosis" learned what I needed for Step 2. Step 2 would have put me at the level of the PAs I was on rotations side by side with. Step 1 type stuff is what put me ahead of them getting pimped on rounds.

I get it, you guys are students and really want to cling to the idea that because Step 2 is more clinically relevant and Step 1 is a total PITA and does have idiotic questions, that it doesn't matter. It does.

Because knowing the MOA of drugs and the process of diseases to the molecular level requires a higher thinking process than being familiar with guidelines.

So you're trying to tell me that as an attending well into practice, you know all those rare enzyme deficiencies that you haven't once seen in practice? Or that you recall detailed neuroanatomy? Most fellows/new attendings wouldn't even pass step 1 so lets take a breather on inflating the value of the material it tests.
Secondly, I didn't say it's not a very useful test. I just think that placing more value on things that are closer to real life performance will have a greater outcome. Plus, plenty of people find step 2 very difficult and put it close to step 1's difficulty.

 

[Postictal Raiden]

So you're trying to tell me that as an attending well into practice, you know all those rare enzyme deficiencies that you haven't once seen in practice? Or that you recall detailed neuroanatomy? Most fellows/new attendings wouldn't even pass step 1 so lets take a breather on inflating the value of the material it tests.
Secondly, I didn't say it's not a very useful test. I just think that placing more value on things that are closer to real life performance will have a greater outcome. Plus, plenty of people find step 2 very difficult and put it close to step 1's difficulty.

My comment was intended to address the OP's question of why step1 carries more weight than step2. IMO, the reason is that step1 requires more dedication and critical thinking than step2.

I also agree with Crayolla that knowing the details of the details is what separates true doctors from doctor wannabes. Sure, most of us won't remember the deficient surface proteins in I-cell disease or the cofactors involved in converting homocystein to methionine. However, 10 years from now, when you are attending a conference or reading an article about a new drug, you won't be totally clueless when you come across such concepts.

 

[Crayola227]

you can't be tested on the minutiae that will be required of you as a specialist before you even begin specialist training

so instead you are tested on the minutiae that is covered in the foundation of every medical student's education

seems pretty rational to me

it's not any more rational to drill you harder on Step 2 about fetal heart monitoring (arguably more clinically relevant than some items on Step 1) if you're going into IM

plenty of content for Step 1 is relevant to future medical practice, some isn't

no test in medical school is going to avoid testing you on information that your career future may make pointless

them's the breaks

 

[AlbinoHawk DO]

Because knowing the MOA of drugs and the process of diseases to the molecular level requires a higher thinking process than being familiar with guidelines.

Yet there are ton of student that we both know that went down on the "dumber" test of Step 2CK. Knowledge is knowledge. Spend time studying biochemistry, you will know biochemistry. Spend time reading guidelines, you will know guidelines. However, guidelines actually have a day-to-day impact.

 

[Wordead]

Summary:

Med students: I dun wanna study this stuff anymore
Residents + Attendings: It's important.
Med students: But I dun wanna, can I take the same courses as the nurse pracs?

 

[sliceofbread136]

Because knowing the MOA of drugs and the process of diseases to the molecular level requires a higher thinking process than being familiar with guidelines.

I don’t agree with this, clinical medicine can actually reach a very high level of thinking imo

 

[Crayola227]

Yet there are ton of student that we both know that went down on the "dumber" test of Step 2CK. Knowledge is knowledge. Spend time studying biochemistry, you will know biochemistry. Spend time reading guidelines, you will know guidelines. However, guidelines actually have a day-to-day impact.

Yes, biochemistry has no impact on clinical outcomes or creating guidelines. Just learn the guidelines. Call yourself a doctor. Leave the hard science to the scientists.

 

[Crayola227]

I don’t agree with this, clinical medicine can actually reach a very high level of thinking imo

Yes it can. The foundation of medical science though, is medical science.

 

[Crayola227]

So you're trying to tell me that as an attending well into practice, you know all those rare enzyme deficiencies that you haven't once seen in practice? Or that you recall detailed neuroanatomy? Most fellows/new attendings wouldn't even pass step 1 so lets take a breather on inflating the value of the material it tests.
Secondly, I didn't say it's not a very useful test. I just think that placing more value on things that are closer to real life performance will have a greater outcome. Plus, plenty of people find step 2 very difficult and put it close to step 1's difficulty.

Ironically, this week I literally pulled my neuroanatomy text from med school from my bookshelf because I needed to review a few things. Just funny is all.

 

[Anti-PD1]

Not really, because using less relevant things to educate & assess ourselves is why NP/PAs can get away with FAR less training and still manage patients to an acceptable point. If we actually put our focus on developing better clinicians (step 2 type material) rather than book worm test takers - we'd be ahead of where we are now.

That. I loved Step 1. I'm glad it's the most important. Because knowing medical science to that level makes you a doctor. You're not a provider. Eventually, algorithms run short. Then what do you do? Intuition.

There are patients with Wegener's, hell even psoriasis, I've seen only recently been given their diagnosis after years of ping-ponging between doctors. Louis Pasteur said, fortune favors the prepared mind. Prepare your mind.

An example, sorry, you've hit a nerve. Only a doctor would know this. A patient experiences a visual field deficit on one side. A workup is negative for ophthalmic disease. Eventually, she also develops a contralateral quadrantanopia. How could this be? An optic glioma has grown from one side and compressed von Willebrand's knee. Someone who went to medical school would have suspicions based on anatomy alone. This isn't in any guideline.

 

[AlbinoHawk DO]

Yes, biochemistry has no impact on clinical outcomes or creating guidelines. Just learn the guidelines. Call yourself a doctor. Leave the hard science to the scientists.

Way to create a strawman. I never said just learn guidelines or biochemistry is useless. However, things need to be measured based on their impact. Everyone in medical school will learn biochemistry and have to a level of competency. On the other hand, guidelines have a day-to-day impact on patients lives the moment you graduate.

That said, I doubt you remember even half the biochemistry you had to learn in medical school. When was the last time you used the Kreb cycle in clinical practice?

It only makes sense both tests are weighed equally as they both have an impact on your practice.

 

[Psai]

Way to create a strawman. I never said just learn guidelines or biochemistry is useless. However, things need to be measured based on their impact. Everyone in medical school will learn biochemistry and have to a level of competency. On the other hand, guidelines have a day-to-day impact on patients lives the moment you graduate.

That said, I doubt you remember even half the biochemistry you had to learn in medical school. When was the last time you used the Kreb cycle in clinical practice?

It only makes sense both tests are weighed equally as they both have an impact on your practice.

The background knowledge you have is important. How can you read a paper that talks about medications for receptors if you have no clue about how those receptors work? It also shows your work ethic and ability to handle large volumes of information as well as synthesize it well.

Step 1 scores are incredibly important and deservedly so. I studied way less for step 2 and scored just as well.

 

[QueenJames]

The problem is medical schools are now filled with millenial brats and crybabies.

The same crybabies who don't want to put in the time but want the rewards and the benefits.

The same crybabies who probably never worked a single job out in the real world and see how good they have it.

Look...

If you don't wanna study hard and put in the time to learn real medicine .... go be a NP or frickin' PA. No skin off of my back.

You can halfass your way through school and life and focus on guidelines all day and be a crappy midlevel your whole life and let somebody else (an actual PHYSICIAN) clean up your mess... until they fire you since you will be pretty much dispensable.

There is no way you can skip years of learning and not put in the work and be a physician.

It's why we go through 11+ years of school and high stakes exam after exam after exam.

What we do is high stakes.

We have people's lives in our hands that trust us and look to us for guidance and answers.

You wanna be the ******* who says "I don't know" to all of your patients... cool. Do your thing boo-boo.

But that's not the attitude of the exceptional physicians I've met and talked to and that damn sure won't be me.

Nut up or drop out.

If not, get back to studying.

 

[Crayola227]

Way to create a strawman. I never said just learn guidelines or biochemistry is useless. However, things need to be measured based on their impact. Everyone in medical school will learn biochemistry and have to a level of competency. On the other hand, guidelines have a day-to-day impact on patients lives the moment you graduate.

That said, I doubt you remember even half the biochemistry you had to learn in medical school. When was the last time you used the Kreb cycle in clinical practice?

It only makes sense both tests are weighed equally as they both have an impact on your practice.

being measured on impact is more in line with what Psai said, than it is "how much you use that specific nugget of intel later"

I don't do calculus anymore, but I sure as **** needed multicalc to fully understand statistics the way I do
to this day, when I read a paper I don't get out my t-value table, but I feel more comfortable basing life and death decisions on evidence I have the educational background to understand fully

as far as the Krebs cycle, the last time I used it was the last time I read a *primary care* article written on how high fructose corn syrup may have an effect on obesity that is related to how different relative proportions of the substrates in the Krebs cycle may affect whether or not the carbohydrate is stored as fat or not, beyond just a simple analysis of calories/gram of carbohydrate in vs calories out

admittedly it was a while ago, but long after I graduated med school, and I did have to review the review chart of the Krebs cycle provided in the article, and that was necessary for me to assess whether or not I was buying what the authors was selling or not

I was glad that I had been educated prior to that article about the Krebs cycle or I would not have been able to critically assess that paper

this sort of thing is being used to create policy, beyond just what I might recommend in a clinic to a patient

So you really have no idea what exactly of the basic medical sciences will be relevant to your practice later, except that they are basic for a reason. The body works a certain way, and that only changes so much with evolution and advancements in our knowledge. We learn more details we didn't know, and we learn more ways to manipulate that, but the principles stand.

 

[TheIllusionist]

Lol at people that think STEP1 is mostly a critical thinking test. Residencies would be better using old versions of the MCAT or SATs as IQ surrogate markers by far. They don't value those types of markers that much so they don't use them.

STEP1 has you memorize a ton of facts and maybe do 2 or 3 step level reasoning questions. STEP2 does the same thing, only you've seen the cases on rotations so you don't need to think as much because you can just remember what was done in that case.

Frankly, both tests are important. Neither tests elite level reasoning skills. Both have a ton of memorization as components. Both have a fair share of thinking. STEP1 it's harder for people to memorize all of the components because there isn't that direct experience reinforcement. For STEP2, there is.

Additionally, shelf exams and studying for them, directly prepares you for STEP2. The reason why PDs didn't really look into STEP2 was because many people had not taken STEP2, so STEP1 was the best tool to standardize applicants.

Furthermore, clinical grades and evaluations are good surrogate markers for 3rd year performance, especially since standardized shelf exam scores are incorporated. That makes STEP2 largely redundant. Whereas, for preclinical years, non standardized curriculum and pass/fail schemes have made it impossible to compare applicants, so STEP1 is not redundant and is therefore in fact relatively more important.

PS: Those of you who think clinical algorithms aren't easier to remember with intuitive reasoning, you're sort of doing it wrong.

Also STEP1 lovers, be thankful, because the trend is to use more drug mechanism type stuff for STEP2 question writing. STEP2 is becoming more like STEP1 over time.

 

[AlbinoHawk DO]

being measured on impact is more in line with what Psai said, than it is "how much you use that specific nugget of intel later"

I don't do calculus anymore, but I sure as **** needed multicalc to fully understand statistics the way I do
to this day, when I read a paper I don't get out my t-value table, but I feel more comfortable basing life and death decisions on evidence I have the educational background to understand fully

as far as the Krebs cycle, the last time I used it was the last time I read a *primary care* article written on how high fructose corn syrup may have an effect on obesity that is related to how different relative proportions of the substrates in the Krebs cycle may affect whether or not the carbohydrate is stored as fat or not, beyond just a simple analysis of calories/gram of carbohydrate in vs calories out

admittedly it was a while ago, but long after I graduated med school, and I did have to review the review chart of the Krebs cycle provided in the article, and that was necessary for me to assess whether or not I was buying what the authors was selling or not

I was glad that I had been educated prior to that article about the Krebs cycle or I would not have been able to critically assess that paper

this sort of thing is being used to create policy, beyond just what I might recommend in a clinic to a patient

So you really have no idea what exactly of the basic medical sciences will be relevant to your practice later, except that they are basic for a reason. The body works a certain way, and that only changes so much with evolution and advancements in our knowledge. We learn more details we didn't know, and we learn more ways to manipulate that, but the principles stand.

There is no argument that they are useful. It has never been my point that they are useless. As you mentioned yourself, you had to review the chart. My point is that you can't discount knowledge that will actually have day-to-day impact as being inferior or less value. My argument is that it holds at least equal value. Using your words, just learn biochemistry. Call yourself a doctor? Leave treating patients to the nurse practitioner? Both things have value to being a doctor that can practice safely around patients.

The background knowledge you have is important. How can you read a paper that talks about medications for receptors if you have no clue about how those receptors work? It also shows your work ethic and ability to handle large volumes of information as well as synthesize it well.

Step 1 scores are incredibly important and deservedly so. I studied way less for step 2 and scored just as well.

Never argued to the contrary that medical science/biochemistry has value. This is exactly the problem when someone twists your words to mean something else.

 

[Crayola227]

IQ markers is not what residencies need or are looking for

please see Psai's post

your point about Step 2 stands

 

[TheIllusionist]

IQ markers is not what residencies need or are looking for

please see Psai's post

your point about Step 2 stands

Agreed. They mostly care about discipline. Most medical students by virtue of getting in have the requisite innate intellect to be not only be competent but also good in terms of the critical thinking necessary to excel as a physician. What separates the bad from the good and even the good from the great are organized study habits, discipline, and people skills (social manipulative prowess). Perhaps, at the super elite level going from the great to the best, other factors really come into play. But most of us aren't going to be at that level.

 

[MedicineZ0Z]

Agreed. They mostly care about discipline. Most medical students by virtue of getting in have the requisite innate intellect to be not only be competent but also good in terms of the critical thinking necessary to excel as a physician. What separates the bad from the good and even the good from the great are organized study habits, discipline, and people skills (social manipulative prowess). Perhaps, at the super elite level going from the great to the best, other factors really come into play. But most of us aren't going to be at that level.

How do you define elite in this context? Better outcomes? Innovation? The latter is so specific as it's done by subspecialist MD/PhDs that I highly doubt you can select for that via a 255 step 1 vs a 235.

Context matters a lot too. Who's more impressive, a 230 with a long list of non-academic achievements + work life balance or a 260 who studied relentlessly and did nothing else? I would think that the former is at minimum wiser and more well-rounded for the real world.

 

[TheIllusionist]

How do you define elite in this context? Better outcomes? Innovation? The latter is so specific as it's done by subspecialist MD/PhDs that I highly doubt you can select for that via a 255 step 1 vs a 235.

Context matters a lot too. Who's more impressive, a 230 with a long list of non-academic achievements + work life balance or a 260 who studied relentlessly and did nothing else? I would think that the former is at minimum wiser and more well-rounded for the real world.

Inventing procedures (that might even save your own life) like DeBakey did is elite.

STEP exams are fairly good assessments for PDs to ascertain the levels of discipline a student has with regard to exam preparation. A minimum level is necessary for the intensive specialty boards. A 260 alone generally means the person has some combination of a strong memory (perhaps even photographic), good background from early education (you need half decent reading speed and comprehension abilities), and organized study habits. A 230 is more of a gamble. So it's up to the PDs to decide. Also, it's a ton of work to weed through all the applicants. Numbers make it a lot easier, but exceptions are made. It's obvious exceptions are made from the Charting the Match Report. But no one will dispute, that an exception, by definition, is rare. Therefore, it is in one's best interests to always maximize test scores and grades and not count on being some sort of exception.

I surmise a major reason MD/PhDs are given more leeway in the residency process, when it comes to scores, is because their PhD is demonstrative of their commitment to the field of medicine, particularly the generally less lucrative niche of academic medicine. That type of stuff falls into the discipline category that PDs like. Of course there are a whole host of other reasons (ie more connections, more demonstrated research productivity that could therefore be relatively more helpful to the insitution's name, even if marginally so).

 

[IslandStyle808]

I believe Stagg737 and a few others gave the best reason. Applicants don't all take their Step 2 exams before applications are sent. They can't use it to pick interview applicants and so they are left with using primarily step 1. With schools increasing and applicants getting more competitive every year, I wouldn't be surprised if residency programs weigh step 2 just as heavily as step 1 in the future. It makes sense considering weirdly enough, some fellowships look at both step 1 and step 2.

 

[Menander's Bust]

Because there was a study a while ago correlating STEP1 (not STEP2) scores with board exam performance after residency. You may not realize, but residencies can lose their accreditation if too many people fail their boards and that “too many” is often not many, like 1 person per year for 3 years in a row. So residencies are going to do their best to make sure you’re a good test taker because their accreditation and existence depends on it.

This is the actual accurate answer to this question. It has essentially nothing to do with material covered on either test. It’s a purely practical reason on the part of residencies.

 

[Menander's Bust]

Yes but as someone who hasn't done specialty board review, are you really in a position to say which test prepares you more on that front? That's what programs ultimately care about when it comes to tests.

Being better at Step 2 material doesn't represent to me that you'll be a better residency candidate choice. Why would you think so? If that material is the reason that NP/PAs can "get away" with managing patients, then why does attending more to that material put us ahead?

Actually, what I notice that I understand better than NP/PAs and allows me to make decisions where they struggle, is a more in depth understanding of biochemistry, pharmacodynamics/kinetics, drug MOA, physiology, etiology of disease, and interpreting studies in more depth. Basically, Step 1 speaks more to that than to Step 2.

Fully understanding almost all of human health from the atom up (or having the background to be able to read and quickly grasp) is where I think the power of the MD lies. I think Step 1 tests more to what makes a doctor a doctor and not a PA.

I had to work really hard to know the basis of disease for Step 1. I basically just went to med school and showed up, nothing more, and literally by "absorption" or "osmosis" learned what I needed for Step 2. Step 2 would have put me at the level of the PAs I was on rotations side by side with. Step 1 type stuff is what put me ahead of them getting pimped on rounds.

I get it, you guys are students and really want to cling to the idea that because Step 2 is more clinically relevant and Step 1 is a total PITA and does have idiotic questions, that it doesn't matter. It does.

I find that the breadth of knowledge is what separates PAs/NPs from MDs. Most MDs don’t remember highly detailed information outside their specialty, but if you pair an MD with a PA/NP and ask each what they know about something outside their specialty the MD will know a lot more. I always say, the difference between a pediatrician who got a 220 on STEP1 and one who got a 257 is the one who got a 257 probably knows a lot more about obgyn and surgery and IM than the one who got a 220. But both are probably comparable in their own specialty.

 

[x123ab]

Studying Step 1 is incredibly boring. I couldn't really believe people actually memorize those lists, literally doing 1000s of flashcards for months and months like some sort of deranged zombie/striver hybrid. I do agree it shows commitment vs CK to handle that. When you step back and look at it, capitalism has really warped human behavior.

 

[Lnsean]

Because knowing the MOA of drugs and the process of diseases to the molecular level requires a higher thinking process than being familiar with guidelines.

This guy hits it on the head. It seems like the only people that don't like this answer are the ones that probably scored low on step 1. There are plenty of people that score well on both step 1 and step 2. They're not mutually exclusively or somesht.

If you just want to manage patients, go be a social worker or a nurse or NA. If you want to heal really sick people, you'll need a solid foundation of disease processes.

 

[Crayola227]

Studying Step 1 is incredibly boring. I couldn't really believe people actually memorize those lists, literally doing 1000s of flashcards for months and months like some sort of deranged zombie/striver hybrid. I do agree it shows commitment vs CK to handle that. When you step back and look at it, capitalism has really warped human behavior.

I agree with all of this, and I'm sure capitalism has some effect/relation, but also, you just have to memorize thousands of facts to be a doctor.

 

[MedicineZ0Z]

This guy hits it on the head. It seems like the only people that don't like this answer are the ones that probably scored low on step 1. There are plenty of people that score well on both step 1 and step 2. They're not mutually exclusively or somesht.

If you just want to manage patients, go be a social worker or a nurse or NA. If you want to heal really sick people, you'll need a solid foundation of disease processes.

Drawing conclusions and thinking in black and white huh?
No one said that step 1 shouldn't count for a lot. This is more of an argument as to why step 2 should count for a lot as well.

 

[Lawpy]

Wait I'm confused. How do you do well on Step 2 CK if you don't do well on Step 1? I thought doing well on Step 1 builds the foundation to do well in clinical years, which means good clinical grades, good shelf exam scores, and thus good Step 2 CK scores. If someone doesn't do well on Step 1, is it reasonable to expect that person will do significantly better on Step 2 CK?

I mean, it could be possible for such improvements to occur but that could be because Step 2 CK is easier than Step 1. But that would mean program directors would know Step 2 CK is easy and that high scores are inflated, which means they would put more weight into Step 1 scores.

 

[Crayola227]

well, it turns out that while they don't both count equally in the residency process, they are equal in the sight of the medical board for obtaining a license to practice medicine in the first place and even begin training

but maybe that's not giving it enough importance

 

[Lawpy]

well, it turns out that while they don't both count equally in the residency process, they are equal in the sight of the medical board for obtaining a license to practice medicine in the first place and even begin training

but maybe that's not giving it enough importance

How does Step 3 factor into this?

 

[Crayola227]

Wait I'm confused. How do you do well on Step 2 CK if you don't do well on Step 1? I thought doing well on Step 1 builds the foundation to do well in clinical years, which means good clinical grades, good shelf exam scores, and thus good Step 2 CK scores. If someone doesn't do well on Step 1, is it reasonable to expect that person will do significantly better on Step 2 CK?

I mean, it could be possible for such improvements to occur but that could be because Step 2 CK is easier than Step 1. But that would mean program directors would know Step 2 CK is easy and that high scores are inflated, which means they would put more weight into Step 1 scores.

It's basically what you said for the most part. The last part of your statement most of all.

Not doing well on Step 1 does concern a school greatly for you and Step 2. It becomes more important to do well on Step 2, and even better than average to "make up" for the Step 1 score. Some of this relates to testing aptitude, which is the big worry. This is why MCAT matters to them to begin with.

If you don't have testing aptitude, it is uphill in a terrible way.

Discipline is concerning because while correctable, you question again if it will be for the second test.

Some people, it's really a question of the material. This is less worrisome because yes, the two tests are quite different, one is generally more difficult, and if your brain isn't well wired for Step 1, but you are a good test taker, disciplined, and otherwise have didactic aptitude and clinical aptitude, you can do just fine on Step 2.

It makes everyone nervous, because it's hard for anyone other than you to know how much discipline was an issue, and it's hard even for you to know why you bombed Step 1 and what it will mean for how you do with a different set of problems.

Step 1 doesn't quite build you up for success the way you're thinking. It's not as much of a stepwise progression as the name would have you believe.

 

[TheIllusionist]

Knowing MOA of drugs involves memorizing a flash card. Autonomic receptors and what each one does and where they are is not orders of magnitude higher thinking than knowing the order to prescribe different preload or afterload altering agents in CHF. Both require a similar level of reasoning skills. Heck STEP1 was pretty damn algorithmic with stuff like micro and there were plenty of random anatomy questions on mine. Btw, not everyone here who thinks STEP2 should count for more than it does did badly on STEP1.

The very proof that STEP1 isn't some cognitive master puzzle is that people who never did super well on more gloaded previous standardized tests can suddenly firecracker their way to a 255. Some of these people probably couldn't get above a C+ in intro physics or calc 2. This is not everyone of course and doesn't represent all 255s. But the very fact that so many kids who were never that good to begin with and didn't have that great of qualifications to even get into medical schools in the US (cough some carribean students) can suddenly beast STEP1, speaks volumes about the test.

That's not to say it isn't important. Knowing molecular basis of disease and management are both very important. Hence why STEP1 and STEP2 should be given a good amount of weight, a situation that btw is trending towards reality. Also, STEP2 is asking more and more mechanistic questions, making it more akin to STEP1 over time.

 

[TheIllusionist]

Also, let's stop this BS about STEP1 being harder.

PERCENTILE is all that matters. STEP2 is a bit easier for everyone. Therefore, it's all the same in the relative scheme.

 

[Crayola227]

How does Step 3 factor into this?

To apply for the temporary limited license to practice under supervision to begin residency
1) must have an MD/DO degree
2) must have passed Step 1 and Step 2 CK
3) it's possible there are a few state boards that don't require Step 2 CS passed to apply, but since almost all school require a passing Step 2 CS to get the degree, it's sorta moot
4) figure you have to pass all 3 to start training

Step 3 you are *not eligible* to take unless you have obtained a medical degree. You do not have to be in a residency program to take it.

You must pass Step 3 AND complete your first year of residency, intern year, to apply for a full license from the state board.

Typically, as long as you are in an accredited program, you can continue under the limited license without taking Step 3 as far as the board is concerned. Step 3 is required for the full license and for board certification after you complete the residency.

However, some programs have made stipulations that Step 3 is to be passed by a specific time, sometimes during the first year, intern year. Sometimes later. Some only by residency end.

It isn't common and typically only under some circumstances that Step 3 is taken after med school graduation yet before residency begins. Nothing stops someone from taking it after med school yet before residency, but in most situations there just isn't time to do so and people don't bother until they are in residency.

 

[Crayola227]

Because there was a study a while ago correlating STEP1 (not STEP2) scores with board exam performance after residency. You may not realize, but residencies can lose their accreditation if too many people fail their boards and that “too many” is often not many, like 1 person per year for 3 years in a row. So residencies are going to do their best to make sure you’re a good test taker because their accreditation and existence depends on it.

This is the actual accurate answer to this question. It has essentially nothing to do with material covered on either test. It’s a purely practical reason on the part of residencies.

I wasn't sure about the correlation with Step and board pass.

One program I interviewed at told me *exactly* what you just did. They said they liked to be the sort of program that looked beyond board scores, and they historically put less weight on it in selecting and ranking applicants, compared to many programs. They did that and apparently they got into just the hot water you are describing. They explained this to say, listen, we aren't the sort of culture that wants to put scores first, but we must graduate physicians who pass the boards. That's 2 fold, because you need the residents to do their part to prepare, but part of that is the program's provided curriculum.

Acknowledging this, they were selecting better test takers by placing more emphasis on Step 1. They would interview without Step 2, but would not rank without it. The other piece was that they revamped their board prep curriculum and support for residents to raise the pass rate.

The program was aware this was a *major* red flag for applicants interviewing there, which is why they took pains to explain what they were doing about it. Luckily the program had so many other things going for it, there was reason to think that turning on their previous philosophy about step scores would turn things around, and they were frank about where they thought they went wrong and why they had to be more Machiavellian about numbers.

So some programs have tried to look past Step 1. With disastrous results.

 

[QueenJames]

**** man... SDN gonna need a safespace subforum because of this post.

We ain't with that hippie crybaby crap ova here playa!

 

[Menander's Bust]

Wait I'm confused. How do you do well on Step 2 CK if you don't do well on Step 1? I thought doing well on Step 1 builds the foundation to do well in clinical years, which means good clinical grades, good shelf exam scores, and thus good Step 2 CK scores. If someone doesn't do well on Step 1, is it reasonable to expect that person will do significantly better on Step 2 CK?

I mean, it could be possible for such improvements to occur but that could be because Step 2 CK is easier than Step 1. But that would mean program directors would know Step 2 CK is easy and that high scores are inflated, which means they would put more weight into Step 1 scores.

Medical education is a redundant curriculum. You just keep learning the same things over and over and over, in more depth, from different angles, but essentially the same things. For some people, especially if they came in not from a science background, things click later. Others learn more by doing. They read about RSV, croup, adenovirus, rhinovirus, etc. but it doesn’t really stick until they start seeing patients. Then they’re like, oh, that kid has croup. I know what that looks like because I’ve seen it before, rather than just having read about it.

 

[username456789]

These threads are always full of Med students who clearly were more suited for PA/NP school.

 

[intubesteak]

These threads are always full of Med students who clearly were more suited for PA/NP school.

PA school is hard AF.

 

[W19]

To apply for the temporary limited license to practice under supervision to begin residency
1) must have an MD/DO degree
2) must have passed Step 1 and Step 2 CK
3) it's possible there are a few state boards that don't require Step 2 CS passed to apply, but since almost all school require a passing Step 2 CS to get the degree, it's sorta moot
4) figure you have to pass all 3 to start training

Step 3 you are *not eligible* to take unless you have obtained a medical degree. You do not have to be in a residency program to take it.

You must pass Step 3 AND complete your first year of residency, intern year, to apply for a full license from the state board.

Typically, as long as you are in an accredited program, you can continue under the limited license without taking Step 3 as far as the board is concerned. Step 3 is required for the full license and for board certification after you complete the residency.

However, some programs have made stipulations that Step 3 is to be passed by a specific time, sometimes during the first year, intern year. Sometimes later. Some only by residency end.

It isn't common and typically only under some circumstances that Step 3 is taken after med school graduation yet before residency begins. Nothing stops someone from taking it after med school yet before residency, but in most situations there just isn't time to do so and people don't bother until they are in residency.

I am assuming Wisconsin is probably one the of states that do not require CS to get a training license because UW-Madison neuro program requires it in October after one starts residency...

Step2 CS clearly shows that med students have no say when it comes to medical education. Everyone knows that test is a scam, and yet no one can do a damn thing about it.

FAQ | Department of Neurology | UW Madison