Why is Step 1 before clinical years a con?

[freedoctor17]

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I always see people listing step 1 before clinical as a con on threads for deciding which school to attend. Why is that? Do you learn more during clinicals that would help you do better on step 1?

 

[LoveBeingHuman:)]

Not sure. Maybe it's just because doing it during/after clinicals gives you more time to study for it?

 

[HomeSkool]

Two reasons I can think of:

1. If you're required to pass it before starting clinicals, a failing score could delay the start of your MS3 year and subsequently your graduation. Starting clinicals before taking it means that a failure wouldn't necessarily delay graduation -- you'd take it again while grinding through your MS3 year.
2. Med students want to delay the day of their reckoning just as much as everyone else.

 

[bananafish94]

I don't know anything about the benefits to the scores or anything like that, maybe you score better after third year because you simply know more. I do know that there is no way I would want this looming over my head during third year. For although the prison of UWorld and Anki contains me for now, soon I shall be free.

 

[Kr#36]

Schools that have gone to that system have seen an increase in step scores

 

[freedoctor17]

Huh personally it just kinda sounds like a trivial thing to have as a con. But I'm the type of person that likes to get things done and out of the way so I guess that's why. Plus I feel like many schools give you dedicated step 1 study time (4 to 6 weeks) from what I've seen around here.

 

[Dr. Meliodas]

Several of the top schools in the country allow you to do this. The way I've heard it done is that your dedicated STEP1 study time is spaced as a rotation block and you can place that anywhere in third year. From what I have heard scores tend to be much highers for those after doing a couple rotations. I know that FIU mentioned this at my interview and said their average STEP1 score was a 240.

 

[AnatomyGrey12]

The Step 1 exam has become increasingly more clinically oriented, meaning it still is testing your basic medical science knowledge but the info is presented in a clinical vignette and a lot of answering the questions is being able to pick out the certain details that are actually important to answering the questions. Lots of fluff in the stems. From students I've talked to that have taken it after rotations they all say that having had to do a year of clinical reasoning on the wards made them much more adept at picking out the relevant info from the stem.

 

[Med Ed]

I always see people listing step 1 before clinical as a con on threads for deciding which school to attend. Why is that? Do you learn more during clinicals that would help you do better on step 1?

This is the newest trend in curricular design, but the real effects of it are still being explored. The handful of schools that have done it for awhile (e.g. Baylor) have students with exceptional metrics, and the ones that have migrated towards it (e.g. FIU) may still have a lot of confounding variables. A few years ago one of the west coast schools was touting its meteoric rise in Step 1 scores, but in the fine print it noted that its MCAT cutoff was raised two years prior.

That said, there is a plausible mechanism for clerkships helping on Step 1. If it is like most things in education, however, it will help some students and harm others.

 

[Kr#36]

Many schools have followed Baylor’s model of doing 18 months of pre-clinicals as opposed to two years. Interestingly, Dell is expanding on that idea and has 1 year pre-clinical, followed by 1 year clinicals, 1 research/mba year, and then the second clinical year in 4th year like everywhere else.

 

[lpp06]

I feel like the majority of schools are still proctoring Step 1 at the end of 2nd year?

 

[freedoctor17]

The Step 1 exam has become increasingly more clinically oriented, meaning it still is testing your basic medical science knowledge but the info is presented in a clinical vignette and a lot of answering the questions is being able to pick out the certain details that are actually important to answering the questions. Lots of fluff in the stems. From students I've talked to that have taken it after rotations they all say that having had to do a year of clinical reasoning on the wards made them much more adept at picking out the relevant info from the stem.

Ok now this reasoning makes much more sense to me.

 

[aldol16]

There are pros and cons to both approaches. The schools who have students take it before the clinical years will claim that you do better because you're closer to the basic science curriculum and the material is fresher in your mind. The schools who have students take it after will say that being in the clinics will help you develop clinical reasoning skills which is how Step 1 is presented. Really, it's a trade-off between those two factors and there are merits and disadvantages to both.

 

[Med Ed]

Many schools have followed Baylor’s model of doing 18 months of pre-clinicals as opposed to two years. Interestingly, Dell is expanding on that idea and has 1 year pre-clinical, followed by 1 year clinicals, 1 research/mba year, and then the second clinical year in 4th year like everywhere else.

Dell followed Duke's lead, not Baylor's. Duke has had a 12 month preclinical curriculum for a long time.

 

[siliso]

They must have changed step 1 a lot in the last 7 yrs if doing clinical rotations would help you do better on it! In my memory the closer you were to Path and plenty of time to cram details the better off you’d be. There’s a rate of decay on the retention of all the factoids that get tested. But if there’s empiric evidence of actual improvement in scores with delay that’s fascinating and I’m off to read.

 

[aldol16]

I don't think the jump in scores was all that significant. That's also confounded by the fact that the applicant pools evolve over time and scores all over are inching up at schools due to applications being more and more competitive.