Why not value Step 2 CK > Step 1 for residency selection?

[knock0ut]

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What are your opinions on why residencies don't begin to look at Step 2 CK for interview selection rather than Step 1? Obviously it is not required for the initial ERAS application, but if PDs really thought it predicted future success better than Step 1, maybe it would become required. Seems like doing well on that exam is much more predictable of being a good physician (although still not a perfect predictor, just better than Step 1 I think). Step 2 questions are much more geared to questions you actually have to think through as a practicing physician.

 

[Psai]

Step 2 is a joke. It really is 2 months 2 weeks #2 pencil for the three exams. I scored better on step 2 with 3 weeks of minimal effort, a leisurely run through of uworld (didn't finish) and watching tons of tv. I busted ass for step 1.

I got all of my interviews without submitting step 2 although they did ask about it when I got there which I thought was weird.

 

[Redpancreas]

What are your opinions on why residencies don't begin to look at Step 2 CK for interview selection rather than Step 1? Obviously it is not required for the initial ERAS application, but if PDs really thought it predicted future success better than Step 1, maybe it would become required. Seems like doing well on that exam is much more predictable of being a good physician (although still not a perfect predictor, just better than Step 1 I think). Step 2 questions are much more geared to questions you actually have to think through as a practicing physician.

Psai's just smarter than me. I've taken a practice Step 2 and am not even hitting my Step 1 score yet with a little over half of my rotations over.

The following is my opinion based on talking with upperclassman, talking to mentors in my field who have local sway, and the surveys/school websites:

While I think Step 1 is still "the exam" don't think for a second that it's not valued! It's required before most rank-lists in IM and for fields like EM it's very critical. Killing Step 2 CK is definitely the ultimate redemption for a below average Step 1 score. I'll speak the field I know about and say that a 240+ CK score can make up for a mess-up on Step 1 and 260+ definitely helps someone with a good/decent Step 1 score. It's value will probably increase every year. At this point, I would like to make a bold opinion and say that for IM, Step 2 is just as important as Step 1 if you were to ask a PD. To go ahead and answer your question, at this point though, the logistics are just that everyone is taking it at different times so they have some scores and not others so they can't officially say that Step 2 is just as important as Step 1. Also, people are slow to adapt to change.

 

[Lawpy]

The following is my opinion based on talking with upperclassman, talking to mentors in my field who have sway, and the surveys/school websites:

While I think Step 1 is still "the exam" don't think for a second that it's not valued! It's required before most rank-lists in IM and for fields like EM it's very critical. Killing Step 2 CK is definitely the ultimate redemption for a below average Step 1 score. I'll speak the field I know about and say that a 240+ CK score can make up for a mess-up on Step 1 and 260+ definitely helps someone with a good/decent Step 1 score. It's value will probably increase every year. At this point, I would like to make a bold opinion and say that for IM, Step 2 is just as important as Step 1 if you were to ask a PD. To go ahead and answer your question, at this point though, the logistics are just that everyone is taking it at different times so they have some scores and not others so they can't officially say that Step 2 is just as important as Step 1. Also, people are slow to adapt to change.

So this means the reverse is also true? Basically does a weak Step 2 hurt an applicant with a strong Step 1? Or can a strong Step 1 make up for a weak Step 2?

 

[Redpancreas]

So this means the reverse is also true? Basically does a weak Step 2 hurt an applicant with a strong Step 1? Or can a strong Step 1 make up for a weak Step 2?

A 240 dropping to a 220 would look terrible according to me,but I've seen a guy match Ortho with that drop but no idea on the context (I think he took it later in the year). I don't think a Step 1 would be able to have as much for a redeeming factor given that Step 2 the more recent test. That being said, there may be cases that are student/residency/field specific where a student had much less time or spent much less effort and that was acceptable to some places. All I have to say from people who wkno what they're talking about is you should aim for a "10 point increase" on Step 2 to consolidate Step 1. Now if it's the same like 250 --> 249 or something along those lines, I think admins will shrug it off so the higher your score, the more forgiveness you'll get but if you're on the lower end like 222 --> 224 you basically blew your chance to redeem yourself with Step 2.

 

[OnePunchBiopsy]

Obviously it is not required for the initial ERAS application, but if PDs really thought it predicted future success better than Step 1, maybe it would become required. Seems like doing well on that exam is much more predictable of being a good physician (although still not a perfect predictor, just better than Step 1 I think).

Correct me if I'm wrong, but I don't believe PD's look at Step 1 as much a "predictable of being a good physician," but more so a number that reflects hard work and preparation that is also a hard line in the sand so they don't have to go through as many residency applications.

 

[togaedere]

Not a PD, but of the PDs I know and have talked to about this (n= like, 4) this seems to be pretty close to the truth. Competitive programs need a cutoff - also a person who is able to integrate material and beast an exam is likely going to carry that stuff forward to other things in their life. Does it mean they can talk to people, no. Does it mean that other residents will like them, no. But that's what the interview is for.

I found step 2 harder than step 1. Was getting a 20-30 point drop in practice tests pretty much up to a week before the exam and I was freaking out cus i really didn't want to not produce on a strong step 1. But then I ended up getting 6 points less which was like whatever. So, bactothebasics you've got tons of time to figure this stuff out.

Correct me if I'm wrong, but I don't believe PD's look at Step 1 as much a "predictable of being a good physician," but more so a number that reflects hard work and preparation that is also a hard line in the sand so they don't have to go through as many residency applications.

 

[sliceofbread136]

Depends on the field, for some it is as important as step 1. I anticipate as time goes along it will get more and more important.

 

[LucidSplash]

Because multiple studies have shown in a variety of specialties that USMLE Step 1 score is a predictor of being able to pass specialty board exams while Step 2 score does not correlate.

USMLE Step 1 board - PubMed - NCBI

/thread

 

[jw3600]

Because multiple studies have shown in a variety of specialties that USMLE Step 1 score is a predictor of being able to pass specialty board exams while Step 2 score does not correlate.

USMLE Step 1 board - PubMed - NCBI

/thread

I never really understood this notion of correlation with passing boards. The majority of the people interested in the step 1 vs step 2 debate are usually very competitive applicants and hard working people. I feel like that group doesn't really overlap with the failing speciality boards population that much.

 

[LucidSplash]

I never really understood this notion of correlation with passing boards. The majority of the people interested in the step 1 vs step 2 debate are usually very competitive applicants and hard working people. I feel like that group doesn't really overlap with the failing speciality boards population that much.

What you feel doesn't really matter since the studies have shown correlation over and over again.

 

[knock0ut]

Thank you for the input, everyone. So if you have an average Step 1 for a competitive specialty (but didn't knock it out of the park), do you feel that doing significantly better on Step 2 CK can significantly increase your odds of getting interviews at competitive programs? Can it make up for a Step 1 not hitting a very high minimum score?

 

[sinombre]

Because multiple studies have shown in a variety of specialties that USMLE Step 1 score is a predictor of being able to pass specialty board exams while Step 2 score does not correlate.

USMLE Step 1 board - PubMed - NCBI

/thread

The very first paper in your PubMed search link concludes the exact opposite of what you're saying.

"Step 2 CK and composite scores were better predictors of achieving ABEM initial certification compared to Step 1 score"

You may be right that data has generally suggested that step 1 is a better predictor, but there are obviously confounding variables. The most obvious being that historically step 1 has mattered much more, so the amount of effort put into it has far exceeded step 2. As step 2 becomes more and more important (and more programs require it/value it) that will likely change.

 

[sinombre]

Intuitively I think it makes more sense to value step 2, given the substance of the test compared to step 1. It makes sense that step 1 has been the main focus historically given that it was the only test PDs could objectively compare applicants with. But if both tests were required, and similar collective efforts were put in to both tests by applicants, I have a hard time believing step 1 would be a better predictor.

I obviously could be wrong.

 

[osprey099]

According to the 2016 PD survey, step 2ck had a 4.4/5 importance factor whereas step 1 had a 4.3/5 importance factor (n=around 150 PDs)


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[Lawpy]

The very first paper in your PubMed search link concludes the exact opposite of what you're saying.

"Step 2 CK and composite scores were better predictors of achieving ABEM initial certification compared to Step 1 score"

You may be right that data has generally suggested that step 1 is a better predictor, but there are obviously confounding variables. The most obvious being that historically step 1 has mattered much more, so the amount of effort put into it has far exceeded step 2. As step 2 becomes more and more important (and more programs require it/value it) that will likely change.

According to the 2016 PD survey, step 2ck had a 4.4/5 importance factor whereas step 1 had a 4.3/5 importance factor (n=around 150 PDs)


Sent from my iPhone using SDN mobile

These are specifically referring to Step 2 CK right? Does Step 2 CS have similar importance? Not too sure since I read several posts on here that it's a fairly useless exam that should be eliminated.

 

[sinombre]

These are specifically referring to Step 2 CK right? Does Step 2 CS have similar importance? Not too sure since I read several posts on here that it's a fairly useless exam that should be eliminated.

No, Step 2 CS is a completely different test. It's basically a test that makes sure you know how to speak English/communicate with people. Step 2 CK is the multiple choice exam similar to step 1.

I think the test is useless for US students. It's probably useful for IMGs/FMGs or non-native English-speakers.

 

[LucidSplash]

The very first paper in your PubMed search link concludes the exact opposite of what you're saying.

"Step 2 CK and composite scores were better predictors of achieving ABEM initial certification compared to Step 1 score"

You may be right that data has generally suggested that step 1 is a better predictor, but there are obviously confounding variables. The most obvious being that historically step 1 has mattered much more, so the amount of effort put into it has far exceeded step 2. As step 2 becomes more and more important (and more programs require it/value it) that will likely change.

I posted the link so you could see the numerous studies there. Yes there are a few that show a difference but the majority is what matters. The OP's question was about why PDs value Step 1 over Step 2CK. The answer is the same as what I stated. It may be different than what those here consider "intuitive" but I was answering the "why" question.

 

[sinombre]

I posted the link so you could see the numerous studies there. Yes there are a few that show a difference but the majority is what matters. The OP's question was about why PDs value Step 1 over Step 2CK. The answer is the same as what I stated. It may be different than what those here consider "intuitive" but I was answering the "why" question.

Fair enough. What do you think though? If the same collective effort was put into both tests, which would be a better predictor? I had always assumed PDs historically valued step 1 more because all applicants have taken it when they apply whereas not all applicants have taken step 2 (although I do think more and more applicants are applying with step 2, which is why I think the emphasis will change over time).

 

[Redpancreas]

Thank you for the input, everyone. So if you have an average Step 1 for a competitive specialty (but didn't knock it out of the park), do you feel that doing significantly better on Step 2 CK can significantly increase your odds of getting interviews at competitive programs? Can it make up for a Step 1 not hitting a very high minimum score?

So you hit 240/250 and I'm thinking a competitive surgical subspecialty like Ortho/ENT (based on the fact that you seem interested in surgery)? If so, I don't think going super hard on Step 2 will benefit you as much as things like research/away performance tbh so aim to score a bit higher or atleast repeat your score but I don't think it's anything do-or-die at this point considerignfrom what I've heard, Step 1 is used as a filter these days and I'm sure you're over it.

 

[LucidSplash]

Fair enough. What do you think though? If the same collective effort was put into both tests, which would be a better predictor? I had always assumed PDs historically valued step 1 more because all applicants have taken it when they apply whereas not all applicants have taken step 2 (although I do think more and more applicants are applying with step 2, which is why I think the emphasis will change over time).

Eh, I don't really have a dog in the fight. I know that a poor Step 1 will get you screened out at a lot of places and will certainly make it difficult to match into something competitive. Fewer if any will screen based in Step 2. Step 2 can help and below average but not completely make up for a really poor one. Conversely a poor Step 2 after and great Step 1 will also give you problems if you don't have a good explanation for it.

 

[BigSkyMontana45]

How important is it to make a 10 point improvement? If I have a Step 1 and Step2CK score of both 235 - is it a red flag? I want to go into academic IM.

 

[sinombre]

How important is it to make a 10 point improvement? If I have a Step 1 and Step2CK score of both 235 - is it a red flag? I want to go into academic IM.

No, it's not a red flag. A red flag would be something like a 20 point drop (or failing). Doing better always looks good, and keeping the same score is probably a neutral thing.