Will USUHS students have Step 1 scores this year?

[2021Doctor]

Looking at the timeline on the website, will USUHS students will be taking Step 1 before or after it goes to PASS-FAIL this year?

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[Matthew9Thirtyfive]

We have been given the option to take it before or after it goes pass/fail with the strong recommendation from osa and military PDs to take it pass/fail.

 

[2021Doctor]

We have been given the option to take it before or after it goes pass/fail with the strong recommendation from osa and military PDs to take it pass/fail.

Do you know why there is a strong recommendation to take it pass/fail?

 

[Matthew9Thirtyfive]

Do you know why there is a strong recommendation to take it pass/fail?

This is what we’ve been told:

1) a mediocre score can hurt, whereas a pass is a net neutral
2) taking it for a pass will put less stress on us and allow us to focus on step 2
3) it’s likely that military PDs will be asked to blind step 1 scores anyway

I don’t know anyone in my class who has scheduled it before Jan 26.

 

[pgg]

3) it’s likely that military PDs will be asked to blind step 1 scores anyway

Wait what?

Step scores won't be part of ranking applicants any more? I don't know how I feel about that.

 

[Matthew9Thirtyfive]

Wait what?

Step scores won't be part of ranking applicants any more? I don't know how I feel about that.

Step 1. Step 2 will still be used. Step 1 is going p/f and the idea is to not bias against people with a pass in the next cycle when it will be mixed.

 

[Mace1370]

It is beyond me why they felt compelled to remove an objective piece of evidence regarding a students performance that is standardized across all medical schools. When I reviewed applicants this year many had step 1 scores and others were pass/fail.

 

[DrMetal]

It is beyond me why they felt compelled to remove an objective piece of evidence regarding

Because medical education is a mess. We insist on the firehose (memorize, test, dump) approach, learning an ungodly and unnecessary volume of information (most of which can be looked up nowadays in a moment's notice) . . . and then we're surprised to find out that most physicians don't harbor a fundamental understanding of anything.

Don't think so? Ask your favorite attending physician what a peptide bond is . . .the answers are comical.

 

[pgg]

It is beyond me why they felt compelled to remove an objective piece of evidence regarding a students performance that is standardized across all medical schools. When I reviewed applicants this year many had step 1 scores and others were pass/fail.

Well from the start the USMLE was supposed to be just a licensing exam, explicitly NOT intended to be used to rank people. So I understand the pushback from people who think it shouldn't be used for a purpose it was never designed for, or validated to work for. There's some merit to their argument.

That said, it is an objective measure of something and there really isn't anything comparable to replace it.

Med school grades? Heh, they're all going to P/F too!

Clerkship written evals? Oh God, how subjective and prone to bias, racism, sexism, and apathy can you get?

In-person interviews? Anyone can bluff through a 30 minute conversation.

Audition rotations? Those are great, but students can't audition everywhere.

What else is there?

Even if you dismiss a large part of modern medical education as misguided or worthless "cram & dump" pseudo-learning ... and much of it actually IS just that ... then at worst the USMLE measures someone's ability to cram & dump. I'll put forth an opinion from the wilderness that the ability to do that is a useful measure of (1) raw intelligence and (2) determination to gut through unpleasant tasks to reach a goal. Both of which are qualities we desire in residents and future colleagues. People who chronically bomb written exams don't want to hear this, but there's a large measure of truth to it.

There's no denying that USMLE scores are correlated with specialty board pass rates. (And probably residency completion rates too but I haven't seen that data.) Show me a PD who's happy about P/F USMLE scores and I'll show you a PD who hasn't had to deal with many residents who had to be guided out of their program and into a different line of work.

Maybe a 6 hour test based on brain teaser booklets from airport snack shops would serve just as well as the USMLE as a screening tool for residency aptitude.

I think P/F USMLE or COMLEX scoring is dumb, and will only result in delaying the point when we identify someone as unsuitable for the more demanding and dangerous specialties. I don't care about the Derm PD wringing his hands about how it'll be so hard to select the best candidates for his 9-4 clinic specialty in which it's impossible to kill a patient, but I feel for the surgery, anesthesia, etc PDs ...

This P/F thing is presented as something objectively good and kind and humane for students, but let's not forget the marginal ones who now squeak through the P/F screening process are the ones who are going to be failing out of residencies they never should have started, 1 or 2 or 3 years into that. That's not a win for them.

 

[Matthew9Thirtyfive]

Well from the start the USMLE was supposed to be just a licensing exam, explicitly NOT intended to be used to rank people. So I understand the pushback from people who think it shouldn't be used for a purpose it was never designed for, or validated to work for. There's some merit to their argument.

That said, it is an objective measure of something and there really isn't anything comparable to replace it.

Med school grades? Heh, they're all going to P/F too!

Clerkship written evals? Oh God, how subjective and prone to bias, racism, sexism, and apathy can you get?

In-person interviews? Anyone can bluff through a 30 minute conversation.

Audition rotations? Those are great, but students can't audition everywhere.

What else is there?

Even if you dismiss a large part of modern medical education as misguided or worthless "cram & dump" pseudo-learning ... and much of it actually IS just that ... then at worst the USMLE measures someone's ability to cram & dump. I'll put forth an opinion from the wilderness that the ability to do that is a useful measure of (1) raw intelligence and (2) determination to gut through unpleasant tasks to reach a goal. Both of which are qualities we desire in residents and future colleagues. People who chronically bomb written exams don't want to hear this, but there's a large measure of truth to it.

There's no denying that USMLE scores are correlated with specialty board pass rates. (And probably residency completion rates too but I haven't seen that data.) Show me a PD who's happy about P/F USMLE scores and I'll show you a PD who hasn't had to deal with many residents who had to be guided out of their program and into a different line of work.

Maybe a 6 hour test based on brain teaser booklets from airport snack shops would serve just as well as the USMLE as a screening tool for residency aptitude.

I think P/F USMLE or COMLEX scoring is dumb, and will only result in delaying the point when we identify someone as unsuitable for the more demanding and dangerous specialties. I don't care about the Derm PD wringing his hands about how it'll be so hard to select the best candidates for his 9-4 clinic specialty in which it's impossible to kill a patient, but I feel for the surgery, anesthesia, etc PDs ...

This P/F thing is presented as something objectively good and kind and humane for students, but let's not forget the marginal ones who now squeak through the P/F screening process are the ones who are going to be failing out of residencies they never should have started, 1 or 2 or 3 years into that. That's not a win for them.

People who are just barely passing step 1 are still matching even with a score. They’re just matching into non competitive fields. So that’s not a great argument. And in the military match, it actually is possible to audition at every program, since there are only a few. Course that doesn’t help those in the civilian match, which make up almost the entire applicant pool.

I don’t know what the answer is, but stratifying applicants based on a single test is ludicrous. And as far as correlation with passing boards, when you look at the literature on that, in basically every specialty, once you are over 200-210, you have over 90% passing with some specialties being at a 99-100% pass rate over a 200 on step 1. So the data don’t really support that a scored step 1 will help you predict which residents are more likely to pass boards, since once you’re passing step 1, you’re pretty much guaranteed to be able to pass boards on the first try.

 

[pgg]

People who are just barely passing step 1 are still matching even with a score. They’re just matching into non competitive fields. So that’s not a great argument.

My argument is that the non-competitive fields skew in a couple of significant directions. One, toward the "harder to kill patients in minutes to hours" fields. And two, in the "less grueling and lengthy training" fields.

There are outliers like derm, which is ultra competitive but the pinnacle of daylight hour, non-emergent, not at risk of rapid patient deterioration because of error, kind of specialty. And while derm can be rather academic, we all know people go into derm for the lifestyle and not because skin is a fascinating daily intellectual challenge. Or ortho, which takes brilliant high achievers and turns them into something more akin to skilled carpenter craftsmen than doctors.

To be clear I'm not saying that psychiatry and peds and FM are easy (dealing with very broad differentials and nebulous presentations is a worthy challenge), or that physicians in those fields can't harm patients with bad care. Just that there are a few points along the way between patient contact and bad outcome to catch errors, or sit back and reflect, or get help with complex or unusual presentations. Those residencies are definitely on the kinder, gentler, reflective, end of the spectrum.

We've come a long way from the abusive and malignant residencies of a couple or three decades ago, but if we're honest, some part of us has to admit that there were some benefits to that sort of "mentorship" that demanded both natural talent and internal drive to produce strong and resilient attendings, particularly in the more procedural and imminently-dangerous-to-patients fields (i.e. the bulk of the "competitive" ones).

I can't really agree that there isn't a strong correlation between high USMLE scores and aptitude to excel in the majority of "competitive" fields. Even if that correlation was weak, USMLE scores would still be useful in identifying the strongest candidates.

To argue otherwise is to argue that there's no role for the use of standardized tests in evaluating and selecting/promoting people, ever.

Could there be a better exam than the USMLE for sorting residency applicants? Sure. Maybe we should make one before we get rid of the USMLE though.

FWIW, my USMLE step 1 score was below the national mean. I'm not speaking from a position of looking down on sub-90th-percentile scorers.

 

[Matthew9Thirtyfive]

I can't really agree that there isn't a strong correlation between high USMLE scores and aptitude to excel in the majority of "competitive" fields. Even if that correlation was weak, USMLE scores would still be useful in identifying the strongest candidates.

To argue otherwise is to argue that there's no role for the use of standardized tests in evaluating and selecting/promoting people, ever.

If we’re talking about passing boards, which was a major point in your post, then the evidence doesn’t support your position. If you’re arguing that people who score better on step 1 will be better doctors, I’m not sure if there is any evidence of that either. I’d be interested to see if there is, since it certainly logically follows that people who have more knowledge tucked away and can think critically better would perform better clinically.

 

[DrMetal]

The whole of medical education is in a total disarray right now, as is the entire profession. I don't think we can figure out what we want to teach medical students. We know the firehose approach doesn't make good physicians. We can make it as hard as we want, but that'll result in less physicians, and ultimately more mid-level encroachment (which we're already seeing in the cognitive non-procedural specialties). Never mind Step 1, I wouldn't encourage anyone to go to medical school right now.

 

[pgg]

The whole of medical education is in a total disarray right now, as is the entire profession. I don't think we can figure out what we want to teach medical students. We know the firehose approach doesn't make good physicians. We can make it as hard as we want, but that'll result in less physicians, and ultimately more mid-level encroachment (which we're already seeing in the cognitive non-procedural specialties). Never mind Step 1, I wouldn't encourage anyone to go to medical school right now.

Those all strike me as odd things to say.

The system we have had, warts and all, for the last few decades/generations, has produced "good physicians" ... or do you really thing the profession is seriously plagued by bad ones?

Nothing -- and I really mean nothing -- we do will result in less physicians. I present EXHIBIT A to be reviewed as the only evidence anyone needs to understand why the med school pipeline will be eternally full. That thread is pushing 20 years. I've half a mind to bump it for the benefit of new SDN'ers ...

Medicine is, and will continue to be, a sure path to a profession with 100% job security and a guarantee of $300K+ incomes to anyone of moderate brightness, a good work ethic, and bare minimum ability to interact with other humans.

We've all got golden tickets, man. Don't let the nurses get you down.

 

[DrMetal]

Those all strike me as odd things to say.

The system we have had, warts and all, for the last few decades/generations, has produced "good physicians" ... or do you really thing the profession is seriously plagued by bad ones?

Nothing -- and I really mean nothing -- we do will result in less physicians. I present EXHIBIT A to be reviewed as the only evidence anyone needs to understand why the med school pipeline will be eternally full. That thread is pushing 20 years. I've half a mind to bump it for the benefit of new SDN'ers ...

Medicine is, and will continue to be, a sure path to a profession with 100% job security and a guarantee of $300K+ incomes to anyone of moderate brightness, a good work ethic, and bare minimum ability to interact with other humans.

We've all got golden tickets, man. Don't let the nurses get you down.

I don't think the profession is plagued by bad ones. I think society (and the medical industrial complex juggernaut) is slowly marginalizing the physician.

 

[Mace1370]

I don't think the profession is plagued by bad ones. I think society (and the medical industrial complex juggernaut) is slowly marginalizing the physician.

That may be true, but has little in my opinion to do with what we are taught in medical school.

Bottom line for me is that we need some way of evaluating candidates, and a standardized test is one piece of objective evidence in additional to other factors that can be used to evaluate someone. Nothing is perfect, and any single measure of evaluation can have weaknesses. To throw out standardize testing entirely is foolish and is done in many cases for ulterior motives (in my opinion).

 

[2021Doctor]

This is what we’ve been told:

1) a mediocre score can hurt, whereas a pass is a net neutral
2) taking it for a pass will put less stress on us and allow us to focus on step 2
3) it’s likely that military PDs will be asked to blind step 1 scores anyway

I don’t know anyone in my class who has scheduled it before Jan 26.

Did everything happen as predicted?
Did students wait until after January 26?

 

[Trefoil]

My argument is that the non-competitive fields skew in a couple of significant directions. One, toward the "harder to kill patients in minutes to hours" fields. And two, in the "less grueling and lengthy training" fields.

There are outliers like derm, which is ultra competitive but the pinnacle of daylight hour, non-emergent, not at risk of rapid patient deterioration because of error, kind of specialty. And while derm can be rather academic, we all know people go into derm for the lifestyle and not because skin is a fascinating daily intellectual challenge. Or ortho, which takes brilliant high achievers and turns them into something more akin to skilled carpenter craftsmen than doctors.

To be clear I'm not saying that psychiatry and peds and FM are easy (dealing with very broad differentials and nebulous presentations is a worthy challenge), or that physicians in those fields can't harm patients with bad care. Just that there are a few points along the way between patient contact and bad outcome to catch errors, or sit back and reflect, or get help with complex or unusual presentations. Those residencies are definitely on the kinder, gentler, reflective, end of the spectrum.

We've come a long way from the abusive and malignant residencies of a couple or three decades ago, but if we're honest, some part of us has to admit that there were some benefits to that sort of "mentorship" that demanded both natural talent and internal drive to produce strong and resilient attendings, particularly in the more procedural and imminently-dangerous-to-patients fields (i.e. the bulk of the "competitive" ones).

I can't really agree that there isn't a strong correlation between high USMLE scores and aptitude to excel in the majority of "competitive" fields. Even if that correlation was weak, USMLE scores would still be useful in identifying the strongest candidates.

To argue otherwise is to argue that there's no role for the use of standardized tests in evaluating and selecting/promoting people, ever.

Could there be a better exam than the USMLE for sorting residency applicants? Sure. Maybe we should make one before we get rid of the USMLE though.

FWIW, my USMLE step 1 score was below the national mean. I'm not speaking from a position of looking down on sub-90th-percentile scorers.

I don’t know. I feel like hospitalists and ICU docs deal with the vast majority of death, and you don’t really need great board scores for either.

Also, USMLE scores aren’t correlated to all board pass rates in all studies, so the one thing you would think it would be valuable for is even a little iffy. I say this as someone who feels that boards/USMLE ultimately benefited me in terms of being able to show objective evidence of having acquired knowledge. I also think that having something objective does liberate people from subjective measures.

Maybe our teaching should be oriented to problem solving instead of mass regurgitation. I will say, I had some courses that focused on researching a specific medical question within pub med, which I felt was useful. I think med school would be a lot more effective and perhaps easier if it were geared towards problem solving. Then the test could also be geared in that direction.

I think medicine is currently floating on the coattails of the selection process. It’s hard to get into medical school, so the selection process selects for critical thinkers. The problem is that we then force them to shut off their brains for two years. By the time we get to clinicals, we can’t even speak the same language as the rest of the hospital, and it takes almost a year to become conversational. Seems to be an inefficient process, but one that does generate someone who has the ability to understand, and maybe is weak in terms of generating the best critical thinkers across the board. That’s something that residency seems to teach us.

 

[narcusprince]

Those all strike me as odd things to say.

The system we have had, warts and all, for the last few decades/generations, has produced "good physicians" ... or do you really thing the profession is seriously plagued by bad ones?

Nothing -- and I really mean nothing -- we do will result in less physicians. I present EXHIBIT A to be reviewed as the only evidence anyone needs to understand why the med school pipeline will be eternally full. That thread is pushing 20 years. I've half a mind to bump it for the benefit of new SDN'ers ...

Medicine is, and will continue to be, a sure path to a profession with 100% job security and a guarantee of $300K+ incomes to anyone of moderate brightness, a good work ethic, and bare minimum ability to interact with other humans.

We've all got golden tickets, man. Don't let the nurses get you down.

You said it clearly. The less quantitaive assessments versus qualitative assessment will introduce a huge amount of bias. I knew that no one could deny my Step scores or Board Scores. I feel if it was all pass/fail whats left is do people like you. I see this experiment lasting a few years then back to objective assessments of ability.

 

[narcusprince]

You said it clearly. The less quantitaive assessments versus qualitative assessment will introduce a huge amount of bias. I knew that no one could deny my Step scores or Board Scores. I feel if it was all pass/fail whats left is do people like you. I see this experiment lasting a few years then back to objective assessments of ability.

Should gpa be pass fail?