MD Causal relationship between Step 1 preparedness and clerkship/Step 2 preparedness?

[Super_Med]

With Step 1 going P/F, a big debate seems to be whether it’s worth dedicating so much time to studying during M1/M2, when this time could be dedicated to research, shadowing, or other EC activities.

Those in favor of keeping up with studying as in any other previous year may argue that even though Step 1 will be P/F, studying hard will prepare you well for clerkships and/or provide a strong foundation for Step 2 CK. (Also I hear some conspiracy theories of there being some sort of hidden internal ranking with Step 1 numerical scores, but not sure if there’s any validity to this).

Those in favor of not studying as much during preclinical may argue that the saved time can be better used to pump out research pubs and other extracurriculars early on, and that studying hard for Step 1 (more than just to pass) won’t translate to much better clerkship performance or Step 2 CK performance (may even lead to premature burnout).

What do you think?

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[Matthew9Thirtyfive]

We take step 1 after our third year rotations. I didn’t keep up any studying during M1/M2, and I’ve honored all my rotations so far. That doesn’t mean studying for step 1 won’t help, but it certainly isn’t necessary.

 

[Lucca]

I think that in the next few years a meta will develop where people will use hybrid step 1 + step 2 CK resources that compile the high yield from step 1 that overlaps with step 2 throughout M1+2 and then use step 1 dedicated period to cram in the other info they need to comfortably get over the P range.

That is to say, there’s no doubt there’s a percentage of step 1 content that is applicable for step 2 and wards but the effort required to rly learn that vs what people were doing to break 250+ have very little to do with one another.

If I were starting M1 this year, I would just focus on the classes and spend the rest of my time exploring specialties, working on building healthy habits, and doing research. The standardized exam rat race just isn’t worth it, personally. That said there are some people for whom grinding for tests is just second nature. All the power to them, but it definitely isn’t me.

Here’s my additional perspective as an md/Phd student: for the past 40 years MD/PhD students have been forgetting the entirety of medical school (and definitely all of step 1 high yield) before returning to wards and still being able to get through clerkships, pass boards, match, meet residency milestones etc. Preclin and step 1 just are not that important, even if there is no doubt that they prepare you for wards and beyond.

 

[Elite Medical Prep]

A solid foundation is needed to do well on Step 2 CK. I never would have done well if I hadn't had that foundation. It's easy enough to pick up on that info during clinical rotations, but with so much riding on CK, why not put the effort in and learn the basics so you have less to learn later? That's my opinion, at least.

 

[catlady87]

I may be a rarity, but I attended all classes during the first two years and tried to really pay attention to and absorb class material, and I think that helped me be successful on my third year clerkships. Most of the step 1 minutiae didn’t come up again after the test, but having a strong foundation was useful for third year both clinicals and shelf exams, and I ended up doing quite a bit better on step 2 than step 1.

 

[aldol16]

It does help in that medicine builds on itself. If you don't learn the Step 1 material, then it may take more work to learn the Step 2 material. Step 2 question stems are similar to Step 1 question stems but instead of asking you for pathophys or the diagnosis, it often asks you for the next step in management. You have to know the diagnosis to know that and to get the diagnosis, you have to know how the disease presents (related to its pathophysiology) and its key associations. So for example, a hiker in the Northeast who develops a ring-like skin lesion is most likely to have Lyme (Step 1 type question) which you would need to treat with something like doxycycline (Step 2 question). The more difficult Step 2 questions might give you that presentation and then ask you about the mechanism of the best drug (inhibits bacterial protein synthesis). You can see that if you don't get the correct diagnosis, you wouldn't have a clue about the answer.

You also get pimped on Step 1 stuff during clerkships, especially IM.

 

[efle]

The core stuff you need to know from Step 1 you can learn from your preclinical curriculum and from studying enough to Pass it. The minutia people used to memorize to aim for 250+ isnt worth it at all anymore. The winners are going to be the people who thoroughly use UWorld for CK throughout their rotations.

 

[Ho0v-man]

I think you need a really solid foundation to do well on step 2/shelves without going crazy on rotations.

But I think you’ll get very biased results on if it helps you succeed on rotations. I’ve yet to meet anyone who thinks they did poorly on wards. In fact, a lot of people who perform poorly on these exams claim that they were amazing on rotations so the exams are stupid.

 

[drducky.]

I think you need a really solid foundation to do well on step 2/shelves without going crazy on rotations.

But I think you’ll get very biased results on if it helps you succeed on rotations. I’ve yet to meet anyone who thinks they did poorly on wards. In fact, a lot of people who perform poorly on these exams claim that they were amazing on rotations so the exams are stupid.

Definitely. I was working with a ms4 and I looked at their uworld step2 questions while they did them and I got all 3 questions right from just my step1 prep.

 

[bGMx]

The core stuff you need to know from Step 1 you can learn from your preclinical curriculum and from studying enough to Pass it. The minutia people used to memorize to aim for 250+ isnt worth it at all anymore. The winners are going to be the people who thoroughly use UWorld for CK throughout their rotations.

As a soon to be M2, with clinical on the horizon (april) when should I start hitting these UWorld qbanks?

 

[Matthew9Thirtyfive]

As a soon to be M2, with clinical on the horizon (april) when should I start hitting these UWorld qbanks?

Uworld for step 2/shelf exams?

 

[efle]

As a soon to be M2, with clinical on the horizon (april) when should I start hitting these UWorld qbanks?

Do you know your rotation schedule? Just do the associated questions during that rotation (like, do the psych Qs during psych).

It's how you prep for the shelves so it doesnt really make sense to do any other way than that

 

[NickNaylor]

The "games" between pre-clinical and clinical years are fundamentally different. Yes, you need to grow your clinical fund of knowledge, which is very probably going to be correlated to your performance during the pre-clinical years, including your performance on step 1. However, being incredibly intelligent does not mean that you will do well on your clerkships. Clinical fund of knowledge is a necessary but not sufficient ingredient of doing well on rotations. The truth is that your ability to interact with patients and other members of the team, be able to function in a potentially high-stress environment, and being able to manage difficult situations are all just as important - arguably more important - than book knowledge.

Pre-clinical years are an exercise in trying to understand and digest as much information as possible. Clinical years are about functioning as an actual clinician. The skillsets required to succeed in both settings overlap to some degree but there are significant differences.

So to answer your question: no, I do not think that there is necessary a direct correlation between pre-clinical performance and clinical performance. I think it's more likely that someone who does well in the pre-clinical years will do well in the clinical years, but there are many intelligent goobers that completely fall flat when it comes to "real life medicine."

 

[Ganon]

I struggled in the first two years of med school, but routinely do way better than average as an M3/M4.
I'm sure there's correlations but way too many confounders to use it predictively. (Just my opinion)

 

[Matthew9Thirtyfive]

The "games" between pre-clinical and clinical years are fundamentally different. Yes, you need to grow your clinical fund of knowledge, which is very probably going to be correlated to your performance during the pre-clinical years, including your performance on step 1. However, being incredibly intelligent does not mean that you will do well on your clerkships. Clinical fund of knowledge is a necessary but not sufficient ingredient of doing well on rotations. The truth is that your ability to interact with patients and other members of the team, be able to function in a potentially high-stress environment, and being able to manage difficult situations are all just as important - arguably more important - than book knowledge.

Pre-clinical years are an exercise in trying to understand and digest as much information as possible. Clinical years are about functioning as an actual clinician. The skillsets required to succeed in both settings overlap to some degree but there are significant differences.

So to answer your question: no, I do not think that there is necessary a direct correlation between pre-clinical performance and clinical performance. I think it's more likely that someone who does well in the pre-clinical years will do well in the clinical years, but there are many intelligent goobers that completely fall flat when it comes to "real life medicine."

This. I have a few classmates I’m close with who struggled hard during preclerkship who are now honoring every rotation in M3. Doing well in preclerkship will definitely make it easier to do well, but not doing well in preclerkship doesn’t mean you can’t do amazingly.

 

[Lawpy]

This. I have a few classmates I’m close with who struggled hard during preclerkship who are now honoring every rotation in M3. Doing well in preclerkship will definitely make it easier to do well, but not doing well in preclerkship doesn’t mean you can’t do amazingly.

The people who struggled in preclinicals and yet acing clinicals are those who i always look up to

 

[Throwaway5129]

I struggled in the first two years of med school, but routinely do way better than average as an M3/M4.
I'm sure there's correlations but way too many confounders to use it predictively. (Just my opinion)

What made the difference?