MD & DO Step 1 Officially P/F >= 01/26/2022

[BluMist]

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[Banco]

I wonder what students are going to try to do here. Take it earlier or delay to just go with P/F?

 

[Lucca]

I wonder what students are going to try to do here. Take it earlier or delay to just go with P/F?

im mstp so taking it for a score to get it out of the way since when i apply to residency the meta game will have long moved on and i dont want to have to think about it during phd, but many others in my program are waiting for it to go p/f anyways. our current M2 class is split more or less 60/40 waiting for P/F or taking it for a score this summer.

 

[Goro]

I wonder what students are going to try to do here. Take it earlier or delay to just go with P/F?

My gut reaction:
Make life easier on yourself and go with the PF exam, and then do well with Step 2. The edge will be off for the latter exam since from what I've seen, it assesses much more clinical thinking/reasoning than raw memory like Step 1 (or Level 1, for that matter).

 

[ohmanwaddup]

Cant wait to see some gunners go for Step 1 in December of 2021

 

[Kracin]

I wonder what students are going to try to do here. Take it earlier or delay to just go with P/F?

My school takes step 1 after rotations (Feb 2022) and is letting us individually decide. The general sentiment is ~25% take it scored, 75% take P/F.

Many students are worried about the exam and scoring poorly. If we want to take it early, we have to jump through hoops to rearrange our clinical schedule.

 

[Lawpy]

The real question is how PDs are going to deal with the mix of P/F and scored Step 1s. It's going to get ugly

 

[frenchyn]

The real question is how PDs are going to deal with the mix of P/F and scored Step 1s. It's going to get ugly

It is stupid to have a mix of P/F and score. I am sure PDs will pick a 260 over a P/F regardless of the transition.

 

[Kardio]

Boo!

 

[Lawpy]

Boo!

Yay! The change was needed!

In before i get flooded with wows, angrys, sads, okays and dislikes

 

[YCAGA]

Yay! The change was needed!

In before i get flooded with wows, angrys, sads, okays and dislikes

I am personally relieved that it is pass/fail. I can basically sign up for any residency I want and skip off into the sunset! I have so much less stress now that they got rid of the silly competition for residency, which apparently had to exist because there are “more applicants than spots”. Classic corrupt and oppressive system. Again, SO glad and #blessed that they took away this objective measure. Now the one standardized test remaining (Step 2 CK) is extra stressful and more subjective attributes are weighed even more heavily than in the past. Thanks USMLE!😃

 

[Lawpy]

I am personally relieved that it is pass/fail. I can basically sign up for any residency I want and skip off into the sunset! I have so much less stress now that they got rid of the silly competition for residency because apparently there are “more applicants than spots”. Classic corrupt and oppressive system. Again, SO glad and #blessed that they took away this objective measure. Now the one standardized test remaining (Step 2 CK) is extra stressful and more subjective attributes are weighed even more heavily than in the past. Thanks USMLE!😃

Things get even more fun when Step 2 CK goes P/F!

 

[YCAGA]

Things get even more fun when Step 2 CK goes P/F!

Fortunately I don’t think they can push that change through before I take it.

 

[Lawpy]

Fortunately I don’t think they can push that change through before I take it.

Maybe not but the change is definitely going to happen a lot sooner compared to Step 1 P/F transition.

 

[Steve_Zissou]

I am personally relieved that it is pass/fail. I can basically sign up for any residency I want and skip off into the sunset! I have so much less stress now that they got rid of the silly competition for residency, which apparently had to exist because there are “more applicants than spots”. Classic corrupt and oppressive system. Again, SO glad and #blessed that they took away this objective measure. Now the one standardized test remaining (Step 2 CK) is extra stressful and more subjective attributes are weighed even more heavily than in the past. Thanks USMLE!😃

Participation trophies all the way down. I know plenty of people disagree that step 1 is useful for anything, but I can promise you that those who worked hard, studying for the exam definitely did better than those who didn't. Has to matter for something, but then again, maybe not.

I do find it interesting though that schools are so quick to say "how well you learn our course material has a strong correlation to how well you do on boards" but also say "boards don't mean anything, at least not anything meaningful."

 

[YCAGA]

Maybe not but the change is definitely going to happen a lot sooner compared to Step 1 P/F transition.

So thousands of residency directors are just going to throw up their hands and accept having NO objective measure of their applicants and no way to filter 500 applications semi-efficiently? I think not. Getting rid of Step 2 scores will be much harder, because at this point it would be 10x more idiotic than making Step 1 pass/fail, which was already a bad decision.

 

[YCAGA]

Participation trophies all the way down. I know plenty of people disagree that step 1 is useful for anything, but I can promise you that those who worked hard, studying for the exam definitely did better than those who didn't. Has to matter for something, but then again, maybe not.

I do find it interesting though that schools are so quick to say "how well you learn our course material has a strong correlation to how well you do on boards" but also say "boards don't mean anything, at least not anything meaningful."

I personally also love the transition from “Don’t worry we will teach your everything on the boards” to “Step 1 knowledge is basically useless but don’t worry, this other equally obscure stuff that I do research on is VERY relevant to clinical practice and will be taught in detail. Oh, also, the foundational stuff on Step 1, you can self-study that 🤡.”

Fortunately my school is actually well run in terms of the pre-clinical curriculum (making professors stick to an outline that follows Step 1/2), but I worry from some other schools. For now they are sticking to covering everything on Step 1 (they don’t want people to fail) and just try to incorporate more clinically relevant stuff like management, which I appreciate for third year and Step 2.

 

[Lawpy]

So thousands of residency directors are just going to throw up their hands and accept having NO objective measure of their applicants and no way to filter 500 applications semi-efficiently? I think not. Getting rid of Step 2 scores will be much harder, because at this point it would be 10x more idiotic than making Step 1 pass/fail, which was already a bad decision.

They didn't have a choice with Step 1 even though they hated it right?

Step 1 P/F has many justified reasons, but i'm all for an actually good standardized test (like the MCAT, so norm referenced, small standard errors etc)

The Steps are misused and have garbage standard deviations by PDs who are struggling to deal with overapplication.

 

[Lawpy]

We need to stop justifying the continued misuse of crappy exams and instead make an actually good exam and resolve the overapplication problem.

 

[wondervisions]

I think folks who are pro scored step 1 are ignoring a fundamental issue here- step 1 is simply an awful standardized exam. The retest fidelity is absolute garbage, meaning the same student can get vastly different scores from one form to the next (in contrast to the MCAT where the confidence interval is +/-2). If you want an objective way to stratify applicants you should be arguing for step 1 reform or replacement with a better standardized exam- one that was designed to stratify applications from the beginning.

Advocating for a scored step 1 is advocating for the opportunity to study your ass off for 2 years for the chance to sit for a single exam that you could reasonably bomb by 15-20 points just because you got a ****ty form. Not to mention the content is esoteric and bears little resemblance to clinical medicine.

 

[AzBasRad]

Taking Step 1 earlier to get a scored result may not be advantageous. Most class of 2024 will have P/F report and residency programs (at least at my home institution) are already transitioning to focus on Step 2 CK.

 

[Ho0v-man]

I think folks who are pro scored step 1 are ignoring a fundamental issue here- step 1 is simply an awful standardized exam. The retest fidelity is absolute garbage, meaning the same student can get vastly different scores from one form to the next (in contrast to the MCAT where the confidence interval is +/-2). If you want an objective way to stratify applicants you should be arguing for step 1 reform or replacement with a better standardized exam- one that was designed to stratify applications from the beginning.

Advocating for a scored step 1 is advocating for the opportunity to study your ass off for 2 years for the chance to sit for a single exam that you could reasonably bomb by 15-20 points just because you got a ****ty form. Not to mention the content is esoteric and bears little resemblance to clinical medicine.

I see this argument a lot. But most people get very very close to their predicted score. I was 4 points off on step 1. And on step 2 it was exactly the same. I’m all for developing a better exam, but I doubt the results would be any different.

Get ready for “h0LiStIc ReViEw” ladies and gents lol.

 

[wondervisions]

I see this argument a lot. But most people get very very close to their predicted score. I was 4 points off on step 1. And on step 2 it was exactly the same. I’m all for developing a better exam, but I doubt the results would be any different.

Get ready for “h0LiStIc ReViEw” ladies and gents lol.

The magic of statistics is that some get very close to their predicted score.

Many do not.

 

[deleted751227]

I think folks who are pro scored step 1 are ignoring a fundamental issue here- step 1 is simply an awful standardized exam. The retest fidelity is absolute garbage, meaning the same student can get vastly different scores from one form to the next (in contrast to the MCAT where the confidence interval is +/-2). If you want an objective way to stratify applicants you should be arguing for step 1 reform or replacement with a better standardized exam- one that was designed to stratify applications from the beginning.

Advocating for a scored step 1 is advocating for the opportunity to study your ass off for 2 years for the chance to sit for a single exam that you could reasonably bomb by 15-20 points just because you got a ****ty form. Not to mention the content is esoteric and bears little resemblance to clinical medicine.

For every student that bombs Step 1 by 15-20 points cause they got “unlucky”, some student overperforms by 15-20 points because they got “lucky” - the net “luck” is the same overall, that’s how variance works, so as a whole population, med students score where they should.

I also think if you are getting 20 point swings on practice tests compared to usmle, your knowledge base isn’t consistent enough.

 

[wondervisions]

For every student that bombs Step 1 by 15-20 points cause they got “unlucky”, some student overperforms by 15-20 points because they got “lucky” - the net “luck” is the same overall, that’s how variance works, so as a whole population, med students score where they should.

I also think if you are getting 20 point swings on practice tests compared to usmle, your knowledge base isn’t consistent enough.

We should be advocating for a test that does not hinge on such luck. You could make the same argument as above if the scores were completely random.

 

[YCAGA]

They didn't have a choice with Step 1 even though they hated it right?

Step 1 P/F has many justified reasons, but i'm all for an actually good standardized test (like the MCAT, so norm referenced, small standard errors etc)

The Steps are misused and have garbage standard deviations by PDs who are struggling to deal with overapplication.

I think folks who are pro scored step 1 are ignoring a fundamental issue here- step 1 is simply an awful standardized exam. The retest fidelity is absolute garbage, meaning the same student can get vastly different scores from one form to the next (in contrast to the MCAT where the confidence interval is +/-2). If you want an objective way to stratify applicants you should be arguing for step 1 reform or replacement with a better standardized exam- one that was designed to stratify applications from the beginning.

Advocating for a scored step 1 is advocating for the opportunity to study your ass off for 2 years for the chance to sit for a single exam that you could reasonably bomb by 15-20 points just because you got a ****ty form. Not to mention the content is esoteric and bears little resemblance to clinical medicine.

Being against Step 1 P/F doesn’t mean we accept a scored Step 1 with a huge standard deviation as the best solution. No one is even saying that using Step 1 scores was a good system, it’s just the new system with P/F is worse. It’s all relative.

Hilariously bad straw man arguments too. You can’t assume that being against Step 1 P/F means we are against ANY reform to Step 1.

 

[Lawpy]

Being against Step 1 P/F doesn’t mean we accept a scored Step 1 with a huge standard deviation as the best solution. No one is even saying that using Step 1 scores was a good system, it’s just the new system with P/F is worse. It’s all relative.

Hilariously bad straw man arguments too. You can’t assume that being against Step 1 P/F means we are against ANY reform to Step 1.

You're arguing for a need of some standardized test. That can coexist with all Steps being P/F. The Steps weren't designed to be abused by PDs to evaluate or screen out applicants

 

[Ho0v-man]

The magic of statistics is that some get very close to their predicted score.

Many do not.

It’s the other way around. Most get their predicted score or really close to it. The only people that score significantly lower are the folks that had first aid out during their practice tests lol. All for having a better test. But step 1 is a very fair exam.

 

[wondervisions]

It’s the other way around. Most get their predicted score or really close to it. The only people that score significantly lower are the folks that had first aid out during their practice tests lol. All for having a better test. But step 1 is a very fair exam.

https://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf

It really isn't a fair exam. The standard error of estimate is +/- 8 points, meaning if you retook the test, 1/3 of the time you will get a score more than 8 points away from your previous score. In contrast, on the MCAT the "confidence band" (not sure what this means statistically) is +/- 2 points.

 

[Ho0v-man]

https://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf

It really isn't a fair exam. The standard error of estimate is +/- 8 points, meaning if you retook the test, 1/3 of the time you will get a score more than 8 points away from your previous score. In contrast, on the MCAT the "confidence band" (not sure what this means statistically) is +/- 2 points.

I’m well aware. Have you actually taken it? I have. It’s a pretty reliable grind if you put in the work. Not that that is necessarily the best way to select for candidates.

Again, all for a “better” exam. But most of the outcry is from people who’re mad that others are out working them.

 

[Aria MD???]

I haven't been able to find this actually posted n the USMLE website. Doe anyone have the actual link?

 

[wondervisions]

I’m well aware. Have you actually taken it? I have. It’s a pretty reliable grind if you put in the work. Not that that is necessarily the best way to select for candidates.

Again, all for a “better” exam. But most of the outcry is from people who’re mad that others are out working them.

You seem to be ignoring the fact that two people who put in the same effort and have the same potential could reasonably score 15 points apart... One could be a 230 and the other a 245.

 

[Ho0v-man]

You seem to be ignoring the fact that two people who put in the same effort and have the same potential could reasonably score 15 points apart... One could be a 230 and the other a 245.

So then no you haven’t. Again what we have to predict your score is very very accurate. I checked your posts. You’re near the end of dedicated. I get why you’re pissed atm. I was too lol. Good luck.

Edit: I promise you there really is a big difference in the knowledge base between those two scores. It’s pretty obvious on rotations too.

 

[wondervisions]

So then no you haven’t. Again what we have to predict your score is very very accurate. I checked your posts. You’re near the end of dedicated. I get why you’re pissed atm. I was too lol. Good luck.

We have statistics from the USMLE that tell us that the test has poor reliability... It doesn't matter how many people on reddit were dead on the score predictor or whatever lol.

 

[YCAGA]

You're arguing for a need of some standardized test. That can coexist with all Steps being P/F. The Steps weren't designed to be abused by PDs to evaluate or screen out applicants

What?? They just removed a standardized test and that is what I am arguing against. Yes, another standardized test CAN coexist with all Steps being P/F. But, they probably should, you know, create and implement a replacement before they take away objective measures.

I feel like you’re messing with us. You’re acting like a new, awesome test with a retest SD of 0.5 out 1000 points has replaced Step 1.

It makes no sense for you to argue in favor of a new change because the old system could be replaced by something better, but then new change is not that something better and there has been 0 talk that something better will ever come about.

 

[YCAGA]

We have statistics from the USMLE that tell us that the test has poor reliability... It doesn't matter how many people on reddit were dead on the score predictor or whatever lol.

What data from USMLE says there is poor reliability? Very few people retake Step exams and if they do, they failed it the first time. You can’t get data on Step like you can with the MCAT, where people retake after a huge range of first-time scores.

 

[Ho0v-man]

We have statistics from the USMLE that tell us that the test has poor reliability... It doesn't matter how many people on reddit were dead on the score predictor or whatever lol.

Yet these scores are great predictors of future performance on such exams in residency, which is part of why they became popular screening tools.

Although in all fairness, I doubt you’re getting better pass rates after the 240s.

 

[wondervisions]

What data from USMLE says there is poor reliability? Very few people retake Step exams and if they do, they failed it the first time. You can’t get data on Step like you can with the MCAT, where people retake after a huge range of first-time scores.

https://www.usmle.org/pdfs/transcripts/USMLE_Step_Examination_Score_Interpretation_Guidelines.pdf

You don't need empirical data to estimate this, you can use statistics. The USMLE estimates the standard error using statistics based on whatever their scoring algorithm is. According to this document, 2/3rds of the time your score will fall within +/- 8 points on a (hypothetical) retake.

 

[Lawpy]

What?? They just removed a standardized test and that is what I am arguing against. Yes, another standardized test CAN coexist with all Steps being P/F. But, they probably should, you know, create and implement a replacement before they take away objective measures.

I feel like you’re messing with us. You’re acting like a new, awesome test with a retest SD of 0.5 out 1000 points has replaced Step 1.

It makes no sense for you to argue in favor of a new change because the old system could be replaced by something better, but then new change is not that something better and there has been 0 talk that something better will ever come about.

My stance is simple

Use the steps to assess competency and for licensing purposes and make all Steps P/F

Make a separate residency version of the MCAT

 

[Ho0v-man]

My stance is simple

Use the steps to assess competency and for licensing purposes and make all Steps P/F

Make a separate residency version of the MCAT

I’m personally against a test similar to the mcat that more so tests your ability to figure out what they’re asking than your knowledge of the material. There is zero reward in clinical medicine for you to be a good test taker. It all comes down to knowing your sh**.

Furthermore, the way we use the mcat is almost just as broken. The folks who make the test said that a 500 is good to go for med school and we’re not predicting much better success at higher scores.

Not really sure what the answer is here though. Pretty much every metric outside of a standardized test can be gamed in some way.

 

[Lawpy]

I’m personally against a test similar to the mcat that more so tests your ability to figure out what they’re asking than your knowledge of the material. There is zero reward in clinical medicine for you to be a good test taker. It all comes down to knowing your sh**.

Furthermore, the way we use the mcat is almost just as broken. The folks who make the test said that a 500 is good to go for med school and we’re not predicting much better success at higher scores.

Not really sure what the answer is here though. Pretty much every metric outside of a standardized test can be gamed in some way.

Steps will still continue to exist in this system though. A pass shows competency in knowledge.

The residency MCAT is solely used as a metric for programs to objectively evaluate applicants.

People can get into med schoool with a 500 though

 

[Gilakend]

I think a more useful measure for residency selection would be a guy who sits in a room and gives applicants a score of 1-10 based on how chill they are. I don't care what you got on step if I hate being around you.

 

[Ho0v-man]

Steps will still continue to exist in this system though. A pass shows competency in knowledge.

The residency MCAT is solely used as a metric for programs to objectively evaluate applicants.

People can get into med schoool with a 500 though

I don’t think we disagree. I know the steps will still be used and all be p/f in the coming years.

I’m all for a better test. I just don’t want it to be like the mcat where it was more about your ability to figure out if the test writer was asking a trick question or creating a hypothetical scenario that requires you to use the information in a novel way. That’s nothing like how any of this works. You’re not given a unique scenario and devise a treatment plan for novel disease that doesn’t exist. You’re just given **** for not knowing what they want you to know.

Getting into an MD school with a 500 is like getting into derm with a 225.

 

[Ho0v-man]

I think a more useful measure for residency selection would be a guy who sits in a room and gives applicants a score of 1-10 based on how chill they are. I don't care what you got on step if I hate being around you.

That’s what a radiology interview is.

 

[Lawpy]

I don’t think we disagree. I know the steps will still be used and all be p/f in the coming years.

I’m all for a better test. I just don’t want it to be like the mcat where it was more about your ability to figure out if the test writer was asking a trick question or creating a hypothetical scenario that requires you to use the information in a novel way. That’s nothing like how any of this works. You’re not given a unique scenario and devise a treatment plan for novel disease that doesn’t exist. You’re just given **** for not knowing what they want you to know.

Getting into an MD school with a 500 is like getting into derm with a 225.

I agree but i can't think of any other approach unfortunately. Thinking what the test writer would do is a dumb but effective way to smash through these tests but i agree the clinical utility of that isn't there

Oh i was just talking all US med schools (including DO).

 

[Lawpy]

I think a more useful measure for residency selection would be a guy who sits in a room and gives applicants a score of 1-10 based on how chill they are. I don't care what you got on step if I hate being around you.

That’s what a radiology interview is.

I'm getting sold on rads day by day

 

[wondervisions]

So then no you haven’t. Again what we have to predict your score is very very accurate. I checked your posts. You’re near the end of dedicated. I get why you’re pissed atm. I was too lol. Good luck.

Edit: I promise you there really is a big difference in the knowledge base between those two scores. It’s pretty obvious on rotations too.

What I'm trying to say is, statistically, there truly may not be a difference between those scores a lot of the time.

Really. It is a bad exam for stratifying candidates.

This is just statistics.

 

[Ho0v-man]

What I'm trying to say is, statistically, there truly may not be a difference between those scores a lot of the time.

Really. It is a bad exam for stratifying candidates.

This is just statistics.

Yeah but there is. Everyone knows how much work it takes to go up into another range of scores. I know it and PDs know it. That’s why they select for higher scores when all else is equal. If it didn’t correlate to future exam performance, it wouldn’t be used.

 

[ohmanwaddup]

I thought step 1 was bogus till I took it and then started clinicals. I use a lot of step 1 knowledge everyday. Sure I've punted biochem pathways and other obscure stuff but by in large the drive to get a high score made me develop a pretty decent foundation of medical knowledge. I don't think I would have studied nearly as hard if it was pass fail, and I don't think that would have been a good thing.

The solution should not have been to make Step P/F to solve PDs putting to much weight on it, the solution should be implemented on the residency side of things. We are changing Step 1 and hoping it has a positive effect on something else entirely down the road, instead of fixing what is currently broken (excessive residency applications submitted per spot offered)

 

[Lawpy]

I thought step 1 was bogus till I took it and then started clinicals. I use a lot of step 1 knowledge everyday. Sure I've punted biochem pathways and other obscure stuff but by in large the drive to get a high score made me develop a pretty decent foundation of medical knowledge. I don't think I would have studied nearly as hard if it was pass fail, and I don't think that would have been a good thing.

The solution should not have been to make Step P/F to solve PDs putting to much weight on it, the solution should be implemented on the residency side of things. We are changing Step 1 and hoping it has a positive effect on something else entirely down the road, instead of fixing what is currently broken (excessive residency applications submitted per spot offered)

I mean the direct solution to overapplication is app caps but SDN will burst into flames of pure rage anytime app caps are mentioned