MD Heard a rumor that Step 1 (and maybe Step 2 CK) may change from scores to P/F. Is that true?

[Matthew9Thirtyfive]

They know there is no data backing your statement though. That’s all gibberish. Only data out there is that standardized test scores are lower no matter where or when for minorities. So to some degree do minorities work less hard / have less medical knowledge than whites or ORM? It’s the fact that PDs KNOW this but they don’t care. Standardized exams have been used in the past to limit diversity. Texas was notorious and got caught. EVERYBODY KNOWS there is an extreme lack of diversity in healthcare and suicide rates are the highest it’s ever been yet nobody wants to talk about the elephant in the room lol it’s like gun reform everyone wants to be safe and think shook shooters are bad but guns?? Nope not the problem

Wow this is all over the place. Let’s not go down off topic rabbit holes please.

---

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[Traveler2016]

Scored, pass/fail, whatever, but does anyone else find it concerning that the current trend amongst pre-clinical students is to obsessively memorize First Aid and Anki while complaining whenever their faculty try to teach them anything not found in these board resources? Step 1 may play a big part in getting you to residency but it sure as s*** does not make you a good clinician.

 

[Chibucks15]

Scored, pass/fail, whatever, but does anyone else find it concerning that the current trend amongst pre-clinical students is to obsessively memorize First Aid and Anki while complaining whenever their faculty try to teach them anything not found in these board resources? Step 1 may play a big part in getting you to residency but it sure as s*** does not make you a good clinician.

exactly. how the hell does a M1 know what's "high yield". That damn phrase is like nails on a chalkboard for me. Just learn things as good as you can. Sure some stuff is nonsense but the world of medicine is nonsense at times too

 

[Ho0v-man]

Scored, pass/fail, whatever, but does anyone else find it concerning that the current trend amongst pre-clinical students is to obsessively memorize First Aid and Anki while complaining whenever their faculty try to teach them anything not found in these board resources? Step 1 may play a big part in getting you to residency but it sure as s*** does not make you a good clinician.

I get what you’re saying and you’re last sentence isn’t wrong. But some PhD forcing me to memorize the rhodopsin cycle doesn’t make me a good clinician either.

 

[Chibucks15]

I get what you’re saying and you’re last sentence isn’t wrong. But some PhD forcing me to memorize the rhodopsin cycle doesn’t make me a good clinician either.

agreed. but the whole "my school isn't teaching me high yield things because it doesnt perfectly match up with FA/zanki/etc" is obnoxious

 

[Ho0v-man]

agreed. but the whole "my school isn't teaching me high yield things because it doesnt perfectly match up with FA/zanki/etc" is obnoxious

No arguments here.

edit: except neuro anatomy teaching obscure tracts with insane levels of detail when any non-neurologist needs to understand only a handful of them.

 

[AnatomyGrey12]

agreed. but the whole "my school isn't teaching me high yield things because it doesnt perfectly match up with FA/zanki/etc" is obnoxious

Those people learn in due time that’s it’s honestly all HY. Except the research rap professors teach. Many things I thought were “low yield” actually showed up in UWorld and on my real test.

 

[Chibucks15]

Those people learn in due time that’s it’s honestly all HY. Except the research rap professors teach. Many things I thought were “low yield” actually showed up in UWorld and on my real test.

Same. Obviously the ridiculous things aren’t important but it’s a necessary evil. And many things that haven’t been on boards have come up in my clinical year so far too

 

[deleted870424]

Scored, pass/fail, whatever, but does anyone else find it concerning that the current trend amongst pre-clinical students is to obsessively memorize First Aid and Anki while complaining whenever their faculty try to teach them anything not found in these board resources? Step 1 may play a big part in getting you to residency but it sure as s*** does not make you a good clinician.

What you say is true. But to be clear most pre-clinical students don’t care about learning how to a good physician until after step 1. We simply dont have time to do really well on this exam AND learn the minutiae required by docs.

 

[Traveler2016]

What you say is true. But to be clear most pre-clinical students don’t care about learning how to a good physician until after step 1. We simply dont have time to do really well on this exam AND learn the minutiae required by docs.

Yeah, I understand what's driving it, I've been there. It's just unfortunate.

 

[Adamgerd]

is it confirmed or very likely that this will pass or is it mainly rumors? Hopefully the former given I am an IMG and especially for IMGs, this seems like it will make it even more difficult for us to get a US residency, now at least if you score much higher than US applicants, you have a chance. With a P/F system? They'll always take US applicants.

 

[2021Doctor]

is it confirmed or very likely that this will pass or is it mainly rumors? Hopefully the former given I am an IMG and especially for IMGs, this seems like it will make it even more difficult for us to get a US residency, now at least if you score much higher than US applicants, you have a chance. With a P/F system? They'll always take US applicants.

What makes you think the decision on what to do with the US Medical Licensing Examination (USMLE) should be based on the desires of IMGs?

 

[Adamgerd]

What makes you think the decision on what to do with the US Medical Licensing Examination (USMLE) should be based on the desires of IMGs?

Well given I never mentioned whether they should or not in my post, merely asked how likely it is to pass, not sure how this question is relevant to what I asked.

 

[THEBACKANDFORTH]

As an M2 starting to really gear all focus towards sopping up board focused material, often just ignoring professors that I know wont provide that in favor of a secondary source, it seems antithetical to the very spirit of the liberal arts education we all have. Antithetical to the spirit of being a doctor. It feels inevitable that this test is becoming pass fail, but it won't be overnight, and it wont screw any of us over currently being washed in the current of this system and haven't done other things to stand apart. My chance to stand apart is step 1; that wont change for any of us. But..

Two years from now a class of med students will enter medical school knowing that to prove themselves to programs directors they will need to learn science and learn it well, start a research project, develop interest in hobbies, prove continued volunteer service to the needy and the community, and just show that they are good people with good intentions still holding a great deal of empathy.

 

[Schwifty]

No arguments here.

edit: except neuro anatomy teaching obscure tracts with insane levels of detail when any non-neurologist needs to understand only a handful of them.

Wow, I’m in my Neuro block right now and this just hit me hard lol

 

[Sleepingdoc]

Pass fail is good.. It is not fair for US students to get only 4 weeks to take the exam after their first year and foreign graduates get all the time in the world to do this.

 

[Matthew9Thirtyfive]

Pass fail is good.. It is not fair for US students to get only 4 weeks to take the exam after their first year and foreign graduates get all the time in the world to do this.

IMO that’s not a great reason to make it P/F since even if they get an amazing score foreign grads have a huge disadvantage in matching.

 

[Dr. Doctor MD]

Pass fail is good.. It is not fair for US students to get only 4 weeks to take the exam after their first year and foreign graduates get all the time in the world to do this.

This is just terrible logic... and you're wrong, it is completely fair.

A US MD with a 215 will likely match better than an IMG with a 240. I've met countless of amazing IMGs with 240s-260s who match terribly even in non-competitive specialties. The bottom 25% of USMDs match way better than the top 25% of IMGs.

 

[Adamgerd]

Pass fail is good.. It is not fair for US students to get only 4 weeks to take the exam after their first year and foreign graduates get all the time in the world to do this.

FMG's do have more time probably but the US curriculum is also designed to aid with learning for the STEP and you learn the same things you need on the STEP while in foreign schools they generally teach differently and also this might be accurate and I'd agree were both US MD's and FMG's or IMG's treated equally but frankly the US MG's have a pretty large advantage, not saying that's fair or not, just stating it is so. if you look at acceptance rates for residency, IMGs generally need at least 250s to match and definitely need much higher STEP grades than US MD's get the same residency, FMG's and US MD's are not judged equally regarding STEP scores.

 

[2021Doctor]

FMG's do have more time probably but the US curriculum is also designed to aid with learning for the STEP and you learn the same things you need on the STEP while in foreign schools they generally teach differently and also this might be accurate and I'd agree were both US MD's and FMG's or IMG's treated equally but frankly the US MG's have a pretty large advantage, not saying that's fair or not, just stating it is so. if you look at acceptance rates for residency, IMGs generally need at least 250s to match and definitely need much higher STEP grades than US MD's get the same residency, FMG's and US MD's are not judged equally regarding STEP scores.

Disagree. At many US schools, the curriculum contains a lot of extra fluff that wastes time and impedes the students efforts to prepare for step 1. The FMG sitting on his/her couch studying 6-12 months for step has no such impairment.

 

[2021Doctor]

IMO that’s not a great reason to make it P/F since even if they get an amazing score foreign grads have a huge disadvantage in matching.

This is a gross overgeneralization. Since about 25% of US physicians are FMGs, about 25% of PDs are now FMGs.
Here is an a nice example.
UAMS Diagnostic Radiology has an FMG PD:
Dr. Kedar Jambhekar, M.D. is the Chief of Body MSK/MRI and the Diagnostic Radiology Residency Program Director. He is an Associate Professor of Radiology at the University of Arkansas for Medical Sciences (UAMS). He joined the staff at UAMS in 2005.
He graduated from medical school in Mumbai, India in 1992 followed by a radiology residency at Tata Memorial Hospital, Mumbai, India. He practiced radiology as a consultant in free standing CT/MRI center in Thane, India before moving to the United States in 1999. He did a fellowship in Interventional Neuroradiology at NYU Medical Center, NY from 2000-2001, followed by an internship in Medicine and Radiology residency at SUNY Downstate Medical Center, NY. He joined UAMS in 2005, did another fellowship in Body MRI and has stayed on as faculty since then.

Kedar Jambhekar, M.D. | UAMS Health

Dr. Kedar Jambhekar, M.D., is the Chief of Body MSK/MRI and the Diagnostic Radiology Residency Program Director. He is a Professor of Radiology at the U...

doctors.uamshealth.com

The radiology PD does not have the medical schools of the residents listed on the resident webpage

Meet Our Residents | Radiology

UAMS

web.archive.org

However, a quick google search shows that 3 of 8 (37.5%) of UAMS 2018 radiology residents are FMGs. The google search shows that 2018 radiology residents included FMG graduates from Kakatiya Medical College (India), Kurnool Medical College (India), and Alexandria University Faculty of Medicine (Egypt).

 

[deleted870424]

IMO that’s not a great reason to make it P/F since even if they get an amazing score foreign grads have a huge disadvantage in matching.

As they should

 

[Grimjow]

The FMG sitting on his/her couch studying 6-12 months for step has no such impairment.

Why are you so intimidated by FMGs? Also, if FMGs can score higher than USMDs by "sitting on a couch" what does that say about you?

 

[Matthew9Thirtyfive]

This is a gross overgeneralization. Since about 25% of US physicians are FMGs, about 25% of PDs are now FMGs.
Here is an a nice example.
UAMS Diagnostic Radiology has an FMG PD:
Dr. Kedar Jambhekar, M.D. is the Chief of Body MSK/MRI and the Diagnostic Radiology Residency Program Director. He is an Associate Professor of Radiology at the University of Arkansas for Medical Sciences (UAMS). He joined the staff at UAMS in 2005.
He graduated from medical school in Mumbai, India in 1992 followed by a radiology residency at Tata Memorial Hospital, Mumbai, India. He practiced radiology as a consultant in free standing CT/MRI center in Thane, India before moving to the United States in 1999. He did a fellowship in Interventional Neuroradiology at NYU Medical Center, NY from 2000-2001, followed by an internship in Medicine and Radiology residency at SUNY Downstate Medical Center, NY. He joined UAMS in 2005, did another fellowship in Body MRI and has stayed on as faculty since then.

Kedar Jambhekar, M.D. | UAMS Health

Dr. Kedar Jambhekar, M.D., is the Chief of Body MSK/MRI and the Diagnostic Radiology Residency Program Director. He is a Professor of Radiology at the U...

doctors.uamshealth.com

The radiology PD does not have the medical schools of the residents listed on the resident webpage

Meet Our Residents | Radiology

UAMS

web.archive.org

However, a quick google search shows that 3 of 8 (37.5%) of UAMS 2018 radiology residents are FMGs. The google search shows that 2018 radiology residents included FMG graduates from Kakatiya Medical College (India), Kurnool Medical College (India), and Alexandria University Faculty of Medicine (Egypt).

How does this show that what I said is a gross generalization?

 

[2021Doctor]

Why are you so intimidated by FMGs? Also, if FMGs can score higher than USMDs by "sitting on a couch" what does that say about you?

Are you trolling? USMDs are generally in time-consuming medical school curriculums and do not have the opportunity to sit on their couch for 6-12 months doing nothing but studying for USMLE. I have met numerous FMGs who did nothing else but study for USMLE for 6-12 months. If you do not understand the difference, then I can't help you.

 

[Grimjow]

Are you trolling? USMDs are generally in time-consuming medical school curriculums and do not have the opportunity to sit on their couch for 6-12 months doing nothing but studying for USMLE. I have met numerous FMGs who did nothing else but study for USMLE for 6-12 months. If you do not understand the difference, then I can't help you.

1. I haven't heard of any foreign med schools employing p/f grading. Though it could be argued that this is a moot point since nobody cares about an IMG' s grades because PDs have no reference point for comparison
2. American med school curricula have reasonable overlap with the content of board exams. Foreign schools practically have none/very little. You can't "Zanki" your way into 70-80s on school exams
3. Here is an article from 2018

Medical students are skipping class in droves — and making lectures increasingly obsolete

“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” said one medical student. Here's why so many students skip med school classes.

www.statnews.com

"Nationally, nearly one-quarter of second-year medical students reported last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015."
Tell me now, how does a US med student who skips class/lectures to focus on board materials differ from an FMG who, as you like to call it, "sits on their couch to prepare for 6-12 months"?

 

[2021Doctor]

View attachment 287248
1. I haven't heard of any foreign med schools employing p/f grading. Though it could be argued that this is a moot point since nobody cares about an IMG' s grades because PDs have no reference point for comparison
2. American med school curricula have reasonable overlap with the content of board exams. Foreign schools practically have none/very little. You can't "Zanki" your way into 70-80s on school exams
3. Here is an article from 2018

Medical students are skipping class in droves — and making lectures increasingly obsolete

“There were times that I didn’t go to a single class, and then I’d get to the actual exam and it would be my first time seeing the professor,” said one medical student. Here's why so many students skip med school classes.

www.statnews.com

"Nationally, nearly one-quarter of second-year medical students reported last year that they “almost never” attended class during their first two, preclinical years, a 5 percent increase from 2015."
Tell me now, how does a US med student who skips class/lectures to focus on board materials differ from an FMG who, as you like to call it, "sits on their couch to prepare for 6-12 months"?

False argument. US medical students generally have mandatory physical exam, PBL, TBL, small group, or lab sessions that have mandatory attendance. They cannot just sit on the couch for 6 months like many FMGs.

 

[2021Doctor]

Here is an FMG study plan that is not comparable to what US MDs are able to do. He scored a 266 but spent more than a year doing dedicated board study. Does he deserve a residency more than a US MD who gets only 4-6 weeks of dedicated board study? Many FMGs have little or no student loan debt which is another vast difference.
August-December 2017
• I did Kaplan anatomy, physiology, biochemistry, and immunology.
• Then I did Sketchy micro I would annotate everything on a separate file while watching videos and add any extra info I found in Kaplan micro (Kaplan is not important- I was overdoing it). Integrate all the bugs with pictures, I always reviewed micro with sketchy pictures so that I would remember all the characteristics of bugs while imagining those sketchy pictures. Honestly, I always hated micro during med school but sketchy made it really fun. Watch it just like a TV show and you will memorize the whole micro at the end.
• Towards the end of December, I realized that I have dumped a lot of time on Kaplan and not started FA that is really important. So, my advice is to start FA early enough during your preparation so that you can integrate Kaplan or any other resource with it.

January-April 2018 (First Aid- 1st read)
• In my opinion, FA is an excellent concise book. But you cannot understand it while reading for the first time unless you have a good grasp of background knowledge.
• I decided to do everything system wise from FA along with other resources, that was the turning point in my preparation. So, instead of doing Anatomy, embryology, physiology, pathology, and pharmacology separately that would take more than 6 months, in my opinion, I did everything in parallel. For example; if I started FA Cardiology
➢ I would do only cardio unit in HY anatomy then read corresponding FA section.
➢ Then read cardio in HY embryology plus corresponding FA section.
➢ Then review cardio physiology Kaplan plus FA section.
➢ Then cardio pathology from Pathoma plus FA section.
➢ Then cardio pharmacology FA.
➢ Ending whole cardio with a quick review
I did every system from FA using this method. It took almost 3–5 days on average to understand and master the system. I regret not starting this method at the start of my preparation. In this approach, you can integrate FA along with multiple resources without being lost in a single subject.
• After completing all the systems, I spent the whole week on Biostats and epidemiology that was a tough subject for me because I am not that good at math. But a small effort in this subject can make a real difference in your score. I took Khan academy lectures on statistics that were really good. I watched Kaplan 2010 Dr. Stephen Daugherty’s lectures that are the gold standard.

May-July 2018 (First Aid 2nd review + UWORLD)
• I bought 6 months UWORLD subscription. I decided to do it system wise in Timed mode. This is really important, first-Why system wise? Because UW is a learning tool with immense information. If you are doing random mode you cannot efficiently integrate it with corresponding units on FA. You don’t want to ignore all the details and you have to annotate that info on your FA or computer whatever is easy for you. I used both methods. I used to save all the histology pictures and tables in flashcards online, and annotate text information on sticky notes. My FA book was full of UW sticky notes towards the end. So, all the new information from UW done with corresponding FA, integrated together to make a whole new picture in my mind. Doing UW changed my perspective of looking into the clinical vignette. Second-Why timed mode? Timing yourself while doing questions is really important and
goes a long way. Its all about practice to get yourself prepared for the real exam, right? I never did a question without timed mode. Even if I had 5 questions left I would do it in timed mode. Even if you are doing offline question do it in timed mode and don’t cheat on yourself.
• It took me almost 90 days to complete UW along with FA 2nd review. I had placed 60 days in my schedule but I lost my pace due to family issues as I already mentioned. You can easily do it in 60 days at one block per day pace.

August-September 2018 (First Aid 3rd review + Annotated UWORLD)
• I started reviewing FA with annotated UW. This is really a crucial time during your prep. You have all the knowledge but maintaining that knowledge is the hardest part. And rushing your review for the sake of completeness is not a good approach. Understand it properly, don’t worry about the time, doing it once but properly is better than reading over and over again.
• I didn’t take NBME until I was sure that I have a good grasp of knowledge, I don’t regret this decision because low score in NBME can hurt your self-confidence but you should not delay NBME towards the end because if you get a low score you don’t have time to improve your weak subjects. So, you have to balance these factors and decide wisely.
• I took first NBME 13 online and scored 248. That was not a great score but I knew I did a lot of silly mistakes. So, I decided to place one more FA review in my schedule for improvements outlined in NBME.

October (First Aid 4th review + UWORLD 2nd round)
• I started 4th review of FA during September and supplemented it with a week more of biostats, ethics including 100 cases by Conrad, Khans 100 cases, it helped me a lot because this was the major weakness in my prior NBME.
• After completing FA 4th I took NBME 15 online and scored 250. I was in shock for a moment but reassured my self with the excuse that I made a lot of silly mistakes again. I would spend hours on researching ‘out of the blue’ NBME questions from Google, Wikipedia etc. But Biostats persisted the major weakness again.
• Well, I decided not to touch first aid until I am done with UWORLD 2nd round. I did UW 2nd round in timed random mode 8–10 blocks per day within a week. If you have done UWORLD properly during the first time you don’t need to do it again i.e one block per day over a month. Use it as an assessment and time management tool this time instead of a learning tool like
before. These 8–10 hours UW marathon made my stamina and tested my concentration that I would need during an actual exam. I found a lot of weaknesses like panicking in difficult questions, why I make silly mistakes, what kind of thoughts affect my judgment so I worked on those aspects specifically like controlling my thoughts about the result while solving vignettes, saving some time to review marked questions, avoiding silly mistakes. I tend to solve hard questions easily and most of my mistakes were easy questions.
• After 2nd round of UW, I took NBME 16 and scored 252. Both silly mistakes and biostats were major issues again.

November (First Aid 5th review + NBMEs + UWSA + USMLE)
• I started 5th and last review of FA in last week of October that continued until the last day before the exam.
• I took NBME 17 during FA 5th almost 2 weeks before the exam and scored 261. Since NBME 17 is easier one I thought it was over-predictive.
• Then I took NBME 19 around 8 days before the exam and scored 259. I have heard that NBME 19 in under-predictive but it was easy for me. I still made silly mistakes.
• Then NBME 18 around 4 days before the exam and scored 257, this time I wasn’t worried about the score because I was sleep deprived and I clearly made silly mistakes.
• UWSA 2- just 2 days before the exam and scored 269. I thought it was over-predictive. But it actually correlated very close to my score. On a side note, UWSA 2 is the hardest of all the
assessment exams.


I know plenty of US MDs who could get a 266 if they spent 15 months on the couch prepping only for USMLE.

 

[Grimjow]

Does he deserve a residency more than a US MD who gets only 4-6 weeks of dedicated board study? Many FMGs have little or no student loan debt which is another vast difference.

I have never come across someone saying IMGs deserve anything, and the fact of the matter is a USMD will ALWAYS be preferred over an IMG, even if the IMG has better board scores and/or more research.
I don't really understand why you chose to point out student loan debts. Do you think USMDs are entitled to a residency because they paid lots of money? How about an American student who goes to med school on a full-ride scholarship?
How do student loans pertain to Step 1 studying anyway?

False argument. US medical students generally have mandatory physical exam, PBL, TBL, small group, or lab sessions that have mandatory attendance. They cannot just sit on the couch for 6 months like many FMGs.

You ignored my second point about American curricula having overlap with board exam content. I have read experiences from top scorerers who say studying for class really helped them build a solid knowledge base for when dedicated comes around.
So it is definitely not 6-12 month vs. 4-6 weeks as you claim.

 

[Matthew9Thirtyfive]

Do you think USMDs are entitled to a residency because they paid lots of money?

We’re entitled to get preference (although I include DOs here too, not just MDs) because this is the US and we should be ensuring our own graduates are getting spots before people coming from foreign countries, just like practically every other developed nation.

The debt argument is part of that because the average medical student here graduates with almost 200k in debt and if they have successfully passed their boards and are going to graduate then they have demonstrated they are competent to continue into training, and they should absolutely be given preference to ensure they will be able to practice and pay off their debt.

 

[FindersFee5]

Here is an FMG study plan that is not comparable to what US MDs are able to do. He scored a 266 but spent more than a year doing dedicated board study. Does he deserve a residency more than a US MD who gets only 4-6 weeks of dedicated board study? Many FMGs have little or no student loan debt which is another vast difference.
August-December 2017
• I did Kaplan anatomy, physiology, biochemistry, and immunology.
• Then I did Sketchy micro I would annotate everything on a separate file while watching videos and add any extra info I found in Kaplan micro (Kaplan is not important- I was overdoing it). Integrate all the bugs with pictures, I always reviewed micro with sketchy pictures so that I would remember all the characteristics of bugs while imagining those sketchy pictures. Honestly, I always hated micro during med school but sketchy made it really fun. Watch it just like a TV show and you will memorize the whole micro at the end.
• Towards the end of December, I realized that I have dumped a lot of time on Kaplan and not started FA that is really important. So, my advice is to start FA early enough during your preparation so that you can integrate Kaplan or any other resource with it.

January-April 2018 (First Aid- 1st read)
• In my opinion, FA is an excellent concise book. But you cannot understand it while reading for the first time unless you have a good grasp of background knowledge.
• I decided to do everything system wise from FA along with other resources, that was the turning point in my preparation. So, instead of doing Anatomy, embryology, physiology, pathology, and pharmacology separately that would take more than 6 months, in my opinion, I did everything in parallel. For example; if I started FA Cardiology
➢ I would do only cardio unit in HY anatomy then read corresponding FA section.
➢ Then read cardio in HY embryology plus corresponding FA section.
➢ Then review cardio physiology Kaplan plus FA section.
➢ Then cardio pathology from Pathoma plus FA section.
➢ Then cardio pharmacology FA.
➢ Ending whole cardio with a quick review
I did every system from FA using this method. It took almost 3–5 days on average to understand and master the system. I regret not starting this method at the start of my preparation. In this approach, you can integrate FA along with multiple resources without being lost in a single subject.
• After completing all the systems, I spent the whole week on Biostats and epidemiology that was a tough subject for me because I am not that good at math. But a small effort in this subject can make a real difference in your score. I took Khan academy lectures on statistics that were really good. I watched Kaplan 2010 Dr. Stephen Daugherty’s lectures that are the gold standard.

May-July 2018 (First Aid 2nd review + UWORLD)
• I bought 6 months UWORLD subscription. I decided to do it system wise in Timed mode. This is really important, first-Why system wise? Because UW is a learning tool with immense information. If you are doing random mode you cannot efficiently integrate it with corresponding units on FA. You don’t want to ignore all the details and you have to annotate that info on your FA or computer whatever is easy for you. I used both methods. I used to save all the histology pictures and tables in flashcards online, and annotate text information on sticky notes. My FA book was full of UW sticky notes towards the end. So, all the new information from UW done with corresponding FA, integrated together to make a whole new picture in my mind. Doing UW changed my perspective of looking into the clinical vignette. Second-Why timed mode? Timing yourself while doing questions is really important and
goes a long way. Its all about practice to get yourself prepared for the real exam, right? I never did a question without timed mode. Even if I had 5 questions left I would do it in timed mode. Even if you are doing offline question do it in timed mode and don’t cheat on yourself.
• It took me almost 90 days to complete UW along with FA 2nd review. I had placed 60 days in my schedule but I lost my pace due to family issues as I already mentioned. You can easily do it in 60 days at one block per day pace.

August-September 2018 (First Aid 3rd review + Annotated UWORLD)
• I started reviewing FA with annotated UW. This is really a crucial time during your prep. You have all the knowledge but maintaining that knowledge is the hardest part. And rushing your review for the sake of completeness is not a good approach. Understand it properly, don’t worry about the time, doing it once but properly is better than reading over and over again.
• I didn’t take NBME until I was sure that I have a good grasp of knowledge, I don’t regret this decision because low score in NBME can hurt your self-confidence but you should not delay NBME towards the end because if you get a low score you don’t have time to improve your weak subjects. So, you have to balance these factors and decide wisely.
• I took first NBME 13 online and scored 248. That was not a great score but I knew I did a lot of silly mistakes. So, I decided to place one more FA review in my schedule for improvements outlined in NBME.

October (First Aid 4th review + UWORLD 2nd round)
• I started 4th review of FA during September and supplemented it with a week more of biostats, ethics including 100 cases by Conrad, Khans 100 cases, it helped me a lot because this was the major weakness in my prior NBME.
• After completing FA 4th I took NBME 15 online and scored 250. I was in shock for a moment but reassured my self with the excuse that I made a lot of silly mistakes again. I would spend hours on researching ‘out of the blue’ NBME questions from Google, Wikipedia etc. But Biostats persisted the major weakness again.
• Well, I decided not to touch first aid until I am done with UWORLD 2nd round. I did UW 2nd round in timed random mode 8–10 blocks per day within a week. If you have done UWORLD properly during the first time you don’t need to do it again i.e one block per day over a month. Use it as an assessment and time management tool this time instead of a learning tool like
before. These 8–10 hours UW marathon made my stamina and tested my concentration that I would need during an actual exam. I found a lot of weaknesses like panicking in difficult questions, why I make silly mistakes, what kind of thoughts affect my judgment so I worked on those aspects specifically like controlling my thoughts about the result while solving vignettes, saving some time to review marked questions, avoiding silly mistakes. I tend to solve hard questions easily and most of my mistakes were easy questions.
• After 2nd round of UW, I took NBME 16 and scored 252. Both silly mistakes and biostats were major issues again.

November (First Aid 5th review + NBMEs + UWSA + USMLE)
• I started 5th and last review of FA in last week of October that continued until the last day before the exam.
• I took NBME 17 during FA 5th almost 2 weeks before the exam and scored 261. Since NBME 17 is easier one I thought it was over-predictive.
• Then I took NBME 19 around 8 days before the exam and scored 259. I have heard that NBME 19 in under-predictive but it was easy for me. I still made silly mistakes.
• Then NBME 18 around 4 days before the exam and scored 257, this time I wasn’t worried about the score because I was sleep deprived and I clearly made silly mistakes.
• UWSA 2- just 2 days before the exam and scored 269. I thought it was over-predictive. But it actually correlated very close to my score. On a side note, UWSA 2 is the hardest of all the
assessment exams.


I know plenty of US MDs who could get a 266 if they spent 15 months on the couch prepping only for USMLE.

This is also a strawman argument. Extra time studying really does not help that much. The relation between dedicated time and scores is not anywhere close to linear. This dude showed that he knew how to study intelligently and he put in the work, and I have nothing but respect for that. Even with a year off, 90% of US MDs are not going to be able to motivate themselves to do this and follow through with such a score.

 

[CyrusHabs7695]

We’re entitled to get preference (although I include DOs here too, not just MDs) because this is the US and we should be ensuring our own graduates are getting spots before people coming from foreign countries, just like practically every other developed nation.

The debt argument is part of that because the average medical student here graduates with almost 200k in debt and if they have successfully passed their boards and are going to graduate then they have demonstrated they are competent to continue into training, and they should absolutely be given preference to ensure they will be able to practice and pay off their debt.

Incoming PC liberal babies in 3....2....1.....

 

[Matthew9Thirtyfive]

The relation between dedicated time and scores is not anywhere close to linear.

Do you have data to support this?

 

[Schwifty]

We’re entitled to get preference (although I include DOs here too, not just MDs) because this is the US and we should be ensuring our own graduates are getting spots before people coming from foreign countries, just like practically every other developed nation.

The debt argument is part of that because the average medical student here graduates with almost 200k in debt and if they have successfully passed their boards and are going to graduate then they have demonstrated they are competent to continue into training, and they should absolutely be given preference to ensure they will be able to practice and pay off their debt.

Not to mention that the majority of that debt is via government loans, and the government is going to want you to pay that back, so it’s in the governments interest (who funds the majority of residencies) to prioritize US graduates.

 

[Grimjow]

We’re entitled to get preference (although I include DOs here too, not just MDs) because this is the US and we should be ensuring our own graduates are getting spots before people coming from foreign countries, just like practically every other developed nation.

The debt argument is part of that because the average medical student here graduates with almost 200k in debt and if they have successfully passed their boards and are going to graduate then they have demonstrated they are competent to continue into training, and they should absolutely be given preference to ensure they will be able to practice and pay off their debt.

I agree my man. USMDs get preference and they should. Just saying that closing off the only avenue where IMGs can hold their own is maybe not such a good idea, and not because of IMGs (at all), but USMDs from lower ranked schools. I am not saying USMLE board exams should take IMGs into consideration before American graduates.

 

[Matthew9Thirtyfive]

You cannot generalize that spots always go to US MDs.
University of Kentucky Neurology Program
9/10 of their spots in the 2019 match went to FMGs.
View attachment 287251
View attachment 287252

Okay but my point is you’re using discrete examples to say you can’t generalize. If you want to say that US grads don’t have an easier time matching then you need to show that. Pointing out a couple anecdotes and individual programs doesn’t do that. Maybe that program sucks and can’t fill with US grads because no one wants to match there.

How many FMGs apply for the match every year? What percentage of them get categorical spots? How many of them get spots in their preferred specialty versus something non-competitive because that’s all they will get interviews for? What is the average step score they need to match and compare that to US grads matching in the same fields?

 

[2021Doctor]

Okay but my point is you’re using discrete examples to say you can’t generalize. If you want to say that US grads don’t have an easier time matching then you need to show that. Pointing out a couple anecdotes and individual programs doesn’t do that. Maybe that program sucks and can’t fill with US grads because no one wants to match there.

How many FMGs apply for the match every year? What percentage of them get categorical spots? How many of them get spots in their preferred specialty versus something non-competitive because that’s all they will get interviews for? What is the average step score they need to match and compare that to US grads matching in the same fields?

You are changing your argument here. You previously implied that US MDs always get preference. Now you are changing it to US MDs always get preference in competitive specialties.
I think everyone will agree that dermatology is competive.
University of MIami dermatology residency currently has 5 FMGs (from med schools in Brazil, Ecuador, Iran, Serbia, and Hungary).

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery

Founded over 60 years ago, our Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery is one of the most respected and dynamic programs in the country. Striving for excellence in all of our missions, we take great pride and joy in working in education, research, clinical care, and...

dermatology.med.miami.edu

Do you seriously believe that there were not 5 excellent students from US medical schools who did not match into dermatology and would have been happy to get those spots? I can also bet that none of those five FMGs had six figure student loans to pay back.

 

[2021Doctor]

The AOA House of Delegates passed a resolution calling for the profession to advocate for federal legislation to allow U.S. medical school graduates to lay first claims on U.S. residency positions.Members of the New York State Osteopathic Medical Society (NYSOMS), which submitted the resolution, believe that the nation’s residency positions should first be offered to graduates of U.S. medical schools before international medical graduates (IMGs) can secure them.
“There’s a collision between the numbers of graduates of U.S. medical schools and the limited number of residency positions currently in the U.S.,” says Robert B. Goldberg, DO, the dean of the Touro College of Osteopathic Medicine in New York. “Soon, those positions will be saturated before we count one internationally trained physician vying for one of the slots.”
Steven I. Sherman, DO, the president of NYSOMS, says he wrote the resolution because the numbers of medical students are increasing while U.S. residency positions have remained relatively stagnant.
“These students need to have a place to go when they are finished,” says Dr. Sherman, who is an ophthalmologist in New York City. “It doesn’t seem right to me that students should incur a tremendous financial debt and not have any place to go afterward.”
The mean reported medical education debt among osteopathic medical school graduates was more than $211,000 last year, according to the American Association of Colleges of Osteopathic Medicine.
The number of first-year enrollees to U.S. medical schools increased 30% between 2002 and 2012, The New England Journal of Medicine reported. At roughly the same time, graduate medical education positions grew by just 0.9% each year from 2001 to 2010. U.S. residency positions have remained static because Medicare funds the bulk of them, and Congress capped the number of residency positions nearly two decades ago by passing the Balanced Budget Act of 1997.
IMGs comprised a sizable share of the National Resident Matching Program’s 2014 matches. Of nearly 27,000 positions offered, more than 3,600 non-U.S.-citizen IMGs matched, while more than 2,700 IMGs who are U.S. citizens landed positions, according to The ECFMG Reporter.
Both Dr. Sherman and Dr. Goldberg, a fellow member of NYSOMS, stress that they have nothing against IMGs.
“Some international medical graduates are outstanding,” says Dr. Sherman, a New York delegate. “They are very well-trained. Many of them have done residencies in their own countries, and they come here and they are very fine doctors. But these residency positions are paid for by federal tax dollars, so U.S. citizens should have the first opportunity to fill them.”
Without postgraduate training, new physicians—with the exception of those in Missouri—are unable to practice and will likely struggle to find work and pay off their debt. Reserving GME spots for graduates of U.S. medical schools is one action the profession can take to better ensure residency positions for its graduates, Dr. Goldberg says.

 

[Matthew9Thirtyfive]

You are changing your argument here. You previously implied that US MDs always get preference. Now you are changing it to US MDs always get preference in competitive specialties.
I think everyone will agree that dermatology is competive.
University of MIami dermatology residency currently has 5 FMGs (from med schools in Brazil, Ecuador, Iran, Serbia, and Hungary).

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery

Founded over 60 years ago, our Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery is one of the most respected and dynamic programs in the country. Striving for excellence in all of our missions, we take great pride and joy in working in education, research, clinical care, and...

dermatology.med.miami.edu

Do you seriously believe that there were not 5 excellent students from US medical schools who did not match into dermatology and would have been happy to get those spots? I can also bet that none of those five FMGs had six figure student loans to pay back.

That’s not what I said. What I said is that you can’t generalize using a couple of data points. I didn’t use competitive specialties to say that us grads only get preference there. The point of bringing that up was that if fmgs mostly have to match into non-competitive specialties because they are forced to by the preferences of the more competitive programs, then that is one facet of their being given lower priority.

My argument is that US grads will almost always get preference all things being equal. If FMGs require higher board scores, are forced into specialties they may not necessarily prefer but are all they can get, and have lower match rates, then that supports that. A program matching mostly FMGs does not demonstrate that US grads didn’t get preference there, as it is completely possible (and probable) that US grads had preference and chose to rank that program low.

 

[2021Doctor]

That’s not what I said. What I said is that you can’t generalize using a couple of data points. I didn’t use competitive specialties to say that us grads only get preference there. The point of bringing that up was that if fmgs mostly have to match into non-competitive specialties because they are forced to by the preferences of the more competitive programs, then that is one facet of their being given lower priority.

My argument is that US grads will almost always get preference all things being equal. If FMGs require higher board scores, are forced into specialties they may not necessarily prefer but are all they can get, and have lower match rates, then that supports that. A program matching mostly FMGs does not demonstrate that US grads didn’t get preference there, as it is completely possible (and probable) that US grads had preference and chose to rank that program low.

I sense some progress. You are now admitting the US grads do not always get preference, you now state "almost always".
I can agree that US MDs predominantly get preference.
I am stating those preferences can shift depending on the program, the PD, the chair, and the faculty.

 

[Lawpy]

I would not mind if they make it pass fail. The USMLE as a metric is garbage anyway.
From the Health Care Blog
Question 1
A 25 year old medical student takes USMLE Step 1. She scores a 240, and fears that this score will be insufficient to match at her preferred residency program. Because examinees who pass the test are not allowed to retake the examination, she constructs a time machine; travels back in time; and retakes Step 1 without any additional study or preparation.

Which of the following represents the 95% confidence interval for the examinee’s repeat score, assuming the repeat test has different questions but covers similar content?

A) 239-241

B) 237-243

C) 234-246

D) 228-252

The correct answer is D, 228-252.

Question 2
A 46 year old program director seeks to recruit only residents of the highest caliber for a selective residency training program. To accomplish this, he reviews the USMLE Step 1 scores of three pairs of applicants, shown below.

230 vs. 235
232 vs. 242
234 vs. 249
For how many of these candidate pairs can the program director conclude that there is a statistical difference in knowledge between the applicants?

A) Pairs 1, 2, and 3

B) Pairs 2 and 3

C) Pair 3 only

D) None of the above

The correct answer is D, none of the above.

Question 3
A physician took USMLE Step 1 in 1994, and passed with a score of 225. Now he serves as program director for a selective residency program, where he routinely screens out applicants with scores lower than 230. When asked about his own Step 1 score, he explains that today’s USMLE are “inflated” from those 25 years ago, and if he took the test today, his score would be much higher.

Assuming that neither the test’s content nor the physician’s knowledge had changed since 1994, which of the following is the most likely score the physician would attain if he took Step 1 in 2019?

A) 205

B) 225

C) 245

D) 265

The correct answer is B, 225.

Another MCQ Test on the USMLE – The Health Care Blog

thehealthcareblog.com

Wait do PDs really care about statistical differences? I thought they're ok in not being 95% confident? @aProgDirector

 

[Matthew9Thirtyfive]

I sense some progress. You are now admitting the US grads do not always get preference, you now state "almost always".
I can agree that US MDs predominantly get preference.
I am stating those preferences can shift depending on the program, the PD, the chair, and the faculty.

Lol wut? My argument has never changed. You are moving goalposts around, tilting at windmills, and cherry picking data.

 

[Lawpy]

Lol wut? My argument has never changed. You are moving goalposts around, tilting at windmills, and cherry picking data.

I need to start tilting a lot more windmills now...

Good novel though

 

[CidHighwind]

This is also a strawman argument. Extra time studying really does not help that much. The relation between dedicated time and scores is not anywhere close to linear. This dude showed that he knew how to study intelligently and he put in the work, and I have nothing but respect for that. Even with a year off, 90% of US MDs are not going to be able to motivate themselves to do this and follow through with such a score.

The problem is that people study at different times besides dedicated. The person that only used 3 weeks of dedicated and got a 250 may have been studying for 6 months prior during classes.

 

[NotAProgDirector]

Like all tests, the USMLE has some "error" in it and if a single person takes the test three times in a row without studying, they will likely get three different scores. The SEM of the test is 6, so 2/3 of the time your "true" score is somewhere +/- 6. In general, people who score higher on the exam "did better" than those who did worse. Arguing that only a difference of 12 points "means anything" oversimplifies the situation - as mentioned I don't need 95% certainty to make a decision or use a metric.

Cutoffs do suffer from this issue, to some extent. If a program has a cutoff of 240, a score of 239 is no different yet gets excluded. If your "true score" (if such a thing was possible) was 240, you'd have some chance of getting a 240 exactly -- which let's assume is 10% (a number I just made up). You'd then have a 45% chance of getting a score higher than 240, and a 45% chance of getting lower. If you get higher, then that's to your benefit -- some some people will "score better than expected" and benefit from that.

But it depends on how a cutoff is used. We have a cutoff which, below that score, we don't interview. If your score is between the cutoff and cutoff+10, we review your app and most of those people don't get interviews -- there has to be something else to make us choose to interview you, and the closer to the cutoff you are, the less likely. Hence scoring just at, or under, or over the cutoff is basically the same. But other programs may differ.