There's a similar thread in the Pre-MD forum that's worth a read.
To people saying there's a correlation between Step 1 score and board passage rates - it's a little disingenuous because you don't have to absolutely crush Step 1 to have a good chance of passing your boards in quite a few specialties. Dr. Carmody's blog at:
The Mythology of USMLE Step 1 Scores and Board Certification notes that:
- Pediatrics - once Step 1 is over 210, you have about a 90% chance of passing the pediatrics boards.
- Internal Medicine - 99% of residents with Step 1 scores over 211 passed the IM boards.
- General Surgery - 85.7% of residents with Step 1 scores over 200 passed on their surgery boards on their first try.
- Ob/Gyn - 100% of residents with Step 1 scores over 200 passed their ob/gyn boards.
- Orthopedics - with Step 1 score of 205, 90% chance of passing ABOS Part 1 Exam (only residents with >50% chance of failing are those that failed Step 1 on first try).
- Anesthesiology - once Step 1 is over 210, >90% chance of passing the anesthesiology boards.
So sure, it's better to have some kind of metric to differentiate the thousands of applicants some programs get, but to say an applicant with a higher Step 1 score is more likely to pass their boards isn't entirely truthful. As you can see above in those specialties, once you hit certain thresholds--which happen to be on the lower side and below the average Step 1 score--you've got pretty good odds of passing your specialty boards. Is a 260 Step 1 impressive? No question. Are they just as likely to pass boards as someone that scored around average to even below average? That's what the data suggest.
Anytime this is discussed, this blog post comes up. I can only speak to the IM "facts" listed above. This is based upon a single residency program, in a single location, over 8 years. It's a huge step to extrapolate that to everyone. I can tell you that in my program, this is certainly not true. Also the minimum pass for S1 has been increasing, so a 211 10+ years ago may not be the same as one now. It's often also claimed that S1 doesn't correlate well with ABIM exams scores, but different people disagree on how much correlation is enough to be useful, and a poor S1 score --> poor ITE score --> remediation --> improvement --> improved ABIM score might explain some of the disconnect also.
I reiterate yet again that it seems that NBME doesn't care about your career aspirations, only that you are competent for Medicine.
This is certainly true. I met with them at AAIM week. They made it 100% clear that the USMLE was a joint project of the NBME and the FSMB, and it wasn't clear that anyone else had a seat at the table.
Overall, my thoughts:
1. There are a limited number of competitive spots. "Competitive" means that more people want them than spots available. PD's will need to make some sort of decision upon whom gets them. If S1 is made P/F, then PD's will latch onto something else. That shuffles the winners and losers -- some people will gain an advantage, some will lose. Whether this is "good" or "bad" depends upon how you look at the situation.
2. Creating score quartiles or ranges is similar. There will always be a cutoff -- one more point pushes you into the next category, that person is a "loser". If one less point drops you a category, you're a "winner".
3. People talk about USMLE cutoffs. The truth for most programs is probably much more flexible. For example, let's say my target S1 score is 250 (I'm making this up, it's an example!). I'd probably take everyone below a 230 and reject them -- they are not getting an interview regardless. For those 230 - 249, I'd review their app -- if something else in the app interests me, they might get an interview. So the difference of a point or five doesn't make a huge difference -- if you get a 229, you get rejected. If you have a 234 (5 points higher), I will look at your app but you'll still probably get rejected unless you have something amazing.
4. If S1 goes P/F, PD's will probably demand S2CK scores at the time of application.
5. If all Steps go P/F, my guess is that fields will create their own standardized exam you'll need to pay for and take. So now you'll have the steps, and a specialty specific exam. And, if you're interested in multiple fields, you'll need to take multiple exams. Perhaps this is better -- the exams can be targeted to the skills programs are interested in. You could be required to tie knots in a deep hole for GS. You'd (perhaps) also be able to retake these exams if you wanted to try to do better, although then you could do worse and there's no guarantee that programs would look at your "best" score.
There's no easy solution. Limiting applications has been discussed but seems unlikely. More realistically, you might get 10 "gold" apps, 10 "silver" apps, and then unlimited "bronze" apps. This would require some way for applicants to actually see how they "stacked up" to current residents in the program, so you know if you're "in the zone" or "a total reach". This then leads to an interesting question for programs -- would they rather have people with high scores but lower interest, or higher interest and lower scores.
