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

[Espressso]

Not everyone takes it prior to the match. You would have to move that up so that everyone takes it. By doing that, we're in the same position as before

If step 1 goes to p/f it'll make step 2 pseudo-required instantly. And that's not necessarily a bad thing. Just take your step 2 before the end of third year and boom. You're golden.

Making step 1 p/f with quartiles seems to be the best happy medium IMO. Step 2 will move up to be the top focus of PDs in terms of who to interview and accept. And students still have a way to stratify themselves.

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[Espressso]

I haven't taken step yet, so I'm clearly a little ignorant to this. But it is interesting that a lot of academics, PDs, and administrators realize the need to change step 1, but only students who crushed the exam want to keep it the way it is.

 

[jhenj529]

If step 1 goes to p/f it'll make step 2 pseudo-required instantly. And that's not necessarily a bad thing. Just take your step 2 before the end of third year and boom. You're golden.

Making step 1 p/f with quartiles seems to be the best happy medium IMO. Step 2 will move up to be the top focus of PDs in terms of who to interview and accept. And students still have a way to stratify themselves.

Like the other poster said, I think people like S2 because it's an easier test overall

If Step 1 goes P/F and Step 2 CK retains numeric scoring, then everyone will take Step 2 CK well before the match.

Were that to happen, we would not be in the same position as before. The pre-clinical curriculum could be reclaimed as something other than 18-24 months of Step 1 prep. And preparing for Step 2 CK is currently better aligned with the normal daily activities of M3 students. Don't get me wrong, there would be unintended consequences, but it may be an improvement over the current situation.

InCUS is the third time the scoring system for Step 1 has been revisited, and it's important to understand why it was arranged. It isn't because Step 1 itself has changed - it's the same imperfect measure of basic science knowledge it was 5-10 years ago. What has changed is the environment, which has converted Step 1 from being an important event to one that is all consuming. A lot of the problem stems from over-application to residency programs, but there is little appetite for addressing that issue.

I feel like s1 gave schools something to shape their curriculum around. God knows what they'd be teaching us if s1 goes pass fail

 

[afib123]

I haven't taken step yet, so I'm clearly a little ignorant to this. But it is interesting that a lot of academics, PDs, and administrators realize the need to change step 1, but only students who crushed the exam want to keep it the way it is.

Maybe in less competitive specialities. I have not seen program directors from competitive specialities talk about step 1 needing to be changed because it's the best way to stratify applicants when the demand is so high.

I think step 1 pass/fail is the most ridiculous thing. If you are so inclined to use Step 2 ck, make both of them required before applying. Move around your Eras deadline to later in the year to give people time to take step 2 ck. I don't think it should be used solely because it's an easier exam and I think makes the first 2 years of med school useless. If Step 1 is p/f, I can finish the first 2 years in 7-8 months and pass Step 1. You want to use the most challenging test to stratify applicants, but if you want to use both go for it.

People have to realize, no PD is being forced to use Step 1. Whatever metrics you guys want to use are available for program directors to use. They just choose to not use extraneous fluff like ECs and leadership.

Step 1 is not the only thing they use for competitive specialities. Clinical grades, research, away rotation performance, letters of rec. It's the whole package. If you don't have a step 1 score, you will have to work hard to get into a competitive speciality. There is a reason you get two entire years to study for it.

 

[Matthew9Thirtyfive]

If step 1 goes to p/f it'll make step 2 pseudo-required instantly. And that's not necessarily a bad thing. Just take your step 2 before the end of third year and boom. You're golden.

Making step 1 p/f with quartiles seems to be the best happy medium IMO. Step 2 will move up to be the top focus of PDs in terms of who to interview and accept. And students still have a way to stratify themselves.

The school I’m going to takes Step 1 halfway through third year. Taking step 1 and 2 within a few months of each other sounds super fun.

 

[jhenj529]

I haven't taken step yet, so I'm clearly a little ignorant to this. But it is interesting that a lot of academics, PDs, and administrators realize the need to change step 1, but only students who crushed the exam want to keep it the way it is.

If you ask this question to real students, almost no one wants this. If they do, they're fighting against their best interests. I don't understand why someone would want to negate the test with the most established resources out there in favor of a test with significantly less established resources. The only people that want this are administrators of medical schools, who are using this as an excuse to make sure their curriculums don't become obsolete. Fact is, their unsatisfied with the idea that you can learn the material better with outside resources in a fraction of the time.

 

[afib123]

If you ask this question to real students, almost no one wants this. If they do, they're fighting against their best interests. I don't understand why someone would want to negate the test with the most established resources out there in favor of a test with significantly less established resources. The only people that want this are administrators of medical schools, who are using this as an excuse to make sure their curriculums don't become obsolete. Fact is, their unsatisfied with the idea that you can learn the material better with outside resources in a fraction of the time.

Precisely. I wouldn't say real students, but you ask most hardworking students, they will want the test. I can see someone who got a 240 feeling bad that they didn't get 250 and the fact that might limit their speciality reach, which I don't think so. Obviously they will be less competitive but plenty of 240s match into competitive specialities.
But when I see a 210 complain that a 250 shouldn't be at more advantage in getting into a competitive speciality (which is what pass/fail does), then I stop arguing because that's beyond my level of thinking.

 

[jhenj529]

Precisely. I wouldn't say real students, but you ask most hardworking students, they will want the test. I can see someone who got a 240 feeling bad that they didn't get 250 and the fact that might limit their speciality reach, which I don't think so. Obviously they will be less competitive but plenty of 240s match into competitive specialities.
But when I see a 210 complain that a 250 shouldn't be at more advantage in getting into a competitive speciality, then I stop arguing because that's beyond my level of thinking.

Imagine if we were in the premed form talking about how the MCAT (and one's GPA) should be pass fail or satisfactory/unsatistfactory. Heads would be exploding about how those are all great metrics for evaluating students, despite all of those things having weak to moderate correlations. Oh wait, the schools retain benifits from all those things, so those metrics are just swell. They had control back then, we have more control now. Let's keep it that way

 

[Med Ed]

Like the other poster said, I think people like S2 because it's an easier test overall

It has a higher mean score than Step 1, but the failure rates for US MD first-time takers is comparable (3-4% vs. 4%).

I feel like s1 gave schools something to shape their curriculum around. God knows what they'd be teaching us if s1 goes pass fail

The Step 1 content outline isn't exactly a mystery, and schools would still have a vested interest in getting their students to pass, even if numerical scoring vanished. There has always been tension between curricula and assessments like the USMLE. Here is an excerpt on the subject from a paper published almost 27 years ago (the authors are representing the NBME's perspective):

Historically, one of the most common questions we have heard from medical school faculty is whether Part I is intended to reflect what is taught or what should be taught - whether the NBME is seeking to follow or lead curriculum change. For the NBME staff, this is a very awkward question. If we answer that the examination reflects what is taught, we are accused of "preventing educational innovation"; if we answer the examination reflects what should be taught, we are accused of "driving the curriculum." It sometimes seems as if half of the nation's medical school faculty are telling us never to change anything and the other half are telling us the specific modifications we should make, with little consensus on the changes, of course. This dilemma has worsened over the past few years, both because schools have adapted to the "new biology" through a range of changes in curriculum (and departmental) structure and content and because new educational approaches are being adopted. Given the present diversity of medical school curricula, it is unclear that "reflecting what is taught" is a meaningful option.

Impact of the USMLE Step 1 on Teaching and Learning of the Basic Biomedical Sciences. Acad Med. 67(9), 553-6, 1992.

 

[afib123]

It has a higher mean score than Step 1, but the failure rates for US MD first-time takers is comparable (3-4% vs. 4%).



The Step 1 content outline isn't exactly a mystery, and schools would still have a vested interest in getting their students to pass, even if numerical scoring vanished. There has always been tension between curricula and assessments like the USMLE. Here is an excerpt on the subject from a paper published almost 27 years ago (the authors are representing the NBME's perspective):

Historically, one of the most common questions we have heard from medical school faculty is whether Part I is intended to reflect what is taught or what should be taught - whether the NBME is seeking to follow or lead curriculum change. For the NBME staff, this is a very awkward question. If we answer that the examination reflects what is taught, we are accused of "preventing educational innovation"; if we answer the examination reflects what should be taught, we are accused of "driving the curriculum." It sometimes seems as if half of the nation's medical school faculty are telling us never to change anything and the other half are telling us the specific modifications we should make, with little consensus on the changes, of course. This dilemma has worsened over the past few years, both because schools have adapted to the "new biology" through a range of changes in curriculum (and departmental) structure and content and because new educational approaches are being adopted. Given the present diversity of medical school curricula, it is unclear that "reflecting what is taught" is a meaningful option.

Impact of the USMLE Step 1 on Teaching and Learning of the Basic Biomedical Sciences. Acad Med. 67(9), 553-6, 1992.

For the year of 2017, a 13 point difference in means of 229 for step 1 vs 242 for step 2. A 13 point difference makes it pretty easy to see why people would prefer the easier step 2. Now at the end of the day the percentiles remain the same so it doesn't matter as PD's will adapt to 260 on step 2 being a 250 on step 1.

 

[afib123]

Imagine if we were in the premed form talking about how the MCAT (and one's GPA) should be pass fail or satisfactory/unsatistfactory. Heads would be exploding about how those are all great metrics for evaluating students, despite all of those things having weak to moderate correlations. Oh wait, the schools retain benifits from all those things, so those metrics are just swell. They had control back then, we have more control now. Let's keep it that way

100%. No med school lecturer would want step 1 because it makes their lectures essentially useless and a waste of money. They would like people to study their each bullet point and take their tests. No offense to them but online resources are better in preparing you for the wards ands step 1.

 

[7331poas]

If Step 1 goes P/F and Step 2 CK retains numeric scoring, then everyone will take Step 2 CK well before the match.

Were that to happen, we would not be in the same position as before. The pre-clinical curriculum could be reclaimed as something other than 18-24 months of Step 1 prep. And preparing for Step 2 CK is currently better aligned with the normal daily activities of M3 students. Don't get me wrong, there would be unintended consequences, but it may be an improvement over the current situation.

InCUS is the third time the scoring system for Step 1 has been revisited, and it's important to understand why it was arranged. It isn't because Step 1 itself has changed - it's the same imperfect measure of basic science knowledge it was 5-10 years ago. What has changed is the environment, which has converted Step 1 from being an important event to one that is all consuming. A lot of the problem stems from over-application to residency programs, but there is little appetite for addressing that issue.

Lmao. Preclinical will not be "reclaimed", I will just switch to step 2 studying (which by the way, has heavy overlap with step 1)

Medical school and their preclinical curriculum is outdated and unnecessary

 

[afib123]

Lmao. Preclinical will not be "reclaimed", I will just switch to step 2 studying (which by the way, has heavy overlap with step 1)

Medical school and their preclinical curriculum is outdated and unnecessary

Yup. Basically start focusing on step 2 instead of step 1. Either way I am not going to waste any time on outdated lectures. The only reason I pay 100,000$ for the first 2 years to get my degree, not to listen to the lecturers. People like to rant on step 1 but step 1 is very clinically relevant. Step 1's focus is mainly on identifying the disease with some basic science with step 2's focus is on treatment or on how to diagnose

 

[Espressso]

Lmao. Preclinical will not be "reclaimed", I will just switch to step 2 studying (which by the way, has heavy overlap with step 1)

Medical school and their preclinical curriculum is outdated and unnecessary

Oh, so we students should start immediately with clinical education? Skip years 1 and 2 right off the bat? I mean, I don't like preclinical years as much as any other student, but to say its unnecessary is laughable.

And if your argument is to say that years 1 and 2 are a joke, and the clinical education is the real important stuff (this second part, everyone agrees with), then why wouldn't you want the emphasis of your residency application to be resting on the board exam that tests you on the clinical education? Wouldn't you rather it be p/f for the first exam, that's over outdated and unnecessary minutia, and more focus and importance on the exam that is more relevant?

 

[Espressso]

Yup. Basically start focusing on step 2 instead of step 1. Either way I am not going to waste any time on outdated lectures. The only reason I pay 100,000$ for the first 2 years to get my degree, not to listen to the lecturers.

If you think we should be focusing on step 2 material rather than step 1 material, great. I agree. That's why changing step 1 to p/f would make more sense than I think you'd like to admit. Make it a competency exam; you learn the material, get a good base of fundamental sciences, learn how to learn effectively, pass the exam, and then move onto the real important clinical aspects of medicine. And focus on crushing step 2. Which should be the more important aspect on one's residency application.

 

[afib123]

Oh, so we students should start immediately with clinical education? Skip years 1 and 2 right off the bat? I mean, I don't like preclinical years as much as any other student, but to say its unnecessary is laughable.

And if your argument is to say that years 1 and 2 are a joke, and the clinical education is the real important stuff (this second part, everyone agrees with), then why wouldn't you want the emphasis of your residency application to be resting on the board exam that tests you on the clinical education? Wouldn't you rather it be p/f for the first exam, that's over outdated and unnecessary minutia, and more focus and importance on the exam that is more relevant?

Because is step 1 is not outdated or unnecessary minutia. Most of the stuff on there is stuff you need to know. Pretty much everything I know about most diseases is from studying for step 1. Step 2 only builds on that knowledge. You don't get to third year and miraculously learn everything about every disease.

 

[afib123]

If you think we should be focusing on step 2 material rather than step 1 material, great. I agree. That's why changing step 1 to p/f would make more sense than I think you'd like to admit. Make it a competency exam; you learn the material, get a good base of fundamental sciences, learn how to learn effectively, pass the exam, and then move onto the real important clinical aspects of medicine. And focus on crushing step 2. Which should be the more important aspect on one's residency application.

I disagree. Score on step 1 is as important as score on step 2.

 

[Espressso]

Because is step 1 is not outdated or unnecessary minutia. Most of the stuff on there is stuff you need to know. Pretty much everything I know about most diseases is from studying for step 1. Step 2 only builds on that knowledge. You don't get to third year and miraculously learn everything about every disease.

I was replying to the comment that said years 1 and 2 are outdated. My point is they are not, proof being step 1 which is testing you on years 1 and 2, is not outdated. We agree, my friend.

I disagree. Score on step 1 is as important as score on step 2.

Yes, both scores are as important. I'm not saying you shouldn't learn the material for step 1. And I'm not saying years 1 and 2 are not necessary. I think the complete opposite actually. But if the clinical assessment is what's more important, than why wouldn't you want the more clinical exam to have more weight and importance?

 

[afib123]

I was replying to the comment that said years 1 and 2 are outdated. My point is they are not, proof being step 1 which is testing you on years 1 and 2, is not outdated. We agree, my friend.




Yes, both scores are as important. I'm not saying you shouldn't learn the material for step 1. And I'm not saying years 1 and 2 are not necessary. I think the complete opposite actually. But if the clinical assessment is what's more important, than why wouldn't you want the more clinical exam to have more weight and importance?

Because step 1 knowledge is essential to master and be tested on. It is not either or. Both are important which is how the system works now and it works perfectly.

 

[Med Ed]

Because step 1 knowledge is essential to master and be tested on. It is not either or. Both are important which is how the system works now and it works perfectly.

Then why did InCUS get convened?

 

[7331poas]

I was replying to the comment that said years 1 and 2 are outdated. My point is they are not, proof being step 1 which is testing you on years 1 and 2, is not outdated. We agree, my friend.




Yes, both scores are as important. I'm not saying you shouldn't learn the material for step 1. And I'm not saying years 1 and 2 are not necessary. I think the complete opposite actually. But if the clinical assessment is what's more important, than why wouldn't you want the more clinical exam to have more weight and importance?

I said that medical school years 1 and 2 are outdated. Not that the information isn't important. The info is incredibly important and I try and learn everything. That being said, I do not need a professor in order to do that.

The only valuable part of medical school in the first 2 years is clinical skills and some very rare content material.

 

[afib123]

I said that medical school years 1 and 2 are outdated. Not that the information isn't important. The info is incredibly important and I try and learn everything. That being said, I do not need a professor in order to do that.

The only valuable part of medical school in the first 2 years is clinical skills and some very rare content material.

It is a scam to get 100,000 from us. No reason I can't study from home and only pay for the last 2 years.

 

[Little Green Mensch]

Knowing what specialties you're competitive for before away rotation applications begin is pretty much a necessity for fields requiring such rotations. You'd have to take Step 2 CK by February to have scores for VSAS (because a decent number of rotations filter by Step 1 score).

If the concern is that 18-24 months of studying for Step 1 leaves students with a poor foundation for clinical medicine, then maybe schools should push for more reasoning-based questions. That said, there were a decent number of those that I saw when I took the test, and only a couple "what is this histology specimen" questions.

As people memorize more and more minutia, the more those 1st-order questions are eliminated as separators (which is a good thing). Clinical medicine, more often than not, is about synthesizing many different pieces of information, rather than recalling some fact you once read in First Aid.

Program directors in some fields really like to see Step 2 CK scores, because they correlate better with board pass rates and inservice exam scores, but I don't think that's true universally.

Ultimately, I'm not sure how making Step 1 pass/fail solves any more problems than it creates. If schools want their preclinical lectures to be as relevant as Step 1 for residency applications, they're going to have to make preclinical grades and curricula nationally-standardized, which is probably a non-starter.

 

[7331poas]

i feel like the test here is to figure out if high step 1 scorers are more likely to honor their clinical rotations versus another medical school that emphasizes "real medicine" and does not allow their students to study for step 1 (if such a thing was possible)

My guess if the first cohort will preform way better.

 

[Ho0v-man]

i feel like the test here is to figure out if high step 1 scorers are more likely to honor their clinical rotations versus another medical school that emphasizes "real medicine" and does not allow their students to study for step 1 (if such a thing was possible)

My guess if the first cohort will preform way better.

My guess is the high scorers probably do. It’s anyones guess as to whether this is from step knowledge. My guess is that highly motivated people are just going to crush it no matter what environment. Just like how pre-clinical gpa has correlation to board performance. It’s arguable. My curriculum has only done maybe half the work for me and took too much time for what it accomplished. The reason there’s a correlation between the two is bc high performing students are going to do what they need to do to get the job done.

 

[Deecee2DO]

God damn this is the worst idea I have ever heard of. How the hell are students from low ranked school going to match competitive specialties?

Instead of a good step score, research years are now basically mandatory. I hope to God this doesn't go into effect until I am done.

same this sounds horrible

 

[Deecee2DO]

Excuse my ignorance but how is this any different than schools moving towards P/F curriculum? I’ve heard some of these same arguments from students who attend institutions with graded preclinical years and an internal ranking system. I would like to think that admins are seeing systemic issues with the current step 1 process that students aren’t aware of, if they are aiming for such a drastic change. What were PDs doing to determine competitive candidates prior to having such a huge emphasis on Step 1? How were people matching into competitive specialties back then?

This has been my question in several other threads. Correct me if Im wrong but i dont think you needed a 250 to match plastics or derm back in the 70s and 80s. From talking with mentors/superiors res programs didnt place the emphasis it does now on the step exam. Why cant we go back to however they did it? As anectodal as it may be id imagine med school and applying to residencies is so much more stressful and more competitive now compared to then

 

[Med Ed]

This has been my question in several other threads. Correct me if Im wrong but i dont think you needed a 250 to match plastics or derm back in the 70s and 80s. From talking with mentors/superiors res programs didnt place the emphasis it does now on the step exam. Why cant we go back to however they did it? As anectodal as it may be id imagine med school and applying to residencies is so much more stressful and more competitive now compared to then

This is probably true. I liken the residency application process of yesteryear with a 400 meter dash. Everyone lined up, ran their hearts out from point A to point B, and the fastest ones took the spoils.

Now residency applicants still have to run from point A to point B, but it has become a circuitous 1200 meter obstacle course to reach the same endpoint. And some people seem excited that the increased difficulty will allow them to separate themselves further from those behind.

The current situation is multifactorial in origin. The reasons include:

1. Over-application. From 2014 to 2018 the average number of residency applications filed per applicant increased by 15.3% (from 78.6 to 90.6). For some context, the average number in 2006 was 47, so there was a 93% increase over 12 years. Looking only at US seniors, the average number went from 22 in 2006 to 60.3 in 2018, a 174% increase.

Given those numbers, you can start to understand the plight of the average program director, who now must find some way to reduce an unmanageable number of applications. Step 1 scores provide an extremely easy and consistent tool for doing that. This is especially true given the rise of P/F grading schemes.

2. Resource bonanza. Believe it or not, back in the day we had our own list of go-to Step 1 study resources, although they seem quaint by today's standards. The proliferation of slickly produced materials, facilitated greatly by broadband internet, has lured the masses out of traditional curricula and into the "parallel curriculum." Can't say I blame them. In fact, I consider it a failure on our part that we got overtaken so quickly and so easily.

I do wonder, however, if I made some online videos and quizzes, slapped the phrase "high yield" on them, and hired a decent web developer, if I couldn't cash in a bit.

3. Social media. Back in the day we didn't have a window into how anonymous medical students across the country were starting Zanki during orientation. We couldn't give the NBME an extra $60 per form to predict our score based on formulas available through Reddit. In retrospect things were blissfully simple. People still got stressed out, had mental health problems, abused Adderall, etc., but things seem worse now. It's like we went from 15% of each class being hyper-focused on Step 1 to 50% to 85% in the course of 10 years.

Given the situation's overall trajectory, which shows no signs of abating, I am not surprised the some of the power brokers are considering drastic action.

 

[Little Green Mensch]

From 2014 to 2018 the average number of residency applications filed per applicant increased by 15.3% (from 78.6 to 90.6). For some context, the average number in 2006 was 47, so there was a 93% increase over 12 years. Looking only at US seniors, the average number went from 22 in 2006 to 60.3 in 2018, a 174% increase.

There's a pronounced information deficit when applying: applicants relying on program websites and word-of-mouth have little idea which programs would be a good fit, and away rotations are not a guarantee of matching at an institution. For most people, it's also only feasible to do 2-3 aways. For smaller specialties, the applicant pool can be substantially different from year-to-year; this can make it more difficult to gauge the strength of your application. If you don't know what twenty-some programs you're competitive for, you'll apply more broadly, because not matching is pretty catastrophic. Even if you're a competitive applicant, it's harder to match on the second try.

I'd love to see programs be forced to publish their hard and soft Step 1 and 2 cutoffs, as well as for number of publications. I think that would give applicants a much better idea of what programs they should not even bother applying to. It's also hard to get an accurate assessment of programs' strengths and weaknesses unless someone (either a previous grad or a faculty mentor) is familiar with the programs in question, but that's a more difficult issue to address.

None of this, however, will stop the guys who are on the cusp of being competitive from applying to every program in their desired specialty. I don't think making Step 1 pass/fail would either; it might even worsen the situation.

 

[Med Ed]

There's a pronounced information deficit when applying: applicants relying on program websites and word-of-mouth have little idea which programs would be a good fit, and away rotations are not a guarantee of matching at an institution. For most people, it's also only feasible to do 2-3 aways. For smaller specialties, the applicant pool can be substantially different from year-to-year; this can make it more difficult to gauge the strength of your application. If you don't know what twenty-some programs you're competitive for, you'll apply more broadly, because not matching is pretty catastrophic. Even if you're a competitive applicant, it's harder to match on the second try.

I'd love to see programs be forced to publish their hard and soft Step 1 and 2 cutoffs, as well as for number of publications. I think that would give applicants a much better idea of what programs they should not even bother applying to. It's also hard to get an accurate assessment of programs' strengths and weaknesses unless someone (either a previous grad or a faculty mentor) is familiar with the programs in question, but that's a more difficult issue to address.

None of this, however, will stop the guys who are on the cusp of being competitive from applying to every program in their desired specialty. I don't think making Step 1 pass/fail would either; it might even worsen the situation.

Last year the AAMC piloted a "residency exploration tool," which will ostensibly allow a given applicant to identify programs that have historically matched people who are similar in terms of scores, grades, research, etc. I believe this is their attempt to address over-application without touching ERAS. Will it work? No clue, stay tuned.

 

[ricksimmonsrafowens]

if I made some online videos and quizzes, slapped the phrase "high yield" on them, and hired a decent web developer, if I couldn't cash in a bit.

hahaha successfully competing in the market of supplemental resources is not easy at all... even the best lecturer at my medical school couldn't approach the quality of Sattar/Najeeb/Goljan/Dr. Ryan lectures... These people truly have the gift of being excellent educators and I am very glad that I had the opportunity to learn from them.

 

[afib123]

hahaha successfully competing in the market of supplemental resources is not easy at all... even the best lecturer at my medical school couldn't approach the quality of Sattar/Najeeb/Goljan/Dr. Ryan lectures... These people truly have the gift of being excellent educators and I am very glad that I had the opportunity to learn from them.

These people don't realize how good exactly Dr. Ryan is for instance. Ryan is a cardiologist trained from Harvard. Just going based on his videos, I wouldn't be surprised if he is one of the best cardiologists in the country. Hands down one of the best explainer of things in my entire life. As far as I am concerned, Dr. Ryan's videos are the mainstream curriculum. The traditional lectures are extraneous stuff that I am paying for only to get my degree not to watch their lectures. This flipped classroom or whatever other stuff they come up with is only to stay relevant the first 2 years. I don't need to pay any money to the university for the first 2 years. I can study on my own.

If everyone pays money to Dr. Ryan instead of their university for the first 2 years, I have no doubt Dr. Ryan can come up with a curriculum that is better than any medical school in the entire country can come up with. He is already doing it in a fraction of cost (100s of dollars vs 100,000 dollars).

They also don't realize how clinically oriented Step 1 has become. There is no way someone with a 210 on step 1 should be on the same playing field as someone with a 250. There is a reason why there are so many specialities in medicine. Pick one that is not so competitive or study hard. Everyone can't get everything.

 

[AnatomyGrey12]

Step 1 is extremely clinical now. This is even reflected in the NBME practice exams. The older versions are more recall and are very different compared to the new forms which require more reasoning and application of knowledge. Getting rid of Step 1 as a scored exam will have disastrous consequences and likely creates more problems than it fixes honestly. I don't see how anyone can think it's a good idea. All the craze about Step 1 would now move to Step 2, which contrary to popular belief, is very similar to Step 1 anyway so please explain how that helps at all?

There is also the fact that people, looking at you SDN, simply put way too much emphasis on exactly how important Step 1 is to residency applications. Sure are there filters? Yes. Are there programs that require a 250+? Yes. But this is more the exception instead of the rule honestly. I've seen way to many people match competitive residencies in competitive specialties (from DO schools no less) than to believe that anymore. Look at charting outcomes, USMDs match ortho with scores in the 230s All. The. Time. The match rate for that cohort is 75%. Maybe we should force schools to do a better job of counseling students instead of telling them bogus crap like they are limited to FM, IM, or Peds if they can't break 230 (I legit know someone who was told this by their advisor at an MD school). It's like no one has ever picked up Charting Outcomes and actually looked at it.

Anyone who thinks that they will be helped by Step 1 going P/F, or that stress levels and "student wellness" will somehow improve, is deluding themselves unless they go to an elite school. All this will do is put greater emphasis on bogus metrics that mean nothing like research output, school prestige, and connections (ie school prestige again). Step 2 will now be filled with the mania of the current Step 1, without the ability to change your application strategy because Step 2 is taken right before you apply. What happens if you are a neurosurgery diehard all the way though medical school and then lay an egg on Step 2 only weeks before applying? You're completely screwed where as now you have time to adjust course. How does that help student's stress levels in the slightest? What a nightmare for anyone that isn't at a school in the top 30. I'd prefer my specialty choices to be limited to my performance in medical school, not by the fact that I got a D in Calculus as an 18 year old idiot.

This idea is the equivalent of the Republicans/Trump coming into office and saying there are problems with Obamacare and then offering up an alternative that was horrendously bad. Sure there are problems with the current model, but changing Step 1 to P/F is not the answer.

 

[Lawpy]

Step 1 is extremely clinical now. This is even reflected in the NBME practice exams. The older versions are more recall and are very different compared to the new forms which require more reasoning and application of knowledge. Getting rid of Step 1 as a scored exam will have disastrous consequences and likely creates more problems than it fixes honestly. I don't see how anyone can think it's a good idea. All the craze about Step 1 would now move to Step 2, which contrary to popular belief, is very similar to Step 1 anyway so please explain how that helps at all?

There is also the fact that people, looking at you SDN, simply put way too much emphasis on exactly how important Step 1 is to residency applications. Sure are there filters? Yes. Are there programs that require a 250+? Yes. But this is more the exception instead of the rule honestly. I've seen way to many people match competitive residencies in competitive specialties (from DO schools no less) than to believe that anymore. Look at charting outcomes, USMDs match ortho with scores in the 230s All. The. Time. The match rate for that cohort is 75%. Maybe we should force schools to do a better job of counseling students instead of telling them bogus crap like they are limited to FM, IM, or Peds if they can't break 230 (I legit know someone who was told this by their advisor at an MD school). It's like no one has ever picked up Charting Outcomes and actually looked at it.

Anyone who thinks that they will be helped by Step 1 going P/F, or that stress levels and "student wellness" will somehow improve, is deluding themselves unless they go to an elite school. All this will do is put greater emphasis on bogus metrics that mean nothing like research output, school prestige, and connections (ie school prestige again). Step 2 will now be filled with the mania of the current Step 1, without the ability to change your application strategy because Step 2 is taken right before you apply. What happens if you are a neurosurgery diehard all the way though medical school and then lay an egg on Step 2 only weeks before applying? You're completely screwed where as now you have time to adjust course. How does that help student's stress levels in the slightest? What a nightmare for anyone that isn't at a school in the top 30. I'd prefer my specialty choices to be limited to my performance in medical school, not by the fact that I got a D in Calculus as an 18 year old idiot.

This idea is the equivalent of the Republicans/Trump coming into office and saying there are problems with Obamacare and then offering up an alternative that was horrendously bad. Sure there are problems with the current model, but changing Step 1 to P/F is not the answer.

Glad to see you back!

 

[Med Ed]

even the best lecturer at my medical school couldn't approach the quality of Sattar/Najeeb/Goljan/Dr. Ryan lectures...

Sounds like you should have gone to a better school.

 

[AnatomyGrey12]

Glad to see you back!

Just for a little bit. I'm heading back to the board cave of wonders tomorrow to start dedicated.

Sounds like you should have gone to a better school.

Like most schools admins I suspect you don't actually understand how just how good and thorough these resources really are... Boards and Beyond is better than anything taught at my school, and we have faculty that were personally tutored by Goljan when he was faculty here.

 

[ricksimmonsrafowens]

Sounds like you should have gone to a better school.

responding with ad hominem - nice!

 

[puahate]

Everyone should just UFAP it up and call it a day.
Let's be real Step 1 isn't going P/F.

 

[afib123]

responding with ad hominem - nice!

This is the consensus for the majority of medical students from every single medical school. It is an absolute pity I have to pay money to the university but use these resources to do well on step 1 and be well rounded clinically.

 

[Med Ed]

Like most schools admins I suspect you don't actually understand how just how good and thorough these resources really are... Boards and Beyond is better than anything taught at my school, and we have faculty that were personally tutored by Goljan when he was faculty here.

I have watched/listened to/read all of them*, thank you very much.

*B&B, Pathoma, Goljan, First Aid, UWorld, and many others.

 

[Med Ed]

Anyone who thinks that they will be helped by Step 1 going P/F, or that stress levels and "student wellness" will somehow improve, is deluding themselves unless they go to an elite school. All this will do is put greater emphasis on bogus metrics that mean nothing like research output, school prestige, and connections (ie school prestige again). Step 2 will now be filled with the mania of the current Step 1, without the ability to change your application strategy because Step 2 is taken right before you apply. What happens if you are a neurosurgery diehard all the way though medical school and then lay an egg on Step 2 only weeks before applying? You're completely screwed where as now you have time to adjust course.

I am curious to hear your opinion on the hot new trend of schools putting Step 1 after clerkships.

 

[jhenj529]

I have watched/listened to/read all of them*, thank you very much.

*B&B, Pathoma, Goljan, First Aid, UWorld, and many others.

And what do you think about them?

 

[Med Ed]

responding with ad hominem - nice!

No, just an acknowledgement of reality. If there isn't a single educator at your school that can match Dr. Ryan then you are justified in your disappointment.

 

[Med Ed]

And what do you think about them?

B&B is a great floor, I wish people wouldn't mistake it for the ceiling. Love Goljan because he actually explains the why of things. Pathoma is overrated, IMHO, but the only real alternative, Robbins, is way too dense for most M2's. First Aid is a great review but a lousy primary learning tool. UWorld is top notch, much better than Kaplan, Firecracker, ScholarRx, etc. I'm curious to see how Amboss gets built out.

 

[AnatomyGrey12]

I am curious to hear your opinion on the hot new trend of schools putting Step 1 after clerkships.

Well seeing as Step 1 is becoming increasingly clinical doing it after clerkships will help their performance and these schools see that. These schools are also largely (not all but a majority) among the elite schools that would receive a benefit from a P/F Step 1 so there's that. Oh and the fact that a lot of those schools also have a truncated pre-clinical so these students aren't usually taking Step 1 right before they apply to residency, it is still about 6 months before.

All of these factors are reasons I wouldn't use these schools as an argument for Step 1 being P/F......

 

[Oh_Gee]

I have watched/listened to/read all of them*, thank you very much.

*B&B, Pathoma, Goljan, First Aid, UWorld, and many others.

did you have teachers better than or on par with Ryan, Goljian, or Sattar when you were in school?

 

[ricksimmonsrafowens]

No, just an acknowledgement of reality. If there isn't a single educator at your school that can match Dr. Ryan then you are justified in your disappointment.

you must feel pretty good about yourself, being a board certified physician working in medical education, and then responding with ad hominem statements to medical students who dont share your view point

 

[AnatomyGrey12]

B&B is a great floor, I wish people wouldn't mistake it for the ceiling. Love Goljan because he actually explains the why of things. Pathoma is overrated, IMHO, but the only real alternative, Robbins, is way too dense for most M2's. First Aid is a great review but a lousy primary learning tool. UWorld is top notch, much better than Kaplan, Firecracker, ScholarRx, etc. I'm curious to see how Amboss gets built out.

I agree with this. I'll say that everyone I know that is uses FA as a primary learning source doesn't do well in class and they don't do well on boards either. I'm curious, what would schools teach differently if Step 1 were P/F? Like what are you actually expecting students to learn differently?

I too think the system needs change, but your reasons for Step 1 to be P/F have been extremely lacking. I have yet to see how any of the problems you have pointed out are changed for the better with a switch in scoring, in fact I mostly see changes for the worse.

 

[AnatomyGrey12]

you must feel pretty good about yourself, being a board certified physician working in medical education, and then responding with ad hominem statements to medical students who dont share your view point

Gotta find some reason to justify charging students hundreds of thousands of dollars for an education that they are actually getting from an online lecture series that costs 200 bucks.

 

[Med Ed]

you must feel pretty good about yourself, being a board certified physician working in medical education, and then responding with ad hominem statements to medical students who dont share your view point

If you think that was an ad hominem then I suggest you grow an epidermis.