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

[Lawpy]

Try to imagine a world where the NBME sends out an announcement that it has been wrong all these years, Step 2 CS is not worth, it and they're eliminating it.

Having a hard time envisioning that? Yeah, me too.

But that's largely monetary? From a stress perspective, i'm not sure how Step 2 CS helps MS4s since a failure could doom their match?

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[ciestar]

So... why is Step 2 CS still in place?

$$$
It’s a $1300 exam

 

[Lawpy]

$$$
It’s a $1300 exam

But the stress of possibly failing? Could that help get rid of Step 2 CS or is that not enough?

 

[slowthai]

But the stress of possibly failing? Could that help get rid of Step 2 CS or is that not enough?

90-95% pass CS, and it's P/F, so there's like no impetus to eliminate it. The percentage of people getting overly stressed out over it is much much less than that for step 1.

 

[7331poas]

But the stress of possibly failing? Could that help get rid of Step 2 CS or is that not enough?

The USMLE when you complain about the stress of Step 2 CS.

 

[ciestar]

But the stress of possibly failing? Could that help get rid of Step 2 CS or is that not enough?

They also leave you waiting for three months whether you passed or not. Only five sites in the entire country and spots fill up 6 months in advance. That id the most stressful part, waiting FOREVER and if you didnt pass, you have to HOPE you find a spot and pass before rank lists are due.

 

[Lawpy]

They also leave you waiting for three months whether you passed or not. Only five sites in the entire country and spots fill up 6 months in advance. That id the most stressful part, waiting FOREVER and if you didnt pass, you have to HOPE you find a spot and pass before rank lists are due.

So thats more of a reason to get rid of it!

But apparently the exam's here to stay because... $$$

 

[ciestar]

So thats more of a reason to get rid of it!

But apparently the exam's here to stay because... $$$

Basically. I took it in July and im scared to death to get my score. Id be very okay with it going away.

 

[PreMedMissteps]

What's the real impetus to make Step 1 P/F? Is it because the average scores have risen too fast or is it that medical schools feel that students aren't focusing on the curriculum as much as board materials?

I’m guessing that there has been an issue with not enough UIMs scoring high enough on Step 1?

 

[ciestar]

I’m guessing that there has been an issue with not enough UIMs scoring high enough on Step 1?

Not everything has to do with race.

 

[Med Ed]

But that's largely monetary? From a stress perspective, i'm not sure how Step 2 CS helps MS4s since a failure could doom their match?

These examinations were not created to help students. They were created to protect the public.

With regard to money, I have always found it better to question judgment rather than motivation. There are always financial incentives in life that mold behavior, but if you were to interrogate everyone who works at the NBME about the utility of their organization I doubt any of them would cite monetary gain as a mission driver. In truth most of them are wonks who are simply chasing the holy grail of the perfect assessment. I do think they showed regrettable judgment in expanding the CS exam beyond its original use as a ECFMG tool. In hindsight it would have been better if the LCME had created clear standards for in-house OSCEs and then let the schools handle it.

 

[PreMedMissteps]

I’m guessing that there has been an issue with not enough UIMs scoring high enough on Step 1?

Not everything has to do with race.

True, not everything has to do with race. However, I do think this is possibly one of the considerations. If certain highly competitive specialty programs are mainly interviewing applicants with high Step 1 scores, and that might mean that enough UIMs are not being interviewed, then this would be a solution.

 

[PreMedMissteps]

Basically. I took it in July and im scared to death to get my score. Id be very okay with it going away.

Isn’t the pass rate in the 90s? Who fails it?

 

[ciestar]

Isn’t the pass rate in the 90s? Who fails it?

It happens enough.
If you fail, it really limits your residency options. I have 400k riding on this. Im allowed to be worried.

 

[deleted171991]

And student affairs deans who have to deal with the spike in test-related mental health issues over the past 5 years. And clinical faculty who complain bitterly that new M3's arrive on the wards unable to do anything other than answer A-E. And ultimately some students who take a 5th year for additional prep time and later realize that program directors see right through them.

This is like saying that we’ll change military service because war is causing mental health issues. Medicine IS war. People die left and right every day, sometimes because of bad doctors.

These generations have had mental health issues since they were born. The disease is called being spoiled and overprotected (e.g. helicopter parenting), based on some bad science from the 70s. Start working on the causes, instead of treating the effects, because the real world couldn’t care less about all these little Gretas and their temper tantrums.

 

[deleted171991]

An exam shouldnt define you.. yet it does. I had a hard time getting over my step 1 score. Some people make you feel like you’ll be a lesser doctor because of an exam score. It is a sucky feeling.

Because you will be... unless you sober up and plug your holes, I mean canyons. All those feelings of inadequacy, of impostor syndrome, are GOOD for you and your patients. I still use them every day to become a better doctor, many years after I became an attending.

Sorry for hurting your feelings. /sarcasm

 

[deleted171991]

It happens enough.
If you fail, it really limits your residency options. I have 400k riding on this. Im allowed to be worried.

Let me tell you how it looks for an FMG: if I hadn’t scored high enough, way higher than most AMGs, I would have never practiced medicine in the US, not even the specialties you are looking down upon. So, please...

 

[VA Hopeful Dr]

This is like saying that we’ll change military service because war is causing mental health issues. Medicine IS war. People die left and right every day, sometimes because of bad doctors.

These generations have had mental health issues since they were born. The disease is called being spoiled and overprotected (e.g. helicopter parenting), based on some bad science from the 70s. Start working on the causes, instead of treating the effects, because the real world couldn’t care less about all these little Gretas and their temper tantrums.

I don't disagree with what you're saying, but med school is different now than when even I came through and I've only been out of school for 9 years now. I know as an FMG things were harder on you, but due to the rapid expansion of schools its heading in that direction for AMGs as well. When I went through the match, if you passed your steps at all you could still get into an FM program without trying too hard. Nowadays even the FM programs have cutoffs.

I'm not saying this is necessarily a bad thing, but it does increase the pressure on students more than when most of us were in training.

 

[ciestar]

Let me tell you how it looks for an FMG: if I hadn’t scored high enough, way higher than most AMGs, I would have never practiced medicine in the US, not even the specialties you are looking down upon. So, please...

LOL
What specialties am I looking down upon? I’m applying FM so it isn’t exactly like I am gunning for derm and thinking anyone else is beneath me, becuase theyre not.

 

[ciestar]

Because you will be... unless you sober up and plug your holes, I mean canyons. All those feelings of inadequacy, of impostor syndrome, are GOOD for you and your patients. I still use them every day to become a better doctor, many years after I became an attending.

Sorry for hurting your feelings. /sarcasm

Not gonna let you bring me down dude. Given the amount of interviews I do have, plenty of PD’s think otherwise.

You’re never going to know everything and I am well aware of that. I’m over it all and i am done caring about step 1, it no longer matters.

 

[deleted957830]

Because you will be... unless you sober up and plug your holes, I mean canyons. All those feelings of inadequacy, of impostor syndrome, are GOOD for you and your patients. I still use them every day to become a better doctor, many years after I became an attending.

Sorry for hurting your feelings. /sarcasm

You should try using them to become a more palatable human being. Online bullying isn't cool, especially when you're an attending. Maybe attend a conference on medical student/physician suicide so you can recognize not to say outlandish things that aren't backed by facts in an attempt to merely put someone down.

 

[Lawpy]

I don't disagree with what you're saying, but med school is different now than when even I came through and I've only been out of school for 9 years now. I know as an FMG things were harder on you, but due to the rapid expansion of schools its heading in that direction for AMGs as well. When I went through the match, if you passed your steps at all you could still get into an FM program without trying too hard. Nowadays even the FM programs have cutoffs.

I'm not saying this is necessarily a bad thing, but it does increase the pressure on students more than when most of us were in training.

Wait, are US MD schools really expanding that fast? Because i was thinking they were expanding at normal rates? I know US DO schools expand and spread like the plague but MDs have different matching outcomes from DOs.

Unless by AMGs, you're referring to both US MD + DO?

 

[Lawpy]

An exam shouldnt define you.. yet it does. I had a hard time getting over my step 1 score. Some people make you feel like you’ll be a lesser doctor because of an exam score. It is a sucky feeling.

What are your thoughts on people doing worse on Step 2 CK than Step 1? Because this is happening at an alarming rate over in Step 2 forums.

 

[VA Hopeful Dr]

Wait, are US MD schools really expanding that fast? Because i was thinking they were expanding at normal rates? I know US DO schools expand and spread like the plague but MDs have different matching outcomes from DOs.

Unless by AMGs, you're referring to both US MD + DO?

I am.

 

[ciestar]

What are your thoughts on people doing worse on Step 2 CK than Step 1? Because this is happening at an alarming rate over in Step 2 forums.

I honestly haven’t thought about it. At the same time, there is no significant dedicated period for step 2 like there was for step 1. Sure, you study for CK throughout third year while studying for shelf exams, but I think people just don’t put as much time into it.

That said, I scored 34 points higher on CK than Step 1.

 

[deleted171991]

Not gonna let you bring me down dude. Given the amount of interviews I do have, plenty of PD’s think otherwise.

You’re never going to know everything and I am well aware of that. I’m over it all and i am done caring about step 1, it no longer matters.

I don’t want to bring you or anybody else down. I have walked in your shoes. Life is not a string of successes, even for ultimately successful people. But every kick in the butt is a step forward.

I just can’t respect the reasons people bring up against this exam (which made me sweat blood, and doubt myself for months, but also respect it). It used to be (and I would be surprised if it isn’t still) a very thorough and adaptive way of finding out the depth and breadth of one’s basic science knowledge, as much as possible in around 320 questions.

The problem is not the exam. The problem is that many applicants don’t take step 2 CK too and/or release their scores, before interviewing. Step 1 is just one piece of the puzzle, and most PDs know that when judging the candidates for the Match. Unfortunately, when one gets 2000 applications for 200 interviews, one needs a fast way to screen through them, and quantitative scores are here to stay, at least for that purpose.

 

[VivaElBirdos]

Sooooo, is this the extent of the Step 1 changes?

Recent Announcements | USMLE

www.usmle.org

"Beginning in mid-2020, the Step 1 and Step 2 Clinical Knowledge (CK) examinations will include an increased number of questions assessing communication skills, system-based practice and patient safety, and legal/ethical skills and professionalism. The length of the testing days for Step 1 and Step 2 CK will not change."

 

[7331poas]

I feel like no, since they said the announcement would happen in the winter

 

[Blanky]

Seems like I may be the first to take the new step 1 unless I take it in April..

 

[CidHighwind]

So basically, they want to make it so if you get a 250+, you’re not someone on the spectrum. I’ve heard the Step 2 changes are what are already on Step 3.

At anyone thinking they would get rid of the main thing programs use when deciding who to give an interview to.

 

[lj_99]

“Communication skills” multiple choice style? Is this just common sense or is this extra material that needs to be studied ?

 

[Med Ed]

Sooooo, is this the extent of the Step 1 changes?

No, these are routine adjustments.

 

[ace_inhibitor111]

So basically, they want to make it so if you get a 250+, you’re not someone on the spectrum. I’ve heard the Step 2 changes are what are already on Step 3.

At anyone thinking they would get rid of the main thing programs use when deciding who to give an interview to.

There’s no evidence that these questions are able to screen for ASD. They’re added more to appease their stakeholders (like the AAMC) than to test anything useful.

 

[CidHighwind]

There’s no evidence that these questions are able to screen for ASD. They’re added more to appease their stakeholders (like the AAMC) than to test anything useful.

Well that’s the actual reason. The thinking behind it though is a lot of people are sick of doctors that are book smart and nothing else. That can study for a test but aren’t good with people, can’t read nonverbal cues, and generally exhibit ASD traits. So I guess the idea is to force the people who want really high scores to try to learn some communication skills along the way. Whether this will be effective remains to be seen.

 

[bananafish94]

Personally, I think that Step 1 and Step 2 CK should be eliminated outright and Step 2 CS should be the only standardized exam required for residency. Every medical student would agree that CS is an incredibly valuable exam that provides essential data for PDs and students! I think the NBME provides a wonderful service that is both priced reasonably and stress-free for everyone. After all, medical students are known to be a population with large amounts of expendable money and thankfully the vast majority of us live in only 5 cities in the United States, which makes everything much more convenient. And thankfully, it couldn’t be easier to schedule! There are more than enough spots and I’ve never met a single person who had to pay to use a bot to schedule an appointment. Most importantly, though, CS made me a better doctor. When I got my score report back and saw that my asterisks were slightly to the right of the “borderline” area, I knew exactly what that meant and what to improve on as I take the next steps in this journey. Thank you, NBME!

 

[slowthai]

Personally, I think that Step 1 and Step 2 CK should be eliminated outright and Step 2 CS should be the only standardized exam required for residency. Every medical student would agree that CS is an incredibly valuable exam that provides essential data for PDs and students! I think the NBME provides a wonderful service that is both priced reasonably and stress-free for everyone. After all, medical students are known to be a population with large amounts of expendable money and thankfully the vast majority of us live in only 5 cities in the United States, which makes everything much more convenient. And thankfully, it couldn’t be easier to schedule! There are more than enough spots and I’ve never met a single person who had to pay to use a bot to schedule an appointment. Most importantly, though, CS made me a better doctor. When I got my score report back and saw that my asterisks were slightly to the right of the “borderline” area, I knew exactly what that meant and what to improve on as I take the next steps in this journey. Thank you, NBME!

I wanted to laugh, but I just started to cry.

 

[Goro]

Wait, are US MD schools really expanding that fast? Because i was thinking they were expanding at normal rates? I know US DO schools expand and spread like the plague but MDs have different matching outcomes from DOs.

Unless by AMGs, you're referring to both US MD + DO?

The number of MD schools that have opened since ~2000 is the same as the number of DO schools, surprisingly. FAU, FIU, UCF and Nova MD to name a few, and that's just in a single state!

 

[CyrusHabs7695]

“Communication skills” multiple choice style? Is this just common sense or is this extra material that needs to be studied ?

https://www.usmle.org/pdfs/step-1/content_step1.pdf

Theres a couple examples in there, seem like common sense

 

[deleted957830]

Well that’s the actual reason. The thinking behind it though is a lot of people are sick of doctors that are book smart and nothing else. That can study for a test but aren’t good with people, can’t read nonverbal cues, and generally exhibit ASD traits. So I guess the idea is to force the people who want really high scores to try to learn some communication skills along the way. Whether this will be effective remains to be seen.

Someone at my school scored >265 and literally gets chewed out on every rotation. Not ASD, just a cocky, arrogant human being. Can't talk to patients, present, or show one ounce of kindness. An attending we both worked with, when said student wasn't around, made an off-the-cuff remark of: "This is why there has been an inverse correlation between step scores and performance in our resident pool".

The bar to library ratio definitely has some merit. Not saying this is the rule by any means, but there are people who are well rounded (i.e. not great step scores but good at everything; personable!) who absolutely kick-ass in the hospital.

It doesn't matter how smart you are if people can't stand you enough to listen to the words coming out of your mouth or if people can't understand you because you can't come down to a common level.

 

[7331poas]

Someone at my school scored >265 and literally gets chewed out on every rotation. Not ASD, just a cocky, arrogant human being. Can't talk to patients, present, or show one ounce of kindness. An attending we both worked with, when said student wasn't around, made an off-the-cuff remark of: "This is why there has been an inverse correlation between step scores and performance in our resident pool".

The bar to library ratio definitely has some merit. Not saying this is the rule by any means, but there are people who are well rounded (i.e. not great step scores but good at everything; personable!) who absolutely kick-ass in the hospital.

It doesn't matter how smart you are if people can't stand you enough to listen to the words coming out of your mouth or if people can't understand you because you can't come down to a common level.

Okay? And that person will get low clerkship scores and letters and will match accordingly. There is nothing wrong with our current system.

 

[Dr. Doctor MD]

Someone at my school scored >265 and literally gets chewed out on every rotation. Not ASD, just a cocky, arrogant human being. Can't talk to patients, present, or show one ounce of kindness. An attending we both worked with, when said student wasn't around, made an off-the-cuff remark of: "This is why there has been an inverse correlation between step scores and performance in our resident pool".

The bar to library ratio definitely has some merit. Not saying this is the rule by any means, but there are people who are well rounded (i.e. not great step scores but good at everything; personable!) who absolutely kick-ass in the hospital.

It doesn't matter how smart you are if people can't stand you enough to listen to the words coming out of your mouth or if people can't understand you because you can't come down to a common level.

I call BS. Congrats you met one weird 260+ kid. I know dozens of 260+ and all of them are clinical and social superstars who are leagues ahead of everyone else in clinical years. I also know one turd at my school with a 260, but again that's the exception rather than the rule.

Your anecdotal story of one annoying kid with a 260 doesn't mean anything. But sure, go ahead keep telling yourself that 90th+ percentile board scorers are weird if that narrative is what makes you feel better about yourself...

 

[deleted957830]

Okay? And that person will get low clerkship scores and letters and will match accordingly. There is nothing wrong with our current system.

I agree. If anything, my anecdotal story reaffirms this. Even if you kill step 1 but are disastrous in other areas, you even out with the rest of the pool and will fall into place accordingly, as you said

 

[CidHighwind]

Someone at my school scored >265 and literally gets chewed out on every rotation. Not ASD, just a cocky, arrogant human being. Can't talk to patients, present, or show one ounce of kindness. An attending we both worked with, when said student wasn't around, made an off-the-cuff remark of: "This is why there has been an inverse correlation between step scores and performance in our resident pool".

The bar to library ratio definitely has some merit. Not saying this is the rule by any means, but there are people who are well rounded (i.e. not great step scores but good at everything; personable!) who absolutely kick-ass in the hospital.

It doesn't matter how smart you are if people can't stand you enough to listen to the words coming out of your mouth or if people can't understand you because you can't come down to a common level.

Exactly, and when this person goes on an away, gets bad letters, and doesn’t match, everyone will be like “OMG THIS PERSON HAD GREAT SCORES BUT DIDNT MATCH, WHAT HOPE DO WE HAVE?” Not realizing it was because no one could stand to be around them. Maybe someone like that would be better at something like Path, but people in general are tired of doctors that are crap socially.

I call BS. Congrats you met one weird 260+ kid. I know dozens of 260+ and all of them are clinical and social superstars who are leagues ahead of everyone else in clinical years. I also know one turd at my school with a 260, but again that's the exception rather than the rule.

Your anecdotal story of one annoying kid with a 260 doesn't mean anything. But sure, go ahead keep telling yourself that 90th+ percentile board scorers are weird if that narrative is what makes you feel better about yourself...

How do people on SDN know everyone else’s Step scores? Is this off of them just being really smart, what they matched into, or do you ask them what they got? Always seemed weird to me how people knew everyone’s steps, and whether the cohort they’re interviewing with was “so amazing and accomplished”. I’m like where on interviews are applicants telling each other their step scores?

 

[deleted957830]

I call BS. Congrats you met one weird 260+ kid. I know dozens of 260+ and all of them are clinical and social superstars who are leagues ahead of everyone else in clinical years. I also know one turd at my school with a 260, but again that's the exception rather than the rule.

Your anecdotal story of one annoying kid with a 260 doesn't mean anything. But sure, go ahead keep telling yourself that 90th+ percentile board scorers are weird if that narrative is what makes you feel better about yourself...

I'm perfectly happy with my score and lot in life. The majority of physicians score under the 90th percentile and go on about their business without a hitch. Your patients will never know the difference.

My score doesn't equal my self-worth or value.

 

[CidHighwind]

Personally, I think that Step 1 and Step 2 CK should be eliminated outright and Step 2 CS should be the only standardized exam required for residency. Every medical student would agree that CS is an incredibly valuable exam that provides essential data for PDs and students! I think the NBME provides a wonderful service that is both priced reasonably and stress-free for everyone. After all, medical students are known to be a population with large amounts of expendable money and thankfully the vast majority of us live in only 5 cities in the United States, which makes everything much more convenient. And thankfully, it couldn’t be easier to schedule! There are more than enough spots and I’ve never met a single person who had to pay to use a bot to schedule an appointment. Most importantly, though, CS made me a better doctor. When I got my score report back and saw that my asterisks were slightly to the right of the “borderline” area, I knew exactly what that meant and what to improve on as I take the next steps in this journey. Thank you, NBME!

All this needs is some emojis and the UWorld copyright warning at the end and you’ll get a lot of karma for this on reddit

 

[Dr. Doctor MD]

Exactly, and when this person goes on an away, gets bad letters, and doesn’t match, everyone will be like “OMG THIS PERSON HAD GREAT SCORES BUT DIDNT MATCH, WHAT HOPE DO WE HAVE?” Not realizing it was because no one could stand to be around them. Maybe someone like that would be better at something like Path, but people in general are tired of doctors that are crap socially.



How do people on SDN know everyone else’s Step scores? Is this off of them just being really smart, what they matched into, or do you ask them what they got? Always seemed weird to me how people knew everyone’s steps, and whether the cohort they’re interviewing with was “so amazing and accomplished”. I’m like where on interviews are applicants telling each other their step scores.

Generally speaking close friends tell each other their step scores, especially as time goes on. Unfortunately that also means that their friends tell their friends, and before you know it the whole schools knows. They also have match panels throughout the year, which almost always include Step 1/2 clinical grades AOA etc. I obviously can't tell you the top 20 step scores of my class in order, but I know countless step 1 scores from my friends in my class as well as those a few years above and one year below. Step scores aren't some big secret. But no, I definitely don't ever talk about that on the interview trail or anywhere outside of face to face with friends, that would be weird.

I will reiterate, 95% of the 250+ crowd are baller human beings and will make smart, compassionate, and quality doctors. You can be absolutely be smart and socially competent, they aren't mutually exclusive, don't buy into the lie that all smart people are socially inept robots and that you need BELOW a 250 to know how to talk to patients.

 

[CidHighwind]

Generally speaking close friends tell each other their step scores, especially as time goes on. Unfortunately that also means that their friends tell their friends, and before you know it the whole schools knows. They also have match panels throughout the year, which almost always include Step 1/2 clinical grades AOA etc. I obviously can't tell you the top 20 step scores of my class in order, but I know countless step 1 scores from my friends in my class as well as those a few years above and one year below. Step scores aren't some big secret. But no, I definitely don't ever talk about that on the interview trail or anywhere outside of face to face with friends, that would be weird.

I will reiterate, 95% of the 250+ crowd are baller human beings and will make smart, compassionate, and quality doctors. You can be absolutely be smart and socially competent, they aren't mutually exclusive, don't buy into the lie that all smart people are socially inept robots and that you need BELOW a 250 to know how to talk to patients.

No one is saying it’s ALL of them, just a decent percentage. And it’s much larger than 5% if we being honest. No one really in our class discussed their Steps except for the person that got the highest, and everyone knew who failed because they got pulled off of rotation. You and your fiends that scored high may think you’re not bad, but I rotated with a lot of students that knew all the “pimp questions” were annoying.

 

[Dr. Doctor MD]

No one is saying it’s ALL of them, just a decent percentage. And it’s much larger than 5% if we being honest. No one really in our class discussed their Steps except for the person that got the highest, and everyone knew who failed because they got pulled off of rotation. You and your fiends that scored high may think you’re not bad, but I rotated with a lot of students that knew all the “pimp questions” were annoying.

Sounds like you are jealous of good clinical students and are taking out your own feelings/disappointment on them :/

Again whatever the percentage of weirdos is in the general med student population it is DEFINITELY not higher in the 250+ crowd than the 250- crowd.

In fact anecdotally some of the most insufferable students on my rotations were the 22X crowd who would never stop gunning and felt that because of a below average step score they had to destroy everyone else to prove that they were decent people. It was super sad.

FYI: Not hating on 220s crowd, most are awesome, just 2 specific people who were the absolute worst. No one ever wanted to be on the same rotation with them.

EDIT: Final point: You will find absolutely terrible people across all board scores; they are not more prevalent in the 250+ crowd

 

[CidHighwind]

Sounds like you are jealous of good clinical students and are taking out your own feelings/disappointment on them :/

Again whatever the percentage of weirdos is in the general med student population it is DEFINITELY not higher in the 250+ crowd than the 250- crowd.

In fact anecdotally some of the most insufferable students on my rotations were the 22X crowd who would never stop gunning and felt that because of a below average step score they had to destroy everyone else to prove that they were decent people. It was super sad

Answering “pimp questions” =\= being able to present, having common sense, asking pertinent questions, working in a team setting, talking to patients, etc...

Also only on SDN is a “22X” score terrible, since a large percentage of students don’t even have that.

 

[CyrusHabs7695]