Pass/ Fail Step 1

[seeinghowitgoes]

Number 6 is the only one relevant at all to medical school. Making Step P/F won’t change any of these one iota.

I don’t know that I agree, and I think there are probably predictors in Med school for at least some of, if not all those outcomes, but of course I can’t claim to know exactly what they’d be (SLOEs for all specialties maybe, MMI residency interviews perhaps, etc).

I guess my only point is, as long as we have step scores to fall back on (which make money for private interests and make it cognitively easy to rank people, albeit not on a metric correlated with any other metric of interest) we as a profession won’t be motivated to figure out what those better evaluation tools are. I don’t think a pass/fail step in and of itself fixes anything, but maybe it motivates us to do a better job developing systems to measure the things that matter.

---

Members don't see this ad.

 

[AnatomyGrey12]

I hope it’s P/F we need other metrics. If the current system was who ever runs the fastest gets preference, that is still a way to stratify residency applicants. And I can take every argument the posters have above in favor of keeping step 1 scored and apply it to my example.

Obviously the people who are fast (me) would want it to remain scored, but those who aren’t will vouch for P/F for all the same reasons why most people are in favor of P/F.

lf you want that competence residency, “work harder”

You gave yet to provide a good alternative yet continue to go on and on about how it needs to be P/F.

For example, I have classmates who work (by necessity) and come from horrendous circumstance/poverty. To argue that if they just "study harder" they will improve, is embarrassing. The relative risk of failing or performing poorly in certain demographics has been well-established. Does that mean that these students will be worse doctors or that they don't deserve to enter a field that they are passionate about? I think that the traits these students bring might make them better doctors than the student from the "average" background (think compassion, empathy, work ethic, etc.).

Right... so you have lots of classmates working during medical school? I doubt that, most schools actively forbid it. At what point do we address the elephant in the room and talk about how the relative risk of failing in certain demographics is directly tied to the fact that the entrance stats of those demographics is lower.... at some point you need to compete with your peers, if you can’t compete with your peers for the specialty you want then no you don’t get to do the specialty you want.

happen to go to a medical school that prides itself on service, with that, many students are chosen based on factors beyond simple metrics. To say that student A will perform better on wards than student B simply due to a step score is asinine (as is the argument that student A will automatically be a better doctor). And to argue that "hard work and perseverance" equals a higher step score means that you are blatantly ignoring the obstacles that certain students face during this process.

Well I mean you can ask any of the attendings on rotations and they will tell you there is 100% a trend that the students who have higher scores tend to be the better performers on the wards. That’s not even arguable so I don’t know why you are trying to argue otherwise.

And yes, harder work and perseverance do equal higher Step scores.

 

[deleted998607]

Except they wont because now the emphasis will be on taking research years, which poor students are not able to do.

Medical schools are starting to take students from low-SES at higher percentages. However, once these students are admitted, the system often fails them. It's sad and it is one of the most ignored topics.

 

[chlorocruorin]

Or you have no stratification and it boils down to being completely random or (more likely) the PDs will just pick based on medical school ranking.

Lmao why is that the default. Step is either scored or it’s just an apocalypse and PDs will go “okay she went to Yale, and he went to Northwestern....Yale is higher ranked so we’ll let her in” hahahaha that will never happen. Those is Meded want more meaningful metrics that’s why it’s considered P/F. Why would they choose a less meaningful metric lmao

 

[sargon2123]

You are correct. But it would hopefully allow students from these demographics to have a better chance to gain entrance to certain specialties (bringing diversity that is much needed in certain, if not all, fields) with a passing score.

Trade in meritocracy for the "hopeful" possibility of increased diversity in certain fields? These certain fields will become less diverse from a more aggregate standpoint because they’ll be populated even more disproportionately by people from top schools.

 

[AnatomyGrey12]

However, once these students are admitted, the system often fails them.

Please tell us how a system that provides then with EVERY opportunity to succeed fails them... at some point you have to perform. It’s just that simple. Everyone has access to the same resources in medical school.

 

[Lawpy]

Lmao why is that the default. Step is either scored or it’s just an apocalypse and PDs will go “okay she went to Yale, and he went to Northwestern....Yale is higher ranked so we’ll let her in” hahahaha that will never happen. Those is Meded want more meaningful metrics that’s why it’s considered P/F. Why would they choose a less meaningful metric lmao

What? PDs are already choosing students from top tier schools over no name/low tier schools in many programs and specialties. Name matters when things get competitive and top schools have a huge wealth of research and networking resources

 

[AnatomyGrey12]

Lmao why is that the default. Step is either scored or it’s just an apocalypse and PDs will go “okay she went to Yale, and he went to Northwestern....Yale is higher ranked so we’ll let her in” hahahaha that will never happen. Those is Meded want more meaningful metrics that’s why it’s considered P/F. Why would they choose a less meaningful metric lmao

Because it already happens? And is mitigated by the fact that there is a common denominator between applicants that allows direct comparison?

I really don’t see how you can be so obtuse about this.

 

[sargon2123]

Medical schools are starting to take students from low-SES at higher percentages. However, once these students are admitted, the system often fails them. It's sad and it is one of the most ignored topics.

The system as a whole is not on trial here. The scoring of step 1 is. In addition, which is more detrimental, a necessary research year, or a number based step 1. Not only does a research year cost money, it eats up a year of attending income.

 

[deleted998607]

And yes, harder work and perseverance do equal higher Step scores.

This quote tells me why you're at where you're at, and also tells me what kind of person you are (one who is societally blind and undeserving of an adequate response).

How quickly the attitude changes once a step score is released. This is exactly why things need to change. Hopefully you wake up one day.

 

[chlorocruorin]

O

You gave yet to provide a good alternative yet continue to go on and on about how it needs to be P/F.

I’m not a PD, it’s not up to me to provide a more meaningful metric. But what if it was how fast you run? What would you about that?

 

[7331poas]

Medical schools are starting to take students from low-SES at higher percentages. However, once these students are admitted, the system often fails them. It's sad and it is one of the most ignored topics.

Okay, and the point of my post was that P/F is going to make it even harder on low-SES individuals.

 

[7331poas]

O


I’m not a PD, it’s not up to me to provide a more meaningful metric. But what if it was how fast you run? What would you about that?

Then I will start training. But comparing running fast to learning the mechanisms of disease for the major organ systems is a fallacy at best.

 

[sargon2123]

This quote tells me why you're at where you're at, and also tells me what kind of person you are (one who is societally blind and undeserving of an adequate response).

How quickly the attitude changes once a step score is released. This is exactly why things need to change. Hopefully you wake up one day.

There are plenty of us who have yet to take step, who don’t count on getting a super high score, and who still want it to remain numbered primarily because we care about keeping the system partly meritocratic

 

[Lawpy]

This quote tells me why you're at where you're at, and also tells me what kind of person you are (one who is societally blind and undeserving of an adequate response).

How quickly the attitude changes once a step score is released. This is exactly why things need to change. Hopefully you wake up one day.

Did you make an account to get into arguments and attack people who disagree with you?

 

[AnatomyGrey12]

This quote tells me why you're at where you're at, and also tells me what kind of person you are (one who is societally blind and undeserving of an adequate response).

How quickly the attitude changes once a step score is released. This is exactly why things need to change. Hopefully you wake up one day.

Nah bro, I put in hundreds of hours for my Step score. But sure, go ahead and ride that high horse.

 

[chlorocruorin]

What? PDs are already choosing students from top tier schools over no name/low tier schools in many programs and specialties. Name matters when things get competitive and top schools have a huge wealth of research and networking resources

Would you be in favor of PDs choosing the applicants who can run the fastest?

 

[Ho0v-man]

Are United States Medical Licensing Exam Step 1 and 2... : Academic Medicine

edical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose. Method This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using...

journals.lww.com

https://oea.sites.medinfo.ufl.edu/files/2010/10/USMLE-step-1-failure.pdf

I have no bone to pick here as I am happy with my Step 1 score. However, I find it discouraging to see some of the arrogant posts on this thread.

I happen to go to a medical school that prides itself on service, with that, many students are chosen based on factors beyond simple metrics. To say that student A will perform better on wards than student B simply due to a step score is asinine (as is the argument that student A will automatically be a better doctor). And to argue that "hard work and perseverance" equals a higher step score means that you are blatantly ignoring the obstacles that certain students face during this process.

For example, I have classmates who work (by necessity) and come from horrendous circumstance/poverty. To argue that if they just "study harder" they will improve, is embarrassing. The relative risk of failing or performing poorly in certain demographics has been well-established. Does that mean that these students will be worse doctors or that they don't deserve to enter a field that they are passionate about if they don't get a 2XX? I think that the traits these students bring might make them better doctors than the student from the "average" background (think compassion, empathy, work ethic, etc.).

I've noticed a trend in medical school that a person's worth = their step score...and it's sad. With that said, I don't agree with P/F. F/P/H would be fine with me, as would combining step 1 and step 2.

To the bolded: yes. Obviously not within a small range, but it’s common sense to think that people who spend more time learning medical sciences well will be better at medicine than people who don’t.

Also, how do you argue that these students have stronger work ethic later in that post? Step 1 is basically a work ethic test.

 

[chlorocruorin]

Then I will start training. But comparing running fast to learning the mechanisms of disease for the major organ systems is a fallacy at best.

The point I was trying to make was they both have little correlation to how good of a doctor one is.

 

[sargon2123]

Did you make an account to get into arguments and attack people who disagree with you?

The thing speaks for itself. He wants to question credibility but cannot do so without trying to get personal. Sad

 

[Lawpy]

Would you be in favor of PDs choosing the applicants who can run the fastest?

Step scores provide objective data but they are viewed in context of many other important things (grades, letters, research etc). That's a better system than getting rid of objective metrics and placing a stronger emphasis on school name

 

[sargon2123]

Would someone be so kind as to re-list only relevant reasons why step 1 p/f is a better alternative than number graded step 1? This thread has gotten awfully long

 

[chlorocruorin]

Step scores provide objective data but they are viewed in context of many other important things (grades, letters, research etc). That's a better system than getting rid of objective metrics and placing a stronger emphasis on school name

“Viewed in context” but we’ll put almost all our emphasis on it. Like c’mon, there was just a thread about not studying for actual classes but studying for step, and ppl agree lmao. If I finish at the bottom of my class bc I spent my
Time studying for step and got a 255, NO emphasis would be on my grades. My step would carry me. But if it was flipped, I’d be in a hole. 30+ years from now, what score would one have to get to match into derm? 270? Is that not ridiculous?

 

[AnatomyGrey12]

O


I’m not a PD, it’s not up to me to provide a more meaningful metric. But what if it was how fast you run? What would you about that?

Would you be in favor of PDs choosing the applicants who can run the fastest?

The point I was trying to make was they both have little correlation to how good of a doctor one is.

Is this really how you’re going to argue your point?

 

[studentdocftw]

P/F simply removes an objective standardized metric from the evaluation process, which will inevitably put more emphasis on the legacy of the medical school you attend. How else could a Vanderbilt IM PD justify ranking a Morehouse graduate over a comparable Emory graduate? Im not saying Step 1 alone gets people a residency (no single metric does), but it's a tool for those from lower tier schools to stand out and compete with those from better known programs. So now the MCAT becomes the most important exam of your medical career...and effectively, nothing changes...we just move the stress period up a couple of years. The notion of a truly "holistic" process is a fantasy...until programs have the ability to shrink the number of applications they have to sort through, they will continue to stratify..if not with Step 1..then with Step 2..AOA...medical school..etc.

 

[7331poas]

“Viewed in context” but we’ll put almost all our emphasis on it. Like c’mon, there was just a thread about not studying for actual classes but studying for step, and ppl agree lmao. If I finish at the bottom of my class bc I spent my
Time studying for step and got a 255, NO emphasis would be on my grades. My step would carry me. But if it was flipped, I’d be in a hole. 30+ years from now, what score would one have to get to match into derm? 270? Is that not ridiculous?

Where is the evidence that studying for class makes you a better doctor? Where is the evidence that studying harder on clerkship makes you a better doctor for that matter.

 

[Lawpy]

“Viewed in context” but we’ll put almost all our emphasis on it. Like c’mon, there was just a thread about not studying for actual classes but studying for step, and ppl agree lmao. If I finish at the bottom of my class bc I spent my
Time studying for step and got a 255, NO emphasis would be on my grades. My step would carry me. But if it was flipped, I’d be in a hole. 30+ years from now, what score would one have to get to match into derm? 270? Is that not ridiculous?

So what's your alternative? You want to place a stronger emphasis on school name and essentially wipe out derm chances of those who went to low tier/no name schools? Because that is what's going to happen by making Step 1 P/F. Top schools are unbeatable when it comes to having a huge wealth of research and networking connections, and getting rid of Step 1 scoring places a stronger emphasis on this.

 

[chlorocruorin]

Is this really how you’re going to argue your point?

View attachment 273057

Lol stop but funny meme tho

 

[chlorocruorin]

Where is the evidence that studying for class makes you a better doctor? Where is the evidence that studying harder on clerkship makes you a better doctor for that matter.

The same place where the evidence is that running faster will make you a better doctor

 

[AnatomyGrey12]

“Viewed in context” but we’ll put almost all our emphasis on it. Like c’mon, there was just a thread about not studying for actual classes but studying for step, and ppl agree lmao. If I finish at the bottom of my class bc I spent my
Time studying for step and got a 255, NO emphasis would be on my grades. My step would carry me. But if it was flipped, I’d be in a hole. 30+ years from now, what score would one have to get to match into derm? 270? Is that not ridiculous?

1. Yes it is viewed in a context. Yes it’s important but not the way many med students pretend it is. This is how DOs March plastics with a 230s and don’t match with a 270. PDs do in fact look at then in context.

2. Nobody at the bottom of the class is getting 255s. That’s an absurd extreme thrown around a lot that doesn’t actually happen in reality.

 

[chlorocruorin]

So what's your alternative? You want to place a stronger emphasis on school name and essentially wipe out derm chances of those who went to low tier/no name schools? Because that is what's going to happen by making Step 1 P/F. Top schools are unbeatable when it comes to having a huge wealth of research and networking connections, and getting rid of Step 1 scoring places a stronger emphasis on this.

I want to place more emphasis on metrics that correlate well with being a good doctor

 

[Lawpy]

I want to place more emphasis on metrics that correlate well with being a good doctor

Which are...?

 

[chlorocruorin]

Which are...?

A P/F step 1. It will still be taken into context as you said with your grades, clerkships, and what not.

 

[Lawpy]

A P/F step 1. It will still be taken into context as you said with your grades, clerkships, and what not.

The reality is it shifts focus to school name, which is a worse system.

 

[7331poas]

A P/F step 1. It will still be taken into context as you said with your grades, clerkships, and what not.

Again, where is it said that "grades, clerkships, and what not" correlate with being a good doctor?

 

[Ho0v-man]

“Viewed in context” but we’ll put almost all our emphasis on it. Like c’mon, there was just a thread about not studying for actual classes but studying for step, and ppl agree lmao. If I finish at the bottom of my class bc I spent my
Time studying for step and got a 255, NO emphasis would be on my grades. My step would carry me. But if it was flipped, I’d be in a hole. 30+ years from now, what score would one have to get to match into derm? 270? Is that not ridiculous?

Bc PDs know that people cheat or find a way to game the system. Preclinical grades barely tell you anything if your unfamiliar with the school. Even if you went to the school, if it’s been more 10 years you probably don’t know how easy or hard any course is. Heck, some teachers even give answers. But a standardized test that everyone takes gives you a pretty good breakdown of how well one learned the material.

As for the 270 for derm: if there’s enough 270s to fill up every derm program in the country then yeah, you better get a 270. Why should you get a spot over someone else when they did something you didn’t? That’s pretty much the crux of the argument.

I’m all for making Step 1 a better test. Some stuff on it is ridiculous and has nothing to do with anything. But even if it was changed to be 100% relevant to being a doctor, it wouldn’t change anything. The rockstars would still crush everything. It’s not unfair that smarter, harder working people have better career opportunities.

 

[premed9901]

I want to place more emphasis on metrics that correlate well with being a good doctor

My salt levels are rising a little reading this comment, srs.

What about derm, plastics, ortho, which already have high overrepresentation from top schools? Something like 40% from top 40 schools? Probably even higher the higher in ranking you go...

What is this "good doctor" nonsense too? I want to match into the specialty I want first before I worry about being a good doctor. I want objective stratification so I have a fighting chance at matching into competitive specialties.

 

[chlorocruorin]

As for the 270 for derm: if there’s enough 270s to fill up every derm program in the country then yeah, you better get a 270. Why should you get a spot over someone else when they did something you didn’t?

This is my argument is that, everyone has said there’s no good metric for predicting how good a doctor is, so why would someone get in solely bc he or she has a higher step score

 

[Lawpy]

This is my argument is that, everyone has said there’s no good metric for predicting how good a doctor is, so why would someone get in solely bc he or she has a higher step score

how does someone going to a top school make them a better doctor?

 

[premed9901]

This is my argument is that, everyone has said there’s no good metric for predicting how good a doctor is, so why would someone get in solely bc he or she has a higher step score

That's not what people are arguing at all. "perfectly competent physician", "good doctor", what's next? Any other red herrings you want to throw out there?

 

[chlorocruorin]

Again, where is it said that "grades, clerkships, and what not" correlate with being a good doctor?

Ask Lawyerp I’m simply using their wording

 

[chlorocruorin]

That's not what people are arguing at all. "perfectly competent physician", "good doctor", what's next? Any other red herrings you want to throw out there?

Yeah I do. What does scoring high on usmle mean?

Now I expect a very thorough answer with literature supporting this answer.

 

[7331poas]

Ask Lawyerp I’m simply using their wording

Lawyerp did not assert that we should use "evidence based criteria" to evaluate residency applicants, you did.

I am just wondering, what criteria would you use to evaluate an applicant versus another that relates to their patient outcomes?

 

[Lawpy]

Ask Lawyerp I’m simply using their wording

You're deflecting. Your argument is you want Step 1 to be P/F because someone with higher Step scores isn't necessarily a better doctor. But you aren't providing an alternative here.

 

[chlorocruorin]

You're deflecting. Your argument is you want Step 1 to be P/F because someone with higher Step scores isn't necessarily a better doctor. But you aren't providing an alternative here.

But do you agree with my statement?

 

[Lawpy]

Also I'm just sad and frustrated that if P/F Step 1 does become implemented, DO students are screwed over even more. DO educators are more focused on forcing students to go into primary care, and DO expansion continues to happen mercilessly. Then we have a merger that could potentially disadvantage DO students unless former AOA programs have special COMLEX/OMM requirements. And now with a P/F Step 1, they would lose an objective metric to prove that they can be just as, if not more than, competitive as their MD counterparts to match into competitive specialties. It's frustrating all around to see DO students getting shafted mercilessly.

 

[Ho0v-man]

This is my argument is that, everyone has said there’s no good metric for predicting how good a doctor is, so why would someone get in solely bc he or she has a higher step score

Bc that person demonstrated that they were willing to work harder to achieve their goals than a lower scoring applicant (within reason). I don’t think step 1 or any other metrics we use actually have any predictive value of what makes a “good doctor” ( which is an ambiguous/ill defined term in and of itself). But I have no way of denying that the guy/gal who scored a 270 is smarter than me and worked MUCH harder than me.

There’s charting outcomes available to everyone. Everyone has access to the same resources. Everyone knows exactly what’s expected of them and can learn it even before starting med school. The only excuse for not accomplishing your goals as it stands now is work ethic and raw talent, mostly the work ethic.

 

[Lawpy]

You know, from my previous post, if P/F Step 1 happens, I am definitely 100% in favor of former AOA programs having COMLEX/OMM requirements that would protect DO students into matching their programs.

 

[chlorocruorin]

Bc that person demonstrated that they were willing to work harder to achieve their goals than a lower scoring applicant (within reason). I don’t think step 1 or any other metrics we use actually have any predictive value of what makes a “good doctor” ( which is an ambiguous/ill defined term in and of itself). But I have no way of denying that the guy/gal who scored a 270 is smarter than me and worked MUCH harder than me.

There’s charting outcomes available to everyone. Everyone has access to the same resources. Everyone knows exactly what’s expected of them and can learn it even before starting med school. The only excuse for not accomplishing your goals as it stands now is work ethic and raw talent, mostly the work ethic.

Dude this is exactly my point. Scoring higher doesn’t = willing to work harder are you serious rn? For one that’s actually wrong, and two it’s completely insensitive. I hope everyone reads that:

“Bc that person demonstrated that they were willing to work harder to achieve their goals than a lower scoring applicant”

 

[Premed2295]

And here’s another un-credible group: those with primary care aspirations who would rather swap an element of meritocracy in The Match for all their peers in favor of reduced stress levels.

I actually said I DON'T want P/F but if it did happen it wouldn't be the worst thing for my speciality. Though I hope it doesnt happen and still want to do really well on Step 1.
I want to do peds for many reasons. Its not that I want low stress. Some elements of life style sure but I genuinely love the patient population I would work with