Pass/ Fail Step 1

[sargon2123]

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

I wish you the best in your aspiration. I wasn’t saying your aspiration is bad in any way, but that the credibility of your peer group is questionable

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[Ho0v-man]

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”

I’m dead serious. I did well bc I put in significantly more time over 2 years than those who didn’t. Its a reflection of my work ethic. It’s as simple as that.

Have you taken Step 1? It sounds like you haven’t.

 

[deleted957830]

The only excuse for not accomplishing your goals as it stands now is work ethic and raw talent, mostly the work ethic.

So by extension, you are saying that minorities and students from low-SES backgrounds are inherently less gifted, lazy, or both? Since both of the aforementioned typically score lower on Step 1? I hope you realize how scary your statement is...

Either the test is based on merit and "raw talent" or there are intrinsic factors that favor people from certain backgrounds. I believe an ethically sound human being would disregard the former.

Comments made on this thread make me realize why people hate doctors. The entitlement and downright arrogance is astonishing.

 

[sargon2123]

I think we should compile lists of reasons for both sides of the original argument instead of debating whether step 1 shows work ethic.

 

[sargon2123]

It seems like the entire argument in favor of the affirmative is “if I can’t have it, no one except the top percentile of med students at top schools can"

 

[Ho0v-man]

So by extension, you are saying that minorities and students from low-SES backgrounds are inherently less gifted, lazy, or both? Since both of the aforementioned typically score lower on Step 1?

Comments made on this thread make me realize why people hate doctors. The entitlement and downright arrogance is astonishing.

I’m from a low SES background. I did well.

I worked three jobs to put myself through undergrad bc I didn’t qualify for student aid. My family made just slightly above what it takes to qualify. They also took out credit cards in my name and trashed my credit so no chance of loans of any kind. Anywhere from 50-70 hrs per week at work. Plus full time coursework in school. Oh and I had a child. Even though most of my income went toward paying for school in the first place, my earnings made me unqualified for student aide again. This crazy workload meant that most of my mcat studying was either doing questions on my lunch breaks or listening to EK audio osmosis. Didn’t do so hot and ended up in an osteopathic school. I absolutely believe that the system is stacked against low SES applicants as I lived through it personally. I sincerely hope that in the future the disadvantages of low SES are paid more attention to in the admissions process because I promise you most of my med school class didn’t have to struggle half as hard as I did to get in.

But that’s undergrad. Once med school starts, everyone is on the same playing field. The disadvantages of being low SES disappear. I don’t empathize with those who don’t do as well once you hit med school.

Paint me as an elitist if it makes you feel better.

 

[deleted957830]

Once med school starts, everyone is on the same playing field. The disadvantages of being low SES disappear. I don’t empathize with those who don’t do as well once you hit med school.

Given your background, I'm shocked by your apparent lack of empathy. I vehemently disagree. Students don't stop being minorities in medical school, and persons from low-SES backgrounds certainly don't leave their life's circumstances at the door when walking into their first medical school classroom. How is the playing field level? If it was level, minorities and low-SES wouldn't be high risk.

No offense, but you are N = 1. The exception doesn't establish the rule. The data is there for everyone to see. And if you truly believe that the playing field is level, that means that you do consider minorities and students from low-SES to be inherently lazy or less talented. This type of thinking lends to why certain populations suffer needlessly and why certain populations refrain from going to the doctor.

Not to mention, I've never heard someone proclaim to be low SES while stating that their family made too much to qualify for aid. I think what you consider to be low-SES and what the government/social services deem to be low-SES are a bit different..just because you're not the richest person in your medical school class or had to work during college doesn't mean you are low SES.

 

[chlorocruorin]

I’m from a low SES background. I did well.

I worked three jobs to put myself through undergrad bc I didn’t qualify for student aid. My family made just slightly above what it takes to qualify. They also took out credit cards in my name and trashed my credit so no chance of loans of any kind. Anywhere from 50-70 hrs per week at work. Plus full time coursework in school. Oh and I had a child. Even though most of my income went toward paying for school in the first place, my earnings made me unqualified for student aide again. This crazy workload meant that most of my mcat studying was either doing questions on my lunch breaks or listening to EK audio osmosis. Didn’t do so hot and ended up in an osteopathic school. I absolutely believe that the system is stacked against low SES applicants as I lived through it personally. I sincerely hope that in the future the disadvantages of low SES are paid more attention to in the admissions process because I promise you most of my med school class didn’t have to struggle half as hard as I did to get in.

But that’s undergrad. Once med school starts, everyone is on the same playing field. The disadvantages of being low SES disappear. I don’t empathize with those who don’t do as well once you hit med school.

Paint me as an elitist if it makes you feel better.

Congrats you have overcame diversity. The amount of times I have heard this. What you are insinuating is that the people who didn’t do as well CHOSE not to. Do you go to Harvard med school? If not you didn’t work hard enough.... everything was in your control and you were too lazy to get that acceptance

 

[chlorocruorin]

I’m from a low SES background. I did well.

I worked three jobs to put myself through undergrad bc I didn’t qualify for student aid. My family made just slightly above what it takes to qualify. They also took out credit cards in my name and trashed my credit so no chance of loans of any kind. Anywhere from 50-70 hrs per week at work. Plus full time coursework in school. Oh and I had a child. Even though most of my income went toward paying for school in the first place, my earnings made me unqualified for student aide again. This crazy workload meant that most of my mcat studying was either doing questions on my lunch breaks or listening to EK audio osmosis. Didn’t do so hot and ended up in an osteopathic school. I absolutely believe that the system is stacked against low SES applicants as I lived through it personally. I sincerely hope that in the future the disadvantages of low SES are paid more attention to in the admissions process because I promise you most of my med school class didn’t have to struggle half as hard as I did to get in.

But that’s undergrad. Once med school starts, everyone is on the same playing field. The disadvantages of being low SES disappear. I don’t empathize with those who don’t do as well once you hit med school.

Paint me as an elitist if it makes you feel better.

Tell that to your attending and see if they agree. **** you better be at the best damn residency and win a Nobel peace prize if not you’re a lazy ****

 

[jhenj529]

Given your background, I'm shocked by your apparent lack of empathy. I vehemently disagree. Students don't stop being minorities in medical school, and persons from low-SES backgrounds certainly don't leave their life's circumstances at the door when walking into their first medical school classroom. How is the playing field level? If it was level, minorities and low-SES wouldn't be high risk.

No offense, but you are N = 1. The exception doesn't establish the rule. The data is there for everyone to see. And if you truly believe that the playing field is level, that means that you do consider minorities and students from low-SES to be inherently lazy or less talented. This type of thinking lends to why certain populations suffer needlessly and why certain populations refrain from going to the doctor.

Not to mention, I've never heard someone proclaim to be low SES while stating that their family made too much to qualify for aid. I think what you consider to be low-SES and what the government/social services deem to be low-SES are a bit different..just because you're not the richest person in your medical school class or had to work during college doesn't mean you are low SES.

The truth is at some point, you're just going to have to preform well regardless of those circumstances. We have many measures in place to help out SES and minority individuals. Another patch job at the top wont fix anything. You have to start from the bottom and fix thoee issues

 

[Ho0v-man]

Given your background, I'm shocked by your apparent lack of empathy. I vehemently disagree. Students don't stop being minorities in medical school, and persons from low-SES backgrounds certainly don't leave their life's circumstances at the door when walking into their first medical school classroom. How is the playing field level? If it was level, minorities and low-SES wouldn't be high risk.

No offense, but you are N = 1. The exception doesn't establish the rule. The data is there for everyone to see. And if you truly believe that the playing field is level, that means that you do consider minorities and students from low-SES to be inherently lazy or less talented. This type of thinking lends to why certain populations suffer needlessly and why certain populations refrain from going to the doctor.

Not to mention, I've never heard someone proclaim to be low SES while stating that their family made too much to qualify for aid. I think what you consider to be low-SES and what the government/social services deem to be low-SES are a bit different..just because you're not the richest person in your medical school class or had to work during college doesn't mean you are low SES.

To your last paragraph, it’s called falling through the cracks. I was raised by a single mom who made $20k/year. She got married in my junior year of high school and their combined income was just barely above the cutoff. I received none of this money.

To the bolded, maybe. It’s not like any of the questions in med school or on step 1 are inherently harder for one race/gender vs another. So perhaps that’s correct if that’s what the data suggests. Eventually you have to produce results. When should that start? Eventually you have to do things that are expected of a doctor. Otherwise, you’re a crappy doctor.

 

[deleted957830]

The truth is at some point, you're just going to have to preform well regardless of those circumstances. We have many measures in place to help out SES and minority individuals. Another patch job at the top wont fix anything. You have to start from the bottom and fix thoee issues

I agree. However, I'm not aware of any residency application measures that help low-SES students. Truthfully, I don't believe there are many for minority students either, other than free audition rotations at certain programs.

Where these students suffer most in medical school is on step 1, and that is a good place to start initiating change.

 

[deleted957830]

Eventually you have to produce results. When should that start? Eventually you have to do things that are expected of a doctor. Otherwise, you’re a crappy doctor.

Step 1 is a licensing exam. If you pass, you have what it takes to carry on and do the things that are "expected of a doctor". Why should low SES students and minorities be punished for not exceeding "pass" by a certain arbitrary number?

 

[Ho0v-man]

Congrats you have overcame diversity. The amount of times I have heard this. What you are insinuating is that the people who didn’t do as well CHOSE not to. Do you go to Harvard med school? If not you didn’t work hard enough.... everything was in your control and you were too lazy to get that acceptance

Yes. Well, either they chose not to or were simply unable to do so. The result is the same. Again, I’m talking about once you get into med school.

I’ve already illustrated how one’s background can be a disadvantage in applying to med school and how my circumstances, like so many others, were not ideal for it.

I’m sure someone from worse circumstances than mine have gotten admitted to top MD schools. They are simply better than me I guess. That’s just something everyone needs to accept at some point in their lives.

 

[jhenj529]

I agree. However, I'm not aware of any residency application measures that help low-SES students. Truthfully, I don't believe there are many for minority students either, other than free audition rotations at certain programs.

Where these students suffer most in medical school is on step 1, and that is a good place to start initiating change.

I was talking about FAP in medical school admissions and those other elements. I agree they're not there for residency, but really at what point do you stop? The issues have to be fixed from the ground up. The systemic discrimination. A patch job doesn't do anything.

 

[Ho0v-man]

Step 1 is a licensing exam. If you pass, you have what it takes to carry on and do the things that are "expected of a doctor". Why should low SES students and minorities be punished for not exceeding "pass" by a certain arbitrary number?

And why should those of us who sacrificed so much to do better than just pass be punished to accommodate others? Again, these students had access to the same resources as everyone else.

 

[deleted957830]

And let's not start this argument of "higher step scores = better doctors". Because then we can just argue that higher mcat = higher step 1 = better doctor. Then higher mcat = MD school = better doctor. Then lower mcat = DO school (statistically) = worse doctor. Going further, better undergrad = higher mcat = higher step 1 = better doctor.

People start arguing at the point where they first experience success. Unfortunately, certain groups never get to say mediocre step 1-->great residency-->great resident-->great doctor. And that's a shame.

And I'm glad to see you still referring to those who score less than you as people who didn't work as hard. It's unfortunate that you don't see what's wrong with that. And it's truly scary that you have that attitude and get to see patients who are different from yourself.

 

[sargon2123]

Here are the lists, just for reference. Feel free to add or amend anything worthwhile:

Affirmative:
1. URM's and Low-SES students score lower on average, so p/f takes away that disadvantage.
2. Step 1 was p/f in the past and that was the original intent of the exam.
3. Number-grading has been stressing out med students everywhere when its time to take the test.

Negative:
1. Number-graded step 1 provides the main element of objectivity and merit to the match process
2. A high step score speaks to reasoning ability in difficult problems/dilemmas as a physician
3. Removing this element of objectivity will put disproportionately more influence on school reputation, and will significantly limit the opportunities of students at all DO schools and most MD schools.

 

[Ho0v-man]

And let's not start this argument of "higher step scores = better doctors". Because then we can just argue that higher mcat = higher step 1 = better doctor. Then higher mcat = MD school = better doctor. Then lower mcat = DO school (statistically) = worse doctor. Going further, better undergrad = higher mcat = higher step 1 = better doctor.

People start arguing at the point where they first experience success. Unfortunately, certain groups never get to say mediocre step 1-->great residency-->great resident-->great doctor. And that's a shame.

And I'm glad to see you still referring to those who score less than you as people who didn't work as hard. It's unfortunate that you don't see what's wrong with that.

But a lot of lower mcat+urm=MD school or mediocre mcat+urm=top MD school combos exist. And I’m not even saying that’s bad. I think it’s great to consider that background and give people a chance. But you can’t just do low or mediocre forever and expect results above mediocre. That’s nonsense.

There’s definitely people who didn’t work as hard as me who outscored me. They’re just smarter. Either way, they knew what they had to do and did it. Someone dumber than me could outscore me by working harder.

You do what you gotta do to get the results you want. I didn’t do what it takes to get a 260. I don’t see how that’s anyone’s fault but my own.

 

[deleted957830]

And why should those of us who sacrificed so much to do better than just pass be punished to accommodate others? Again, these students had access to the same resources as everyone else.

I want you to repeat this to your medical school's dean. At my school, you would be suspended for saying something so ridiculous and insensitive. Or better yet, stand in front of a room of minority medical students and tell them how inferior their work ethic is since, statistically speaking, the scores aren't up to snuff. You are unreal...

 

[sargon2123]

I want you to repeat this to your medical school's dean. At my school, you would be suspended for saying something so ridiculous and insensitive. Or better yet, stand in front of a room of minority medical students and tell them how inferior their work ethic is since, statistically speaking, the scores aren't up to snuff. You are unreal...

Minority students aren't failing or borderline failing in droves. Is that what you are implying?

Maybe the mods can weigh in on whether this person violated the racism/harrassment policy of SDN.

 

[Espressso]

The only valid argument against using step 2 as the main numerical objective value in ERAS is the one @AnatomyGrey12 has pointed out, which is that if we use step 2, then it throws off peoples timelines if they don't do as well on it as expected and thus, can't apply to neurosurg or whatever competitive specialty that they had planned. But IMO, I don't think that is that big of a deal. I mean if you aren't planning for backups already then you're making a mistake at it is.

I don't see the problem with f/p/hp or quartiles for step 1, then have step 2 become the more important exam, which forces us to take it earlier than normal (Spring/early summer of third year), which means you have your score well before ERAS opens. And if you're a borderline student, it would be wise to have backups in place for an application if something goes wrong on your ortho app bc of Step 2 score. This seems to be a semi decent change if the NBME is dead set on making some change. Students from non-big name schools still have the chance to crush step 2, and also get high pass on step 1.

 

[deleted957830]

Minority students aren't failing or borderline failing in droves. Is that what you are implying?

Maybe the mods can weigh in on whether this person violated the racism/harrassment policy of SDN.

RR >13

 

[sargon2123]

RR >13

What does this mean?

 

[deleted957830]

What does this mean?

The relative risk of a minority student failing step 1 is greater than 13. Compare this to just over 2 for low ses (which is still astonishing).

Edited

 

[sargon2123]

No one said failing in droves. The relative risk of a minority student failing step 1 is greater than 13. If advocating for change based on this number is racism, along with contending that people who score low don’t necessarily have poor work ethic, I don’t know what to say. This is mentioned directly on the usmle website in terms of why they want to change scoring.

You may want to read about what racism means.

I was saying that if you think the other poster’s question about accommodations was racist, then we should direct the moderators’ attention to it.

 

[deleted957830]

I was saying that if you think the other poster’s question about accommodations was racist, then we should direct the moderators’ attention to it.

My apologies. I’m all ramped up. I fixed my previous response

 

[920820]

A SDN thread can't be a SDN thread without bringing up discussions on SES and minority identity. Congrats everyone you did it again!

If Step 1 goes P/F more people are just going to prioritize Step 2 CK before residency applications are submitted. Y'all know where my energy is going to be focused towards.

 

[freelancePsychic]

Here are some pros/cons as I see them.

Pass fail pros:
1. The confidence intervals are too wide to make for a good way to stratify people.

2. One high-stakes exam is needlessly stressful. One bad day shouldn’t screen out someone from their desired career.

3. After a relatively low score, increasing step score doesn’t show significantly improved clinical ability or board pass rates.

4. Even if it correlated well, the most competitive specialities don’t require more clinical knowledge than the least competitive specialities. Derm doesn’t require a high score because it is more intellectually demanding than Peds.

5. Studying for step distracts from activities that provide useful skills for your future career, e.g. research training for academics, more clinical experiences, public/global health stuff, etc.

6. Some groups tend to get lower step scores. Pass fail may increase representation of these groups in competitive specialities.

Cons:
1. The system would become less meritocratic. Even if step isn’t a great measure of clinical ability, there needs to be a way for ambitious students from obscure MD or DO programs to match competitive specialities. Without step it’s harder.

2. Step 2 may supplant step 1 in stratifying applicants- this would be a negative since it is taken at a more stressful time with less time available for studying, and less time to recover if you get a bad score.

3. More emphasis would be placed on ECs like research. Some students would have to do work they dislike and is irrelevant for their future career, while others would face more competition for stuff like lab spots.

4. More emphasis on subjective measures like clinical grades, LORs, and school reputation

 

[deleted957830]

Here are some pros/cons as I see them.

Pass fail pros:
1. The confidence intervals are too wide to make for a good way to stratify people.

2. One high-stakes exam is needlessly stressful. One bad day shouldn’t screen out someone from their desired career.

3. After a relatively low score, increasing step score doesn’t show significantly improved clinical ability or board pass rates.

4. Even if it correlated well, the most competitive specialities don’t require more clinical knowledge than the least competitive specialities. Derm doesn’t require a high score because it is more intellectually demanding than Peds.

5. Studying for step distracts from activities that provide useful skills for your future career, e.g. research training for academics, more clinical experiences, public/global health stuff, etc.

6. Some groups tend to get lower step scores. Pass fail may increase representation of these groups in competitive specialities.

Cons:
1. The system would become less meritocratic. Even if step isn’t a great measure of clinical ability, there needs to be a way for ambitious students from obscure MD or DO programs to match competitive specialities. Without step it’s harder.

2. Step 2 may supplant step 1 in stratifying applicants- this would be a negative since it is taken at a more stressful time with less time available for studying, and less time to recover if you get a bad score.

3. More emphasis would be placed on ECs like research. Some students would have to do work they dislike and is irrelevant for their future career, while others would face more competition for stuff like lab spots.

4. More emphasis on subjective measures like clinical grades, LORs, and school reputation

This may sound crazy, but couldn’t school name be replaced with us md, us do, etc to make it more generic?

Excellent summary btw.

 

[freelancePsychic]

This may sound crazy, but couldn’t school name be replaced with us md, us do, etc to make it more generic?

Excellent summary btw.

Thanks! And I suppose so. But pass fail will most likely benefit Yale students more than Albany students for instance. And even among mid to low tiers regional reputation would be more important under pass fail. I think it would be easier to match CA if you were from Irvine or a local DO that had put students in that program before, than if you were from a generic midwestern school for instance. That’s what I was trying to get at.

 

[Giovanotto]

The only valid argument against using step 2 as the main numerical objective value in ERAS is the one @AnatomyGrey12 has pointed out, which is that if we use step 2, then it throws off peoples timelines if they don't do as well on it as expected and thus, can't apply to neurosurg or whatever competitive specialty that they had planned. But IMO, I don't think that is that big of a deal. I mean if you aren't planning for backups already then you're making a mistake at it is.

I don't see the problem with f/p/hp or quartiles for step 1, then have step 2 become the more important exam, which forces us to take it earlier than normal (Spring/early summer of third year), which means you have your score well before ERAS opens. And if you're a borderline student, it would be wise to have backups in place for an application if something goes wrong on your ortho app bc of Step 2 score. This seems to be a semi decent change if the NBME is dead set on making some change. Students from non-big name schools still have the chance to crush step 2, and also get high pass on step 1.

Better idea. Why have two steps? Call it step 1.5 and get rid of this multiple stem exam nonsense/cash cow.

 

[Ho0v-man]

I was saying that if you think the other poster’s question about accommodations was racist, then we should direct the moderators’ attention to it.

My personal experience with those underperforming on step 1 has been with high SES caucasians who take multiple vacations during the year and even during dedicated.

It is not racist to expect the same results from someone regardless of race/ethnicity/gender etc.

If the mods believe differently then that’s fine. Go ahead and ban me.

 

[Roverreign]

I'm somewhat ambivalent about the whole situation. Hard to say what will come to pass, but I think even having this possible change being proposed highlights that PDs are perhaps placing too much emphasis on this one exam. For some specialties, there's no chance at redemption in later years, no matter what you do or how hard you work. I definitely think Step 1 is a valuable tool to use for evaluating a student, but it should truly just be one aspect of a holistic look at an applicant. It's weighted too heavily for some fields. My impression is that it's just a tool for PDs to make sure the residents they take on are not a risk factor for failing their Boards.

 

[Neopolymath]

I’m not sure what data you’re thinking of when you say people who score well on step do better on the wards? Things I care about:

1) mortality rates by provider (case mix adjusted obviously)
2) cost of care by provider (case mix adjusted obviously)
3) high patient satisfaction scores by provider (can be HCAHPs, whatever makes sense)
4) enjoyable to work with for all staff (hard to quantify, but maybe you could adapt press ganey employee engagement or satisfaction scales and see if different providers galvanize their coworkers more)
5) efficient enough to see enough volume to generate enough income to stay afloat (have to be able to make money, the sad but unfortunate truth)
6) fewer professionalism reports to state medical boards

I’m sure I’m missing a couple but those are off the top of my head.

Being “better on the wards” by being able to quote a physical exam test with a sensitivity of 4% and specificity of 6%, or knowing the mechanism of action of more drugs without looking them up in this age of information being easily accessible, is not impressive or patient-centered to me. Things that affect co-workers or affect patients (outcomes or costs, not random surrogate outcomes) are what make people good docs.

Happy to see data showing step 1 scores make people better docs by the metrics that matter though, I just have yet to come across it.

Being better on the wards - as a student. Whatever let's you sleep at night though lol.

 

[seeinghowitgoes]

Being better on the wards - as a student. Whatever let's you sleep at night though lol.

If step 1 just correlates with 3rd year ward performance then it could definitely just be pass/fail because you have clerkship grades already, why do we need a duplicate measure for residency selection? Obviously the hope has been that it could give additional information - sadly, it cannot currently predict the things I mentioned (aka predict who will be a good doc), which was really the point of my argument.

A good screener doesn’t predict something nobody cares about (being a good third year student), it’s used to predict how one will perform in the future (like when you’re actually a doc in residency and beyond) on metrics that matter. So yes, those outcomes I mentioned, while not applicable to med students while they are med students, are what we want to predict with any test given in Med schools and used for residency selection (like Step 1 is used currently). Making step Pass/fail doesn’t address the horrendousness of the screener to measure outcomes that matter - which is why I’ve said time and time again I probably favor a pass/fail step but I also wouldn’t die on that hill - but making it pass/fail may just make us dig a little deeper when we can’t just cognitively unload using a number like we do now screening apps via step 1 scores.

On an unrelated and general note, I really don’t get the condescension on this thread. Dang.

 

[Neopolymath]

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

I don't think you understand how to argue a point at all. Why do you keep doing this?

 

[Espressso]

I'm somewhat ambivalent about the whole situation. Hard to say what will come to pass, but I think even having this possible change being proposed highlights that PDs are perhaps placing too much emphasis on this one exam. For some specialties, there's no chance at redemption in later years, no matter what you do or how hard you work. I definitely think Step 1 is a valuable tool to use for evaluating a student, but it should truly just be one aspect of a holistic look at an applicant. It's weighted too heavily for some fields. My impression is that it's just a tool for PDs to make sure the residents they take on are not a risk factor for failing their Boards.

That's the thing. It's become a crazy time because it's become a valuable tool for PDs. Another important aspect would be to limit the amount of apps people send. Or the tiered application idea.

 

[Lawpy]

Are people here intentionally ignoring the stronger focus placed on school name? Everyone keeps complaining that Step 1 is being way too heavily emphasized but what they fail to realize is devaluing this exam will place a much more massive emphasis on school name and school prestige. How is that a good thing?

 

[Ho0v-man]

If step 1 just correlates with 3rd year ward performance then it could definitely just be pass/fail because you have clerkship grades already, why do we need a duplicate measure for residency selection?

This is honestly a good point. The problem being that 3rd year is poorly standardized between schools or even between sites at the same school. Some attendings “don’t believe” in honors. Some give them out like candy. Some schools make it impossible to get honors while others give it to like 1/2 the class. Some schools make shelf exams an inconsequential part of your grade, others make it 100% of your grade. If third year had real standardization across schools then this point would have much more merit. But I’m honestly surprised that these grades are taken more seriously than preclinical grades bc a lot of it is really just a likability score. :/

 

[Neopolymath]

TIL that I'm racist and a POS because I think someone who scored 250/260/270 is either harder working, smarter or both than someone who scored 230. If nothing else it signals to PDs that this applicant is willing to put everything into crushing this exam even if we all know it's sort of silly. That message carries more weight than anything honestly. Sorry, I guess?

 

[Neopolymath]

This is honestly a good point. The problem being that 3rd year is poorly standardized between schools or even between sites at the same school. Some attendings “don’t believe” in honors. Some give them out like candy. Some schools make it impossible to get honors while others give it to like 1/2 the class. Some schools make shelf exams an inconsequential part of your grade, others make it 100% of your grade. If third year had real standardization across schools then this point would have much more merit. But I’m honestly surprised that these grades are taken more seriously than preclinical grades bc a lot of it is really just a likability score. :/

Some students take shelf exams after a different number of IM weeks than other students even at their own school and thus would have a different amount of time to study etc etc. 3rd year is probably less standardized than the first two years of medicine by far given everyone that isn't insane just UFAPS the first two years.

 

[Premed2295]

1. How far from exam are you out?
2. What are your weak areas, any trends you've spotted? Are you struggling with physiology, anatomy, or a body systems?
3. Are you aggressively using FA, B&B, Anki decks or sort of doing light reviewing with them and then focusing on questions?

Just got accepted!!

Some students take shelf exams after a different number of IM weeks than other students even at their own school and thus would have a different amount of time to study etc etc. 3rd year is probably less standardized than the first two years of medicine by far given everyone that isn't insane just UFAPS the first two years.

Could you not then argue the same for step 1. Some schools offer step 1 after 2nd or 3rd year while others halfway through second year.

Do you not think that would make some people inherently score lower because they had less time to prepare if the shelf exams have a major effect.

That doesn’t seem to typically be the case

 

[Espressso]

What do you guys think the main reason is the NBME is even thinking about making changes to step 1?

 

[chlorocruorin]

TIL that I'm racist and a POS because I think someone who scored 250/260/270 is either harder working, smarter or both than someone who scored 230. If nothing else it signals to PDs that this applicant is willing to put everything into crushing this exam even if we all know it's sort of silly. That message carries more weight than anything honestly. Sorry, I guess?

You’re not racist. You scored higher because you’re a better test taker maybe? C’mon I know you’re smarter than that. Work ethic has very little to do with performance on a standardized test. But since you make the claim, where is your supporting data? Minorities score lower than there counterparts on standardized tests across the board (SAT,GRE,MCAT,USMLE) are they lazier than you? It’s going to be a shame when you are not at the top inn whatever area and you realize that even with a high work ethic you will still not be at the top. Have you ever heard of good test takers and poor test takers? Lmao y’all crack me up on here. You’re going to be a doctor yet can’t even figure out that, it’s a damn shame. And the scary part is, many agree with you which is wrong and why P/F is a better alternative IMO.

Consider this example. Idk who you are but i know damn well you not running a 4.3 forty. If I said
“If you can’t run a 4.3 forty yard dash then you don’t have a higher work ethic than me bc I worked my butt of and got it.”

Or what if I said, “no matter the gender, if you can’t bench 300lbs, then you don’t have a higher work ethic than me, I don’t care that it would be tougher for females and those who don’t work out. if you can’t bench that much you don’t have that high of a work ethic”

 

[Chelsea FC]

How are people with red flags on their apps, like a repeated year suppose to redeem themselves ??

 

[Ho0v-man]

You’re not racist. Maybe a POS because you are being highly insensitive and you’re flat out wrong lmao. You scored higher because you’re a better test taker maybe? C’mon I know you’re smarter than that. Work ethic has very little to do with performance on a standardized test. But since you make the claim, where is your supporting data? Minorities score lower than there counterparts on standardized tests across the board (SAT,GRE,MCAT,USMLE) are they lazier than you? You sound like POS when you think just bc you put in hard work means that everyone who scores high must have put in the same amount of work and people who score less don’t. Literature literally contradicts your claim linking usmle and work ethic in residency. Again, you are making claims out of your ass. It’s going to be a shame when you are not at the top inn whatever area and you realize that even with a high work ethic you will still not be at the top. Have you ever heard of good test takers and poor test takers? Lmao y’all crack me up on here. You’re going to be a doctor yet can’t even figure out that, it’s a damn shame. And the scary part is, many agree with you which is wrong and why P/F is a better alternative IMO.

Consider this example. Idk who you are but i know damn well you not running a 4.3 forty. If I said
“If you can’t run a 4.3 forty yard dash then you don’t have a higher work ethic than me bc I worked my butt of and got it.”

Or what if I said, “no matter the gender, if you can’t bench 300lbs, then you don’t have a higher work ethic than me, I don’t care that it would be tougher for females and those who don’t work out. if you can’t bench that much you don’t have that high of a work ethic”

Looking through your posts, it looks like you’re a premed and were fortunate gain acceptance to several MD schools with kind of crappy stats. Maybe URM, low SES, ESL, lucky state, I don’t know and I don’t care. The point is, you’re gonna be a doctor. Congrats!!

But from these posts it seems like your insecure about being a low stat applicant and projecting them onto this discussion. It took me two tries to break 500 in the mcat and I did it just barely. I had similar insecurities. But while being a good test taker is super important for the mcat, it’ll never save you on step if you don’t know your sh**. In fact, a lot of the complaints about this transition to pass/fail are bc it disproportionately benefits high mcat scorers (which examines test taking ability and some basic sciences) vs high step scorers (an examination of the fundamental sciences related to being a doctor, a knowledge exam). One of the lowest performing students in my class probably had the highest mcat score because test taking skill was carrying him almost all the way.

You can do well on these exams even if you’ve been mediocre up until now. It’s a whole different ball game. But you gotta put in the work.

 

[Neopolymath]

You’re not racist. Maybe a POS because you are being highly insensitive and you’re flat out wrong lmao. You scored higher because you’re a better test taker maybe? C’mon I know you’re smarter than that. Work ethic has very little to do with performance on a standardized test. But since you make the claim, where is your supporting data? Minorities score lower than there counterparts on standardized tests across the board (SAT,GRE,MCAT,USMLE) are they lazier than you? You sound like POS when you think just bc you put in hard work means that everyone who scores high must have put in the same amount of work and people who score less don’t. Literature literally contradicts your claim linking usmle and work ethic in residency. Again, you are making claims out of your ass. It’s going to be a shame when you are not at the top inn whatever area and you realize that even with a high work ethic you will still not be at the top. Have you ever heard of good test takers and poor test takers? Lmao y’all crack me up on here. You’re going to be a doctor yet can’t even figure out that, it’s a damn shame. And the scary part is, many agree with you which is wrong and why P/F is a better alternative IMO.

Consider this example. Idk who you are but i know damn well you not running a 4.3 forty. If I said
“If you can’t run a 4.3 forty yard dash then you don’t have a higher work ethic than me bc I worked my butt of and got it.”

Or what if I said, “no matter the gender, if you can’t bench 300lbs, then you don’t have a higher work ethic than me, I don’t care that it would be tougher for females and those who don’t work out. if you can’t bench that much you don’t have that high of a work ethic”

This is a huge mess and would take take quite the lengthy screed to unpack all the fallacies in it. You put an awful lot of words in my mouth that I didn't say and have repeatedly failed to discuss pretty much anything in good faith in this thread with numerous posters. That's ok. When you are done with Step 1 I will be expecting your manifesto explaining why Step 1 is racist so that I can understand what I missed.

As for your analogies, as bad as they are at arguing your point, I will humor them. Medicine uses metrics like that already. You just don't notice it because the bar is far lower. No one can "work" to be taller so the NBA is filled with the 0.1% of people who fit those attributes. This is another example of your analogy. Is the NBA wrong for not letting less physically gifted athletes into the league? Medicine doesn't have a barrier to entry near as high AND (imperfect as they are) has some methods to help people enter it that are disadvantaged. Intelligence is a barrier to entry medicine in general. I don't see you fighting for people to be doctors with 25 mcats lol. Why not??? You said yourself these people can't choose that they aren't very smart.

Choosing a specialty is a different matter. No one guaranteed you upon acceptance that you wouldbe a neurosurgeon or the Center on an NBA team even if you are good enough for the NBA overall. The attractiveness of a specialty determines its competitiveness. It is not in the best interests of PDs to take less competitive applicants ("because they want to be an orthopedic surgeon SOOOOOO bad") just because it might not be fair to whoever is whining. It's economics. Performing well in medicine is a combination of intelligence and work ethic much like height is a precursor to doing well in the NBA. I can't help it if some people can't ball that hard.

And on a semi-serious, but humorous note, this discussion reminds me of the great Daniel Tosh skit about being test-takers.

 

[AnatomyGrey12]

I want you to repeat this to your medical school's dean. At my school, you would be suspended for saying something so ridiculous and insensitive. Or better yet, stand in front of a room of minority medical students and tell them how inferior their work ethic is since, statistically speaking, the scores aren't up to snuff. You are unreal...

If your school would suspend someone for that.... if you think Step isn’t heavily correlated with effort then you haven’t taken Step.

What do you guys think the main reason is the NBME is even thinking about making changes to step 1?

The elite school students are whining about “wellness.” Medical educators are also complaining because no one attends their garbage lectures anymore.

 

[993444]

I wonder if they might end up doing a tier system instead (Fail, Pass, High Pass, Honors Pass etc)?