Pass/ Fail Step 1

[Cranjis McBasketball]

“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”

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[ginsengreset]

I thought it was pretty well-established that test-taking ability plays a huge role for the MCAT, but takes a backseat to being able to cram loads of information when it comes to Step 1. The latter would be pretty correlated with work ethic, especially since there are loads of Anki decks that require daily review but can get you pretty far in terms of Step 1 prep.

On the other hand, if you haven't had the resources early-on to perfect your studying and come up with your own unique strategies to maximize the amount of information you retain, I guess you'd be disadvantaged relative to someone who did, even if you had the same work ethic.

 

[Ho0v-man]

Medical educators are also complaining because no one attends their garbage lectures anymore.

The way I’ve looked at this aspect isn’t so much that they care about attendance. It’s more along the lines that they don’t care at all. Imagine if a school had an entire class of sub 205 step scores. That administration is going to come down HARD on every department. But if it’s magically replaced with a “P” then it doesn’t matter. Going p/f for step 1 essentially puts zero pressure on schools to ever improve their curricula.

 

[920820]

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

If you read the preliminary InCUS recommendations you'd see they've considered recommending a quintile scoring system.

 

[993444]

preliminary InCUS recommendations.

dont even know what that is

 

[920820]

dont even know what that is

https://www.usmle.org/pdfs/incus/incus_summary_report.pdf

Page 14

Changes within the USMLE program should take place to meet the following goals.
1) Reduce the adverse impact of the current overemphasis on USMLE performance in
residency screening and selection through consideration of changes such as pass/fail
scoring.
The most direct means by which the USMLE program may be able to reduce unintended adverse
impact is to consider fundamental changes to its current score reporting practices. Options that
garnered significant discussion at InCUS included the following:
(a) Pass/Fail (of Step 1 alone or the entire USMLE sequence);
(b) Categorical/tiered scoring of USMLE (e.g., quartiles, quintiles, or some other division);
(c) A composite score across the assessments within USMLE’s Decision Point 1 (DP1),
consisting of aggregate performance information from Step 1, Step 2 CK and Step 2 CS.

I am opposed to P/F scoring as much as the next person, but I am worried that there is a growing number of people who think that the future of Step 1 will be P/F or bust, and nothing in between, when the reality is that there are still a myriad of suggested possibilities on what changes will be formally recommended.

 

[Ho0v-man]

https://www.usmle.org/pdfs/incus/incus_summary_report.pdf

Page 14

Changes within the USMLE program should take place to meet the following goals.
1) Reduce the adverse impact of the current overemphasis on USMLE performance in
residency screening and selection through consideration of changes such as pass/fail
scoring.
The most direct means by which the USMLE program may be able to reduce unintended adverse
impact is to consider fundamental changes to its current score reporting practices. Options that
garnered significant discussion at InCUS included the following:
(a) Pass/Fail (of Step 1 alone or the entire USMLE sequence);
(b) Categorical/tiered scoring of USMLE (e.g., quartiles, quintiles, or some other division);
(c) A composite score across the assessments within USMLE’s Decision Point 1 (DP1),
consisting of aggregate performance information from Step 1, Step 2 CK and Step 2 CS.

I am opposed to P/F scoring as much as the next person, but I am worried that there is a growing number of people who think that the future of Step 1 will be P/F or bust, and nothing in between, when the reality is that there are still a myriad of suggested possibilities on what changes will be formally recommended.

B and C are super reasonable. I personally like C the most as it actually gives you a chance to redeem yourself if Step 1 goes kinda sideways for whatever reason. The way it’s setup now is that if you don’t meet the step 1 cutoff, it doesn’t matter if you “kill step 2” despite the fact that that’s the advice often parroted on sdn. Even though it’s highly unlikely, under the current setup for some fields you could literally get a 280 on step 2 and it wouldn’t matter because you got a 220 step 1. That’s insane.

 

[AnatomyGrey12]

B and C are super reasonable. I personally like C the most as it actually gives you a chance to redeem yourself if Step 1 goes kinda sideways for whatever reason. The way it’s setup now is that if you don’t meet the step 1 cutoff, it doesn’t matter if you “kill step 2” despite the fact that that’s the advice often parroted on sdn. Even though it’s highly unlikely, under the current setup for some fields you could literally get a 280 on step 2 and it wouldn’t matter because you got a 220 step 1. That’s insane.

The only caveat with C is it looks like they would make Step 2 CS scored which would be the worst and most subjective thing they could possibly do. That test is already worthless, giving it the ability to tank someone is crazy.

The way it’s setup now is that if you don’t meet the step 1 cutoff, it doesn’t matter if you “kill step 2” despite the fact that that’s the advice often parroted on sdn.

Eh I’ve seen this happen multiple times in real life. Many of those Step 1 screens aren’t as hard as many believe.

 

[Ho0v-man]

The only caveat with C is it looks like they would make Step 2 CS scored which would be the worst and most subjective thing they could possibly do. That test is already worthless, giving it the ability to tank someone is crazy.


Eh I’ve seen this happen multiple times in real life. Many of those Step 1 screens aren’t as hard as many believe.

Ah, I figured it would just be like a p or an f next to a numerical score.

 

[studentdocftw]

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”

I appreciate your perspective, but stop with the analogies. They are out of place and not applicable to the situation at hand.

 

[jhenj529]

The only caveat with C is it looks like they would make Step 2 CS scored which would be the worst and most subjective thing they could possibly do. That test is already worthless, giving it the ability to tank someone is crazy.


Eh I’ve seen this happen multiple times in real life. Many of those Step 1 screens aren’t as hard as many believe.

Yeah the MCAT screens are a million times worse.

 

[Chibucks15]

I’m way behind this thread but after taking step, scoring is necessary. However, it isn’t simply a work ethic test, which is the common statement on here. I studied longer and harder than my buddy and he beat me by 20+ points. People have different ceilings. Intelligence is a real factor.

The system I’ve thought would work is put it into quartiles so people don’t get worked up over a 228 vs a 230, 248 vs 250, etc. Also rework some of the content to be more relevant. We don’t need as many specific pathways and BS like that

That way it’s still stratified but takes off some of the burn students go wild with. Idk everyone needs to chill

 

[libertyyne]

1. Step 1 is dumb exam that does not predict how good of a doctor you will be.
2. Step 1 is a direct function of how hard you worked during m1-m2. More likely than not, people that did not work during m1, m2 ended up delaying in my class or failing it all together. It is nothing like the MCAT where intelligence / test taking plays a huge role.
3. Low step scores do not necessarily exclude you from the most competitive specialties, since there are still applicants that match at the lower end of the spectrum, just makes it difficult.
4. URM disadvantage is not going to go away since the damage done during primary schooling means that they are still going to fail the pass fail exam at current rates.
5. USMLE is already tiered. Most places just soft screen based on those tiers.
6. Step 2 is going to become the next step 1, not going to make a difference. Or subject NBMEs or class standing and school rank.

 

[studentdocftw]

https://www.usmle.org/pdfs/incus/incus_summary_report.pdf

Page 14

Changes within the USMLE program should take place to meet the following goals.
1) Reduce the adverse impact of the current overemphasis on USMLE performance in
residency screening and selection through consideration of changes such as pass/fail
scoring.
The most direct means by which the USMLE program may be able to reduce unintended adverse
impact is to consider fundamental changes to its current score reporting practices. Options that
garnered significant discussion at InCUS included the following:
(a) Pass/Fail (of Step 1 alone or the entire USMLE sequence);
(b) Categorical/tiered scoring of USMLE (e.g., quartiles, quintiles, or some other division);
(c) A composite score across the assessments within USMLE’s Decision Point 1 (DP1),
consisting of aggregate performance information from Step 1, Step 2 CK and Step 2 CS.

I am opposed to P/F scoring as much as the next person, but I am worried that there is a growing number of people who think that the future of Step 1 will be P/F or bust, and nothing in between, when the reality is that there are still a myriad of suggested possibilities on what changes will be formally recommended.

The composite score is a solid medium. It would effectively become the most objective metric conveying your performance in the 4 years of medical school. I'd make it a blind average...so PDs wouldnt know how you did on each individual exam, just your average score for both. It would give people a chance at redemption for poor Step 1 performance, but would simultaneously encourage everyone to finish strong (in the past step 2 was glossed over...I know it's more important now but I'm sure some specialties just want to see a pass).

 

[AnatomyGrey12]

average...so PDs wouldnt know how you did on each individual exam, just your average score for both.

I mean, with only two tests it’s not hard to figure out what someone got on bh tests from the average.....

 

[studentdocftw]

I mean, with only two tests it’s not hard to figure out what someone got on bh tests from the average.....

It's not hard to make an educated guess, but you would never truly know. I know of some classmates that made 220s on step 1, but 260s on step 2. In the current system, that 220 would be screened out at some places..but with a composite average, a 240 would probably meet the cutoff at most programs. Now of course, given a composite system, the average screen would probably increase...but if we assume that 220 is the current cutoff for step 1..that's around 30%...equivalent to roughly 235 on step 2. If places still used 30% as the cutoff for the composite, the new cutoff would be around a 228. I'm sure there are plenty of people that score 220 on step 1 and then 240 on step 2..as that jump is reasonable. Previously screened out, they would now meet the cutoff, but the PDs would never know that candidate scored 220 on step 1 (for all they know, it could've been 230/230, 220/240, 235/225, etc.)

 

[deleted765155]

I'm convinced that anyone supporting step 1 becoming pass fail either:

a) got less than a 230 and is salty
b) goes to a top-tier med school and doesn't need a high score to do the specialty that they want
c) has yet to take step 1 and doesn't want to grind

yall suck with your holistic bull

I'm saving my score report and submitting it as a supplementary document to any residency programs if it's taken away from me.

 

[Chibucks15]

I'm convinced that anyone supporting step 1 becoming pass fail either:

a) got less than a 230 and is salty
b) goes to a top-tier med school and doesn't need a high score to do the specialty that they want
c) has yet to take step 1 and doesn't want to grind

yall suck with your holistic bull

I'm saving my score report and submitting it as a supplementary document to any residency programs if it's taken away from me.

I think it’s a lot more of the latter 2. People who got 225+ are still in pretty good shape if they don’t want Uber competitive things. It’s the people who wanted surgery but got 210s or less that make the noise

 

[Neopolymath]

I'm convinced that anyone supporting step 1 becoming pass fail either:

a) got less than a 230 and is salty
b) goes to a top-tier med school and doesn't need a high score to do the specialty that they want
c) has yet to take step 1 and doesn't want to grind

yall suck with your holistic bull

I'm saving my score report and submitting it as a supplementary document to any residency programs if it's taken away from me.

You mean you don't want to be judged on how many bs fake volunteering activities you did?

 

[deleted765155]

You mean you don't want to be judged on how many bs fake volunteering activities you did?

Well we should be judged by that because more volunteering equals more holistic doctor

 

[Ho0v-man]

I think it’s a lot more of the latter 2. People who got 225+ are still in pretty good shape if they don’t want Uber competitive things. It’s the people who wanted surgery but got 210s or less that make the noise

Mos def. Even a DO with a 220 can get any non surgical/non derm field. Just sometimes not at *gasp* top places.

 

[sargon2123]

Quartiles/quintiles honestly seem like a great solution and a great way to meet both sides in the middle

 

[Chibucks15]

Mos def. Even a DO with a 220 can get any non surgical/non derm field. Just sometimes not at *gasp* top places.

If people want to leave me places in the Midwest at middle places because those types of things are “below them” then sure whatever floats your boat. Enjoy your research year because you can’t match in the NE or Cali at the top places and ‘can’t imagine anywhere else’

Idk I’ve met a lot of people who will refuse anywhere besides those places and it’s such an immature nonsense mindset

 

[AnatomyGrey12]

Mos def. Even a DO with a 220 can get any non surgical/non derm field. Just sometimes not at *gasp* top places.

Hell even for General Surgery as long as a DO with 220 is willing to apply all over the country and audition at the DO programs they have a pretty good shot if they have no red flags. People get so caught up in prestige and location, it’s insane. If you will only do X specialty if its in a certain location or at a certain tier of program then you never really wanted that specialty in the first place.

I'm convinced that anyone supporting step 1 becoming pass fail either:

a) got less than a 230 and is salty
b) goes to a top-tier med school and doesn't need a high score to do the specialty that they want
c) has yet to take step 1 and doesn't want to grind

yall suck with your holistic bull

I'm saving my score report and submitting it as a supplementary document to any residency programs if it's taken away from me.

This. I honestly don’t see how they could implement a retroactive P/F for people who already have their scores. PDs would also flip out because they wouldn’t have any way to compensate for the loss of their number one comparison metric, ie no time to develop a specialty specific exam.

 

[jhenj529]

Quartiles/quintiles honestly seem like a great solution and a great way to meet both sides in the middle

But then it comes down to imagine if you were 1 point away from the next quintile. 239 to 240 might not be a big difference now but if those are in two separate quintiles that makes all the difference

 

[Giovanotto]

But then it comes down to imagine if you were 1 point away from the next quintile. 239 to 240 might not be a big difference now but if those are in two separate quintiles that makes all the difference

It sucks, but a lot of places are doing this on their end already. I mean there are VSAS sites out there that won't take students that score < 225 on USMLE Step 1. Imagine missing that by one point.

 

[Chibucks15]

It sucks, but a lot of places are doing this on their end already. I mean there are VSAS sites out there that won't take students that score < 225 on USMLE Step 1. Imagine missing that by one point.

But at the same time I bet they put that to discourage apps. And when they’re 220+ I bet they still get looks

 

[993444]

What are the most common EC's to do in medical school, besides research?

 

[Chibucks15]

What are the most common EC's to do in medical school, besides research?

None that matter. Nobody really cares about VP of random specialty club where you don’t do anything. I did a couple just for CV fillers but don’t expect them to garner anything

 

[olabrador23]

What are the most common EC's to do in medical school, besides research?

after Step goes P/F, my guess is spending huge time kissing big b*tts will probably the most common EC next to research whose to kiss up (jk) (sigh)

 

[993444]

None that matter. Nobody really cares about VP of random specialty club where you don’t do anything. I did a couple just for CV fillers but don’t expect them to garner anything

So residency placement really just depends on Research + Step scores + Clerkship performance +LORS?

 

[Chibucks15]

So residency placement really just depends on Research + Step scores + Clerkship performance +LORS?

And being competent/not being an a hole yeah pretty much. Some ECs can get you networking opportunities that help and some are so unique and cool that they stand out,
But running some club for a year at school ain’t that important. I literally didn’t have to even interview for mine because they needed somebody and asked if I wanted to do it

 

[olabrador23]

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.

no they do not have to. Why can they not continue to enjoy the same advantages that got them in med school in the first place??? Same resource or not, do you come from a disadvantaged background like they do??? of course you do not.

yeah, so It is only fair...

(Disclosure: I am a person of color, a refugee, no money + no English when I got here. So please do not tell me that I do not know how hard things are that I have had to overcome... sheeez....)

 

[Lawpy]

As much i like to discuss various hypothetical scenarios, we don't know the final decision. And apparently the attendings over in the specialty forums think the change is unlikely going to happen. So it's probably best to wait and see.

Also, from my understanding based on what experienced members/faculty said, it is apparently extremely unlikely that those who took Step 1 and got scores will get retroactively converted to pass/fail. That just gives an opportunity for NBME to get massively sued.

 

[olabrador23]

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

yeah, except that Step P/F will probably make that problem even worse....

 

[993444]

As much i like to discuss various hypothetical scenarios, we don't know the final decision. And apparently the attendings over in the specialty forums think the change is unlikely going to happen. So it's probably best to wait and see.

Also, from my understanding based on what experienced members/faculty said, it is apparently extremely unlikely that those who took Step 1 and got scores will get retroactively converted to pass/fail. That just gives an opportunity for NBME to get massively sued.

Do we know when the decision will be made?

 

[Lawpy]

Do we know when the decision will be made?

Supposedly in the fall of this year: United States Medical Licensing Examination | Invitational Conference on USMLE Scoring

 

[Lucca]

Just caught up reading like 4 pages and doesn’t seem anyone’s budged an inch. I think @freelancePsychic had the best good-faith summary of the two most polarized camps. It would be nice if everyone actually read the document before posting lol they also go into pros/cons in the reading materials on the incus website + the podcasts + the final recommendations...

the most important takeaways from all of those materials that are being almost completely ignored in this discussion, in my opinion, are:

A) changes to Step 1 scoring are extremely unlikely to happen without changes in other parts of UME/GME precisely because different stakeholders on either side of the Match have such different goals and priorities. The only thing that is ever discussed is some mythical universe where Step 1 goes P/F overnight and then absolutely nothing else happens as a consequence of that; a universe which was never going to materialize by the impetus of InCUS or not judging from the comments of PDs and Med Ed folks online alone.

B) stakeholders don’t think there’s enough research on many of these issues to make the best possible decision so kicking the can down the road until there’s more study on alternatives is just as likely at this point as anything else.

I stand my ground of:
1) high-stakes standardized exams are a bad way to do anything except train people for high-stakes standardized exams.
2) the scoring of an exam should reflect the resolution of the exam to suss out meaningful differences, broadly defined. If the range at which that is possible is big, the scoring needs to be coarse relative to performance; if it’s small, scoring needs to be fine relative to performance. For Step 1 it is ****ing massive and quintiles/quartiles seems the most sensible compromise
3) hard cap application number per specialty applied
4) more standardized, multidimensional metrics for PDs to use to make better informed decisions that are more likely to yield meaningful selection criteria built upon longitudinal performance in medical school not just one day; e.g. SLOE-type system across the board.

 

[Lawpy]

yeah, except that Step P/F will probably make that problem even worse....

I agree. I haven't found any arguments in favor of P/F that made sense. Most are from biased students at top schools who want school name to matter more while they can use the time to churn out more papers, get another degree, do fun things etc. or those who think Step 1 is too heavily emphasized without realizing the worse alternative that'd happen if Step 1 goes P/F.

 

[Giovanotto]

But at the same time I bet they put that to discourage apps. And when they’re 220+ I bet they still get looks

You're wrong. They're hard cut offs.

 

[Lawpy]

Just caught up reading like 4 pages and doesn’t seem anyone’s budged an inch. I think @freelancePsychic had the best good-faith summary of the two most polarized camps. It would be nice if everyone actually read the document before posting lol they also go into pros/cons in the reading materials on the incus website + the podcasts + the final recommendations...

the most important takeaways from all of those materials that are being almost completely ignored in this discussion, in my opinion, are:

A) changes to Step 1 scoring are extremely unlikely to happen without changes in other parts of UME/GME precisely because different stakeholders on either side of the Match have such different goals and priorities. The only thing that is ever discussed is some mythical universe where Step 1 goes P/F overnight and then absolutely nothing else happens as a consequence of that; a universe which was never going to materialize by the impetus of InCUS or not judging from the comments of PDs and Med Ed folks online alone.

B) stakeholders don’t think there’s enough research on many of these issues to make the best possible decision so kicking the can down the road until there’s more study on alternatives is just as likely at this point as anything else.

I stand my ground of:
1) high-stakes standardized exams are a bad way to do anything except train people for high-stakes standardized exams.
2) the scoring of an exam should reflect the resolution of the exam to suss out meaningful differences, broadly defined. If the range at which that is possible is big, the scoring needs to be coarse relative to performance; if it’s small, scoring needs to be fine relative to performance. For Step 1 it is ****ing massive and quintiles/quartiles seems the most sensible compromise
3) hard cap application number per specialty applied
4) more standardized, multidimensional metrics for PDs to use to make better informed decisions that are more likely to yield meaningful selection criteria; e.g. SLOE-type system across the board.

That's why I'm looking forward to the final decisions made. Unfortunately, P/F Step 1 threads keep getting bumped or created regularly with paranoia and hypothetical scenarios being repeated endlessly. We can make suggestions provided they are actually reasonable. But in the end, the decisions are made by the higher-ups so the med students have no choice but to play the game.

 

[AnatomyGrey12]

You're wrong. They're hard cut offs.

But they often aren’t. I literally know people that matched at programs with scores below their published cutoff. You can also find examples of it through the residency threads on SDN.

I even know of DOs who matched ortho with scores below the published cutoff.

So sure, sometimes they are hard cutoffs, but many times they actually aren’t and someone still reads the apps.

 

[Espressso]

But they often aren’t. I literally know people that matched at programs with scores below their published cutoff. You can also find examples of it through the residency threads on SDN.

I even know of DOs who matched ortho with scores below the published cutoff.

So sure, sometimes they are hard cutoffs, but many times they actually aren’t and someone still reads the apps.

 

[libertyyne]

If people want to leave me places in the Midwest at middle places because those types of things are “below them” then sure whatever floats your boat. Enjoy your research year because you can’t match in the NE or Cali at the top places and ‘can’t imagine anywhere else’

Idk I’ve met a lot of people who will refuse anywhere besides those places and it’s such an immature nonsense mindset

nothing immature about having a prefernce for specific areas.

 

[libertyyne]

You're wrong. They're hard cut offs.

My neurosurgery and Ortho programs say they have cuttoffs Around 235 but also said that if you are below those numbers just email them.

 

[Espressso]

My neurosurgery and Ortho programs say they have cuttoffs Around 235 but also said that if you are below those numbers just email them.

IM programs I've emailed have also mentioned that these cut-offs are soft and if you're just under them, to contact them and let them know. Seems to be variable depending on the program.

 

[jhenj529]

It sucks, but a lot of places are doing this on their end already. I mean there are VSAS sites out there that won't take students that score < 225 on USMLE Step 1. Imagine missing that by one point.

I have not seen a single program with a dead and fast cut off like they do for the MCAT score.

 

[Chibucks15]

nothing immature about having a prefernce for specific areas.

Not at all. But a preference is different than an outright refusal to even consider because “I’m definitely an ivy material person and can’t be bothered by anything lower”. I’ve legit been talked down to for not wanting some of those places haha to each their own I guess

 

[7331poas]

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”

Good test taker does not exist. There are people who know content and those who do not.

 

[Giovanotto]

I have not seen a single program with a dead and fast cut off like they do for the MCAT score.

Well obviously I have otherwise I wouldn't be posting about it. And I was referring to VSAS, still not sure how the match is, but if it's anything like my experience with VSAS then....