Pass/ Fail Step 1

[jhenj529]

Nothing you have written is in any way related to what I wrote.

It might be good for you to do some reading comprehension practice. The AAMC has some good passages for you to look at. Ignorance is bliss

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[Lawpy]

IF is the key word. There's no guarantee. With the match structured the way it is, you almost have 99% chance matching into A residency with that score. The same cannot be said about DO schools and a 500 MCAT

Idk it's hard to view match process as something guaranteed after seeing numerous stories of people going unmatched every year

 

[jhenj529]

Idk it's hard to view match process as something guaranteed after seeing numerous stories of people going unmatched every year

That's because they're trying to go Ortho or bust.

 

[VA Hopeful Dr]

It might be good for you to do some reading comprehension practice. The AAMC has some good passages for you to look at. Ignorance is bliss

Hardly, but why don't you explain how your nonsense related to my post?

 

[NotAProgDirector]

It's because people aren't getting the specialties they want because of Step 1 cutoffs.

There are a limited number of Ortho spots each year (picking Ortho for example, feel free to exchange with Derm / Top IM / etc). More people want those spots than the number available. Much like musical chairs, someone isn't getting a seat/spot when the music stops / match happens. If we stop using S1 as a selection criteria, then something else gets used. For every person who didn't get an ortho spot in the prior system who now gets one, someone else loses a spot. Whether that's fair or good all depends upon your point of view.

 

[aldol16]

There are a limited number of Ortho spots each year (picking Ortho for example, feel free to exchange with Derm / Top IM / etc). More people want those spots than the number available. Much like musical chairs, someone isn't getting a seat/spot when the music stops / match happens. If we stop using S1 as a selection criteria, then something else gets used. For every person who didn't get an ortho spot in the prior system who now gets one, someone else loses a spot. Whether that's fair or good all depends upon your point of view.

I am against making Step 1 P/F. I do not believe that there is any other better metric for students. I think if one had to create a system to distinguish people, everyone behind a veil of ignorance would select a system that is standardized, quantitative, and sufficiently reliable at distinguishing high performers from low performers. I think Step 1 does that. It doesn't tell you how good of a doctor that person will be, but that's not the point of Step 1, in my opinion. The point of Step 1 is to assess how well a medical student can learn and apply medical knowledge and principles. So I think the way forward is making it more critical thinking and analysis heavy rather than rote memorization (it is already headed in that direction).

 

[Espadaleader]

I have a different position. Step 1 SHOULD be pass/fail. You are a first or second year. You’re new. You are getting adjusted. Pass/fail. Step 2 should be graded. You are a 4th year. You had 4 years to overcome your public high school, crappy undergrad etc.

 

[Espadaleader]

At that point, Step 2, I need to know you can close for the in service exams

 

[kb1900]

I have a different position. Step 1 SHOULD be pass/fail. You are a first or second year. You’re new. You are getting adjusted. Pass/fail. Step 2 should be graded. You are a 4th year. You had 4 years to overcome your public high school, crappy undergrad etc.

Right right...it’s after 20 years of education where you gotta draw the line. 18 years is way too soon /s

 

[aldol16]

I have a different position. Step 1 SHOULD be pass/fail. You are a first or second year. You’re new. You are getting adjusted. Pass/fail. Step 2 should be graded. You are a 4th year. You had 4 years to overcome your public high school, crappy undergrad etc.

This sounds like what someone who did well on Step 2 but poorly on Step 1 would say. I'm not saying that you are that person (please don't respond defending your high Step 1 score). I'm just saying that this would basically 1) benefit someone who does fit that profile and 2) punt the ball down the road for a worse field position. Basically, then you'll have people who want to go into neurosurgery doing poorly on Step 2 after basically finishing med school and having no time to become competitive for any other specialty without taking time off.

 

[sargon2123]

He went to a top 5. His proposal would benefit students from his alma mater and the like

 

[Vladimir7]

It might be good for you to do some reading comprehension practice. The AAMC has some good passages for you to look at. Ignorance is bliss

DAAYYUUUM. Thats some HIGH KEY shade.. chill y’all pleasee

 

[premed9901]

Reminder that the period for feedback is drawing to a close, and that even new scores that have been standardized may become marked as simply "pass/fail"; United States Medical Licensing Examination

@libertyyne

 

[libertyyne]

Reminder that the period for feedback is drawing to a close, and that even new scores that have been standardized may become marked as simply "pass/fail"; United States Medical Licensing Examination

@libertyyne

I already have a PDF copy of mine, I am going to attach that sucker to all residency applications one way or the other.

 

[sargon2123]

I already have a PDF copy of mine, I am going to attach that sucker to all residency applications one way or the other.

A moment of silence for those who will forget to do this or who are unaware of p/f step 1 (yes there are plenty of oblivious med students about this)

 

[ginsengreset]

If a change is made to report only pass/fail outcomes on one or more Step examinations, score reports provided to examinees will still include information about relative performance, both overall and in specific content areas.

Does this mean you would still get your percentiles?

 

[aldol16]

This is still so hopelessly idiotic. It's hard to see why anybody would support this except students at the best medical schools going into fields without much competition from other students at their med school. Hard to believe that any other intelligent person who's thought about this would be for it.

 

[Ho0v-man]

Reminder that the period for feedback is drawing to a close, and that even new scores that have been standardized may become marked as simply "pass/fail"; United States Medical Licensing Examination

@libertyyne

Glad I saw this post. Saved it on 3 devices

 

[Ho0v-man]

This is still so hopelessly idiotic. It's hard to see why anybody would support this except students at the best medical schools going into fields without much competition from other students at their med school. Hard to believe that any other intelligent person who's thought about this would be for it.

Dude, there’s organizations led by medical students who are all in $300k+ debt lobbying for Medicare for all. I believe anything at this point lol.

 

[chlorocruorin]

Dude, there’s organizations led by medical students who are all in $300k+ debt lobbying for Medicare for all. I believe anything at this point lol.

Because they care about maybe serving idk serving the community and patients instead of focusing on themselves. Lol Yeah that’s crazy tho couldn’t understand why that person wanted to become a doctor in the first place lmao makes no sense to me lmao.

It’s not like doctors have poor family members that can’t afford healthcare or anything.

I can’t figure for the life of me why someone would ever want to advocate for that

 

[jhenj529]

Dude, there’s organizations led by medical students who are all in $300k+ debt lobbying for Medicare for all. I believe anything at this point lol.

Medicare for all has been shown to save money in healthcare in the long run. It fixes the greed insurance companies and pharm companies, whicb I have not heard one physican raving about.

 

[AnatomyGrey12]

Medicare for all has been shown to save money in healthcare in the long run. It fixes the greed insurance companies and pharm companies, whicb I have not heard one physican raving about.

Because they care about maybe serving idk serving the community and patients instead of focusing on themselves. Lol Yeah that’s crazy tho couldn’t understand why that person wanted to become a doctor in the first place lmao makes no sense to me lmao.

It’s not like doctors have poor family members that can’t afford healthcare or anything.

I can’t figure for the life of me why someone would ever want to advocate for that

 

[sargon2123]

This is still so hopelessly idiotic. It's hard to see why anybody would support this except students at the best medical schools going into fields without much competition from other students at their med school. Hard to believe that any other intelligent person who's thought about this would be for it.

Once again, if you’re at a top school or a school well-connected with what you want to do, the decreased stress of step 1 pass/fail will encourage you to strongly support it

 

[Premed2295]

So there is a real chance that my Step 1 in February 2020 is pass fail?

Not too happy about that. My entire class has studied based on wanting high step scores. We aren’t at a super high tier program so we figured we needed that boost.

 

[7331poas]

So there is a real chance that my Step 1 in February 2020 is pass fail?

Not too happy about that. My entire class has studied based on wanting high step scores. We aren’t at a super high tier program so we figured we needed that boost.

Same situation here except feb 2021 since we take after 3rd year. This is so ****ty.

 

[jhenj529]

So there is a real chance that my Step 1 in February 2020 is pass fail?

Not too happy about that. My entire class has studied based on wanting high step scores. We aren’t at a super high tier program so we figured we needed that boost.

Some scores already taken might be negated

 

[seeinghowitgoes]

So there is a real chance that my Step 1 in February 2020 is pass fail?

Not too happy about that. My entire class has studied based on wanting high step scores. We aren’t at a super high tier program so we figured we needed that boost.

Beautiful statement highlighting the issue with step. The fact that studying for it helps only with the test and is not in and of itself valuable.

I don’t have much to say about pass/fail vs incremental scoring (benefits to, or issues with really, both ways of doing it), but wow do I look forward to the day we figure out a better way to predict who will be a good doc (high patient satisfaction, high value prescribers, fewest unprofessional citations, whatever metric).

 

[Neopolymath]

Beautiful statement highlighting the issue with step. The fact that studying for it helps only with the test and is not in and of itself valuable.

I don’t have much to say about pass/fail vs incremental scoring (benefits to, or issues with really, both ways of doing it), but wow do I look forward to the day we figure out a better way to predict who will be a good doc (high patient satisfaction, high value prescribers, fewest unprofessional citations, whatever metric).

People who score well tend to do better on the wards. No surprise really. What he meant was he would have rather spent that time working out, drinking beer, and chilling during didactic if it didn't mean as much. That doesn't disregard my first statement though.

 

[Premed2295]

Beautiful statement highlighting the issue with step. The fact that studying for it helps only with the test and is not in and of itself valuable.

I don’t have much to say about pass/fail vs incremental scoring (benefits to, or issues with really, both ways of doing it), but wow do I look forward to the day we figure out a better way to predict who will be a good doc (high patient satisfaction, high value prescribers, fewest unprofessional citations, whatever metric).

Exactly the issue. We may have prepared for class exams differently if it weren't for step being taken midway through second year. Or chosen to be more involved in other pursuits. Our dedicated in December 2019- February 2020 and I am afraid Im going to have to hedge my bets getting a relatively lower number score by using only half my dedicated, or I am going to have to just take a pass fail. This is terrifying.

 

[Lawpy]

This is still so hopelessly idiotic. It's hard to see why anybody would support this except students at the best medical schools going into fields without much competition from other students at their med school. Hard to believe that any other intelligent person who's thought about this would be for it.

Apparently medical educators don't care and are widely in favor of P/F Step 1. I'm just more focused on what's actually going to happen.

 

[Premed2295]

People who score well tend to do better on the wards. No surprise really. What he meant was he would have rather spent that time working out, drinking beer, and chilling during didactic if it didn't mean as much. That doesn't disregard my first statement though.

Tend to do better on the wards, but it isn't quite a 1:1. While I think that more knowledge HELPS I know several gunners who cant speak to patients and several relatively weaker students who are greater at speaking to patients. I know my class is a small sample size for the country, but is not 100% that those who do well on step are the best prepared to be physicians. It is an important piece of it but not the only one.

 

[Giovanotto]

Lol, not only are we getting a combined match as DOs, but now this too? Freaking LOL. Keep increasing those class sizes AOA. Where's Queen's PCP fam shout out when you need it?

(Can we please just make Step 2 P/F rather than Step 1, thanks! Would make the next 4 weeks a lot more pleasant for me)

 

[Premed2295]

This might be a crazy idea, but what if part of a residency interview was having students interact with a few real patients on the ward in the field they want to go into. This would test their ability to talk to patients, their knowledge of that sort of medicine, their ability to interact with the team and so on.

Step 1 is not the best metric of anything, it's a lot of memorizing drugs and diseases a small subset of which each speciality will ultimately concern themselves with. And most doctors Ive observed keep Robbins in their office anyway.

 

[Neopolymath]

Tend to do better on the wards, but it isn't quite a 1:1. While I think that more knowledge HELPS I know several gunners who cant speak to patients and several relatively weaker students who are greater at speaking to patients. I know my class is a small sample size for the country, but is not 100% that those who do well on step are the best prepared to be physicians. It is an important piece of it but not the only one.

Great, you can point to a couple people but despite this weird rhetoric that tends to show up in these conversations, the truth and reality is that superior students tend to perform superiorly every step of the way. This has been rehashed ad nauseum on SDN. I guess people just tell themselves this myth to make themselves feel better? And of course it isn't a 100% occurrence. I was just pointing out that when high scorers say they wish they did something else if it went P/Fwhat they usually mean is chill more and focus on wellness not study more relevant stuff.

 

[7331poas]

Beautiful statement highlighting the issue with step. The fact that studying for it helps only with the test and is not in and of itself valuable.

I don’t have much to say about pass/fail vs incremental scoring (benefits to, or issues with really, both ways of doing it), but wow do I look forward to the day we figure out a better way to predict who will be a good doc (high patient satisfaction, high value prescribers, fewest unprofessional citations, whatever metric).

And of course you ignore the last part of his statement that highlights the failures of going P/F for step 1.

 

[7331poas]

This might be a crazy idea, but what if part of a residency interview was having students interact with a few real patients on the ward in the field they want to go into. This would test their ability to talk to patients, their knowledge of that sort of medicine, their ability to interact with the team and so on.

youre right, that is crazy.

 

[seeinghowitgoes]

And of course you ignore the last part of his statement that highlights the failures of going P/F for step 1.

And of course you ignore the last part of my statement where I essentially say this isn’t an endorsement for either system of scoring, rather a general statement about using assessments that are poorly aligned with the outcome metrics we care about in medicine.

Geez people relax - I thought that was a pretty benign statement.

 

[seeinghowitgoes]

People who score well tend to do better on the wards. No surprise really. What he meant was he would have rather spent that time working out, drinking beer, and chilling during didactic if it didn't mean as much. That doesn't disregard my first statement though.

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.

 

[Lawpy]

Lol, not only are we getting a combined match as DOs, but now this too? Freaking LOL. Keep increasing those class sizes AOA. Where's Queen's PCP fam shout out when you need it?

(Can we please just make Step 2 P/F rather than Step 1, thanks! Would make the next 4 weeks a lot more pleasant for me)

Nah medical educators love Step 2 CK. So many posts on here stating why Step 2 CK having a stronger focus will be a great idea because that exam is clinically relevant as opposed to memorization heavy and practically useless Step 1.

Meanwhile, Step 2 CS, which is P/F, is continuing to be implemented happily with zero opposition from medical education leaders even though students find them to be extremely stressful and unduly expensive/annoying since a possible failure could effectively torpedo their chances of matching.

 

[sargon2123]

Apparently medical educators don't care and are widely in favor of P/F Step 1. I'm just more focused on what's actually going to happen.

Of course they are. From their perspective, matching struggles don’t affect them. Med students skimping out of their lectures to study step do.

Is there some kind of higher power this could be brought to? So many groups presenting arguments in favor of p/f step 1 have a huge vested interest in making it happen, to the point that their credibility cannot possibly be in tact.

 

[sargon2123]

In addition, there are enough groups out there that favor p/f step 1 to where it is not too far from reality anymore. I’d suggest everyone start looking into backup "specialty plans" now, and get some advising in light of this.

 

[Premed2295]

Lucky for me not many really wants to go into Peds so I shouldnt have a problem matching even with the ridiculous P/F system.

 

[TheIllusionist]

Both STEP exams are a **** ton of memorization. Quintiles is best comprimise. I say this as a biased MOFO who scored 82nd and 86th percentile on them respectively

 

[deleted998607]

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.

 

[chlorocruorin]

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”

 

[sargon2123]

Lucky for me not many really wants to go into Peds so I shouldnt have a problem matching even with the ridiculous P/F system.

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.

 

[sargon2123]

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? 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.

A change to p/f or h/p/f wouldn’t remedy the relative risk in *failing* "well-established in certain demographics"

 

[AnatomyGrey12]

This might be a crazy idea, but what if part of a residency interview was having students interact with a few real patients on the ward in the field they want to go into. This would test their ability to talk to patients, their knowledge of that sort of medicine, their ability to interact with the team and so on.

So........ a sub-i.....

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

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

 

[deleted998607]

A change to p/f or h/p/f wouldn’t remedy the relative risk in *failing* "well-established in certain demographics"

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.

 

[7331poas]

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”

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.

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.

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