MD & DO Perspectives on taking Step 1 scored vs P/F for the c/o 2024

[blueturtle22]

I was wondering if we could get a little more discussion going for those in the class of 2024 who would be interested in taking Step 1 scored rather than P/F. I've only seen maybe a couple of other threads both here and reddit on the matter, and maybe rightly so since nobody can predict the exact effects that this change will have. However, I'd like a little guidance mostly because I am trying to make a study plan (which I honestly should have done way earlier if I was considering taking step scored, but now is better than never right?).

Studying-wise, I've been using the AnKing deck since M1 and have done about 17k cards so far. I don't resuspend cards after each block and as such have kept up with all my reviews every day (except for Anatomy, which I assume isn't too bad since it's traditionally low yield for step and can be crammed). If I were to take Step scored before January, I'd obviously have to kick up the pace into extreme high gear to finish the remaining content. My school unfortunately has a full 2-year preclinical curriculum, and I've been mostly following the pace of the courses (usually a week or two ahead). I'd have to do a hell of a lot more if I wanted to be ready in time, which is why I really need guidance on how to proceed so I can use my time effectively starting now. I regret not posting this over the summer when I had more time, but it is what it is I guess.

From what I understand reading the few other posts on this matter, some say that PDs will shift focus on scores to solely Step 2 CK for my class, regardless of whether or not we choose to take Step 1 scored. There's no consensus on this; however, and there's no way to know that there won't be PDs who still take Step 1 scores into consideration notwithstanding the P/F change as long as we have a score. Furthermore, a good score can only be a boon to an application, right? At the very least, having a (good) score for Step 1 will unequivocally be better than a simple Pass.

I can understand how the solution to this conundrum for those who are aiming for uncompetitive specialties is to take it P/F, but for at least moderately competitive specialties like Rads (which I'm personally interested in) or others for which competitiveness has historically been dictated by a stellar Step 1 score, I'm unsure if taking it P/F is the best option in terms of longterm prospects. Furthermore, the amount of effort I've put forth to maintain my content knowledge by keeping up with my reviews every day does not warrant taking Step P/F in any sense. That's just a gross misappropriation of time that I could have spent on other activities. I understand the sunk cost fallacy, but in this case, I do have an option to take Step 1 scored still. I'd just need to do a lot more than I'm currently doing. I'm also at a mid-tier school, and prestige will undoubtedly matter more in the P/F step era. Finally, I have not done any research or many EC's, so having a good Step score would just be nice to have.

I'd appreciate any and all perspectives on this matter and hope to engender a more robust discussion on this thread than what I've seen so far. I'm sure that a lot of my classmates have similar concerns but either neglect to actually consider taking Step scored because they're simply expected to just take it P/F now or are too scared to be labeled a gunner. Either way, hopefully, this helps others with similar concerns to come to a conclusion as to what would be best to do.

(posted this in the main forum to hopefully get more traction; please lmk if I need to post it in the step 1 subforum instead)

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[Matthew9Thirtyfive]

Every PD I’ve asked this question (I’m c/o 2023, but take it in third year) has suggested I take it p/f. Their reasoning has been that

1) we don’t know what PDs will do, and it’s likely many will simply ignore all step 1 scores,

2) for those that don’t, a low score will hurt you, but a pass will just be a net neutral,

3) the focus will definitely be on step 2, and taking step 1 p/f will allow more time to prep for getting a great step 2 score, and

4) having less stress is always a good thing.

Again, not my opinion. But the advice of a half dozen PDs across various specialties. So still a small n, but not zero.

 

[notretired]

I thought about it then shifted focus to taking it p/f for similar reasons to m935's post above, it just doesn't seem worth it. While some days I feel like I'm wasting my time by keeping up w/anki and doing amboss/uworld, I also recognize that if I'm ready to sit the exam on Jan 27th I'll have a glorious last 4months of 2nd year.

 

[deleted905798]

Every PD I’ve asked this question (I’m c/o 2023, but take it in third year) has suggested I take it p/f. Their reasoning has been that

1) we don’t know what PDs will do, and it’s likely many will simply ignore all step 1 scores,

2) for those that don’t, a low score will hurt you, but a pass will just be a net neutral,

3) the focus will definitely be on step 2, and taking step 1 p/f will allow more time to prep for getting a great step 2 score, and

4) having less stress is always a good thing.

Again, not my opinion. But the advice of a half dozen PDs across various specialties. So still a small n, but not zero.

I'm in a similar position to you (c/o 2023 taking it after 3rd year); I've heard mixed things personally. I think your advice definitely applies to c/o 2024 but in OUR case a majority if not supermajority of our peers (c/o 2023 applying to residency next year) will have a graded STEP 1 because they take it the traditional way (i.e., after 2nd year). As such me and you will be the minority with a P/F. I don't think it's a dealbreaker either way but I don't think that PD's will "ignore all step 1 scores". Let me know what you think

 

[Matthew9Thirtyfive]

I'm in a similar position to you (c/o 2023 taking it after 3rd year); I've heard mixed things personally. I think your advice definitely applies to c/o 2024 but in OUR case a majority if not supermajority of our peers (c/o 2023 applying to residency next year) will have a graded STEP 1 because they take it the traditional way (i.e., after 2nd year). As such me and you will be the minority with a P/F. I don't think it's a dealbreaker either way but I don't think that PD's will "ignore all step 1 scores". Let me know what you think

The PDs I talked to were talking about for our match year. Like specifically for class of 2023. Again, it was only a half dozen, but they all had the same advice.

 

[catnip12]

I'm also class of 2023 and take Step in 3rd year and for what it is worth I have been flagging down anyone who can provide guidance on this. My advisors have said that I should take it scored. Yet, the PD in the field I am interested in said I should take it P/F and channel that extra effort into extracurriculars vs research vs sanity preservation. I think I am leaning P/F even though I am hoping to go into something quite competitive.

 

[Lucca]

My advice to people in the class of 2024 looking to take Step 1 scored is don't.

 

[Matthew9Thirtyfive]

I'm also class of 2023 and take Step in 3rd year and for what it is worth I have been flagging down anyone who can provide guidance on this. My advisors have said that I should take it scored. Yet, the PD in the field I am interested in said I should take it P/F and channel that extra effort into extracurriculars vs research vs sanity preservation. I think I am leaning P/F even though I am hoping to go into something quite competitive.

Yep. The PDs in the fields I have been interested in have told me to take it p/f and spend that time on ECs and stuff.

 

[blueturtle22]

My advice to people in the class of 2024 looking to take Step 1 scored is don't.

Would you mind elaborating as to why not? I'm just trying to get as many perspectives on the matter as possible.

 

[Lucca]

Would you mind elaborating as to why not? I'm just trying to get as many perspectives on the matter as possible.

I don’t have much to add beyond what @Matthew9Thirtyfive already said, except to add that our advisors have essentially told us the same thing.

I’d also add that many people start dedicated but the knowledge that you could potentially just wait till pass/fail can make it difficult to motivate yourself to grind. Studying for step 1 is 75% effort and 25% psychological. Probably 3 in 4 of my classmates who wanted to take it scored decided to just take it p/f at some later point 1-2 weeks into dedicated. It doesn’t take very long to figure out that the insane amount of effort required to go from passing to average to then a score that would actually help you and not just be “neutral” simply is. Not. Worth. It.

As an analogy, I once was with an oncologist in their clinic and a new chemo pt had refused a prescription for nausea meds. The doc said “you don’t need to take them, just keep them on hand in case you feel nauseous”, but the pt still refused. The doc said “ok! But if you change your mind just let us know and we will get them to you.”

After that visit the doc said to me “some people really don’t like taking meds. Everyone wants to do the experiment themselves and see if they get nauseous. But I’ve done the experiment 1,000 times. Just take the nausea meds.”

P/F is the cure for nausea you have yet to experience. Just take it.

 

[catnip12]

I don’t have much to add beyond what @Matthew9Thirtyfive already said, except to add that our advisors have essentially told us the same thing.

I’d also add that many people start dedicated but the knowledge that you could potentially just wait till pass/fail can make it difficult to motivate yourself to grind. Studying for step 1 is 75% effort and 25% psychological. Probably 3 in 4 of my classmates who wanted to take it scored decided to just take it p/f at some later point 1-2 weeks into dedicated. It doesn’t take very long to figure out that the insane amount of effort required to go from passing to average to then a score that would actually help you and not just be “neutral” simply is. Not. Worth. It.

As an analogy, I once was with an oncologist in their clinic and a new chemo pt had refused a prescription for nausea meds. The doc said “you don’t need to take them, just keep them on hand in case you feel nauseous”, but the pt still refused. The doc said “ok! But if you change your mind just let us know and we will get them to you.”

After that visit the doc said to me “some people really don’t like taking meds. Everyone wants to do the experiment themselves and see if they get nauseous. But I’ve done the experiment 1,000 times. Just take the nausea meds.”

P/F is the cure for nausea you have yet to experience. Just take it.

I’m curious as to why you took it for a score @Lucca if you are MSTP and matriculated in 2019 like M935, Hippocrates, and I did. Or at least, I remember seeing you post about being in your dedicated.

Edit: nvm you don’t owe me an explanation for why you did or didn’t do anything.

 

[Ganon]

I'm an average M4 who had a terrible step 1 score (21X, way below predicted), and I would have loved to have taken P/F for that reason. It was a fluke, but it doesn't matter, it will follow me forever now.

It's easy to assume you'll get a 240-250, but the stats of what the majority actually score show that for many, the P/F will help instead of hurt.

If I was top of my class on every test, 520 MCAT etc. I'd shoot for scored, but for at least the bottom half/average students I'd say P/F

 

[Lucca]

I’m curious as to why you took it for a score @Lucca if you are MSTP and matriculated in 2019 like M935, Hippocrates, and I did. Or at least, I remember seeing you post about being in your dedicated.

Edit: nvm you don’t owe me an explanation for why you did or didn’t do anything.

haha dont worry about it. I took it scored for a simple reason: get it out of the way and not have to interrupt my research schedule / plans to study for a test I wouldve forgotten A LOT of content for already after a year out from pre-clin. I also personally believe that the score, low, average, high, whatever will have essentially no impact when I apply and no one other than MD/PhDs in my specific cohort applies with a score. I'm glad I did! but for an M1 or 2 right now? Nahhhh just wait.

 

[Redpancreas]

Would you mind elaborating as to why not? I'm just trying to get as many perspectives on the matter as possible.

I don't have a dog in this fight but why would you make life harder than it needs to be? Who is going to be looking at Step 1 when most the residents have only a P/F score? You're not turning heads with the 250 you worked so hard for anyone. The focus is going to be on Step 2. Yes, Step 1 prep process helps for Step 2 but the two tests have key differences and I think it makes sense to focus on mastering Step 1 content but from a Step 2 CK perspective (next best step, etc.) if that makes sense. In other words, integrate clinical thinking early into the process of learning about diseases.

 

[Anakinmemer]

Furthermore, the amount of effort I've put forth to maintain my content knowledge by keeping up with my reviews every day does not warrant taking Step P/F in any sense. That's just a gross misappropriation of time that I could have spent on other activities.

Why did you put so much time in when you knew it was going to be pass/fail?

I am class of 2024 but we take it after third year so I don't have a choice and will be p/f. The vast majority of other applicants will be p/f as I think it is incredibly rare to take step 1 before January of your second year. The only people who may have scores are those who took a research year, which I do not believe is common in rads, but may have an effect on fields like derm where tons of people took a research year and thus have a score. In either case, I would never risk taking it scored 6 months before you even finish your preclinical curriculum. A good score might just be ignored, a bad score will leave a bad taste in their mouth even if they don't formally utilize it.