Step 1 P/F: Decision

[Mass Effect]

While I don't feel as strongly as @premed1875, there is no doubt that the SAT is related to outcomes after college:

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Figure 1 in this paper suggests that higher SAT scores correlate to higher income, higher likelihood of earning a doctorate degree, higher likelihood for holding a patent, publish a paper and more.

Maybe the SAT doesn't measure potential or intelligence, maybe it measures diligence or the availability of opportunity. Whatever the case may be, it is absolutely reasonable to conclude that SAT/ACT has something to do with the workforce.

No, it isn't reasonable to conclude that. The paper you cite is only looking at the highest scorers on the SAT, not at the general population of students, which includes people who DIDN'T take the SAT, which is premed1875's point. There are plenty of people who don't take the SAT for any number of reasons and kick ass in the workforce, even more than those who do. The trouble is you're gauging accomplishments in the workforce related to math and science when the vast majority of the workforce involves anything but. Sure, you can make the case that higher SAT scorers are likely to become more educated and engage in things like research and patents, but that does not mean that those who don't take the SAT are lesser "quality" of workers. At all.

The SAT is really about who has the money to pay fortunes to test prep companies to prepare them for the coveted scores. Some students manage on their own, but let's not pretend it's a level playing field. If grew up in the best school systems or private schools, have thousands upon thousands to spend on test prep, you're likely going to do better than those who went to a county high school in a poor school district and limited studying to buying a textbook with questions. Doesn't mean the former is any more quality a worker than the latter, even in medicine.

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[deleted1005514]

The SAT is really about who has the money to pay fortunes to test prep companies to prepare them for the coveted scores. Some students manage on their own, but let's not pretend it's a level playing field. If grew up in the best school systems or private schools, have thousands upon thousands to spend on test prep, you're likely going to do better than those who went to a county high school in a poor school district and limited studying to buying a textbook with questions. Doesn't mean the former is any more quality a worker than the latter, even in medicine.

Actually, one could argue that the poor kid who had to bust his a** to get a decent SAT score and had no one pushing him to do so is the harder worker than the rich kid who attended a prep course that mom/dad pushed for.

 

[Mass Effect]

Actually, one could argue that the poor kid who had to bust his a** to get a decent SAT score and had no one pushing him to do so is the harder worker than the rich kid who attended a prep course that mom/dad pushed for.

That's exactly my point.

 

[Anonymous Lurker]

No, it isn't reasonable to conclude that. The paper you cite is only looking at the highest scorers on the SAT, not at the general population of students, which includes people who DIDN'T take the SAT, which is premed1875's point. There are plenty of people who don't take the SAT for any number of reasons and kick ass in the workforce, even more than those who do. The trouble is you're gauging accomplishments in the workforce related to math and science when the vast majority of the workforce involves anything but. Sure, you can make the case that higher SAT scorers are likely to become more educated and engage in things like research and patents, but that does not mean that those who don't take the SAT are lesser "quality" of workers. At all.

The SAT is really about who has the money to pay fortunes to test prep companies to prepare them for the coveted scores. Some students manage on their own, but let's not pretend it's a level playing field. If grew up in the best school systems or private schools, have thousands upon thousands to spend on test prep, you're likely going to do better than those who went to a county high school in a poor school district and limited studying to buying a textbook with questions. Doesn't mean the former is any more quality a worker than the latter, even in medicine.

I don't think it's an unreasonable leap to assume that the test has some predictive value for the general population as well, after all there must be something the test is measuring. I'm also aware that the test is biased towards those who had resources and enrichment early in life. That said, I still think the test has value. Let me give you an example: One of my friends wanted to go into research. Fortunately for him, both of his parents held PhDs and were able to use their connections to get him exposure to research starting in high school. Because of his early experience and connections, he was able to really do amazing research in undergrad. Was he the hardest worker or the smartest person? No, but at the end of the day, he was able to use his early advantages to better capitalize on the opportunities given to him in undergrad. Similarly, even if you only got a good SAT score because you took prep courses, at the end of the day, you took those courses, learned something and are better prepared to excel in your courses and capitalize on the opportunities in college. The test is till measuring something that predicts success and therefore it has value.

 

[Cornfed101]

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Malcolm Gladwell has a couple podcast episodes about the LSAT and why it’s dumb to have timed tests when real life isn’t quite like that. I think the same could be true for the MCAT and any other standardized test really. Episodes 1 and 2 of season 4.

 

[Mass Effect]

I don't think it's an unreasonable leap to assume that the test has some predictive value for the general population as well, after all there must be something the test is measuring. I'm also aware that the test is biased towards those who had resources and enrichment early in life. That said, I still think the test has value. Let me give you an example: One of my friends wanted to go into research. Fortunately for him, both of his parents held PhDs and were able to use their connections to get him exposure to research starting in high school. Because of his early experience and connections, he was able to really do amazing research in undergrad. Was he the hardest worker or the smartest person? No, but at the end of the day, he was able to use his early advantages to better capitalize on the opportunities given to him in undergrad. Similarly, even if you only got a good SAT score because you took prep courses, at the end of the day, you took those courses, learned something and are better prepared to excel in your courses and capitalize on the opportunities in college. The test is till measuring something that predicts success and therefore it has value.

It is an unreasonable leap. The test measures who's good at taking a test, most of whom have a wealth of resources. Your analogy doesn't work because taking those courses teaches you only how to do well on the test, not about the workforce or anything else. The SAT is not about real life and the workforce. There's a good reason no employer ever asks for your SAT scores.

 

[readmypostsMD]

It is an unreasonable leap. The test measures who's good at taking a test, most of whom have a wealth of resources. Your analogy doesn't work because taking those courses teaches you only how to do well on the test, not about the workforce or anything else. The SAT is not about real life and the workforce. There's a good reason no employer ever asks for your SAT scores.

my thought was that SAT is more like an IQ test, meaning that your score will be limited more by your raw processing power and intelligence. So you can shovel as much money and resources into preparing for the test, but your final score will be far more limited by your innate ability to solve complex problems quickly.

I mean, I spent tons of money and resources on my mcat prep and I hit a ceiling that I couldn’t surpass simply because I couldn’t solve hard questions fast enough. On the other hand, my friends from low income backgrounds spent a fraction of money and time on studying for the mcat, but still surpassed my score because they are just innately more intelligent than me.

It would make so much sense to me that people who can score well on the SAT will find themselves in workplace situations with difficult problems and they will have the raw intellectual ability to solve them.

If someone can’t solve a complex problem quickly, then they will probably not be able to solve a complex work problem under time pressure

obviously it’s not the be all end all test, but I think it’s extremely important to have a standardized predictive tests. Yeah of course rich kids may get some advantage, but their own brain will limit their potential. And yeah, rich people have access to resources that improve their lives. That’s just the way our society works. And the only other way is basically equalizing everybody, aka communism I think. I mean the playing field will always be unequal in our society.

If we level the playing field for testing by getting rid of it, how do we level the playing field for students who live in broken homes that are distracting? What if the student doesn’t have a mom? Do we get the government to give the family a mom so that kid doesn’t struggle in school from not having 2 parents? What if the kid doesn’t have a fast laptop, but the rich kid has a 38 in monitor that allows him to study more efficiently? And ultimately, how would you address the unfairness in students’ IQ? Wouldn’t the students with a high IQ have an advantage in school? That seems a bit unfair especially because that student was just born that way and did nothing to deserve it?

In fact, I always thought we should have students take the SAT under intense distracting conditions to see who can still score high with lots of distractions

 

[Mass Effect]

my thought was that SAT is more like an IQ test, meaning that your score will be limited more by your raw processing power and intelligence. So you can shovel as much money and resources into preparing for the test, but your final score will be far more limited by your innate ability to solve complex problems quickly.

I mean, I spent tons of money and resources on my mcat prep and I hit a ceiling that I couldn’t surpass simply because I couldn’t solve hard questions fast enough. On the other hand, my friends from low income backgrounds spent a fraction of money and time on studying for the mcat, but still surpassed my score because they are just innately more intelligent than me.

You're thinking about it all wrong. The SAT is not an IQ test anymore than Step 1 is an IQ test. Test preps will give you strategies to succeed but yes, most people will hit a ceiling. That doesn't mean that the ones whose ceilings are below yours are worse quality workers. That's like saying the guy with a 220 Step 1 will be a worse doctor than the 260 Step 1 and we know that isn't true. Also, your assertion doesn't take into account those who don't take the test and still manage to be A+ employees. There were just all kinds of things wrong with your claim.

It would make so much sense to me that people who can score well on the SAT will find themselves in workplace situations with difficult problems and they will have the raw intellectual ability to solve them

As someone who's been in the workforce, I assure you that's not true. Someone's ability to COPE (that's what it is) and figure out tough situations is not the least bit dependent on an SAT score nor is it dependent on intelligence. And again, the SAT is not an IQ score.

If we level the playing field for testing by getting rid of it, how do we level the playing field for students who live in broken homes that are distracting? What if the student doesn’t have a mom? Do we get the government to give the family a mom so that kid doesn’t struggle in school from not having 2 parents? What if the kid doesn’t have a fast laptop, but the rich kid has a 38 in monitor that allows him to study more efficiently? And ultimately, how would you address the unfairness in students’ IQ? Wouldn’t the students with a high IQ have an advantage in school? That seems a bit unfair especially because that student was just born that way and did nothing to deserve it?

Dude, this discussion wasn't about social justice. It was about whether or not those with high SAT scores (of those who actually took the SAT) are better workers.

 

[justaperson274939135]

As someone who's been in the workforce, I assure you that's not true. Someone's ability to COPE (that's what it is) and figure out tough situations is not the least bit dependent on an SAT score nor is it dependent on intelligence. And again, the SAT is not an IQ score.

^^ this. a lot of evidence that social emotional intelligence is a stronger indicator for career success

 

[Yankees27]

It is an unreasonable leap. The test measures who's good at taking a test, most of whom have a wealth of resources. Your analogy doesn't work because taking those courses teaches you only how to do well on the test, not about the workforce or anything else. The SAT is not about real life and the workforce. There's a good reason no employer ever asks for your SAT scores.

Your argument is flawed....Who said the SAT was about real life situations and the fact that an employer doesnt ask about a SAT score makes no sense whatsoever. You need some type of measure and while the SAT may not be a tell-all as to how someone will perform in real life, it is nonetheless a starting point in academia to evaluate a student, not the only measure, not perfect by any means, but it is a part of wholistic approach.

 

[Anonymous Lurker]

You're thinking about it all wrong. The SAT is not an IQ test anymore than Step 1 is an IQ test. Test preps will give you strategies to succeed but yes, most people will hit a ceiling. That doesn't mean that the ones whose ceilings are below yours are worse quality workers. That's like saying the guy with a 220 Step 1 will be a worse doctor than the 260 Step 1 and we know that isn't true. Also, your assertion doesn't take into account those who don't take the test and still manage to be A+ employees. There were just all kinds of things wrong with your claim.

If the SAT only measured test-taking ability, why does it predict future success among young top 1% scorers? What does test taking ability have to do with your likelihood to file a patent or publishing a paper? Surely it must be measuring something other than test-taking ability. And if it can measure that something else in young top 1% scorers, why is it such a leap to assume that the SAT also measures that something in the general population to at least some degree?

I think we've strayed very far from discussion about step 1 p/f. I understand that standardized tests aren't perfect and that it would be foolish to base decisions solely on standardized tests. However, as imperfect as they are, standardized tests provide some information about the test-taker and it would be equally foolish to disregard them entirely. I believe that having imperfect information is better than not having that information at all. Unfortunately, with step 1 going p/f and colleges going test-optional, we are giving up that information.

 

[Mass Effect]

If the SAT only measured test-taking ability, why does it predict future success among young top 1% scorers? What does test taking ability have to do with your likelihood to file a patent or publishing a paper? Surely it must be measuring something other than test-taking ability

Because the top 1% are likely extremely bright, just as the top 1% of MCAT test-takers are. Doesn't mean that they're better doctors, does it? You must also consider what percentage of the 1% were from well-off families and/or groomed for success since birth? There's a reason some people score exceptionally well on the SAT and it isn't always about ability.

And if it can measure that something else in young top 1% scorers, why is it such a leap to assume that the SAT also measures that something in the general population to at least some degree?

Again, because you're making a faulty assumption, unless you believe the top 1% of scorers on the MCAT or on Step 1 are the best doctors as well?

 

[Mass Effect]

Your argument is flawed....Who said the SAT was about real life situations

The same person who argued high-score SAT was a good predictor of how good an employee you are. That is what I was responding to, after all.

and the fact that an employer doesnt ask about a SAT score makes no sense whatsoever

In the context of the above, it absolutely does? Did you even read the thread? If the SAT was a predictor of how good an employee you'd be, then all employers would ask for it.

You need some type of measure and while the SAT may not be a tell-all as to how someone will perform in real life, it is nonetheless a starting point in academia to evaluate a student, not the only measure, not perfect by any means, but it is a part of wholistic approach.

When did I say otherwise? The only thing I said was that the SAT has nothing to do with how good an employee you are in the workforce.

 

[deleted915325]

my thought was that SAT is more like an IQ test, meaning that your score will be limited more by your raw processing power and intelligence. So you can shovel as much money and resources into preparing for the test, but your final score will be far more limited by your innate ability to solve complex problems quickly.

I mean, I spent tons of money and resources on my mcat prep and I hit a ceiling that I couldn’t surpass simply because I couldn’t solve hard questions fast enough. On the other hand, my friends from low income backgrounds spent a fraction of money and time on studying for the mcat, but still surpassed my score because they are just innately more intelligent than me.

It would make so much sense to me that people who can score well on the SAT will find themselves in workplace situations with difficult problems and they will have the raw intellectual ability to solve them.

If someone can’t solve a complex problem quickly, then they will probably not be able to solve a complex work problem under time pressure

obviously it’s not the be all end all test, but I think it’s extremely important to have a standardized predictive tests. Yeah of course rich kids may get some advantage, but their own brain will limit their potential. And yeah, rich people have access to resources that improve their lives. That’s just the way our society works. And the only other way is basically equalizing everybody, aka communism I think. I mean the playing field will always be unequal in our society.

If we level the playing field for testing by getting rid of it, how do we level the playing field for students who live in broken homes that are distracting? What if the student doesn’t have a mom? Do we get the government to give the family a mom so that kid doesn’t struggle in school from not having 2 parents? What if the kid doesn’t have a fast laptop, but the rich kid has a 38 in monitor that allows him to study more efficiently? And ultimately, how would you address the unfairness in students’ IQ? Wouldn’t the students with a high IQ have an advantage in school? That seems a bit unfair especially because that student was just born that way and did nothing to deserve it?

In fact, I always thought we should have students take the SAT under intense distracting conditions to see who can still score high with lots of distractions

N=1 but I never took an SAT prep course of any sort and scored 2040 (or something like that). I actually almost wasn’t allowed to graduate because of skipping to many days. In the end, I think I’m a pretty good worker lol.

Anyway, I think when all other variables are controlled for, SAT could be some sort of IQ test. But my expertise in assessing cognitive function is only in children with severe developmental disabilities, not with mentally competent high schoolers. Now if we’re talking about the Mullen or DAS, I’ll tell exactly what the results mean haha

 

[Anonymous Lurker]

Because the top 1% are likely extremely bright, just as the top 1% of MCAT test-takers are. Doesn't mean that they're better doctors, does it? You must also consider what percentage of the 1% were from well-off families and/or groomed for success since birth? There's a reason some people score exceptionally well on the SAT and it isn't always about ability.

Ok I did more digging and research into the general population. This study shows that the ACT correlates highly to general intelligence (IQ) with the correlation being between 0.55 to 0.81 depending on which test you use (total n=11,914)

http://www.iapsych.com/iqmr/koening2008.pdf

This meta analysis covering 85 years worth of studies shows that general intelligence is the best predictor of job performance (r=0.51), better than peer scores, years of experience and more:

APA PsycNet

psycnet.apa.org

I understand that this is not a perfect argument because it does not directly compare ACT scores to job performance, however, given the strong correlations and high sample sizes, I would feel comfortable concluding that the ACT does predict job performance

If the SAT was a predictor of how good an employee you'd be, then all employers would ask for it.

As for why employers don't ask for your SAT score:
1) I think they should
2) They sure as heck ask you where you went to college (at least for your first job) which in turn depends on your SAT score

I can understand why one would want to believe that test scores don't matter in real life, but the data doesn't support that belief.

 

[NeuResurgens]

I can understand why one would want to believe that test scores don't matter in real life, but the data doesn't support that belief.

I agree with this. Test scores are not the end-all be-all that many students and faculty consider them to be, as personified by step 1 becoming a sort of gatekeeper for residency programs. But in the step 1 argument people have been stating that test scores have "no correlation whatsoever" to someone's physician performance, that they're useless metrics and offer absolutely nothing by which you can gauge the applicant's quality, and that's just naive as well, likely wishful thinking.

 

[bobjonesbob]

It's my opinion that the additional knowledge to climb from 230 to >250 is roughly equivalently useful in a clinic. I think most people who read alot about the history and design of the test, and who experience making that climb themselves, would agree with me.

Hence earlier, when you defended Step you didn't defend it because it made you better at your specialty. You defended it for being a reliable way to grind out success, just like Pi is. The analogy is just to illustrate that an objective metric is still crap when it's objectively measuring something useless.

Dude comparing the utility of the content on step 1 to memorizing the digits of pi is an extremely bad take. Is the material that will take you from a 250 to a 265 highly relevant to the average clinic patient? Definitely not but physician training isn't really about being the most efficient and high yield. Look at the level of sub-specialization in medicine. If you want a training system designed on the 80/20 principle become a PA.

You've also openly admitted that you gamed the exam by taking a longer than average dedicated study period and using a "binge and purge" study strategy. People who studied harder longitudinally are able to retain a lot more of that information and have a better ability to integrate it in clinical practice.

 

[efle]

Dude comparing the utility of the content on step 1 to memorizing the digits of pi is an extremely bad take. Is the material that will take you from a 250 to a 265 highly relevant to the average clinic patient? Definitely not but physician training isn't really about being the most efficient and high yield. Look at the level of sub-specialization in medicine. If you want a training system designed on the 80/20 principle become a PA.

You've also openly admitted that you gamed the exam by taking a longer than average dedicated study period and using a "binge and purge" study strategy. People who studied harder longitudinally are able to retain a lot more of that information and have a better ability to integrate it in clinical practice.

It's a fine take in my book, but hey, I dont need to convince anybody anymore, that war is over. If in a few years theres a catastrophic drop in the quality of MS3s because they didnt flashcard as hard as before, I'll eat my socks.

I did indeed binge and purge it and had no problem in the clinical rotations afterwards. Go figure.

 

[longhaul3]

It's a fine take in my book, but hey, I dont need to convince anybody anymore, that war is over. If in a few years theres a catastrophic drop in the quality of MS3s because they didnt flashcard as hard as before, I'll eat my socks.

I did indeed binge and purge it and had no problem in the clinical rotations afterwards. Go figure.

I think there's a middle ground. A lot of med students will do the bare minimum to pass Step 1 the same way we have always treated CS. They will be way behind when it comes to Step 2CK. There is so much overlap between the two. Step 1 is not useless. That knowledge is fundamentally what separates the MD degree from midlevels.

 

[efle]

I think there's a middle ground. A lot of med students will do the bare minimum to pass Step 1 the same way we have always treated CS. They will be way behind when it comes to Step 2CK. There is so much overlap between the two. Step 1 is not useless. That knowledge is fundamentally what separates the MD degree from midlevels.

People are still going to have the third year with 6+ NBME shelf exams to catch them up for Step 2 CK. I found my studying for the medicine shelf to be way more applicable than the Step 1 basic science and physio.

 

[Matthew9Thirtyfive]

If in a few years theres a catastrophic drop in the quality of MS3s because they didnt flashcard as hard as before, I'll eat my socks.

Not sure if the quality will drop but I don’t know how great it is now given that the expectation is to know absolutely nothing.

 

[efle]

Not sure if the quality will drop but I don’t know how great it is now given that the expectation is to know absolutely nothing.

My residents and attendings, especially in Medicine and Surgery, absolutely expected us to know things. But it was things I'd learn from UpToDate or the Step 2 CK qbanks, not from First Aid. The whole Osler service tradition is to constantly be teaching and learning every day on rounds, but it's all clinically related not "which receptor is mutated in achondroplasia" type nonsense

 

[longhaul3]

People are still going to have the third year with 6+ NBME shelf exams to catch them up for Step 2 CK. I found my studying for the medicine shelf to be way more applicable than the Step 1 basic science and physio.

The shelf exams are definitely more relevant, because it's the same material, but CK is a harder exam than people realize and draws a lot on Step 1. I personally think there's a huge foundation for CK that's built through Step 1 studying that will be missing, no matter how much shelf studying or dedicated Step 2 studying one does.

Also, Step 1 encompasses basically all of medicine. The shelf exams and CK only cover a few core specialties. There is almost zero content from my specialty on CK, but there's a ton of it on Step 1. Bottom line from my perspective is that I'm not looking forward to having med students who just studied for a P rotate with us. They'll be way behind.

 

[efle]

The shelf exams are definitely more relevant, because it's the same material, but CK is a harder exam than people realize and draws a lot on Step 1. I personally think there's a huge foundation for CK that's built through Step 1 studying that will be missing, no matter how much shelf studying or dedicated Step 2 studying one does.

Also, Step 1 encompasses basically all of medicine. The shelf exams and CK only cover a few core specialties. There is almost zero content from my specialty on CK, but there's a ton of it on Step 1. Bottom line from my perspective is that I'm not looking forward to having med students who just studied for a P rotate with us. They'll be way behind.

Hahah yeah woe is us, when we're residents our med students will only be at the level that our attendings were at their stage. How will we ever cope.

 

[readmypostsMD]

Ok I did more digging and research into the general population. This study shows that the ACT correlates highly to general intelligence (IQ) with the correlation being between 0.55 to 0.81 depending on which test you use (total n=11,914)

http://www.iapsych.com/iqmr/koening2008.pdf

This meta analysis covering 85 years worth of studies shows that general intelligence is the best predictor of job performance (r=0.51), better than peer scores, years of experience and more:

APA PsycNet

psycnet.apa.org

I understand that this is not a perfect argument because it does not directly compare ACT scores to job performance, however, given the strong correlations and high sample sizes, I would feel comfortable concluding that the ACT does predict job performance



As for why employers don't ask for your SAT score:
1) I think they should
2) They sure as heck ask you where you went to college (at least for your first job) which in turn depends on your SAT score

I can understand why one would want to believe that test scores don't matter in real life, but the data doesn't support that belief.

Thanks for finding the evidence haha

SAT questions seem to test more innate intelligence than the mcat, which seems more content based. In other words, the mcat is more like Jeopardy and SAT is more like Wheel of Fortune lmao

it always confuses me why people don’t understand how your ability to answer complex SAT-like questions quickly will be a strong predictor of success in the workplace

 

[Mass Effect]

it always confuses me why people don’t understand how your ability to answer complex SAT-like questions quickly will be a strong predictor of success in the workplace

Because it won't. And the evidence shared doesn't prove otherwise. The SAT has no correlation to quality of the workforce.

 

[ace_inhibitor111]

I’m wondering if people just have a skewed understanding of what’s actually tested on Step 1 versus what’s on Zanki (which is just a shotgun of everything). I’m one of those people who remembers 80% of every exam, and not one question on my Step 1 ever asked something as picky as what genetic mutation causes achondroplasia, and no questions on the Krebs cycle either. Usually it’s something that you can logically deduce, like “man has fibrous bands in his palm that make it hard to move, what type of cell is causing it?” You should be able to figure it out even if you’ve never heard of the disease before, and that’s the point: generalizability.

Knowing the treatment for genital warts is useful if you’re going into OB or primary care, sure. But it’s not going to be used for most other specialties. However, understanding how viruses work and can influence the cell cycle is something that should be generalizable to most specialties in one way or another.

 

[Matthew9Thirtyfive]

My residents and attendings, especially in Medicine and Surgery, absolutely expected us to know things. But it was things I'd learn from UpToDate or the Step 2 CK qbanks, not from First Aid. The whole Osler service tradition is to constantly be teaching and learning every day on rounds, but it's all clinically related not "which receptor is mutated in achondroplasia" type nonsense

Yeah they expect us to know stuff too. But I read all over the place in here that you’re not expected to know anything and if you know where the bathroom is you’re good.

 

[VA Hopeful Dr]

Because it won't. And the evidence shared doesn't prove otherwise. The SAT has no correlation to quality of the workforce.

I think the disconnect here is in the definition of "the workforce". I'd be surprised if SAT score didn't correlate with college performance, but a high SAT won't make a better plumber or kindergarten teacher. It might make a better PhD or something else that requires lots of schooling, but probably less so for much else.

 

[efle]

I’m wondering if people just have a skewed understanding of what’s actually tested on Step 1 versus what’s on Zanki (which is just a shotgun of everything). I’m one of those people who remembers 80% of every exam, and not one question on my Step 1 ever asked something as picky as what genetic mutation causes achondroplasia, and no questions in the Krebs cycle either. Usually it’s something that you can logically deduce, like “man has fibrous bands in his palm that make it hard to move, what type of cell is causing it?” You should be able to figure it out even if you’ve never heard of the disease before, and that’s the point.

I mean I've taken Step 1 and seen all the content in UFAPS, and my understanding is that Zanki just compiles all those into bite sized flashcards.

I 100% did have questions like that, in fact the 2-3 questions per block that separate me from a 270 were overwhelmingly those kinds of knowledge-check Qs. The reasoning based Qs were slam dunks. You may just not have noticed them because they were absurdly easy to someone who had that mental flashcard queued up.

 

[Mass Effect]

I think the disconnect here is in the definition of "the workforce". I'd be surprised if SAT score didn't correlate with college performance, but a high SAT won't make a better plumber or kindergarten teacher. It might make a better PhD or something else that requires lots of schooling, but probably less so for much else.

Yes, thank you for saying it better than I did. I noted above that SAT may correlate well with academics, but not with the workforce in general.

 

[efle]

I'll buy that smart people tend to do well on the SAT and tend to do well professionally too, compared to dumber people.

But as mentioned above, if you run a plumbing company and your major criteria for hiring is their high school test scores, you're not going to be running it for very long.

 

[AnatomyGrey12]

I 100% did have questions like that, in fact the 2-3 questions per block that separate me from a 270 were overwhelmingly those kinds of knowledge-check Qs.

So you’re complaining about a test being minutia based when reality is ~21/280 of those questions are the type of questions you’re talking about....

The majority of my Step 1 was directly clinically relevant. On my IM service I got pimped daily about cardiac phys, pathophys of diseases, MOA of drugs, etc. All of that is what makes up the majority of Step 1.

 

[Anonymous Lurker]

Yes, thank you for saying it better than I did. I noted above that SAT may correlate well with academics, but not with the workforce in general.

The study relating to intelligence and workforce performance makes note of the fact that different jobs have different cognitive demands (end of page 264). That said, 62% of U.S. jobs were classified as medium complexity and the r value used (0.51) corresponded to those jobs. 62% is a LOT and some jobs have even more cognitive demands. It is safe to say that the relationship between intelligence and workplace performance holds for the workplace in general. Additionally, jobs have become more cognitively demanding over the years and the unpublished updated version of that paper has a higher r value at 0.65:

https://testingtalent.com/wp-content/uploads/2017/04/2016-100-Yrs-Working-Paper-on-Selection-Methods-Schmit-Mar-17.pdf

 

[readmypostsMD]

I think the disconnect here is in the definition of "the workforce". I'd be surprised if SAT score didn't correlate with college performance, but a high SAT won't make a better plumber or kindergarten teacher. It might make a better PhD or something else that requires lots of schooling, but probably less so for much else.

this is sort of built in to my argument. A plumber wouldn’t need an SAT score to find a job or get into trade school

my argument is that colleges should use SAT for evaluating applicants because SAT will in general predict future quality as an employee, the assumption being that that person - having made a huge investment in college - is going on to perform a mid to high complexity job that generally pays more, ie accounting, marketing, actuary, web design, engineer, finance, manager... altho I know plumbers get paid a lot

obviously the predictive power of the SAT for the quality of the employee depends on the job the person takes. If the person takes a job as a Starbucks barista, the SAT won't mean anything

I’m just saying that overall, SAT is important for college admissions because it helps select for smart people that then go into professions, or hopefully go onto professions, in which being smart is critical

with that, I’d say college is WAY overrated and pointless for so many people who go and major in hermaphroditic genderless underwater Marxist basket weaving

also, I think we should make high school applicants to college also take an IQ test in addition to the SAT

 

[Ho0v-man]

So you’re complaining about a test being minutia based when reality is ~21/280 of those questions are the type of questions you’re talking about....

The majority of my Step 1 was directly clinically relevant. On my IM service I got pimped daily about cardiac phys, pathophys of diseases, MOA of drugs, etc. All of that is what makes up the majority of Step 1.

I had a very similar experience. I remember having a hardy-Weinberg type question which kinda ticked me off at the time. There’s also some dumb cell bio that has no business being on there. All together, I’d be very surprised if that was even close to 20 questions.

But man I was ready for stupid absurd embryo, biochem, and esoteric ways bacteria develop anti microbial resistance and it just didn’t happen. It was such a grind to do well on that exam but the level of minutiae is greatly over-hyped imo.

 

[Neopolymath]

I had a very similar experience. I remember having a hardy-Weinberg type question which kinda ticked me off at the time. There’s also some dumb cell bio that has no business being on there. All together, I’d be very surprised if that was even close to 20 questions.

But man I was ready for stupid absurd embryo, biochem, and esoteric ways bacteria develop anti microbial resistance and it just didn’t happen. It was such a grind to do well on that exam but the level of minutiae is greatly over-hyped imo.

Most of the science based pimp questions for me during third year were step 1 facts or things that were obvious because of step 1 facts. Same thing for the shelves. I'm sure CK will be the same.

New students reading this who will have P/F step: STUDY FOR STEP 1. It made 3rd year so much easier and saved me time too by not having to look up dumb stuff to remember the foundation of what I was trying to figure out clinically.

COMATs are stupid but I swear every exam I would have 5-10 questions that were not mentioned or phrased the same in 3rd year prep but obvious due to step 1 anki.

 

[NeuResurgens]

So you’re complaining about a test being minutia based when reality is ~21/280 of those questions are the type of questions you’re talking about....

The majority of my Step 1 was directly clinically relevant. On my IM service I got pimped daily about cardiac phys, pathophys of diseases, MOA of drugs, etc. All of that is what makes up the majority of Step 1.

Yeah, I also disagree with people in the pro-p/f camp who say that step 1 having basic science questions makes it a bad test to judge from. Those esoteric questions are not as common as they're made out to be and are really just there to keep too many people from getting perfect scores. Most of the things on step 1 felt like something that was clinically relevant, or at least served as a useful foundation to understanding a concept that is.

 

[VA Hopeful Dr]

this is sort of built in to my argument. A plumber wouldn’t need an SAT score to find a job or get into trade school

my argument is that colleges should use SAT for evaluating applicants because SAT will in general predict future quality as an employee, the assumption being that that person - having made a huge investment in college - is going on to perform a mid to high complexity job that generally pays more, ie accounting, marketing, actuary, web design, engineer, finance, manager... altho I know plumbers get paid a lot

obviously the predictive power of the SAT for the quality of the employee depends on the job the person takes. If the person takes a job as a Starbucks barista, the SAT won't mean anything

I’m just saying that overall, SAT is important for college admissions because it helps select for smart people that then go into professions, or hopefully go onto professions, in which being smart is critical

with that, I’d say college is WAY overrated and pointless for so many people who go and major in hermaphroditic genderless underwater Marxist basket weaving

also, I think we should make high school applicants to college also take an IQ test in addition to the SAT

Except I'm not sure any of that is true (well, except that bold part - 100% agree there). The SAT predicts college performance at best. I'm not sure that correlates with job performance. I suspect many of us here have a biased cohort we think about for this sort of thing since we tend to hang out with other high-achieving nerds.

I would be very surprised if your average marketing people scored really well on the SAT. Or your insurance salesman. You know, jobs that don't necessarily require a college degree to actually do.

 

[efle]

So you’re complaining about a test being minutia based when reality is ~21/280 of those questions are the type of questions you’re talking about....

The majority of my Step 1 was directly clinically relevant. On my IM service I got pimped daily about cardiac phys, pathophys of diseases, MOA of drugs, etc. All of that is what makes up the majority of Step 1.

Not my complaint at all. My complaint is that those 20-30/280 questions have become the major focus and primary determinant of who does well on this test, because that's the gap from average to 250s-260s.

I think it's awesome that we have to take USMLE Step 1 and score a 70% or better to become licensed physicians. Many of the questions are great reasoning-based ones on issues we really will encounter. But the 20 Q's that separate a 240 from 260? Gimme a freakin break, those will never make you a better clerk or resident or attending.

My issue has never been with Step 1 existing and needing to be passed with a high percentage correct. That's wonderful. I just hate how the small handful of trivia Qs have become a major mechanism of distinguishing oneself.

 

[ChymeofPassion]

This may have been talked about before, but with COVID throwing a wrench into, well, the entire world, could the P/F implementation be pushed past its earliest start?

 

[Matthew9Thirtyfive]

This may have been talked about before, but with COVID throwing a wrench into, well, the entire world, could the P/F implementation be pushed past its earliest start?

No one knows. Literally. They don’t even know most likely.

 

[efle]

This may have been talked about before, but with COVID throwing a wrench into, well, the entire world, could the P/F implementation be pushed past its earliest start?

NBME has been saying they will proctor at schools or homes but will not consider a P/F acceleration. Who knows if that will stay true under a 1918-style second wave, if that happens.

 

[enchantments]

This may have been talked about before, but with COVID throwing a wrench into, well, the entire world, could the P/F implementation be pushed past its earliest start?

One can only hope

 

[Ho0v-man]

Most of the science based pimp questions for me during third year were step 1 facts or things there were obvious because of step 1 facts. Same thing for the shelves. I'm sure CK will be the same.

New students reading this who will have P/F step: STUDY FOR STEP 1. It made 3rd year so much easier and saved me time too by not having to look up dumb stuff to remember the foundation of what I was trying to figure out clinically.

COMATs are stupid but I swear every exam I would have 5-10 questions that were not mentioned or phrased the same in 3rd year prep but obvious due to step 1 anki.

This all day long. In fact I even had some attendings directly teach the step 1 type information on internal med before bothering with the clinical Step2 style stuff that it leads into. They’ll think highly of you if they have to spend less time bringing you up to speed.

 

[efle]

This all day long. In fact I even had some attendings directly teach the step 1 type information on internal med before bothering with the clinical Step2 style stuff that it leads into. They’ll think highly of you if they have to spend less time bringing you up to speed.

I absolutely agree. Studying yourself up to the level to comfortably Pass step 1 will mean learning a ton of things you do need. What I'd urge everyone to consider is that they'd probably know these pimp answers regardless of whether they score 230s or 250s.

Put another way: Do two people who answer 82% correct and 87% have fundamentally different abilities to reason through human physio and patho? I'd say no. The fact that their CIs overlap would seem to agree. Yet, we treat 235 and 250 like they're a world apart in residency applications, which makes no sense.

 

[AnatomyGrey12]

I think it's awesome that we have to take USMLE Step 1 and score a 70% or better to become licensed physicians. Many of the questions are great reasoning-based ones on issues we really will encounter. But the 20 Q's that separate a 240 from 260? Gimme a freakin break, those will never make you a better clerk or resident or attending.

My issue has never been with Step 1 existing and needing to be passed with a high percentage correct. That's wonderful. I just hate how the small handful of trivia Qs have become a major mechanism of distinguishing oneself.

240 and 260? No that's not that important. a 220 and a 250? Yes those students have a pretty different base level of knowledge and the difference does actually matter IMO. I mean we've rehashed this a million times, but I don't disagree with you in that we could probably find something better. My big issue is we DON'T have something better, and an alternative should have been created instead of getting rid of Step and just magically hoping something better would take it's place.

What I'd urge everyone to consider is that they'd probably know these pimp answers regardless of whether they score 230s or 250s.

In my experience on all of my rotations so far, this is 100% not true.

 

[bananafish94]

Now that I've had some time to sit with this for awhile I guess I basically come down on the side of this being a good idea. I just feel like the whole Step 1 thing got so wildly out of control that something had to be done. All incoming students would talk about is Step 1. The expectation became memorizing tens of thousands of flashcards starting from Day 1 at the expense of literally everything else. I obviously don't blame people for this because it's rational behavior considering how important it is in the residency process, but it was a little disheartening for me to be in small groups discussing challenging concepts in anatomy or pathophysiology, or having actual physicians talk to us about physical diagnosis, etc. only to see people completely ignore everything and do Anki. Again, I completely understand because that's what the system wants, but I think there should be a middle ground.

That said, the obvious concern is that the madness will just shift to Step 2 and nothing will change, except for students from "prestigious" schools getting a more disproportionate share of opportunity. I still feel like the best way to go about this in the long term is to actually address the underlying cause which is the ridiculous amount of applications we have to send that forces programs to make hard Step 1 cutoffs, which causes a death spiral. Maybe that means an application cutoff, or an early decision type of program, or something. But the Step 1 madness is definitely a symptom of a greater problem so I'm not optimistic anything will be fixed until that is addressed.

 

[Matthew9Thirtyfive]

but it was a little disheartening for me to be in small groups discussing challenging concepts in anatomy or pathophysiology, or having actual physicians talk to us about physical diagnosis, etc. only to see people completely ignore everything and do Anki.

What school do you people go to? This does not happen at my school. We actually enjoy our clinical reasoning sessions and they make up a good chunk of our faculty exams.

 

[bananafish94]

What school do you people go to? This does not happen at my school. We actually enjoy our clinical reasoning sessions and they make up a good chunk of our faculty exams.

It's certainly not everyone but it was definitely a significant number of people, especially as we got further into M2 year. I know the prevailing sentiment on this forum is "ignore everything that isn't Anki/Step 1" until you take Step 1, which I suppose does make sense given how it's currently probably the most important part of your application. And there are obviously very real problems with how a lot of pre-clinical content is delivered and structured but I'm hopeful that we can eventually figure out a medical school model where the first two years aren't just a distraction form studying flashcards from a review book.