Ask Dr. Gray: Premed Q&A: Will the Changes to the USMLE Affect COMLEX?

Session 91

Will DO and international medical schools be adversely affected by the changes to USMLE Step 1? What does the NRMP survey data say? Listen and find out!

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[00:24] Question on How Pass/Fail Guidelines Affect DO Applicants

Step 1, Step 2, Step 3, they’re still scores. In Episode 379 of The Premed Years Podcast, I laid out my thoughts about step one going pass-fail. And really what it comes down to is it’s changed.

USMLE is not that old. The USMLE Step system was born in the early 90s so it’s not that old. There’s this great article in a research publication that basically laid out the history of medical certifications.

This whole credentialing process and these medical exams started in the late 1800s to early 1900s. States used to have their own individual tests, and then they came together and started these different tests. There used to be things like bedside tests, which is like what we have as our clinical skill section of Step 2 now.

Then in the early 1990s, they dropped this. Medical students now need to take a test in the second year of medical school, and then another test on your fourth year of medical school. And then the third test during residency.

In the end, the process will still move on. The world will still turn and everyone will be happy.

'It's just changed and everything will still be okay.'Click To Tweet

[03:00] What Program Directors Look for in Applicants

Everyone is saying you have to go to the most prestigious medical school to get the top residency. But that’s not the case.

Based on the 2018 NRMP Program Director Survey, Figure 1 shows the percentage and mean importance rating for different factors in selecting applicants to interview.

Only 50% (average rating of 3.8 out of 5) of program directors cared about whether the applicant is a graduate of a highly-regarded U.S. medical school. For Step 1, program directors gave a rating of 4.1 (94%), and Step 2 was a 4.1(80%).

The survey is just citing the most amount of program directors that stated it as a factor in determining who they want to invite for an interview. It was just the most popular factor, not the most important factor.

[04:39] What it Means for the DO Applicants

“If Step 2 becomes more important, you still have the opportunity as a DO student to take step 2 and do well.”Click To Tweet

As a DO student, you still have the opportunity to stand out. A lot of this process has always been subjective. And a lot of students scream from the rooftops saying that’s just not fair. There needs to be an objective way to measure this.

Well, life is subjectively unfair. When you apply for jobs, they’re not going to have you take this test to determine if you are fit for this job. It’s not an objective world.

[06:57] What Program Directors I’ve Talked To Think

On my Specialty Stories podcast, I talk to program directors, and this is something that I’ve been asking for a while now because I knew this was coming. And the conversations I’ve had with program directors when I asked them about Step 1 potentially going pass-fail is how is this going to change their residency process? And most of them answered it really won’t. They look at every application no matter what.

Premeds don’t believe this because when they apply to medical school, and they say they look at every application, that’s just not true because they get 10,000 applications. But residency programs don’t get that many applications. They may get a few hundred or a thousand. So it’s possible to look through every application. And so most of them say nothing will change. They’ll have to look at some different things potentially a little bit differently. But nothing will change.

“Residency programs don't get that many applications. They may get a few hundred or a thousand. So it’s possible to look through every application.”Click To Tweet

Your scores in your clerkships are really important as well as those letters of recommendation, the Dean’s letter. And only a few of them have no idea what to do and that they’ll figure it out.

[08:31] What the Future Holds

'Nobody knows. But everything will be okay.'Click To Tweet

Students who got into a DO school shouldn’t withdraw their acceptance and fix their application and reapply to MD schools. Go to the school where you’re happy that you were accepted and be a strong candidate. At the end of the day, that will never change. And that’s the key to everything in your journey, which is you working hard.

The fact that USMLE only did Step 1 pass-fail confuses me. And there are lots of rumors as to why they did this. But at the end of the day, it doesn’t matter. They did it.

Those are exams to determine whether or not you are capable of practicing medicine here in the United States. And a score doesn’t tell you that. A pass or fail tells you that the score is just being used in a way that it’s really not supposed to be used. It’s not meant to be used to determine your strength to be a radiologist versus an internist. It’s just a score.

Personally, I’m glad that Step 1 went pass-fail. Hopefully, it’ll reduce the stress on students in the first couple of years of medical school. Hopefully, every Step turns pass-fail. And that we as a society and culture of premeds and medical students would go show our other traits and skills.

Work hard during your rotations. and be the best student out there. Not by pushing down other students but by just being the best you and have that stand out. Yes, it’s subjective. And yes, there are bad attendings out there who may hurt you in this process. But that’s life in general as well.