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passionateaboutmed

USMLE after year 1 of med school

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Hi, 

I'm a first year medical student in Ontario (I'm trying to remain completely anonymous for the potential backlash :(). Taking standardized tests and academics is my biggest strength (528 MCAT, 4.0 GPA in a very rigorous program). I was looking forward to take USMLE and get a good score for matching to USA, but in 2022 (which is when I was supposed to take USMLE step 1) it's gonna be pass and fail, which won't help me with matching. It's much harder for me to work on the other parts of the application that make me competitive than do a test (do electives in US, get great LORs from the faculty of those universities). Hypothetically, if I do a lot of independent studying aided with a lot of background in all the topics of USMLE because of my undergrad, is it even possible for me to take USMLE after my first year? aka in the last year that it offers scores.  I'm completely aware that I might end up not doing well but it's just a risk I'm willing to take as matching to a good program in US is not a necessity, just an added bonus if it happens (I have family members in USA, love some cities, etc). If I do bad, I'll just forget about it and focus on matching in Canada which doesn't require competitive test scores. 

One other issue I was thinking about is that the cohort that will be applying with me will have it as P/F. I would still be able to mention my score since I took it earlier but the majority will have taken it as P/F. 

I realize what I'm proposing is very unheard of and I wouldn't have dreamt of doing it they didn't change their system to P/F in 2022. I'm looking forward to hearing any other aspects I haven't considered. 

 

 

 

 

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5 hours ago, passionateaboutmed said:

Hi, 

I'm a first year medical student in Ontario (I'm trying to remain completely anonymous for the potential backlash :(). Taking standardized tests and academics is my biggest strength (528 MCAT, 4.0 GPA in a very rigorous program). I was looking forward to take USMLE and get a good score for matching to USA, but in 2022 (which is when I was supposed to take USMLE step 1) it's gonna be pass and fail, which won't help me with matching. It's much harder for me to work on the other parts of the application that make me competitive than do a test (do electives in US, get great LORs from the faculty of those universities). Hypothetically, if I do a lot of independent studying aided with a lot of background in all the topics of USMLE because of my undergrad, is it even possible for me to take USMLE after my first year? aka in the last year that it offers scores.  I'm completely aware that I might end up not doing well but it's just a risk I'm willing to take as matching to a good program in US is not a necessity, just an added bonus if it happens (I have family members in USA, love some cities, etc). If I do bad, I'll just forget about it and focus on matching in Canada which doesn't require competitive test scores. 

One other issue I was thinking about is that the cohort that will be applying with me will have it as P/F. I would still be able to mention my score since I took it earlier but the majority will have taken it as P/F. 

I realize what I'm proposing is very unheard of and I wouldn't have dreamt of doing it they didn't change their system to P/F in 2022. I'm looking forward to hearing any other aspects I haven't considered. 

 

 

 

 

You’d be better asking this on StudentDoctor imo, as they’re far more knowledgeable about the US matching system than we do (I mean we’re a Canadian-focused forum after all...)

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1 hour ago, robclem21 said:

Why do you want to do residency in the US?

I have a few family members in different states, also I feel like academics don't play a big role in matching to programs here where as in USA with STEP 1 scores you can use your academics to match if it's your strength. For example, my MCAT scores didn't help me past the cut off points in Ontario schools where as if I was applying in USA I would've had a shot in some Ivy league universities. Of course, If I match to a Canadian program I would still consider it/accept it but I just want to give US programs a shot too if my hypothetical USMLE score turned out ok. 

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To answer your question directly, a lot of canadian students who do the USMLE do it at the end of the first summer. The american medical schools pre-clerkship curricula teaches to the exam, so it makes sense to take it at the end of pre-clerkship as you've done all the teaching by that point and have 2 years to review, but candian schools' preclerkship curricula are somewhat more oriented towards clinical medicine and lower yield for the USMLE. Canadian students usually get the summer after first year for a break so they basically spend the summer studying then take it, as past that you get busy studying for osces/nbmes etc.

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I would be very surprised if you managed to hit even an average score on step1 after 1 year of medical school. I think if you were dedicated, you could pull a pass but test taking skills won't help if you don't have the knowledge to back it up and you're missing at least half of the content then. You'd basically look at over doubling your work load over the first year because you have to learn all the year 2 material as well + some material that the US emphasizes that Canadian schools don't. While its certainly possible, I think there are better uses of your time (friends, family, shadowing, even research etc). Do you know what you're interested in yet? That'll skew the usefulness as well as what score you need to aim for

If you go through with this, definitely update us haha, I wanna see how this turns out.

Just saw bearded frog's post, I've heard occasionally students from McMaster will write it after year 1 since its a 3 year program, but people at my school all definitely wrote it after 2nd year, and our scores are all pretty mediocre (lol maybe we're just dumb though)

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Taking it now will affect your score for sure. This isn't like the MCAT where you can do well with good reasoning skills and is purely dependent on studying and rote memorization.

Step 1 will become P/F, yes. But you can still take and kill Step 2, which will continue to be scored.

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I think you'll be better off just writing it after second year, when it's pass/fail. You're competing against Americans who have 2 whole years of schooling that tailors to the test, plus dedicated time to study. It's unlikely that you'll score well after 1 year, since there is A LOT of material covered in Step 1. 

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It's rumored that Step 2 will replace Step 1 for resident selection purposes.  It's also considerably more clinically useful with overlap with the LMCC Part I,  so I'd suggest focussing on Step 2 rather than Step 1 (which also fits in with NBME shelfs that are still used at some schools).  Given the curricular differences, even getting a Pass on Step 1 will take quite a bit of work.

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On 10/11/2020 at 10:44 AM, interestedinrads said:

I would be very surprised if you managed to hit even an average score on step1 after 1 year of medical school. I think if you were dedicated, you could pull a pass but test taking skills won't help if you don't have the knowledge to back it up and you're missing at least half of the content then. You'd basically look at over doubling your work load over the first year because you have to learn all the year 2 material as well + some material that the US emphasizes that Canadian schools don't. While its certainly possible, I think there are better uses of your time (friends, family, shadowing, even research etc). Do you know what you're interested in yet? That'll skew the usefulness as well as what score you need to aim for

For most Canadian medical schools, the relevance of the second year of pre-clerkship to the USMLE is going to be relatively low. I'd estimate you're going to have to study 70% of the content on your own anyway, and usually its only the first summer you have to dedicate time to studying it, although you could take it at any point in second year probably.

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On 10/11/2020 at 9:34 AM, passionateaboutmed said:

Hi, 

I'm a first year medical student in Ontario (I'm trying to remain completely anonymous for the potential backlash :(). Taking standardized tests and academics is my biggest strength (528 MCAT, 4.0 GPA in a very rigorous program). I was looking forward to take USMLE and get a good score for matching to USA, but in 2022 (which is when I was supposed to take USMLE step 1) it's gonna be pass and fail, which won't help me with matching. It's much harder for me to work on the other parts of the application that make me competitive than do a test (do electives in US, get great LORs from the faculty of those universities). Hypothetically, if I do a lot of independent studying aided with a lot of background in all the topics of USMLE because of my undergrad, is it even possible for me to take USMLE after my first year? aka in the last year that it offers scores.  I'm completely aware that I might end up not doing well but it's just a risk I'm willing to take as matching to a good program in US is not a necessity, just an added bonus if it happens (I have family members in USA, love some cities, etc). If I do bad, I'll just forget about it and focus on matching in Canada which doesn't require competitive test scores. 

One other issue I was thinking about is that the cohort that will be applying with me will have it as P/F. I would still be able to mention my score since I took it earlier but the majority will have taken it as P/F. 

I realize what I'm proposing is very unheard of and I wouldn't have dreamt of doing it they didn't change their system to P/F in 2022. I'm looking forward to hearing any other aspects I haven't considered. 

you may find that to prevent bias the US school's will exclude the step 1 score regardless - that way all applicants on the same playing field which would be their desire - it would be fundamentally unfair for some one to use a scored test to gain advantage over a cohort that doesn't have access to a score. Blinding the reviewers to the score is a common way to prevent that issue. Same as in Canada some Quebec school have grades that show up on the transcripts - we still are advised not to use them basically.  I can easily see you going through this and the score simply thrown away regardless. If I was running a US program for residency that is exactly what I would do. 

The basic assumption now is with step 1 going away that step 2 is going to fill most of the void. That is just another test which it seems would be a similar challenge for you. I am not sure the rush to completed test 1 when you already know they will be really using test 2 (?). It would seem more logical to sure pass step one, but redirect that extra study time to step 2 (which you have to score as highly as possible on anyway regardless if you want to match than to aim for a maximum score on a test that has limited utility (if any really).

now can you do it? sure yes you can - many people I know end up looping back for that test quite a bit later on - like advanced residency or fellowship times for a variety of reasons, and for them the material is very "stable" form them as med school can be 7 years+ prior. They just do it then, and once you prep for a royal college level style exam USMLE test seem like minor annoyances in terms of studying requirements ha.  

 

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On 10/15/2020 at 3:22 PM, bearded frog said:

For most Canadian medical schools, the relevance of the second year of pre-clerkship to the USMLE is going to be relatively low. I'd estimate you're going to have to study 70% of the content on your own anyway, and usually its only the first summer you have to dedicate time to studying it, although you could take it at any point in second year probably.

You're right that the emphasis is different in most Canadian medical schools, but Step 1 stills covers all the organ blocks, which are usually covered throughout pre-clerkship, on top of a lot of basic sciences (biochemistry, immunology, genetics,..) .  What can make Step 1 challenging  is the level of detail for concepts that are less familiar/emphasized, including pharmacology (for HIV, cancer, biologics..) which are typically learned later on a as needed basis in most Canadian programs.  

18 hours ago, rmorelan said:

now can you do it? sure yes you can - many people I know end up looping back for that test quite a bit later on - like advanced residency or fellowship times for a variety of reasons, and for them the material is very "stable" form them as med school can be 7 years+ prior. They just do it then, and once you prep for a royal college level style exam USMLE test seem like minor annoyances in terms of studying requirements ha.  

Interesting - I've heard that Step 1 can be challenging, because of its non-clinical focus from senior residents - that finding time to study for Step 1 is tough even outside a Royal College Year.  A poster on the thread below was suggesting that doing the US MLEs asap is important for surgery as it can become a barrier later on for fully trained surgeons.  I'd imagine pathologists would find Step 1 much more straightforward - probably varies by program and individual.  I'd imagine that "working backwards" could be helpful in some cases - i.e. Step 2  first, which is more clinical, and then Step 1 as there is some overlap.

 

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1 hour ago, indefatigable said:

You're right that the emphasis is different in most Canadian medical schools, but Step 1 stills covers all the organ blocks, which are usually covered throughout pre-clerkship, on top of a lot of basic sciences (biochemistry, immunology, genetics,..) .  What can make Step 1 challenging  is the level of detail for concepts that are less familiar/emphasized, including pharmacology (for HIV, cancer, biologics..) which are typically learned later on a as needed basis in most Canadian programs.  

Interesting - I've heard that Step 1 can be challenging, because of it's non-clinical focus from senior residents - that finding time to study for Step 1 is tough even outside a Royal College Year.  A poster on the thread below was suggesting that doing the US MLEs asap is important for surgery as it can become a barrier later on for fully trained surgeons.  I'd imagine pathologists would find Step 1 much more straightforward - probably varies by program and individual.  I'd imagine that "working backwards" could be helpful in some cases - i.e. Step 2 or 3 first, which is more clinical, and then Step 1 as there is some overlap.

 

oh you wouldn't do it in the royal college year unless you are super-human or insane ha. Challenge of course is a relative thing as well - remember residents usually just need to pass the silly thing, not do well on it. They also don't have to be as afraid of failing it either - in the end for most of the reasons for a resident to take it passing it is enough. I have seen fellows and residents super focus and pass reasonable well Step 1 in 2-3 months of study time. Not "easy" but again you want to so something most don't you will just have to pay for it. 

can you write step 2 before step 1? Honest didn't look but I thought they had to go in order. 

I think they are correctly stating you need the steps to get the type of visa that lets you work in the US. Even for some fellowships if you want to work in the US and then stay there you need to go there with the right visa (i.e. not J1, which is the easiest to get but has a 2 year return requirement. You can get around it but it is hard. H1B is easier to work with). 

all this is complex - and depends on what you are hoping to do in the end. 

Edited by rmorelan

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7 hours ago, rmorelan said:

oh you wouldn't do it in the royal college year unless you are super-human or insane ha. Challenge of course is a relative thing as well - remember residents usually just need to pass the silly thing, not do well on it. They also don't have to be as afraid of failing it either - in the end for most of the reasons for a resident to take it passing it is enough. I have seen fellows and residents super focus and pass reasonable well Step 1 in 2-3 months of study time. Not "easy" but again you want to so something most don't you will just have to pay for it. 

can you write step 2 before step 1? Honest didn't look but I thought they had to go in order. 

I think they are correctly stating you need the steps to get the type of visa that lets you work in the US. Even for some fellowships if you want to work in the US and then stay there you need to go there with the right visa (i.e. not J1, which is the easiest to get but has a 2 year return requirement. You can get around it but it is hard. H1B is easier to work with). 

all this is complex - and depends on what you are hoping to do in the end. 

No- that's exactly the point.  Even in a non-Royal College year, finding time can be a challenge, at least according to some residents.  Some people were able to do them early in residency.  Maybe fellowship could give more time in some cases.  Some programs would obviously be closer to the material.    

Yes - Step 2 CK can be done before Step 1, but the rest needs to be done in order.

Yes - I agree with visa.  It's more the suggestion that some were sort of stuck, because they couldn't "face" the US MLEs.  I wouldn't normally think of surgeons as not being able to "face" a non-obstacle.

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1 hour ago, indefatigable said:

No- that's exactly the point.  Even in a non-Royal College year, finding time can be a challenge, at least according to some residents.  Some people were able to do them early in residency.  Maybe fellowship could give more time in some cases.  Some programs would obviously be closer to the material.    

Yes - Step 2 CK can be done before Step 1, but the rest needs to be done in order.

Yes - I agree with visa.  It's more the suggestion that some were sort of stuck, because they couldn't "face" the US MLEs.  I wouldn't normally think of surgeons as not being able to "face" a non-obstacle.

for many programs the best year to do it is the first year - your are often off rotation quite a bit, and getting super high performance on those rotations is not as critical as the actual exam. Plus to be clear the score score was less of a concern - they aren't using this to secure a residency spot after all. 

It wasn't a function of having more time in fellowship - it was a function of now the barrier was simply in the way and had to be removed no matter the cost. It is amazing how much time you can throw at things when you simply don't have a choice ha (that is the royal college year in a nut shell). Doesn't mean it was trivial just that it was necessary. 

I am not sure why they though the face the USMLEs? did they provide a reason? I mean any doctor is quite used to writing the sort of test the USMLE is based on and most have undergraduate degrees in foundational material for the test. 

Ha good to know actually on the test order! 

Edited by rmorelan

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I don't think it is necessary (for fellowship reasons only), many non-USMLE based fellowships over there, can do Canadian ones, or go to another country like UK/Australia, etc. It won't be the end of the world, and not everyone needs ALL the doors to be open. Not everyone does well on standardized tests, even if they have studied for it, so no need to freak out those people.

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2 hours ago, IMislove said:

I don't think it is necessary (for fellowship reasons only), many non-USMLE based fellowships over there, can do Canadian ones, or go to another country like UK/Australia, etc. It won't be the end of the world, and not everyone needs ALL the doors to be open. Not everyone does well on standardized tests, even if they have studied for it, so no need to freak out those people.

completely true - and very good fellowships at that. Some of this will depend on the speciality - some so what you to have it as you can then in theory moonlight, which is another way of saying you can cover inconvenient shifts while your staff sleeps ha!

My fellowships just as an example didn't require the USMLE at all. 

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3 hours ago, rmorelan said:

for many programs the best year to do it is the first year - your are often off rotation quite a bit, and getting super high performance on those rotations is not as critical as the actual exam. Plus to be clear the score score was less of a concern - they aren't using this to secure a residency spot after all. 

It wasn't a function of having more time in fellowship - it was a function of now the barrier was simply in the way and had to be removed no matter the cost. It is amazing how much time you can throw at things when you simply don't have a choice ha (that is the royal college year in a nut shell). Doesn't mean it was trivial just that it was necessary. 

I am not sure why they though the face the USMLEs? did they provide a reason? I mean any doctor is quite used to writing the sort of test the USMLE is based on and most have undergraduate degrees in foundational material for the test. 

Ha good to know actually on the test order! 

Honestly, it's really the first time I've done a standardized test (Step 1) and felt like I'd really not want to do that again - could be a lot of confounding factors - other stressor at the time, knowledge level at that point, time to prepare, other individual factors..  I think having to go back to do something like the MCAT would be psychologically easier for me, even though it's a lot further, although in retrospect Step 1 does seem much easier, I think it may be just where I was at the time (especially as it does overlap with Step 2 material). 

One thing that struck me then was how strongly one's knowledge is dependent on the educational system - the concepts emphasized and way of thinking was quite a bit different than what was taught in my pre-clinical curriculum, but I could see that ultimately later on things started to converge at the clinical level.  I think it was a good decision to make Step 1 P/F, as I agree it's main purpose seemed to be serving as a resident selection filter, whereas Step 2 at least is grounded in clinical practice.  

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15 hours ago, rmorelan said:

you may find that to prevent bias the US school's will exclude the step 1 score regardless - that way all applicants on the same playing field which would be their desire - it would be fundamentally unfair for some one to use a scored test to gain advantage over a cohort that doesn't have access to a score. Blinding the reviewers to the score is a common way to prevent that issue. Same as in Canada some Quebec school have grades that show up on the transcripts - we still are advised not to use them basically.  I can easily see you going through this and the score simply thrown away regardless. If I was running a US program for residency that is exactly what I would do. 

The basic assumption now is with step 1 going away that step 2 is going to fill most of the void. That is just another test which it seems would be a similar challenge for you. I am not sure the rush to completed test 1 when you already know they will be really using test 2 (?). It would seem more logical to sure pass step one, but redirect that extra study time to step 2 (which you have to score as highly as possible on anyway regardless if you want to match than to aim for a maximum score on a test that has limited utility (if any really).

now can you do it? sure yes you can - many people I know end up looping back for that test quite a bit later on - like advanced residency or fellowship times for a variety of reasons, and for them the material is very "stable" form them as med school can be 7 years+ prior. They just do it then, and once you prep for a royal college level style exam USMLE test seem like minor annoyances in terms of studying requirements ha.  

 

Thanks, I understand your point about about the scores not being used regardless and that's a concern I have too before going through with this plan. However, I don't think it's fair because technically they could've taken it after first year as well if they wanted to. The school I'm going to is teaching minimum, and I mean it, MINIMUM science. I'm saying this to emphasize I wouldn't be in a better position than they are at the end of first year. I'm not saying I will, but hypothetically, if someone manages a good score after 1 year of medicine why should their score be thrown away?! Others could've done the same. I would say ignoring the score is what's gonna be unfair. I don't think going out of your way to use your own sets of talents to set you apart is "unfair" to others. 

I guess I could reach out to some residency directors and see if this is gonna be the case before putting myself through that! At the end, I can always try to do my best on STEP 2. 

I was wondering if there's a chance that pass and fail change will be pushed back a year? 

Edit: upon further reading, some are even suggesting that starting from class of 2022, only pass and fail will be reported to the ERAS. I guess it's truly a waste of time to write it to get a great score which means there's no use taking it after first year. This is just perfect :/ 

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4 minutes ago, offmychestplease said:

not sure what you mean "The school I'm going to is teaching minimum, and I mean it, MINIMUM science". How do you know how your content differs from other medical schools in Canada? 

because I have close friends in 3 other Ontario schools and we compare what we are learning. I also have 2 friends in US schools. It's not hard to see how the depth of science taught differs between schools. 

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44 minutes ago, passionateaboutmed said:

Thanks, I understand your point about about the scores not being used regardless and that's a concern I have too before going through with this plan. However, I don't think it's fair because technically they could've taken it after first year as well if they wanted to. The school I'm going to is teaching minimum, and I mean it, MINIMUM science. I'm saying this to emphasize I wouldn't be in a better position than they are at the end of first year. I'm not saying I will, but hypothetically, if someone manages a good score after 1 year of medicine why should their score be thrown away?! Others could've done the same. I would say ignoring the score is what's gonna be unfair. I don't think going out of your way to use your own sets of talents to set you apart is "unfair" to others. 

I guess I could reach out to some residency directors and see if this is gonna be the case before putting myself through that! At the end, I can always try to do my best on STEP 2. 

I was wondering if there's a chance that pass and fail change will be pushed back a year? 

Edit: upon further reading, some are even suggesting that starting from class of 2022, only pass and fail will be reported to the ERAS. I guess it's truly a waste of time to write it to get a great score which means there's no use taking it after first year. This is just perfect :/ 

in practical terms that was my main point - in this highly regulated systems it would not surprise me at all if it wasn't reported, and they just stop using that information even if it was. If there is a good reason to covert to a pass fail (debated of course I know but still enough that they did switch) then there is a good reason not to use it at all, so I suspect there is a very good chance they won't. Sometimes practicality overrides the other concerns. As you know systems like med/residency don't make a lot of room for any kind of exception.

Still doesn't change my other point mind you that is step 2 is the replacement, you simply have a different test to study for - and one that again is considered a more useful one for performance as an actual doctor. No reason you cannot study very hard for that test and do well on it (?) in truth you won't have a choice there either - as regardless of your step one score it seems they will all use the step 2 score as the screening test. It will likely be the primary tool to even get the rest of your application considered. 

There would be I would say almost no chance it would be moved back date wise - too many wheels in motion, too many fought for it for too long, and too many students will very loudly complain. 

Edited by rmorelan

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1 hour ago, indefatigable said:

Honestly, it's really the first time I've done a standardized test (Step 1) and felt like I'd really not want to do that again - could be a lot of confounding factors - other stressor at the time, knowledge level at that point, time to prepare, other individual factors..  I think having to go back to do something like the MCAT would be psychologically easier for me, even though it's a lot further, although in retrospect Step 1 does seem much easier, I think it may be just where I was at the time (especially as it does overlap with Step 2 material). 

One thing that struck me then was how strongly one's knowledge is dependent on the educational system - the concepts emphasized and way of thinking was quite a bit different than what was taught in my pre-clinical curriculum, but I could see that ultimately later on things started to converge at the clinical level.  I think it was a good decision to make Step 1 P/F, as I agree it's main purpose seemed to be serving as a resident selection filter, whereas Step 2 at least is grounded in clinical practice.  

sure - although the at least prior entire US education system as centred around that test so for them at least it wasn't a foreign language. For Canadians we do it a lot differently and by-pass a lot of the topics (and I really do think for the most part that is a better approach - memorizing exact biochemical pathways for things we do not yet even have treatments for will just have you forgetting them within a year or two at best. What really is the point?) 

I didn't like the USMLE step 1 at all - particularly doing it after you have your clinical training. You just keep thinking how completely useless a lot of it really is. Fortunately you really can just say to  a lot of it "nope" ha. I mean honestly failing it had no consequences so over studying to ensure a high score was wasting time. Better to study what you think is enough and if you don't do well just do it again - but that of course is not doing the test at the med school point for possible residency. 

Probably the MCAT would be (if you didn't do it prior - I suppose that is also a standardize test) because most premed degrees are covering that material at least. WIth USMLE you really aren't on the same track. 

 

Edited by rmorelan

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5 hours ago, rmorelan said:

sure - although the at least prior entire US education system as centred around that test so for them at least it wasn't a foreign language. For Canadians we do it a lot differently and by-pass a lot of the topics (and I really do think for the most part that is a better approach - memorizing exact biochemical pathways for things we do not yet even have treatments for will just have you forgetting them within a year or two at best. What really is the point?) 

I didn't like the USMLE step 1 at all - particularly doing it after you have your clinical training. You just keep thinking how completely useless a lot of it really is. Fortunately you really can just say to  a lot of it "nope" ha. I mean honestly failing it had no consequences so over studying to ensure a high score was wasting time. Better to study what you think is enough and if you don't do well just do it again - but that of course is not doing the test at the med school point for possible residency. 

Probably the MCAT would be (if you didn't do it prior - I suppose that is also a standardize test) because most premed degrees are covering that material at least. WIth USMLE you really aren't on the same track. 

For sure there's a lot of individual effort to do well on Step 1, although there's no question that US schools need their students to do well too (with school curricular variations).  Even though the LMCC Part I has essentially zero bearing on matching to residency for Canadian students, detailed analysis of student results is broken down by faculty and so Canadian faculties at least want their students to pass  - one can imagine the pressure in the US is quite a bit higher given the stakes.  My school did certainly seem to want students to succeed on the MCCQE I, despite its general lack of "importance".

In the US, I think it was pretty clear that the "hidden curriculum" of Step 1 was really beginning dominate student focus (e.g. with board prep products), much more than even US faculties wanted, as most students realized that the single greatest factor to match was doing well on Step 1.  No question there have been a lot changes that have occurred over the past couple decades, like the rise in IMG education, and so taking Step 1 out of the equation probably ensures US students have better matching opportunities,  especially from well-known institutions.

I'm not sure the transition to Step 2 CK will be immediate, across the board, although practically speaking I'm sure many PDs would like that to happen.  Probably programs will very soon start to mention what they're looking for which will put pressure on people to write Step 2 CK well before residency applications which will eventually result in a systemic shift... all this in the middle of a pandemic!

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