 Step one is now what? All right guys, but in all seriousness, this huge news broke out yesterday about step one, which prior to yesterday was probably considered the most important exam you took in your medical school career is now pass fail. So what does that mean? Is it good? Is it bad? I'll give you my thoughts on this video as well as future direction that you should consider. Let's get into it. All right guys, welcome to the MD journey. My name is Laksh. I am a resident physician who makes videos just like this for individuals and students like you, succeed on their medical journey with less stress. Today we are talking about a huge conversation of step one becoming pass fail. I'm gonna give you my thoughts and I want you guys to be included in the conversation. So drop your comments down below. Let me know what your thoughts are. So I can also understand different viewpoints and perspectives and while you're down there, go ahead and smash the like button and join the community by hitting the subscribe button as well as that notification bell. But as of yesterday, February 12th, 2020, I found out through multiple different notifications on Twitter, Instagram, DMs, that step one is now pass fail. And when you look through the reaction, it's really not unified. Some people are really happy and some people not so much. So let's talk about the good, the bad and the ugly in this video. So first let's talk about why this change was made in the first place. So the USMLE is actually co-sponsored by two different governing boards. One you're more familiar with is the MBME and the other one is the FSMB. But these two governing boards have had conversations through feedback that they've gotten from students as well as institutions on how to make changes to each of the respective step exams. So there's step one, step two and step three and you take these at different points in your medical school as well as residency journey. But these two governing boards announced yesterday that step one which prior to this used to be realistically the most important exam you took in medical school as well as your medical career in general is now going to be pass fail. So this means that any student who's going to start medical school the fall of 2020 is likely going to be affected by this. And if you're already in med school or you're about to take step one this year or next year, this score change won't affect you. So is this good or is this bad? I've heard a lot of y'all's thoughts on Instagram that some of you guys love it. Some of you think it's complete BS and I really want to give you my thoughts. Let's talk about the things that are really good. So first let's talk about the obvious and that's that step one used to be the most important piece of information that residency programs used to use to evaluate their applicants. And so rightfully that also made step one the most demanding and stressful exams for students and it wasn't abnormal to have that affect your wellness as well as have students who would isolate themselves for weeks to months away from all different hobbies from friends, from family, from wellness in general to prepare and do well on this exam. A lot of pressure came from doing well on step one. So now that the score is officially being changed to pass fail, you can understand how the stress is just decreased tenfold. And I can speak from experience because when I started medical school my institution switched from a grading scheme to a pass fail scheme for the first year and a half of preclinicals and that made my wellness so much better despite medical school being stressful as is I can only imagine myself being more stressed if I had a score to prepare for. So now you can see how first and second year med students will definitely feel a sense of relaxation and not as much stress going into step one. The second thing that I think is really good about this change and this is my personal preference is that now we can really focus on what matters. Honestly people who perform well on step one don't necessarily correlate to a great doctor. You may be a really smart doctor but you may be pretty crappy with your patient experiences. And I've seen these individuals on my rotations as well as residency as well as people who have now become attendings is that you may not be the best physician although you did well on exam but sometimes that score can dictate the trajectory of your future career. So now that step one is pass fail we can really focus on what matters. And that includes clinical prowess but also how you interact with your patients, how you interact with team members and how you can focus on critical thinking instead of just an ABC exam. Now obviously a lot of the feedback I've been seeing on social media on this topic have been from current med students. So it's not gonna be from students who are actually gonna be affected by this change. It's only gonna be from students who start the fall of 2020 of their med school career. So a lot of the feedback I've been getting has been well this kind of sucks. Really a lot of the animosity as well as discomfort towards this change comes from some of the questions such as how do I separate myself now? If I come from a not so well known med school if I come from a low income background or if I come from a Caribbean med school or an international med student, how do I now separate myself from residency programs compared to somebody who comes from a higher institution? And that is a completely valid question. How do you separate yourself? And truly the answer is, we just don't know yet. I had a fellow yesterday on my cardiology rotation that told me that you guys come from a great med school but there's somebody that's gonna come from an Ivy League school and they may be more incompetent than you but still may have a higher chance of getting a competitive residency specialty compared to you. And there is some truth to that. We just don't know within these two years of how residency programs are gonna change as well as how med students and med schools are gonna change to allow them to have more information because step one used to be the most important piece of information that a residency program is focused on. Now they're gonna have to kind of look to other things. Now on that point, as step one becomes past fail step two CK is likely gonna carry more weight and I think there's some good and bad within this kind of change as well. First of all, I think step two CK is probably more evaluative of what kind of physician you're going to be in terms of critical thinking and clinical prowess versus step one which asks you the name of random enzymes. They honestly, at this point, I just don't need to remember, I can look them up. So there's going to be more of an emphasis on an exam that is probably more representative of the kind of physician you have the potential of being. But with that being said, obviously when you now move the weight over to a different exam step two CK becomes more important but it's also very hard to study for that exam. You're taking clinical rotations which have exams already built into them. Sometimes your institution may not give you specific time off to study for step two CK and you're gonna have to get creative with your fourth year schedule to study for it. And as rotations during your third year are noted to be notoriously common for burnout adding an extra exam that's now even more important just kind of makes it more stressful obviously. Now the next thing that's going to be affected by this change is that you're going to have a bigger emphasis on your rotation grades as well as your shelf exams. And the hard part is for the rotation grade sometimes it's not easy to have that be standardized from institution to institution. As well as instructor to instructor you can be on a rotation and have a really great attending who gives you a great grade. And then I may go on that same rotation with a different attending and may get a high pass just because their grading schemes were off. And I can see that as a problem for institutions that are considered more lower or mid tier of them more likely to give their students higher grades in the hope that they can still stand out for residency applications. And honestly that's not the way it should be but I can understand why that change would be made. To close out this video I want to talk about probably the most important thing which is where do we go from here? What do you go from here? And while this change is polarizing I want to make it known that obviously it's not new. We've changed things around the medical school journey all the time. For example when I was applying to med school MCAT used to have a writing portion which they then took away. I could hear all my upperclassmen saying well I had a right of writing section and now you don't that's not fair. Sorry if my grandpa accent not quite amazing yet. And if it's not the MCAT then you've already seen institutions do this and you're gonna see it more now of making their first two years pass fail as well as transitioning their students into rotations quicker which will help them do better on step two CK. And some things are kind of a little bit unknown. What kind of information will residency programs now ask for? Now that step one is pass fail. Are they gonna ask for video interviews like they do for the emergency medicine residency programs? Are they now going to ask for more specific evaluations or more letters of recommendation? Or is there going to be different forms of assessments that are thrown into your clinical rotations to help them evaluate you? So is this going to be a bumpy road? And I think for the first two to three years absolutely you're gonna have institutions that are just gonna be required to be more creative to get their students in a better position. You're gonna have residency programs they're gonna try to find creative ways on evaluating and extrapolating more information from potential applicants. And it also means that you as a student will probably have to get more creative whether that means involving yourself in research more, doing more shadowing and basically getting yourself in front of the faces and the physicians that you may wanna one day emulate. But bottom line, I do think this is going to be a good change for early med students that are still trying to figure out how to study, how to kind of understand and absorb all this information without having the pressure to step on. But it is going to be a rough patch for students later on to understand how to separate themselves on their rotations as well as step two CK to really get into residency programs. So it's a lot to digest I know and hopefully we can get a lot of interesting innovations that move medicine in the right direction where doctors are better clinicians than they are better test takers. But it's gonna require some innovation over the years to get to that point. But hopefully you guys did enjoy the insight in the video. Make sure you go ahead and like and subscribe. And if you do wanna help at different phases of your medical school journey, then go ahead and check out the resources linked down below, as well as if you're trying to still do well and step on regardless of what score you now need, go ahead and check out the Step One Academy to kind of help you from start to finish on doing well on that exam with less stress. But as I mentioned at the start of this video guys, I really wanna understand your perspective, your pros and your cons and make sure you drop your comments down below. Let me know what you like, what you don't and then what future direction you see us going now that this news is official. But thank you guys so much for watching. Make sure you go ahead and like and subscribe and hit that notification bell for videos just like this one coming at you on a weekly basis. Thank you guys so much for watching. Hopefully I've been a little helped to you on your journey. Thanks for being part of mine. Peace.