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Step 1 Going Pass/Fail, Here’s What I Think


All right guys, what do I think of this new news that Step 1 of the
National Medical Boards, this is the USMLE, who
knows what the hell it is? I had to take it, medical
students have to take it. It’s that Step 1, that the score of which
determines your future, at least according to
legend and in fact reality, if you want to do a super specialty like radiology, dermatology,
plastic surgery, orthopedics, these kinds of things are very competitive and so the score on this test, by the way it’s a multiple choice test, hours, you study for months, if not years. Stress, pressure, hair loss. I cracked a tooth studying for this thing ’cause I was grinding my teeth at night. And I was at UCSF in the ’90s and this test, it was so important that, pretty much, the entire
curriculum at one point was revolving around what to do and, in fact, I used a book
called ‘First Aid for the Boards’ which, I eventually ended
up meeting the authors, Vikas and Tao, and working
with them to write questions. It’s a whole industry preparing medical students for this freaking test. And they just announced
that they’re gonna change it from a score out of 265,
or 275 or whatever it is to a pass fail. Wo-hoo! So, people have asked me,
“What do you think about this? “Yay, or nay or what?” And here is the actual nuanced answer. So there is a huge part
of me that’s, like, “Screw this test.” All it does is waste hundreds of hours and months of time of people, students who are in the prime of their
academic and creative lives. They’re in their twenties,
or early thirties, they have so much energy
and we suck all of it out for a test that has absolutely nothing to do with clinical medicine. No patient you touch
is gonna have anything to do with that test and I’ll
tell you how I know this, because I got a 99th
percentile score on that test. I studied by playing video
games with my friends and going through mnemonics,
going through First Aid, doing all that stuff,
stressing, losing hair, look, and I got a great score. The third year came around, you take it some time
after the second year, the third year came around, I did, when you’re supposed to
actually see patients, I had no effing idea what I was doing. I’ve never been so depressed and scared as going on the wards and realizing, “I have no clue what I’m doing”. That test has nothing to do with reality. But what do we use it for? We use it as a bar that
you have to jump over so that you can get to the
best residency program, or the best specialty, or whatever it is. And that’s what it’s used for. So, make it pass fail, right? That’ll fix the problem because now we don’t stress people out. They just have to do well enough to pass this basic bar of understanding, knowing that they are diligent enough to do that and that’s fine. Okay, great. Seems to make perfect sense. I say, actually, delete the whole test, it’s a total waste of time, but I’m in the minority. Here’s the push back. What happens if you’re in a
osteopathic medical school? Or you’re at a foreign medical school? Or you’re at a medical
school in Caribbean? And you, maybe you screwed up in college, maybe you’re not the best test-taker, maybe you weren’t super diligent. Maybe you were a real screw-up, and you’ve got your act together, and you really wanted to be a doctor bad, and you ended up going to
one of these other schools? And again, there’s a
whole spectrum of people that are amazing clinicians
that come out of these schools. They distinguish themselves
from the mainstream, upper tier medical schools
by their board scores. If you take that away,
now you have to, kind of, figure out, “Well, okay, how are they “going to distinguish themselves?”. And this is where we have to rethink all of medical education,
’cause why should we use a stupid, meaningless test to play games with people’s futures? We oughta be assessing
medical students differently. Looking at their humanistic attributes, taking the time they would’ve
spend studying for this test and saying “Hey, do something
amazing in the world.” “Go to Africa and do something crazy.” “Cure a disease.” “Go do research.” “Write a book.” “Make an YouTube channel
and educate people.” “Do something creative, and also engaging” “and meaningful in the world,” “and show us who you are.” And we can look at that and go, “You know what, you’d make an amazing” “orthopedic surgeon or whatever”. And maybe that’s how
we oughta be doing it. So we’re asking the wrong questions. All of medical education is fundamentally screwed up anyways because we, okay, hold on. I did a speech in 1999 at the
end of UCSF Medical School. Go watch it if you haven’t seen it. I said exactly what I
meant in that speech, which is almost everything we did seemed absolutely ridiculous, had nothing to do with patients, was demoralizing, depressing and broken, and that was 1999. Do you think it’s gotten better? It’s gotten worse. We’re more about teaching to
the test now than we ever were. We’re more about reducing what are gonna be our future
healers to automatons. And then you have the AMA talking about, “Should we be teaching medical students” “how to use the EHR so they
can be more efficient?”. What are we doing? It’s as broken as it’s ever been. The whole thing needs to be fixed and we gotta start just
by getting rid of Step 1. Let’s be honest with ourselves. It doesn’t help anybody. If you wanna screen doctors for diligence, you’re already screening them
to get in the medical school. We oughta be then screening
for who are these beautiful, creative, passionate people
that are gonna contribute to their fellow human beings, humanity and society in general. And Step 1, Step 2 and Step 3 of the USMLE National
Boards is not doing that. And I’m sorry if that’s gonna piss off people in the Caribbean,
or the osteopathic schools who are using this. We need better ways to
value your contributions than a bulls**t test, all right? So, here’s the call to action. We oughta be lobbying
and creatively thinking about better ways to train, screen and promote the best medical students who are gonna make the best doctors. Almost never is that due to a very high test score, all right? And you’re looking at someone who got a very high test score, who’s marginally, I mean, I’m barely staying out of prison, all right? So, use that as a bar. That being said, all joking aside, this is serious, serious topic. Talk to your med school administrators. We may need to talk to the legislatures. This may be a bigger
movement, all right guys? Share this video. Like this video. Become a Supporter. And don’t, if you’re
studying for USMLE right now, put down that book, smoke a joint, drink something, go out and
see some absent friends, swipe left, whatever it takes, be a Godd**n human being, all right? ‘Cuz you’re gonna be
a better doctor for it. All right, we out.

93 Comments

  1. John Blackburn
    John Blackburn February 23, 2020

    Wondered when the medical profession would follow in the path of our illustrious higher and lower education systems. When do they start grading pass/fail in medical schools?

  2. Bass Town Ncs
    Bass Town Ncs February 23, 2020

    big up

  3. Bass Town Ncs
    Bass Town Ncs February 23, 2020

    awesomely epic

  4. Melissa Story
    Melissa Story February 23, 2020

    But how would they test the brilliance of doctors who have poor human skills but are amazing at saving lives? What would the test be to screen for best bed side manner vs best surgeons? Idk something to think about.

  5. Adnan A
    Adnan A February 23, 2020

    “All of medical education is fundamentally screwed up anyways” 😂

  6. Rik
    Rik February 23, 2020

    I'm about to take step 3. Studying for this test prevents me from studying for the specialty I'm actually going into. It's making me a worse doctor.

  7. Danny
    Danny February 23, 2020

    Here’s an idea — ZdoggMD on the Joe Rogan Experience podcast. Reach out to him if you haven’t already! He’d love your personality and perspective. Explain to him alternatives to M4A.
    PS renal fellow

  8. Uhlbelk
    Uhlbelk February 23, 2020

    Yea, push that type A1 personality, as if the tests didn't already skew that direction.

  9. Anika A
    Anika A February 23, 2020

    i am studying for the step 1 and wish i could do everything you said! dont know where to find a joint tough! 🙁

  10. Erika Ronska
    Erika Ronska February 23, 2020

    Anyone in the medical field should be required to work as a CNA for a semester – from an RN in California

  11. Chris Lee
    Chris Lee February 23, 2020

    You’re 100% right look honestly I think the MED school system needs a revamp it was designed before we had even a quarter of the scientific knowledge we have now and we are trying to shove it in our head for a year and a half when really I’d be fine with a 5th year if it gave us time to actually absorb all this information AND still get the clinical and human contact skills we need. Believe me as a non traditional MED student I wouldn’t want to spend another year or spend the money for another year but I genuinely think we would all be better physicians if we did. Instead of streamlining the info to shove it in an outdated time frame.

  12. Kevin Sagers
    Kevin Sagers February 23, 2020

    The whole system is backwards. You have schools basing admissions off of “diversity quotas” instead of straight up merit, then you need a test in the middle of med school to re-separate them back out into something resembling a meritocracy.

  13. Rachel Duncan
    Rachel Duncan February 23, 2020

    As a nurse, I know that studying for the NCLEX did not prepare me for my career. BUT I really appreciated that it was a pass/fail test.

  14. kinpatu
    kinpatu February 23, 2020

    John Mandrola expressed similar criticism of the test on his podcast this week as well.

  15. Zafar Syed
    Zafar Syed February 23, 2020

    In the early 80s, the geniuses who thought there would be a glut of physicians and said not to build new medical programs, not to increase the class size, realized their mistake 10 yrs later. I heard of them getting rid of the score 15-20 yrs ago, and now they are finally doing it, but again geniuses can't figure out what to do to. To replace the score with something else so that DOs, USIMGs, FMGs have a space to get anything better than Family/Internal Medicine? I think that might also be a very likely reason behind the change being done now compared to before… fill up even more primary care spots and leave more attractive/competitive spots for US grads

  16. Betty Jo Nelson
    Betty Jo Nelson February 23, 2020

    Where can we find the 1999 speech you talked about?

  17. A S
    A S February 23, 2020

    😱was waiting for your thoughts on this, wasn’t disappointed.

  18. Traygus
    Traygus February 23, 2020

    Very refreshing perspective, and I totally agree. Thanks ZDogg!

  19. Joseph Barrett
    Joseph Barrett February 23, 2020

    Ricky and Morty…. Nice shirt

  20. J.P. Silva
    J.P. Silva February 23, 2020

    I mean, if you want NPs practicing as doctors reducing the stress on basic sciences would help. American healthcare it's becoming funnier by the day.

  21. James Smith
    James Smith February 23, 2020

    You can't just keep saying "the test is a terrible way to assess performance" and then NOT PROVIDE any alternatives. You're opinion might be a sound one, but until you quit rattling on about assessing beautiful hardworking candidates "humanistic abilities," there is no objective way to assess someone's candidacy.

    Is the test the best way? Of course not.

    Is the the best objective measure we have to date. Yup.

  22. James Smith
    James Smith February 23, 2020

    How does having a you tube channel or going on a mission trip vacation to Africa demonstrate that you are able to spend 100 hours a week at the hospital, excel in the OR, and pass your oral and written boards?

  23. Leah Hona
    Leah Hona February 23, 2020

    It’s the same with nursing and the NCLEX. Spend so much time learning how to pass the NCLEX, you have to learn how to be a nurse on your first job!

  24. Jon
    Jon February 23, 2020

    Raising my hand over here…. DO grad 2001 who made above the 90 percentile on USMLE using the exam to help me get into an allopathic Radiology residency . Getting into my residency back then required more than that score given the perceptions. It took extra work outside of medical school, showing my character and dedication to patients and to the field on my externships. My attendings at the time are now my colleagues. Now I teach MD's and DO's residents and medical students and I understand how they reviewed candidates back then. I am quick to let the medical students know the true secret. The score was but a component. Character, work ethic, dedication and social interactions were and are critical.

  25. Faraz Rahman
    Faraz Rahman February 23, 2020

    The problem with alternatives proposed is how inaccessible they are, how subjective they are, and how they perpetuate inequality. Students at top schools will have better clinical sites, better lecturers, more prestigious faculty, and more opportunities to get involved with research. This move doubles the effect of building connections, at the expense of objective data. Next you're gonna end up with more ass-kissers, more useless unreplicable research, and more socialites. Anyone from unconventional backgrounds that could otherwise prove worth through data get hamstrung.

  26. Juan Manuel Martinez
    Juan Manuel Martinez February 23, 2020

    As a foreign MD looking at the idea of a residency in the US this is super scary, I mean, I totally agree the exam is a bullshit system but… well, now what? how does it affect people's chances.

  27. Dragnerve
    Dragnerve February 23, 2020

    They gonna make it pass/fail and make it harder to pass 🙂

  28. Arpest Qargust
    Arpest Qargust February 23, 2020

    I'm taking Step1 in less than a week. Pray for me

  29. James Huffman
    James Huffman February 23, 2020

    This will actually help IMG's in a weird way…currently many top domestic schools push off step 1 till end of year 3 (imgs cant do this). The domestic schools get an extra year of prep, and can apply for residency programs without a step 2 score.

    Now, step 2 score matter. Everyone will take them at the end of ms4 BEFORE applying for residency.

    Just having "Harvard med, step 1 pass, step 2 pending" won't look very good.

  30. New Channel
    New Channel February 23, 2020

    My thoughts on the GRE. But that's for us nobodys.

  31. Wolfpac Wolfpac
    Wolfpac Wolfpac February 23, 2020

    All Medical Technologists take an ASCP board test. In 2003, it was pass/fail. Now it is a score. You can take to work as a Medical Technologist period. I passed first time. If I retake the test now, I would possibly fail. All the tests do is that you can regurgitate info. Not how you use the info to treat or diagnose patients.

  32. bmahoney1568
    bmahoney1568 February 23, 2020

    I’d rather have step 1 determine my future than the alternative which is who your parents know or how expensive a private prep-school your parents put you in, because those are the only other factors that determine your fate in medicine.

  33. christa delacruz
    christa delacruz February 23, 2020

    I wrote those tests as a Canadian, hoping to practise in the US . Test scores high. I agree with your take. This test does not reflect your competency as an MD. I am thankful I did not waste a second on it studying as I had just given birth and went in with a comme si comme ca attitude. I am now 15 plus years in practice in a surgical specialty. I implore new grads not to get hung up on these exams.

  34. Sean Andresen
    Sean Andresen February 23, 2020

    It seems like Step 2 is going to have a lot more weight on it as like the last standardized metric of academic potential there is… Honestly this is the test that aims to assess actual clinical practice so it might not be a bad thing to have more weight on this. I'm an MS2 who just got my Step 1 score back (happy about it) and it is pretty weird knowing that I'm part of the last generation of med students where this much weight is placed on that strange test.

  35. Dolores Rosas
    Dolores Rosas February 23, 2020

    Completely agree with you in that we as humans not just doctors we need to have a life to be creative. Its kind of the similar argument to my old psychiatry professor in my psychiatry rotation. I am third year medical student living in Mexico City, Mexico and dual citizen of Mexico and the US. The things I do to be creative outside of medicine is YouTube and writing to 2 web novels that are both decently popular fun romance stories.

  36. Biggs Dickleson
    Biggs Dickleson February 23, 2020

    Just a note from an osteopathic viewpoint: Step 2 will now be the new Step 1 in determining your medical future.

  37. CPRinfringer
    CPRinfringer February 23, 2020

    @ZDoggMD – GradPLUS loans put medical students on a level economic playing field. Students entering college are absolutely not on a level socioeconomic playing field with one another (especially if their parents were members of the working class). I’m sure that students at elite medical schools are excellent people. They were already very rewarded for their excellence (more impactful research opportunities, preference for prestige by residency program directors, etc). The students at Harvard med use BWH as their safety program. This change makes the work done by students during undergrad, where we already know the playing field is not economically level, more important than medical school (where the economics are more fair).

  38. Alexander Herrin
    Alexander Herrin February 23, 2020

    Penn State College of Medicine is on top of this, they are introducing patient interactions within the first months of med school 😀 granted we don't treat patients we talk to them

  39. Brandy Maeleelynn
    Brandy Maeleelynn February 23, 2020

    Omfg are u talking about the NCLEX?!?! Sounds about the same honestly. We come out not knowing much either anymore and have to roll with it. It's a stupid meaningless test that does nothing for us. Just my opinion. It took me well over a year to feel half competent as a nurse after passing my boards aka NCLEX. You are not wrong it is bull shit cause it makes other people money! You know it. You should have just said it. Also one of the many reasons I scrapped the idea of going med school long ago. It is the same as nursing school but on another level of damn. Needless tests that prove not much about us as a person.

  40. Marc5840
    Marc5840 February 23, 2020

    Zdogg, you know there are dumb docs out there. Don’t pretend. There are students accepted for their race or gender, nepotism, etc. The step 1 helped residency programs wade through all the BS and find the gems that knew how to take medicine seriously.

    What about organic chemistry? Same thing: an undergrad course that will grind you up and spit you out and has ZERO helpfulness as a doctor. Yet it’s true usefulness is weeding out all those idiots who mindlessness checked out “medicine” as their goal for college. Only those who truly wanted to be doctors put in the time to make the grades to get them into Med school.

    Could things be done better, sure. But unless we have a solid alternative, let’s stick with what has worked for generations.

  41. Dorothy Mankey
    Dorothy Mankey February 23, 2020

    He’ll yeah!

  42. Carlos Hernandez
    Carlos Hernandez February 23, 2020

    As an osteopathic medical student… this leaves me wondering about the future. I've only taken Level 1. Took it twice…… Idk how to feel about this.

  43. MRooz
    MRooz February 23, 2020

    Although I disagree with ZdoggMD for dismissing the value of Step 1 content, this test is part of the whole money making machine called ECFMG that charges hundreds of $ just for scrambling bunch of questions. BTW, any candidate paying for that additional insane amount to recheck his/her score should be barred from practicing medicine due to their insane share of stupidity.

  44. The Internets
    The Internets February 23, 2020

    This is definitely bad for D.O. students. They now have no way to standout for the uber competitive specialties/programs who don't give two shits about COMLEX.

  45. Joie
    Joie February 23, 2020

    So many professions have meaningless tests and then you get into the real world and you are totally unprepared. Thanks for speaking on this subject.

  46. Jenna Khivka Pratt
    Jenna Khivka Pratt February 23, 2020

    I wonder what Dr Jen Arnold would think of this. Imagine how much harder she had to work than you to be allowed the same privilege of a medical license.
    Often, those of us that are different rely on standardized tests and other sort if blinded tools to evaluate us fairly

  47. Mary Leigh
    Mary Leigh February 23, 2020

    Could be worse, have you heard how Canada makes a doctor?

  48. coffeefish
    coffeefish February 23, 2020

    Your way is worse ZDogg. It opens the door to political corruption. I'd rather my clinician did nothing but study medicine. You want to heal humanity, don't go to med school. If you don't like the questions, then work to change the questions. Otherwise, the process becomes an impossible to manage, milieu of subjectiveness.

  49. P
    P February 23, 2020

    Amen!

  50. Patrick Showalter
    Patrick Showalter February 23, 2020

    Medicine is in trouble. The USMLE is the least of its problems. Huge shortage of physicians is starting to happen. Burnout is rampant. Bureaucrats have taken over. Gotta restore the prestige of the profession by increasing the autonomy, creativeness, leadership, and care of its most important professionals.

  51. Autobahn Speed
    Autobahn Speed February 23, 2020

    Step 1 was a brutal test and I agree all the boards are just a money making scam but his alternative was stupid. No one has time to write a book or go to Africa while in Med school. As a grad from a Caribbean school in a highly competitive specialty I think this move is making it easier for people especially those in the US and screwing the IMGs. Now Step 2 is going to be weighed more. The whole system needs to be revamped not one test. This goes for the ABIM as well.

  52. Rena Linderer
    Rena Linderer February 23, 2020

    As a DO, I didn't even take the USMLE- I took the COMLEX, which is the osteopathic equivalent. Still ended up in an allopathic pediatric residency. People may say it's just because it was pediatrics since that's easy to get into but I don't know. Just another wrench to throw in there.

    Side note- there was an ad for a USMLE webinar right after your video 🤣😭😆

  53. Florence Cavalcante
    Florence Cavalcante February 23, 2020

    Do we really want med students and dr's smokin' joints??

  54. shms ganeem
    shms ganeem February 23, 2020

    Well me as an IMG in our school or even our country don't have what you are talking about ! 
    in my school we don't even have the chance to participate in research opportunity because in fact their is a minority who do research and no student allowed to be part of it ! , and also as an IMG, going to the US to do clinical rotation it quite expensive i remember paying over 10 thousand dollar to have 2mo of clinical rotation and it was not at a very good place ! i was only undergraduate so my family had to pay for that ! 
    so the whole process of being a US practioner well be exclusive for being from a very wealthy family ! its pretty upsetting and unfair for the less fortunate people who are trying to create their own path , because at the end we don't have the advantages that you have in your country ! 
    so the only thing we have in our hand is STEP 1! though its a mentally and physically tiring process but we are welling to do it because this is our only chance !
    THANK you doctor !

  55. Shivani Shastri
    Shivani Shastri February 23, 2020

    Yes but do you think of COMLEX? It’s a DO board exam without pas/fail

  56. Yasser Essa
    Yasser Essa February 23, 2020

    What’s Zdogg specialty

  57. Joseph
    Joseph February 23, 2020

    As an OMS-1 I really appreciate that you looked at both sides of the coin instead of just regurgitating the same opinions as every other "famous doc" on youtube. This change doesn't help D.O's, low-tier MDs or IMGs. This only helps MDs at prestigious institutions. Sure, what medical school you get into should hold weight but this really kills the notion of an equal playing field. Some students went from horrible high schools to community colleges to whatever medical school they can get into. Without scoring this test there is nothing to distinguish the lowest ranked student at an t-20 from the number one student anywhere else.

  58. maxthefax13
    maxthefax13 February 23, 2020

    I ultimately agree with this stance @ZDoggMD, but as a current DO student, I really wish they had planned this announcement better and had good quality answers to questions like "what things can med students focus on now to stand out?" or "is this change going to affect students that take a scored Step 1, but apply to residency alongside students who took a P/F Step 1"

  59. erynlasgalen1949
    erynlasgalen1949 February 23, 2020

    Amen. The American medical qualification process is designed to be unnecessarily exclusive, which is why there are too few doctors and those few end up being overworked. I want a doctor who thinks putside of the box. Because sometimes that IS a zebra running past.

  60. Michael Hernandez
    Michael Hernandez February 23, 2020

    I mean, the test was originally intended to be a pass fail test anyway.

  61. MrPhange Phange
    MrPhange Phange February 23, 2020

    Internists: Step 1 is important!
    Surgeons: Krebs Cycle u mean Peloton Cycle

  62. A. Shah
    A. Shah February 23, 2020

    Agree. The tests are useless. Make them like the stupid ABIM board where it is a checkpoint for whatever stupid competency that it measures (spontaneous regurgitation of prefabricated hypothetical answers), but do not make it a focus of medical education, or the sole determinant of a medical career afterwards.

    Let's also make sure we as practicing physicians are protected from ABIM becoming a USMLE where we entangle physicians with BS requirements for no good benefit, except for their bottom line.

  63. Bilal Nadeem
    Bilal Nadeem February 23, 2020

    I couldn't agree more. I don't want people who can take a test and don't show up to follow up on patients. I want people who come to work and are diligent about learning about clinical medicine.

  64. Steffan May Music
    Steffan May Music February 23, 2020

    Totally agree that much of medical education is completely antiquated and irrelevant to clinical medicine. Needs a total overhaul. There needs to be a separation between clinical and non-clinical/research pathways. We studied biochem for 2 solid weeks and has 2 lectures on diabetes in the first two years. As an outpatient Internist, I don’t exactly rely on biochem to treat patients these days. With such a vast amount of knowledge to try to learn, it’s impossible to justify wasting any time on things that just don’t matter. ZDogg University Medical School??

  65. Ross Heinrich
    Ross Heinrich February 23, 2020

    Is that a Rick and Morty shirt?

  66. JustMikeThings
    JustMikeThings February 23, 2020

    Amen. Im someone who didn’t get into my first choice specialty: ophthalmology. Never mind that I had done tons of rotations, done research, had great letters, and was clearly passionate about the field… my scores were “below average” so I was a no go. Luckily, I matched into my second choice, but part of me still feels like Step 1 kept me from being the doctor I wanted to be, and that’s just messed up that a number kept me from fulfillment in my career.

  67. Theseus
    Theseus February 23, 2020

    Sorry but if a doctor is opening me up and fiddling with my insides I want to know they were at least in the top 90 of their class, not a 'well he was good enough'.

  68. Madhukar Kumar
    Madhukar Kumar February 24, 2020

    RIck and Morty Shirt. BADASS

  69. Irvin Coria
    Irvin Coria February 24, 2020

    You are 100% right. I love this video.

  70. SKGMD11
    SKGMD11 February 24, 2020

    while youre at it – get rid of the fucking MOC tests every 10 fucking years

  71. Walter White
    Walter White February 24, 2020

    I love the idea of Pass / Fail. However, I'm intrigued at how this will change the future of residency selection. I love the idea that our competitiveness will be judged on our clinical skills and rationing in the step 2.

  72. Kesha Kesha
    Kesha Kesha February 24, 2020

    That's why in Canada we do not have this freakin' Step 1 (the equivalent of). Our board exams are all clinical!!

  73. Gjokaj
    Gjokaj February 24, 2020

    There’s way too many exams honestly. They want to get as much money out the student as they can.

  74. TechnoDonut
    TechnoDonut February 24, 2020

    My medical school will soon do away with letter grades. Now this. Soon the only thing to differentiate residency applicants will be letters from attendings who barely know them.

  75. حموده
    حموده February 24, 2020

    I'm an img and was doing it after graduation, but now I'm going all in 2021 because it's the last exam with scores

  76. Ha080
    Ha080 February 24, 2020

    whats your thought on the merger with DO and MD residencies ?

  77. RoyShuri
    RoyShuri February 24, 2020

    While I agree with the overall point you were making in the video, my step 1 score gave me the chance to pursue radiology as a DO student. I would not have gotten as many interviews and many of the PDs commented on my score. I am glad this change does not affect me because students would have to rely more on what their institution can offer for them as support, and oh boy does my school not offer…

  78. BLESSING EZE
    BLESSING EZE February 24, 2020

    Lmao! @Am barely staying out of prison😂

  79. Daniel Silva
    Daniel Silva February 24, 2020

    Dr. Z! Hey, I want to respectfully agree/disagree. I agree there needs to be lots of changes, etc. etc, however I would strongly argue that we should ONLY make changes when there is a reasonable alternative in place. Medical training definitely has it's flaws, but I would much prefer the current medical training system that the pyramidal JD system that currently exists. I'm thinking we're going to be heading that way…

  80. Bob Gill
    Bob Gill February 24, 2020

    When I clicked on the video I thought I wasn't going to like you, completely wrong. I liked your video.

  81. Emily Page
    Emily Page February 24, 2020

    Thank you Dr. Z. I am a registered nurse and I feel the same about entrance exams and nclex. I teach allied health students and some are great test takers and suck at clinical and some are fabulous clinicians and sadly struggle with testing.

  82. Makeup McHoardington
    Makeup McHoardington February 24, 2020

    The NCLEX is being revamped, if it hasn’t already, to a essay and case study format from the multiple choice. 😯 #hard

  83. sebatian
    sebatian February 24, 2020

    they should LOWER THE COSTS!!!!!!!!

  84. Dr. Shilpa Gowda
    Dr. Shilpa Gowda February 24, 2020

    BRILLIANT video. I think that the AAMC needs to build a system in which medical schools give better ROI to students and help them figure out what specialty they would be good at – perhaps by replacing that Step 1 study period with something actually meaningful, as you said, and allowing the student, in the prime of his/her creative life, to get out in the world and do something that they sacrificed their 20s for, what motivated them to go into medical school in the first place, and better the world while they are at it. In doing so, the AAMC could resolve so many unnecessary yet shockingly common mental health issues among medical students. Furthermore, the ACGME needs to better incentivize residency/fellowship program directors to spend time making good decisions about their admissions. Currently, program directors don't have time to do so on top of all the other administrative burdens that they have (and having to document (sometimes artificially) that they "improved" their residents by marking arbitrary levels of progress on core competencies). Therefore, they rely on some arbitrary step 1 bar, which is quick and easy, knowing all too well that this is a b/s way of evaluating whole human beings. If you have any knowledge of statistics, you will see how meaningless these cut-off scores can be, and they disadvantage many of the medical students who would make supreme physicians, because their minds don't work well in taking b/s multiple choice trivia tests but rather clinical applications of core knowledge. Residency turnover and stress could be minimized if residencies actually approached this whole process more thoughtfully, more accurately assessing which students would do well, work well together, and thrive in their programs. Maybe the ACGME would have to deal with less issues that arise once medical students are in residency if they made these changes.

  85. Sharlizellé
    Sharlizellé February 24, 2020

    “I’m barely staying out of prison,” omg 😂😂😂 #favoritequoteoftheday

  86. Amy Lynn
    Amy Lynn February 25, 2020

    Maybe I'm in the minority but I don't like the idea of putting more emphasis on publications in order to get into competitive residencies. Yes-I suck at research and I hate that so many specialities were basically closed to me for that reason. However, if I'm going to have an ophthalmologist operate on my eyes, I don't see why having somebody publish a lot of papers will make them a better surgeon. That's partially how we got Christopher Duntsch, who graduated from a prestigious neurosurgery residency with a ton of research but less than a hundred surgeries under his belt and ended up having severe complications in 33 of his first 38 surgeries along with 2 deaths. (https://www.texasobserver.org/anatomy-tragedy/). (Yes he had other problems, but the residency graduated him and he even got a spinal fellowship based on his research and not any clinical skills). I'm all for research, but by only opening these residencies to researchers we are selecting against good clinicians and good surgical technicians. If anybody can explain where I'm wrong, I welcome the feedback.

  87. Austin Nguyen
    Austin Nguyen February 25, 2020

    Thanks for sharing your thoughts! I definitely think the change will be better for student wellness early on, but I am worried that this will just deviate the stress to Step 2. I agree that the changes in the system will only be beneficial if the entire system is revamped, but just changing step 1 will not fix the issue and could even make medical school more stressful.

  88. Yadzia Oliver
    Yadzia Oliver February 25, 2020

    I love you zdogg!!!! This is what I wanted to say for so long!!! Ty

  89. Jace Burton
    Jace Burton February 26, 2020

    It doesn’t matter because step 2 is going to replace step 1 in stratification

  90. MGAG MGAG
    MGAG MGAG February 26, 2020

    I am an IMG from Cuba who love medicine with all my heart and I screwed my step 1 score (205) I don't even know what happen to me that day.I was relax, didn't have any pressure and when I got my score I was like WTFFFFFFFFFFF. Anyway I am studying for my CK which is going to be next week and you know something, everything what you said Sir is the only, complete, honest true.An stupid score does not make you a better doctor.Who you are and the care you give to your patients, the knowledge, that is the most important thing.I don't want to be in a fancy residency program, I just want to practice medicine again which is my passion.

  91. Lorianne Reyes
    Lorianne Reyes February 26, 2020

    How much bigger is the First Aid going to get? 😂 We can’t keep up with all the research.

  92. Athenian Macedonia
    Athenian Macedonia February 26, 2020

    Hi Dr. Z! As a current student at your alma mater who just came off rotations and now studying for part 1 under our new curriculum, I'd respectfully have to disagree that the knowledge/content for the exam is, as you said, completely irrelevant to patient care on the wards. Sure, you'll never have to look at a renal biopsy and interpret the findings (thank you pathology!), but you'll be expected to rattle off a healthy differential diagnosis for RPGN and how to advance your patient's diagnostic and medical trajectory while they await their procedure. Similarly, when you're on psych for instance, you'll definitely be expected to know the full range of antipsychotics, their specific indications and contraindications, potential side effects to counsel the patient on, and how to monitor and manage adverse reactions in the acute setting. On surgery, you'll also be expected to know, for instance, what empiric antibiotics to start a burn victim on based off the likely pathogens (i.e. pseudomonas), alternative agents in patients with certain hypersensitivities or comorbidities (lets avoid amp+gent in our pregnant patient, oh and erta doesn't provide sufficient coverage!), and the physiology behind various approaches to volume resuscitation (half NS probably not a good idea to maintain intravascular volume). Finally, when you're at a quaternary medical center, zebras begin to morph into horses and when a patient has been pushed around from hospital to hospital to no avail, it sometimes requires the out-of-the-box thinking, promoted by Step 1, to help the patient out. While I certainly agree that a high Step doesn't guarantee a good physician, a low score (without remediation) guarantees a poor physician who is probably more likely to order unnecessary tests, over-utilize consulting services, overlook alternative diagnoses, etc. I resist the notion that eliminating a major impetus to expand your knowledge of medicine is in the best interest for patients or students alike. Desirable qualities such as creativity, dedication to global health, etc. were screened for and established at entry to medical schools. During these short 4 years, we must remain focused on the task at hand – development of a strong foundation of medical knowledge and clinical skills to best serve our communities.

  93. Dani Alt
    Dani Alt February 26, 2020

    That's me! Recient gradueated IMG, I have done research, president of an organization from my University for 3 years, I have travel to too many countries training medical students, lot of extraacademic activities, speak 4 languages, top of my class for 7 years and I got 201 in my step 1 🙁

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