USMLE step 2 questions - How we fail medical students with bad questions
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- เผยแพร่เมื่อ 3 ก.ค. 2024
- Vinay Prasad, MD MPH; Physician & Professor
Hematologist/ Oncologist
Professor of Epidemiology, Biostatistics and Medicine
Author of 500+ Peer Reviewed papers, 2 Books, 2 Podcasts, 100+ op-eds.
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Med school taught me that Burkitt Lymphoma has a translocation of the MYC gene, but not that type 2 diabetes is caused by eating junk food.
lmao this is too real
Because they want to try experimental gene therapy on that.
Not the real issue as you stated.
Sugar. It's the added sugar. Not all junk food.
Well maybe then it’s not about med school and your knowledge?
Junk food doesn't cause type 2 diabetes though. Lots of ppl eat junk food and don't have that.
Keep in mind you have 1.5 minutes for this question and 319 more to go
Vinay, when I was a practising Histopathologist I was sent an experimental test by the British College of Pathology to see what I thought of it. My answer was this.
"I can answer some of these questions and not others. All these questions have one thing in common. Not a single one of them has knowledge which is of any use I can think of to a practical diagnostic histopathologsist."
I, on the other hand, being such a practitioner would have no problem asking questions which would all be relevant.
Conclusion. The tests should be set by those who do, not those who talk a lot.
A lot of questions have ivory tower answers that don't apply to reality, either.
It's because Step exams are bout STRATIFICATION, not CERTIFICATION. I'm learning that the hard way right now as a medical student lol
It’s an IQ test like all standardized tests are. It’s about making a bell curve.
Funny you say this because it wasn't a stratification tool the begin with. It was just "you pass" and "here's your meaningless score" back in the day. Ask any baby boomer doc and they'll tell you this. It became one, but because it was made to not be one initially, the fact they made it more a stratification tool made the test worse. (Fun fact: in the 90s step 1's average score was 200, today with P/F the score is set to around 200). The NBME are basically failing people on purpose to justify the validity of their exam.
@@ericaeli3807but what is being stratified is NOT IQ at all, not intelligence or reasoning, but rote memorization. It yields a bell curve but it isn't measuring intelligence. More concerning, it isn't measuring the ability or knowledge necessary to practice medicine either. The Steps are a poor metric in general.
@@JoshWarnerMDPhDI heard the step scores do correlate with program director assessment of the intern.
Step scores probably do correlate with IQ but the r value is gonna be lower than say the SAT. After all, ability to do rote memorization correlates with IQ.
Dr Prasad, current US MD student here who also acknowledges that I’m paying loads of money to practice my pattern/buzzword recognition skills. With that said, would you be willing to write two or three questions yourself that you believe would be valuable for medical students and make a video going over them and explaining why they’re better than the ones here? Would love the opportunity to see what valuable questions from a practicing physician would look like. Thanks!
I've never felt better as a 4th year med student trying to go into ophthalmology than knowing the answer to that last question lol. Sketchy for the win!
Took my step 2 almost three years ago….
The answer is in the top right of sketch (art sketch on top of the roof.) Sketchy is fantastic.
I love how VP despises and disapproves of the vast and varied medical incompetencies. Does his health improve by degrees as he vents his exasperation? I think it does! And he helps civilization as well.
This!
Contempt where contempt is deserved. Best for us all.
I can’t tell you how many med school graduates look at me like I’m an alien when I ask them to give me a definition of the word “diagnosis.” No one has asked before!
And unsurprisingly, a good number don’t know what it means to arrive at a coherent diagnostic conclusion. The notes contain random clinical facts but no insight into the patient’s pathology. Presentation is all over the place. At internship.
Some others are really good to be sure but there are interns who definitely should not have graduated.
My suggestion for endless criticism from Vinay. Create your own question bank and teach students relevant clinical medicine.
He can’t do it all -
Be careful giving out the student’s identity . Definitely must remain anonymous. Just like there is no transparency from usmle, they surely don’t want their beans spilled. Nice job
Proof that it’s a business, not a training program. But how do you test, can you relate to patients in a way that gets them to open and say the buzzword, because Lord knows, it’s not going to be my physical exam of the spleen tip?
We're starting interns now, the first thing I told them is that they have to ignore the BS they've just been taught and go see some real patients. A lot of them are from UCSF, they need a lot of help....
I am not a doctor, i just find medical stuff very interesting and wish i had gone that career path. I am curious - if you saw that last question in a real patient, why would you not do an infectious disease workup before looking at cancer? Or infectious disease along with another cause of the weird leukocyte counts
Neuropsychiatrist here, so this isn't what I do on a daily basis, so I could definitely be wrong.
When we see night sweats with weight loss, I think most of us would be thinking TB, malignancy, or menopause (only in the right context with normal white count).
I think the leukocyte count is much too high for a typical infection. In real life, I'd at least get a CXR and/or quantiferon to rule out TB.
This is uWorld which we use at my school to study for step 1 so yes the questions are more theoretical and biochem based than practical, but I am surprised to hear even with that being said that practicing doctors find these irrelevant. Wish we focused more on what you are talking about. For example, so many questions talk about palpating the spleen lol
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UWorld has steps 2 and 3 as well. I think this was step 2.
Do one with step 1 questions! That test asks about the most random factoids which we never use!
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The ABP questions are horrible too, but we aren't allowed to even discuss or share their content, so it will never get fixed.
What if you leaked the questions anyway? Anonymously if needed
@mka6245 I won't be unethical. We have to sign a non disclosure agreement to access this board certification requirement.
Truth.
Not at all surprising. I am a Hospitalist who works on the front line. Our currency is clinical uncertainty because the knowledge base is forever shifting. We are asked to make binary decisions when the educational basis for deriving them is an amalgam of uncertainty. Beware the confident recommendation because those situations are honestly pretty unusual.
Please continue theisa series of board qs reviews!! We all need this.
Is there any effort today to improve the selection of questions for these tests in any professional licensure? As I attend medical lectures, I often say to myself, why is the lecturer spending any time on these obscure points when in real life practice this seems such a waste. I hope we can get better. How is it that ChatGPT is the best test taker?
This was interesting and entertaining!
Please do more this!
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The point of these exams is to separate the surgeons from the PCPs....or so USMLE/AMA thinks. In reality, they create a really screwed up way of comparing medical students for residency positions where those who score average or below have essentially 0% chance of matching into a lucrative specialty. In the end, its all about salary and prestige.
The bottom fell out of radiation oncology. You can get into it with average USMLE scores and their pay is above average for a little longer (govt working to change)
The questions are pretty dumb often - pretty random. However, the worst part is in my ongoing certification exams which often ask us trivia. I think the problem is that academics are nerds and trivia is easy. Trivia separates who studied from who didnt….determines who puts in some effort. But the doctors dont get paid for making these questions so trivia is quick and easy for them. My background is lots of stats and Epi so I will always give them feedback about these questions and have offered to write questions - but I am not in academics and am nobody. But the work involved to improve all these things is too much for volunteers who are busy managing grants, teaching, clinic, papers.
Many doctors: Med students should know everything our committee of five know about our specialties. Please do not consider that none of us have much idea about what the other four members consider essential.
👉🏽 Re question 1, what stands out to me is the almost imperceptible subtle brainwashing:
2:28
‘and is compliant with medications’
So right off the bat the programming is - meds are needed and a given for the patient (aka no diet lifestyle needs be addressed), checking for adverse effects of meds not considered, contraindications not considered, etc.
It’s just mentioned amidst other fact info, as a given, so casual that students don’t think to question.
‘does not use tobacco alcohol AIT
drugs
2:28
and is compliant with medications
2:30
temperature is 992 blood pressure 128
2:32
over 82 pulse 88’
Blah blah and blah!
The USMLE writers spelled fluorescence wrong.
Once in my entire life I palpated a spleen. It was 3rd year, Gen Surgery, morning rounds, attending asked me to palpate the spleen.
It was ten pounds. 😂
A big reason I didn't go to med school, I wanted to become a doctor to help people not take exams, the test makers think they're very clever and I'm sure they'd only need 17 people to change a single light bulb. Research suggests it takes 17 people, in fact let's mandate it! 😉
It might not be about core knowledge but it's about molding one psychologically to memorize rote and develop the strong work ethic necessary to be a doctor. It's akin to telling a boxer that all those thousands of miles you ran over the years during training camp were pointless because it's only a 36 minute fight.