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Step 1 and Step 2 CK in One Unified Exam!
by StepTaker 04-21-2010, 04:05 PM

There's been a significant rumor recently that Step 1 and Step 2 CK exams are to be merged!

Here I am thinking out loud about this possible event.

First of all, let's remember that these exams have been basically designed to assess the progress of the medical student during the education years of med school. They were not designed with the full graduate or the IMG in mind, though later on they were extended to include the latter.

Having said so, it is unlikely that they are to be merged because it would be unwise to leave the medical student untested until the end of the long medical school years.

Many students drop out from medical school right after Step 1 failure and choose to look for another path. It would be unfair for these students to waste another two years of their life until they choose to drop out.

Moreover, studies and observations have consistently found that doctors do better job and are safer for their patients when they are continually assessed. This is why CME has been created and this is why we unlikely to see less exams than what we have now. In fact, some people may argue that we need more than two comprehensive exams to verify a graduate!

Speaking of the last point, I think that currently Step 1 and Step 2 CK exams are an overwhelming assessment experiences that put the lives of potential future doctors under jeopardy. What if you were out of mood on that day? what if you were sick on that day? It's unfair to lose all your future perspectives just because of two-days events! Leave alone if they make it one day!

Looking at this issue from another angle, one might argue that the incorporation of basic medical sciences into applied clinical sciences certainly improve the advancement of health care with better research oriented doctors. That's why the modern model of medical education is to expose students to clinical scenarios right from the start when their anatomy and physiology is still fresh in mind.

And for the same noble reason the NBME, FSMB, and ECFMG have progressively changed Step 1 and CK styles to be closer to each other. Nowadays you have more clinical scenarios in Step 1 and more pathophysiology questions in CK. So in effect they seem to be very similar exams. However, there's still several core differences between the two and you cannot simply make them one exam.

It's unfair to ask the second year student to choose between CT and MRI and likewise it's unfair to ask the graduate to remember what the Okazaki fragments are about!

Looking at the economic ramification of this proposed merger does seem to be futile. Because right now you have 322 Step 1 items and 352 Step 2 CK items and it would be impossible to make one day 647 items exam. Ultimately you need to split off the proposed merger exam into two days and thereby you have lost the whole point. If they are two days then they are two exams and it doesn't matter if you have them day after day or a seven years apart!

PS- I was inspired to write about this after reading this thread
Step 1 and Step 2 to be merged!!
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Old 07-29-2010
Steps History: CK+CS
Posts: 138
Threads: 28
Reputation: 88
hmm..truly that is a good perspective of looking at the things..
I agree...
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Old 04-25-2012
Steps History: Not yet
Posts: 9
Threads: 0
Reputation: 10
yes you are right in some way's but check out this video toward's the end he say's about it ...listen carefully ...

there is a big chance of merging step's " why yes "
1. graduates tend to forget what's asked in test in step 1 when taking step 2 ,

eg: step 1 question's given in step 2 in experimental section of usmle ( ie 22 marks q's)
it was not being answered by student's , this question's what's the use of step 1 , science or clinic's

2. graduates have confusion between subject's and take it as different one's , which is not NBME aim to bring out good doctor's clinically and intellectually ,

eg: step 1 , 2 , 3 where asked same clinically relevant question which needed much integration between subject's , 3's always answered most of them ,2's less, and 3's least ;

their strategy to make scientific doctor's seem to fade , boz simply the materiel's are too vast to learn in 2 year's
they seem to recognize it now , boz every time they put an experiment it tends to prove that science should be learned from clinics and not the other way round ,
more to problem based learning , not relevant materiel "mugging up " learning then problem solving boz u seem to get lost in between ;

read the attached file for more insight to what actually is changing in education , i found it interesting
Attached Files
File Type: pdf problem based learning.pdf (119.3 KB)

Last edited by mathew720; 04-25-2012 at 10:56 AM.
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