Channel Title: Sheriff of Sodium Channel Description: Videos and podcasts on medical education and residency selection from thesheriffofsodium.com <video> Do USMLE cheaters lower my score? Description: Do people who cheat on the USMLE and achieve very high scores lower the scores for honest examinees? The answer is no (or at least, not as far as we know). The reference group for the USMLE are examinees from U.S. MD-granting medical schools who are taking the test for the first time. So far, the only examinees whose scores have been invalidated for cheating are international medical graduates. </video> <video> How many residency positions are preliminary? Description: How many residency positions are preliminary - and how many are categorical? Can the growth in residency positions overall be explained by a growth in PGY-1 transitional and preliminary medicine/preliminary surgery positions? </video> <video> The COMLEX Level 2-PE is coming back Description: Don’t say I didn’t warn you. The NBOME seems intent on bringing back a clinical skills examination as a requirement for licensure - likely for the DO Class of 2028. NBOME Core Competency Capstone for DOs (C3DO): https://www.nbome.org/c3do/ X post: https://x.com/jbcarmody/status/1812856888813306129?s=61&t=26I8DpCR65k8SG5Fx81zVg </video> <video> Tuition-Free Medical School: Winners & Losers Edition Description: Earlier this week, Michael Bloomberg donated $1 billion to Johns Hopkins University in order to make the school “tuition free” for (most) students. The announcement generated lots of fawning media coverage and inspired debates and hot takes on social media. So you know what that means. It’s time to break it down, Winners & Losers style. _ References and call-outs, in chronologic order: 1. New York Times coverage of the Johns Hopkins gift: $1 Billion Bloomberg Gift to Hopkins Makes Tuition Free for Most Medical Students https://www.nytimes.com/2024/07/08/us/bloomberg-donation-johns-hopkins- medical.html 2. The New York Times Magazine on how long it would take the average Amazon worker to acquire their founder’s wealth: 9 Ways to Imagine Jeff Bezos’ Wealth https://www.nytimes.com/interactive/2022/04/07/magazine/jeff-bezos-net-worth.html 3. ProPublica reporting on billionaires’ effective tax rates: The Secret IRS Files: Trove of Never-Before-Seen Records Reveal How the Wealthiest Avoid Income Tax https://www.propublica.org/article/the-secret-irs-files-trove-of-never-before-seen- records-reveal-how-the-wealthiest-avoid-income-tax 4. 55% of medical students say debt has “no influence” on specialty choice: Thomas B. Free medical tuition: will it accomplish its goals? JAMA 2019; 321(2): 143. https://jamanetwork.com/journals/jama/article-abstract/2718252 5. Systematic review on medical student debt and specialty choice: Pisaniello MS, et al. Effect of medical student debt on mental health, academic performance and specialty choice: a systematic review. BMJ Open 2019; 9:e029980 https://bmjopen.bmj.com/content/bmjopen/9/7/e029980.full.pdf 6. Here’s the Sheriff of Sodium video that resulted in a takedown request from a medical school featured in the top 10 most expensive medical schools. (Fast forward to around the twelve minute mark for the offensive graphic.) Addressing Osteopathic Medicine’s Vulnerabilities: The View Through an External Lens https://youtu.be/RC3pFmynxJQ?si=1cyprZONdGfH5FZl 7. Here’s the video on the Flynn effect and merit in medicine: On the Flynn Effect and Merit in Medicine: https://youtu.be/FHOCuKW8new?si=eb4uaiDO-Z6DHQiA _ MUSIC: “Clutch,” by Nicolas Major. </video> <video> How many USMLE questions are experimental items? Description: How many questions on the USMLE are scored - and how many are unscored experimental items? We actually learned the answer to this during the COVID-19 pandemic. Here was my original Tweet when it happened: https://x.com/jbcarmody/status/1268904159522295808?s=46&t=bmm1gv3HxWdNazimqL_3_w </video> <video> Should USMLE Step 3 be Pass/Fail? Description: Should USMLE Step 3 become pass/fail? I’m just not sure it matters much when we’re talking about the Fredo of the USMLE Corleone brothers. Here’s the news article on the AMA resolution: https://www.ama-assn.org/medical-residents/usmle-step-3/move-usmle-step-3-pass-fail-boost-residents-well-being There are some other components that could be useful - such as shortening the length of the exam (from two days to one) and allowing U.S. medical students to take the exam before they begin residency. </video> <video> FACT POLICE: The USMLE Step 1 Pass Rate Description: Have you heard that more students are failing the USMLE Step 1 exam than ever before, or that 25-50% of students are deferring their Step 1 exam because they’re unprepared to pass the test? Me, too! Thing is, there’s a lot of silly, sky-is-falling, and self-interested misinformation out there. So today, I’m back as the FACT POLICE, to explain how we should - and shouldn’t - make sense of changes in the pass rate. _ NOTES: 1. Wanna re-watch the original episode of FACT POLICE? It’s here: FACT POLICE: Residency applicants and residency positions https://youtu.be/L75fj_5Ar4s 2. Here’s the X post with the good ol’ days of Step 1 shower studying: https://x.com/seandreyer/status/1514649772384309252?s=61&t=26I8DpCR65k8SG5Fx81zVg 3. If somehow you missed my video on the USMLE cheating scandal, it’s here: Mailbag: Wrapping Up the USMLE Cheating Scandal https://youtu.be/MR1hzK-hu34 4. And here’s the paper on the University of Michigan’s 14% deferral rate in 2015-2016: Daniel M, et al. Perspect Med Educ 2019; 8(3): 187. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565661/ _ MUSIC: “Clutch,” by Nicolas Major. </video> <video> Board certification for exceptionally qualified IMGs: Winners & Losers Edition Description: For as long as the American Board of Internal Medicine has existed, completing an accredited U.S. residency program has been a pre-requisite to sitting for the internal medicine board exam. But last week, the ABIM announced a proposal that would allow “exceptionally qualified” international medical graduates who complete a U.S. fellowship program to to sit for both their general and specialty medicine boards - even if they did their residency overseas. This would be a major change to longstanding policies… so you know what that means. That’s right, it’s time to break it down, Winners & Losers style. _ NOTES: 1) The ABIM’s video explaining the pilot is here: https://youtu.be/p52BVyjVVNw?si=Z8hbjTdXnHeeGhs- 2) I also referenced a few old Sheriff of Sodium videos… -The Match, Part 1: Why do we have a Match? (includes discussion on why we have residency training/history of board certifying organizations) https://youtu.be/jRxHn5l6E4A -Bypassing residency for IMGs in Tennessee: Winners & Losers Edition https://youtu.be/VeGqKHYLxYQ -The ABIM Under Fire: How Doctors Can Realistically Fix MOC https://youtu.be/aNgf6oYZlcg 3) If you want to comment on the ABIM proposal, there is a link here: https://blog.abim.org/call-for-public-comment-pilot-model-pathway-to-board-eligibility-for-exceptionally-qualified-international-medical-graduates/ _ MUSIC: “Clutch,” by Nicolas Major. </video> <video> Why can’t I re-take the USMLE? Description: </video> <video> The Man Who Beat the USMLE (in Court) Description: In 2020, resident sent an email to a state medical board. Attached was a copy of a USMLE score report showing a passing score on Step 3. There was just one problem. The score report was fake. This is the incredible-but-true story of how that resident beat the USMLE in court and received a medical license without ever passing Step 3. _ NOTES: 1. In the United States, there is a public right to observe judicial proceedings. Although courts can seal records for good cause, there's a presumption that what occurs in court should be transparent and open to public inspection. Anyone can inspect public court records on PACER (though registration and a per-page charge are required). https://pacer.uscourts.gov 2. Here's the video that discusses how there's NEVER been a USMLE score recheck that resulted in a score change: Mailbag: Questions about the USMLE https://youtu.be/co05HNjJUPQ 3. Here's the video with advice on getting kicked out of residency/medical school, in which I made the point "Policies are your best protection": Mailbag: Help! I’m Getting Kicked out of Medical School https://youtu.be/scDJECi6bLY _ MUSIC: "Clutch," by Nicolas Major. </video> <video> Do hospitals really lose money on doctors? Description: According to a recent report from a healthcare consulting firm, hospitals lose $304k on every physician they employ. How did they come up with this figure? It’s called budgetary gerrymandering, and I’ve got a slightly longer video on it for anyone interested. </video> <video> Inside the Sausage Factory: How the USMLE Passing Standard is Set Description: How is the passing score for the USMLE determined? And why does the minimum passing score keep increasing over time? In this video, I’ll answer both questions - and provide an overview of the Angoff standard setting method; the Angoff modifications used by the National Board of Medical Examiners; the differences between norm-referenced and criterion-referenced exams; and even review some questions from the original NBME exam. NOTES: 1. I mentioned a couple of previous Sheriff of Sodium videos… On rising USMLE performance: A Brief Update on USMLE Score Creep https://youtu.be/1gKKAZ5aO8E -On the appropriate context for the USMLE Step 1 pass rate: FACT POLICE: The USMLE Step 1 Pass Rate https://youtu.be/Ov2tkX-_YGI 2. Here is the NBME’s survey on the “ideal” fail rate for the USMLE: Margolis J, Clauser BE, Winward M, Dillon GF. Validity evidence for USMLE examination cut scores: results of a large-scale survey. Acad Med 2010; 85 (10): S93-S97. https://pubmed.ncbi.nlm.nih.gov/20881714/ 3. There’s also a vintage post on the USMLE pass rate on the Sheriff of Sodium website: https://thesheriffofsodium.com/2019/01/20/a-peek-inside-the-usmle-sausage-factory-setting-the-step-1-minimum-passing-score/ _ MUSIC: ‘Clutch,’ by Nicolas Major. </video> <video> What’s the average USMLE Step 2 CK score? Description: New USMLE score performance data just dropped… and the mean Step 2 CK score is now 249. NOTES: Here are the most recent USMLE Score Interpretation Guidelines: https://www.usmle.org/sites/default/files/2022-05/USMLE%20Step%20Examination%20Score%20Interpretation%20Guidelines_5_24_22_0.pdf </video> <video> Charting Outcomes in the Match: Winners & Losers Edition Description: Every two years, the National Resident Matching Program releases their “Charting Outcomes in the Match” reports. This year, we got three reports, with 799 pages of charts and data showing how applicant qualifications are associated with the likelihood of matching into different specialties for MDs, DOs, and international medical graduates (IMGs). The Charting Outcomes reports are a treasure trove of data that highlight important trends in residency selection; what qualifications program directors really care about; and some just plain fun stuff about biostatistics. So you know what that means. Yup, it’s time to break it down, Winners & Losers style. _ NOTES: 1. Wanna check out the Charting Outcomes reports for yourself? They’re linked here: https://www.nrmp.org/about/news/2024/08/the-2024-charting-outcomes-reports-are-now-available/ 2. Along the way, I referenced a few other Sheriff of Sodium videos: -FACT POLICE: Residency applicants and residency positions https://youtu.be/L75fj_5Ar4s -The Applicant’s Guide to Strategic Preference Signaling https://youtu.be/pmRwRDe2gs8 -ERAS and Financial Conflict of Interest at the AAMC https://youtu.be/PRR7PaoF1lY 3. Here’s more on Simpson’s Paradox: https://plato.stanford.edu/entries/paradox-simpson/ 4. Here’s a paper on how anti-drug campaigns had no effect (or might have even increased!) teen drug use: Block LG, et al. Am J Public Health 2002; 92(8): 1346-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447241/ _ MUSIC: “Clutch,” by Nicolas Major. </video> <video> Advice for the Residency Interview Description: Interview Day is where your rank position is determined - which is why I’m always surprised that so many residency applicants under-prepare for the interview, make avoidable mistakes, or fall into traps. Here’s my advice for how to put your best foot forward. _ NOTES: NRMP Program Director Survey (2024): https://www.nrmp.org/match-data/2024/08/charting-outcomes-program-director-survey-results-main-residency-match/ Maxfield CM, et al. Bias in radiology resident selection: do we discriminate against the obese and unattractive? Acad Med 2019; 94(11): 1774-1780. https://journals.lww.com/academicmedicine/fulltext/2019/11000/bias_in_radiology_resident_selection__do_we.41.aspx Kassam AF, et al. Swipe right for surgical residency: exploring the unconscious bias in resident selection. Surgery 2020; 168(4): 724-729. Dr. Glaucomflecken video: How to Ace Your Neurosurgery Residency Interview https://youtu.be/C5BD9DGXoYk?si=h5KM6bMEkqLAYlNh _ CREDITS: Images: https://wojak-studio.com Music: “Clutch,” by Nicolas Major. </video>

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