Competitiveness for Residency

[cookiecrumbles]

I'm scoring in the low 200s on practice exams and am signed up to take Step 1 in a few weeks. Does anyone know where to find information on competitiveness for residencies like IM or General Surgery at well-respected but not like MGH or Hopkins? I don't know what specialty I'm going to want to go into and I'm worried about being limited by a low score. I'm debating whether I need to take time off from school to have more time to study for Step 1. Does anyone have any advice? Thanks in advance.

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[NotAProgDirector]

http://www.nrmp.org/match-data/main-residency-match-data/

Down near the bottom of the page you'll see "Charting outcomes in the match". There's one for IMG's, and one for US grads, so don't get confused. The most recent report is 2011, but they are certain to publish a 2013 version sometime soon.

if by low 200's you mean 200-210, that's not so good. The minimum pass is in the 190's. Depending upon the rest of your application you will get interviews in IM with scores that low, but you may find your choices limited. In GS, it will be an uphill struggle. If you're not a USMD, more so.

 

[cookiecrumbles]

Thanks for your response. I'm a US med student. I'm scoring in the low 200s right now. I think I can get my scores into the 210s before I take the exam in a few weeks, but I'm wondering what the cut-off is for respectable IM programs. Like if I could get my score to 220, would I have a shot at a good program? I don't know if it's better to bite the bullet and take the exam or take a few months leave from school to get my scores up. I've seen the data you sent but there's no specific information on individual programs.

 

[RadOncDoc21]

Don't fool around with Step 1.

Make it count because a low step I score is similar to having herpes and residency programs are like potential new partners... Yeah someone might take you, but you're better off being safe now!

 

[padastra]

Thanks for your response. I'm a US med student at a state school. I'm scoring in the low 200s right now. I think I can get my scores into the 210s before I take the exam in a few weeks, but I'm wondering what the cut-off is for respectable IM programs. Like if I could get my score to 220, would I have a shot at a good program? I don't know if it's better to bite the bullet and take the exam or take a few months leave from school to get my scores up.

Define "good program". Top 30 IM will be very difficult with a 220. However, taking a few months' leave from school to study for Step 1 will also be a red flag.

 

[mercaptovizadeh]

Do whatever it takes to get that score up into the 230+ range. Important for GS and increasingly for IM as well. I hear the average step 1 for interviewees for IM at Yale is 250! Yale is not even a tip top IM program, so you can imagine the situation is similar/worse for top IM programs, and probably even worse in GS.

There are ways to buy up extra study time with light/fake rotations such as BS electives and research months. This assuming your med school allows you to take these course prior to taking step 1. If not, you just have to buckle down and study like mad. Spend a few hours researching what resources high scorers have used. The trend seems to be a few central key resources alongside an excellent question bank such as usmle world.

 

[amine2086]

I hear the average step 1 for interviewees for IM at Yale is 250! Yale is not even a tip top IM program.

Yale is up there. Not sure what your definition of tip top is. To answers OPs question, many programs use step 1 as a filter. Without a 220+, you will likely be filtered out of most/all mid-tier and above academic IM programs.

 

[mercaptovizadeh]

Yale is up there. Not sure what your definition of tip top is. To answers OPs question, many programs use step 1 as a filter. Without a 220+, you will likely be filtered out of most/all mid-tier and above academic IM programs.

My perception is that Yale is generally ranked high teens to low 20s. It's not Hopkins or Columbia or even Mayo. The fact that their interviewee average step 1 is 250 means that....they are a getting a ton of high scoring applicants, which means that the competition at MGH or UCSF IM is that much fiercer. It's not step 1 that differentiates people at those places. It's LORs, personal and political connections, phone calls from powerful people, interesting and unique ECs, etc.

 

[JoshSt]

Thanks for your response. I'm a US med student at a state school. I'm scoring in the low 200s right now. I think I can get my scores into the 210s before I take the exam in a few weeks, but I'm wondering what the cut-off is for respectable IM programs. Like if I could get my score to 220, would I have a shot at a good program? I don't know if it's better to bite the bullet and take the exam or take a few months leave from school to get my scores up. I've seen the data you sent but there's no specific information on individual programs.

If you can schedule vacation time at the beginning of your academic year without penalty, do it. Like others said, taking extended time off would be a red flag. Your Step 1 score is extremely important for any field, you don't want to fight an uphill battle with <220 score, especially a <210 score. The NBME exams are very accurate in terms of score prediction.

Advice: whatever you're doing for studying, do more Uworld. Minimum of 4 blocks/day and preferably 6 to 8.

 

[cookiecrumbles]

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[womp]

Vast majority of academic general surgery programs will not touch you with a 210. You need to bring that Step 1 up. Or be content in less competitive specialties and community programs.

I wouldn't even begin to worry about Step 2 scheduling right now. Your priority should 100% be on Step 1.

 

[angel20]

how does it look if one takes a year off to do research at hopkins or harvard while studying for step1? we only get 5 weeks to study for step 1 and if we take longer to study, we will graduate late.

 

[gutonc]

how does it look if one takes a year off to do research at hopkins or harvard while studying for step1? we only get 5 weeks to study for step 1 and if we take longer to study, we will graduate late.

1. You've been studying for Step 1 for 2 years. If you can't wrap it up in 5 weeks of obsessive, focussed study, you've got bigger problems.

2. Do you have this "research at hopkins or harvard" lined up already? With a guaranteed successful project and a first author paper (or 3)?

 

[angel20]

about research hopkins is lined up. My adviser from undergrad is aware of my situation and i will be working for her. Nothing in this world is guaranteed...I can't promise i will publish 6 papers or 3 or 1. All i can say is that i will do my best.
I had some personal matters that I had to attend to earlier this months and thats why it took time and attention away from "focused" studying.

 

[DermViser]

Vast majority of academic general surgery programs will not touch you with a 210. You need to bring that Step 1 up. Or be content in less competitive specialties and community programs.

I wouldn't even begin to worry about Step 2 scheduling right now. Your priority should 100% be on Step 1.

Curious why this is. Is there a correlation between Step 1 scores and ABSITE scores?

 

[ram006]

I'm scoring in the low 200s on practice exams and am signed up to take Step 1 in a few weeks. Does anyone know where to find information on competitiveness for residencies like IM or General Surgery at well-respected but not like MGH or Hopkins? I don't know what specialty I'm going to want to go into and I'm worried about being limited by a low score. I'm debating whether I need to take time off from school to have more time to study for Step 1. Does anyone have any advice? Thanks in advance.

I've seen some people take time off to study for step 1, but it's usually because of a family or life emergency or something like that. If you're going to take time off, you need a reason other than "I wasn't scoring well so I needed to keep studying." I should clarify, you need a good reason for your interviews. You don't need to explain yourself to the pigs in your dean's office who may not actually be giving you sound advice.

Just as an example from my surgery program to illustrate why taking a hiatus may be perceived as a negative. Some of our FMGs have monster step 1/2 scores. Some of them have those scored because they studied for 2 years. Unfortunately, a significant number of them consistently score in the 30's on the ABSITE. Our US grads might not average as high on USMLE but I've never heard of any of us struggling that badly. My opinion is that US grads are more of a standardized product and a lower risk in the eyes of some people when it comes to test taking, but I digress...

So why would the time issue even matter, you ask? Well, during residency your time to study is very limited and you have to be efficient. I'm not a program director, but I would imagine this is why seeing someone take a lot of time off to study for step 1 might be a concerning and make them question whether or not they have the discipline to fulfill clinical and academic obligations. On the other hand, scoring in the low 200's can't be viewed much better.

I think you have to be brutally honest with yourself. Are you scoring that low because something is going on in your life that is distracting you, or is it because you've never really excelled on standardized exams and this is just the next score in a line of mediocre performances? I'm not saying that to be harsh, I'm saying it so you understand how it will be viewed. The absolute worst case scenario is for you to take time off and still score poorly. That will, without a doubt, close a lot of doors.

But even after all that is said, it doesn't matter what is going on in your life. People will empathize or whatever, but no one actually cares enough to let you slide by with a crappy score. And they shouldn't. Residency is a competition. It's reality.

Do whatever you need to do to feel as prepared as you can, but realize that without a solid score, taking time off will be viewed poorly.

 

[DermViser]

I've seen some people take time off to study for step 1, but it's usually because of a family or life emergency or something like that. If you're going to take time off, you need a reason other than "I wasn't scoring well so I needed to keep studying." I should clarify, you need a good reason for your interviews. You don't need to explain yourself to the pigs in your dean's office who may not actually be giving you sound advice.

Just as an example from my surgery program to illustrate why taking a hiatus may be perceived as a negative. Some of our FMGs have monster step 1/2 scores. Some of them have those scored because they studied for 2 years. Unfortunately, a significant number of them consistently score in the 30's on the ABSITE. Our US grads might not average as high on USMLE but I've never heard of any of us struggling that badly. My opinion is that US grads are more of a standardized product and a lower risk in the eyes of some people when it comes to test taking, but I digress...

So why would the time issue even matter, you ask? Well, during residency your time to study is very limited and you have to be efficient. I'm not a program director, but I would imagine this is why seeing someone take a lot of time off to study for step 1 might be a concerning and make them question whether or not they have the discipline to fulfill clinical and academic obligations. On the other hand, scoring in the low 200's can't be viewed much better.

THIS.

 

[ram006]

Curious why this is. Is there a correlation between Step 1 scores and ABSITE scores?

Some people think so but the literature is mixed.

My opinion is that the more accurate statement is past academic performance correlates with future academic performance. Step 1 is just a really hard exam that everyone has to take. The problem I have with using it alone or as a cut off is that it's only a snapshot. But I guess if you're a PD, you play the odds.

 

[DermViser]

Some people think so but the literature is mixed.

My opinion is that the more accurate statement is past academic performance correlates with future academic performance. Step 1 is just a really hard exam that everyone has to take. The problem I have with using it alone or as a cut off is that it's only a snapshot. But I guess if you're a PD, you play the odds.

Esp. when the are other candidates who could replace you easily. Hence it's easier to just put a filter and not have to worry about it.

 

[ram006]

My perception is that Yale is generally ranked high teens to low 20s. It's not Hopkins or Columbia or even Mayo. The fact that their interviewee average step 1 is 250 means that....they are a getting a ton of high scoring applicants, which means that the competition at MGH or UCSF IM is that much fiercer. It's not step 1 that differentiates people at those places. It's LORs, personal and political connections, phone calls from powerful people, interesting and unique ECs, etc.

I would imagine the people that applied to Yale are also applying to MGH, UCSF, etc. They're all fishing from the same applicant pool. As someone once said, I can give you a list of 10 programs that are top 5 quality.

 

[IM2GI]

My perception is that Yale is generally ranked high teens to low 20s. It's not Hopkins or Columbia or even Mayo. The fact that their interviewee average step 1 is 250 means that....they are a getting a ton of high scoring applicants, which means that the competition at MGH or UCSF IM is that much fiercer. It's not step 1 that differentiates people at those places. It's LORs, personal and political connections, phone calls from powerful people, interesting and unique ECs, etc.

There is no way the average step 1 at Yale IM interviews is 250, don't buy it.

IM is getting more competitive, but lets not get crazy.

 

[IM2GI]

how does it look if one takes a year off to do research at hopkins or harvard while studying for step1? we only get 5 weeks to study for step 1 and if we take longer to study, we will graduate late.

If I had the pressure of studying for step 1 for a year, I might have killed myself. There is an overwhelming amount of material to cover, and you will forget what you studied a month later anyway.

Step 1 is awful, you gotta hit the books harder than you ever have in your life for 5 weeks and leave it all on the table.

 

[jturkel]

Do whatever it takes to get that score up into the 230+ range. Important for GS and increasingly for IM as well. I hear the average step 1 for interviewees for IM at Yale is 250! Yale is not even a tip top IM program, so you can imagine the situation is similar/worse for top IM programs, and probably even worse in GS.

You either heard wrong or you are terribly misinformed

My perception is that Yale is generally ranked high teens to low 20s. It's not Hopkins or Columbia or even Mayo. The fact that their interviewee average step 1 is 250 means that....they are a getting a ton of high scoring applicants, which means that the competition at MGH or UCSF IM is that much fiercer. It's not step 1 that differentiates people at those places. It's LORs, personal and political connections, phone calls from powerful people, interesting and unique ECs, etc.

Yale > Mayo for medicine. Fellowship is something different. And step1 does differentiate people at many places....there are plenty of people with 240s, 50s, 60s, 70s....too many qualified people? let's raise the min score on our filter/cutoff.....