Help. Low Step 1 Score. Is emergency medicine still possible?

[twospadz]

Got my step 1 score back recently. My score is 227. Feel like I shot myself in the foot. Is it possible for me to match into emergency medicine. Or is it not worth trying?

Im also at a US allopathic school. If that helps.

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[witzelsucht]

i know someone who just matched at a great program with 2-teens. stop being ridiculous

 

[Druggernaut]

Got my step 1 score back recently. My score is 227. Feel like I shot myself in the foot. Is it possible for me to match into emergency medicine. Or is it not worth trying?

What's the average now? 230?

The thing that'll keep you from matching is your out-of-control neuroticism.

 

[link2swim06]

I scored 199. Had over 15 interviews and matched very high on my list. This was less than 2 years ago. Chill the heck out.

/end thread

 

[twospadz]

Thx everyone. Its just I hear program directors saying they are getting apps in the mid 230s. Hopefully, I can match in the future. Appreciate it.

 

[RustedFox]

Shut the **** up.

 

[twospadz]

Shut the **** up.

Jeez relax I really am clueless about the difficulty of the matching process. A lot of my smart classmates want to do EM. I don't understand why your being so abrasive.

 

[BoardingDoc]

Jeez relax I really am clueless about the difficulty of the matching process. A lot of my smart classmates want to do EM. I don't understand why your being so abrasive.

This is a far greater hindrance to your chances of matching EM than your step 1 score.

 

[RustedFox]

Its cool, ese. I think you've got it figured out now.

 

[Brigade4Radiant]

Jeez relax I really am clueless about the difficulty of the matching process. A lot of my smart classmates want to do EM. I don't understand why your being so abrasive.

Because you are making other uninformed people with a worse score than yours very nervous. EM isn't that competitive Hell OBGYN is more competitive than EM.

 

[Zebra Hunter]

Because you are making other uninformed people with a worse score than yours very nervous. EM isn't that competitive Hell OBGYN is more competitive than EM.

OB/Gyn is not more competitive than EM if you are going by Step scores

 

[Birdstrike]

Anything is possible if you keep trying.

 

[Jlaw]

Thx everyone. Its just I hear program directors saying they are getting apps in the mid 230s. Hopefully, I can match in the future. Appreciate it.

I've talked to a number of EM PD's and they all told me they consider SLOE's, clinical grades, and Step 2 to be much more important than Step 1 and pre clinical grades. That said a 227 is for all intents and purposes an average score so you hardly did yourself a disservice. I know plenty of people who matched to their top choices last year with 21x's and low 22x's.

Also you say a lot of your classmates want to do EM but trust me, a lot of them will change their tune when they actually get out on rotations. We probably have 80-100 people from each class in the EM interest group during first and second year and ~20 who end up applying EM during 4th year.

 

[alpinism]

I've talked to a number of EM PD's and they all told me they consider SLOE's, clinical grades, and Step 2 to be much more important than Step 1 and pre clinical grades. That said a 227 is for all intents and purposes an average score so you hardly did yourself a disservice. I know plenty of people who matched to their top choices last year with 21x's and low 22x's.

Also you say a lot of your classmates want to do EM but trust me, a lot of them will change their tune when they actually get out on rotations. We probably have 80-100 people from each class in the EM interest group during first and second year and ~20 who end up applying EM during 4th year.

Gotta get those free lunches bro.

 

[Angry Birds]

Jeez relax I really am clueless about the difficulty of the matching process. A lot of my smart classmates want to do EM. I don't understand why your being so abrasive.

The reason you are getting such a negative response is that it is hard to believe that you already didn't know that your score is just fine. If you didn't, then you really are clueless.

It's a well-known tactic of people to ask about their scores being good enough even when they know they are.

On the other hand, you aren't as bad as those people who ask, "I have a 291 on Step 1 and a 290 on step 2... Will I stand a chance since my score went down on step 2???"

 

[Angry Birds]

Shut the **** up.

Agreed.

 

[UCA2390]

Well... I'll re-post the exact thing I said in your FIRST thread about this in the Allo forum Friday morning before posting this same question here.. for sake of other people searching.. Im just a MS3 with access to internet and google search/NRMP data.

"Well, if you look at the data-- you're right in the thick of it! Even though you're "below average" so were 1/2 of the people that matched into EM last year. It looks like you have a near 95% chance of matching based on step 1 score alone (with proper advising/applications/interviewing I assume -- dont hang your hat on it)

The bar graph shows your score is among the group of the highest # accepted. The line graph shows your chances of matching based on score (I'm assuming youre US MD)

I got a 224 recently, and was thrilled that I was in the EM range still. Plus I've heard from 2 PDs, a few attending and residents at the SAEM natl conference that Step 1 is good to do well/fine on for EM, but Step 2 also holds a lot of weight. Im heavily involved in EM research so my application also has that. Not all step scores are created equal but based on data alone it doesn't seem like you should be worried about no chances... My main objective is to stay in Detroit area though so it all depends on goals!"

 

[twospadz]

This is a far greater hindrance to your chances of matching EM than your step 1 score.

I understand what you mean.

Agreed.

The reason you are getting such a negative response is that it is hard to believe that you already didn't know that your score is just fine. If you didn't, then you really are clueless.

It's a well-known tactic of people to ask about their scores being good enough even when they know they are.

On the other hand, you aren't as bad as those people who ask, "I have a 291 on Step 1 and a 290 on step 2... Will I stand a chance since my score went down on step 2???"

I wasn't trying to be obnoxious. I was really serious. If the step 1 average is 230, and I got a 227, that means Im below average. Until people let me know about the distribution in the charting outcome in EM matching is when I began to understand I actually have a good chance. I'm just saying.

 

[filhodeinferno]

I understand what you mean.


I wasn't trying to be obnoxious. I was really serious. If the step 1 average is 230, and I got a 227, that means Im below average. Until people let me know about the distribution in the charting outcome in EM matching is when I began to understand I actually have a good chance. I'm just saying.

I'd say your score won't hurt you, but your lack of awareness of the application process and how things are supposed to play out might...

 

[jw3600]

I understand what you mean.


I wasn't trying to be obnoxious. I was really serious. If the step 1 average is 230, and I got a 227, that means Im below average. Until people let me know about the distribution in the charting outcome in EM matching is when I began to understand I actually have a good chance. I'm just saying.

....do you know what an average IS?

 

[Pons Asinorum]

I need a macro that will autopopulate the ALiEM residency application google hangout videos into every thread created by a current medical student in this forum. They really do answer every single question that could be asked.

 

[hundreddaysoff]

Yes, I matched EM this year with Step 1 210s. FWIW, multiple rotation directors and PDs did tell me that I needed to improve substantially on Step 2 to maximize my chances, and I did that. I did get more interviews at less academic places and more rejections at more academic places, so it's my suspicion that the more academic places are more likely to use a Step 1 cutoff 225--230 (just like the published cutoffs for away rotations on VSAS), but I have no proof of this. And it's hard to disentangle all the other criteria: I was also right in the middle of my med school class academically and never found out my SLOE results. So as other people have said, the answer is "yes, depending on your other numbers and SLOEs".

 

[UCA2390]

Yes, I matched EM this year with Step 1 210s. FWIW, multiple rotation directors and PDs did tell me that I needed to improve substantially on Step 2 to maximize my chances, and I did that. I did get more interviews at less academic places and more rejections at more academic places, so it's my suspicion that the more academic places are more likely to use a Step 1 cutoff 225--230 (just like the published cutoffs for away rotations on VSAS), but I have no proof of this. And it's hard to disentangle all the other criteria: I was also right in the middle of my med school class academically and never found out my SLOE results. So as other people have said, the answer is "yes, depending on your other numbers and SLOEs".

uh, just scoring a 2XX on my step-1-- I am sad to see I might get cut-off at the 225! Boo, but gotta play the game I suppose!

 

[alpinism]

Eh you'll make the 220 cutoff which is the one most competitive programs use.

230 is few and far between (as of last year).

 

[UCA2390]

Eh you'll make the 220 cutoff which is the one most competitive programs use.

230 is few and far between (as of last year).

Well thank you for the re-assurance. Its hard to have an idea of where to apply/ where you have a chance with these types of metrics. Is "score cut-off" information something programs are open about? I have used FRIEDA but the only information some have is the "range" of scores they accept and some have no information at all.

 

[hundreddaysoff]

Well thank you for the re-assurance. Its hard to have an idea of where to apply/ where you have a chance with these types of metrics. Is "score cut-off" information something programs are open about? I have used FRIEDA but the only information some have is the "range" of scores they accept and some have no information at all.

Programs are not usually open about score cutoffs. You can always just apply to all the EM programs if you're really worried. The extra few thousand bucks is a drop in the bucket in the context of our careers.

 

[BruceWilly]

Will you be a competent ed doc if you go to a smaller community type program where you do not see as many different cases?

 

[Birdstrike]

Will you be a competent ed doc if you go to a smaller community type program where you do not see as many different cases?

Yes, possibly more competent. Cases don't come to the ED by referral, like they do in subspecialties. They just show up. In fact, you could argue that you get an inferior experience at places where you're seeing patients for "admit for liver transplant" and other rarities constantly, because in 9/10 real life EDs you're going to see "MI," "kid run over by vehicle," "fell and broke my 90 yr old neck," "pit bull versus face," or "broken light bulb in rectum."

So it's not like pediatric cardio thoracic surgery fellowship where you need to be at that "one place." You'll see most of everything everywhere, in EM.

Exception: critically injured and ill kids. Since sick kids aren't as common, that's the one thing harder to get at a smaller community place and it helps to have a strong Peds EM presence.

What's most important is the overall culture of where you train, whether you feel it's a good fit for you and whether the people you work with that's will help you have the best 3 or 4 years possible, versus a malignant environment where everyone is content be be miserable and allow you to be miserable for 3 years. Go somewhere you like the people you'll be working with. Attendings that are smart, quality people, are preferable to brilliant jerks. This is 3 years of your life.

 

[noshie]

Got my step 1 score back recently. My score is 227. Feel like I shot myself in the foot. Is it possible for me to match into emergency medicine. Or is it not worth trying?

I got into an ACGME program with a 212... And I'm a DO, if that matters anymore. I ended up with 21 ACGME interviews. It is definitely not easy to get interviews with a low step 1, but if you apply broadly and are not really determined to only stay in one location (Either way, only applying in one region, even with a really good step one score and rank, is like shooting yourself in the foot), it is possible. I applied to about 120 places, and dropped a pretty penny on applications. Totally worth it in my opinion.

On another note, I don't agree with public hazing, and I see you've got some haters because of your post. However, I do agree that by this point, if you really want to do EM... you should be eating, living and breathing how the EM application process works and the trends of prior EM applicants. That being said, most of the people I know that matched EM last year were just as clueless because they were too busy spending most of their time on their new found freedom in fourth year (I decided to get an MBA, so I may be a little bitter). At this point, I am surprised by nothing, and I am just glad that you are asking questions and not sitting around waiting to figure it out until the last minute. So good for you.

 

[Oncolizumab1]

Thanks for all of the input. I lurk more than post, but I had been scoring in the 230s-240s and got a 225 on the USMLE. I did much better on COMLEX (594), but I think I want to go for ACGME EM. Reading a lot of these forums, you get a more false idea of what is competitive. I will work hard and am fairly confident I can improve on Step 2. If I apply broadly, I'm getting the vibe I have an okay shot at matching? Not trying to be "that guy", I just am not very sure about how much DO bias is really out there.

 

[racerwad]

Thanks for all of the input. I lurk more than post, but I had been scoring in the 230s-240s and got a 225 on the USMLE. I did much better on COMLEX (594), but I think I want to go for ACGME EM. Reading a lot of these forums, you get a more false idea of what is competitive. I will work hard and am fairly confident I can improve on Step 2. If I apply broadly, I'm getting the vibe I have an okay shot at matching? Not trying to be "that guy", I just am not very sure about how much DO bias is really out there.

Dude, relax, you'll be fine. @noshie's post just before yours is anecdotal, but the NRMP's Charting Outcomes data suggests that their experience is not a fluke. I am also a DO with similar Steps (and much lower COMLEX) and I was also able to match into an ACGME program. Take a deep breath and relax. Work hard, be polite, audition at programs you're interested in. Nothing is guaranteed but matching ACGME EM is not impossible.

 

[noshie]

Thanks for all of the input. I lurk more than post, but I had been scoring in the 230s-240s and got a 225 on the USMLE. I did much better on COMLEX (594), but I think I want to go for ACGME EM. Reading a lot of these forums, you get a more false idea of what is competitive. I will work hard and am fairly confident I can improve on Step 2. If I apply broadly, I'm getting the vibe I have an okay shot at matching? Not trying to be "that guy", I just am not very sure about how much DO bias is really out there.

One of the things that I have not seen mentioned much on these forums is the fact that a lot of the programs in the northeast are very DO friendly, and some of them actually accept people through the ACGME match with only COMLEX scores every year. My program actually has a few people in the two classes ahead of me that only took COMLEX and got several ACGME interviews in various places around the country. A solid COMLEX is nothing to scoff at. Sometimes a higher COMLEX can allow the program to see that you are able to perform well on the boards, but maybe didn't have a good go at the USMLE at that time. I got this type of comment a few times on interviews as well.

I agree that there is a false sense of the competitiveness of applicants on SDN, but that shouldn't be what stops you from following the specialty that you have a passion for. If you want something bad enough, there will always be a way to get it if you work hard and people can see that you have a sincere desire to pursue it. To be honest, if I posted a "what are my chances" thread and got a lot of bad feedback, I would still apply if I knew that deep down I would not be happy doing anything else (In fact, I have posted a few threads like this a long time ago, and did get bad feedback... We all see how that turned out. Haha.) Point being, there is no way to know that your USMLE is too low or ineffective unless you apply and give yourself a chance. The trends are helpful, but it is ultimately a case by case basis.

 

[vtucci]

Ok. I agree that many students get little or no mentoring and do not understand this process. I have had to have a come to jesus talk with some clueless rotating students about ERAS, the step scores, their application lists, personal statements etc because they have not hooked up with a faculty mentor at an EM program. This is a forum students turn to for advice because all else has failed.

 

[amberphana]

Hey, i'm from a caribbean medical school with a Step 1 score of 226... my clinical grades aren't the best.. excellent marks from preceptors, but shelf grades are not good bringing my clinical grades down. I'm not sure if 226 is enough for an IMG in emergency?

 

[dotcb]

I matched at my #1 choice with a lower score, although was from a US school. Apply broadly, use any connections, and have a back up plan.

 

[Arcan57]

The original post is the equivalent of the girl that snaps a selfie wearing a size 4 dress that just happens to give a generous view of cleavage while standing at the exact angle, arm, and hip position that had to take hours to figure out and posts it with a "feeling fat" hashtag.

Yeah, you're not going to be a fitness model but barring an abhorrent personality you're still going to get dates.

 

[carbonizedeyesockets]

I did a survey of classmates who matched EM and the lowest reported step 1 was around 205 and they matched their #2 program. Lower the score, the lower the chance to getting into a "big name" place or a place that happens to be regionally popular. Keep in mind that EM is the 4th biggest by numbers, and it will never be "hard" to match in to if you apply broadly and realistically.

 

[TheBlueBlazer]

Dear everyone, please do more than look on the front page of this forum. All of these questions are asked AD NAUSEUM EVERY F-ING YEAR WITH THE SAME F-ING ANSWERS OVER AND OVER AND OVER. OMG AM I GOOD ENOUGH WITH ____!?!?!? Seriously, spend even 45 seconds before starting YET ANOTHER thread for this same exact topic. Let me give you a hint, look by looking at posts from exactly a year ago.




Also, if you're a DO student, don't be an idiot. Be a big kid and take the USMLE. Don't convince yourself that because there was this one guy this one time you heard from a friend got this spot at a place with only a COMLEX that you don't need to take the USMLE. It's a better exam, the money is a drop in the bucket, and being a DO myself, if I saw someone was either too lazy or too scared to take the USMLE and instead bet my future on the POS exam that is the COMLEX, I would gloss right over your app.

 

[twospadz]

The original post is the equivalent of the girl that snaps a selfie wearing a size 4 dress that just happens to give a generous view of cleavage while standing at the exact angle, arm, and hip position that had to take hours to figure out and posts it with a "feeling fat" hashtag.

Yeah, you're not going to be a fitness model but barring an abhorrent personality you're still going to get dates.

Lol. These type of posts are making me feel good. I really told myself if I didn't hit a 230 I wouldn't apply for EM before I took step 1. But you guys have made me feel like I can really match. Thx