Step 2 vs. Away for a Person With Failed First Attempt at Step 1

[surfinghaole]

Hi,

I am asking a question for a friend of mine. She failed step 1 on her first attempt and passed on her second attempt. She is applying in family medicine and is graduating from an LCME-accredited Canadian medical school but trying to couples match in the USA (and she is pending permanent residency).

How important will it be for her to have a passing step 2 CK score on her application by September 15 in order to get interviews?

She can put Step 2 CK off until Dec/Jan/Feb and fill the end of her summer/fall with family med rotations or she can take Step 2 CK at the end of August and get a score by the end of September for her application. Presuming she passes, but doesn't do that great on Step 2 CK, what would be better for her, not having a step 2 CK score to submit in the fall (but having one before rank lists are due) and having an awesome evaluation from an American program she rotates at (she always does super well on clinical evals) OR having a crappy step 2 CK score (but passing) and not having any American FM evals to submit to programs in September.

She asked me and I have no clue. What are people's thoughts?

On a total side note, would it be important for her to have a completed step 2 CS in september as well? She has no trouble with clinical stuff so could probably take a sick day and fly out to LA to do it some time in summer if necessary.

Thanks for any help you can provide!!!

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[RangerBob]

I'm sure other will chime in, but I think programs get very nervous when they see any board failures. It helps that your friend is applying to FM, so there are a lot of programs out there that are less/un-competitive or even go unfilled (though the latter may go unfilled for a reason). However, your friend is also applying for a couples match, which hurts her because it's going to limit her geographically. I don't know how going to a Canadian school affects her odds, but I would imagine it puts her at a disadvantage because FM programs are less likely to be familiar with her school. I had a friend who was a Canadian citizen and she said that put her at a huge disadvantage--but she also wasn't applying to FM, which has a lot of IMG/FMG-heavy programs since it's not as popular with US graduates.

So, there are a number of things that will hurt your friend's application. If she applies broadly enough she'll still get in somewhere. But I would think if she wants to increase her chances of matching she should have a solid passing Step 2 (CK and CS) score by the time she submits her application in September. I would say the absolute latest she should take them is so her scores are back by at least mid-late January, so that programs will see her passing scores before rank lists are finalized (though some small programs may finalize their list at the end of December--if I'm not mistaken FM interviews very early, so if a program wraps up interview season in Dec they will probably finalize their list shortly after).

If your friend doesn't have a passing score by that time, programs may rank her much lower than they otherwise would have, as they don't want to match someone that they think might not pass step 2 (and thus not graduate from medical school on time). And for that same reason, more selective programs may not invite her for an interview in the first place--if they have a lot of students who, like her, did well clinically, but also passed Step 1 and are from a more familiar medical school, then the residency program is going to invite those people instead of her.

I think doing an away rotation only helps to get into that particular program. If she's dead set on one particular program them maybe it'd be worth doing an away (while still taking Step 2 in time to submit her score prior to late Jan). But away rotations (or letters of recommendation from away rotations) generally don't help to get an interview or ranked higher at another program. I don't even think doing a rotation at the #1 FM program would help. I applied to PM&R which is a much smaller specialty, but also similar in that programs are looking for applicants who will be a "good fit," and no program I interviewed cared where I did my rotations--they only cared that I did at least one PM&R rotation and knew what the field was. Unless you're lucky and your letter writer is best friends with the program director, I don't think it'll be any different than a letter from her home program. (In fact, the home program letter probably matters more since it'll be assumed they know her better)

As far as your question about a mediocre Step 2 score on-time and no US rotation goes, it's simple--she can't get a mediocre score. She needs to make up for a poor Step 1 score, plain and simple. If she gets a mediocre score, well, then that's what happens. But she needs to score as high as she can, especially if her passing Step 1 score happens to be low. But most importantly is she needs to pass, and if she can't guarantee passing prior to application time it may be best to wait. Failing Step 2 the first time would really hurt her application, so if she can't take off time to study prior to September, maybe it's worth delaying.

Also--taking a sick day to take CS is a very bad idea. I assume you meant her just requesting time off, but in case she actually plans to call in sick to take CS that could get her in big trouble.

 

[surfinghaole]

Thank you so much for your detailed thoughts. To clarify, even if she didn't take step 2 CK at the end of August, she will still take it before the end of January, so there is no possibility where final rank lists would be turned in by programs and she wouldn't have a step 2 CK score to show them.

The question is about getting interviews, which I am thinking will be her biggest challenge. If she gets interviews, I honestly think she will be in good shape because her extracurriculars are insanely impressive and she is super charming, there is no one that doesn't like her. Do people think when programs offer interviews that they would just never offer her an interview if they couldn't see her step 2 CK score yet (given that she failed the first time)? If anyone who has failed step 1 before or has heard about how someone who had failed was advised in this regard it would be helpful.

Unfortunately, as her Canadian school is not at all accommodating about providing time to take these American exams, for her to get step 2 done by the end of August would leave her 8 weeks to study, but 6 of those weeks she would be doing clinical rotations. Given that her strengths are not in standardized test taking this will probably result in a less than stellar step 2 score. She would not take it if she were not confident she would pass (being aware that a fail on step 1 and step 2 would just make things that much worse).

The alternative to that would be having a couple months to study in November and December (when she is on research blocks with little responsibility) and 3 dedicated weeks to study to get a score back some time in late Jan/Feb, probably ending up with a better score, and having the opportunity to get a positive eval out of an American FM program to send out before all the interview spots are gone.

In regards to the utility of the American FM rotation eval for her application. She already has honors in a family medicine rotation to show programs when she applies from her home institution and strong letters. The issue she is worried about is that while her school is LCME-accredited, programs might not interview her if they don't see an eval from at least one US-based program.

As a total side note, while in theory Canadians should be better off than IMGs, because they are LCME-accredited and don't have to deal with ECFMG certification, etc, I sometimes wonder if she might have trouble because no programs will have ever seen an application from her school, while they get boatloads of Caribbean applicants. Only like 20 Canadians a year enter the US match, and 0 have entered in FM in like forever as far as I can tell. (FM is only 2 years in Canada and gets paid more than in the USA, so there would be no reason to except for her partner who is American.) BTW, partner may help her as he is a strong applicant in his specialty, though not sure if that can bring interviews when a person gets filtered out for failing step 1 once.

Thanks again for the help! Would love/appreciate any other comments!

 

[IM2GI]

Failing step 1 is a huge red flag. You will want to show a strong step 2 in follow up. PDs don't want to risk you not being able to start. If you don't take it/show your score, most programs will screen you out.

 

[shiftingmirage]

I would strongly encourage having CK done before applying. I think there are PDs out there who would consider someone with an initial Step 1 failure and subsequent passing and passing of CK who would not consider someone with a successful Step 1 retake and no CK score. I don't know how many/what percent of PDs would approach it like that, but I would imagine there are at least a couple. A Step 1 fail with no CK will close some doors.

Regarding CS, while it is not Step 1, it can be tricky as the scoring system is not very well broken down. People used to mock it and say all you had to do was show up, but there are people from top 10 US schools, people who aced Step 1, aced rotations, and failed CS. This is a very small number, but the test should be taken seriously.