Taking Step 1 or Step 2 for Residencies.

[Darkskies]

Hello,

I am a 3rd year medical student at an osteopathic institution. Thus far I have only taken COMLEX level 1 and scored around a 520. I know I am capable of scoring much higher and would have taken the USMLE step 1 as well if I wasn't going through a bad spate of nonacademic related issues that I'm still kind of recovering from. I scored a 32 on the MCAT. I wish I had been able to put the things affecting me to the back of my mind during second year since now that I'm on rotations, I'm finding it very hard to study for the USMLE step 1 at the same time.

I tentatively plan on taking the USMLE step 1 in January either before or just as the spring semester begins. At this point, I think I can realistically shoot for a 200-210 or a 220 at the highest on the step 1. Does this still look more favorable to the majority of residencies over just having a COMLEX score? I also plan on studying hardcore for the USMLE step 2 and blowing it out of the water come July. Should I just forget about the USMLE step 1 and focus on my clinical rotations and studying for the USMLE step 2? Does having only a high USMLE step 2 score and no Step 1 score still give me an advantage over having only COMLEX scores?

My goals are to just do the best I can and have a variety of options to choose from when it comes to residencies. I am currently interested in Internal Medicine(Infectious Diseases), EM, Pathology, and Psychiatry. Thanks in advance!!!

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[Winged Scapula]

Hello,

I am a 3rd year medical student at an osteopathic institution. Thus far I have only taken COMLEX level 1 and scored around a 520. I know I am capable of scoring much higher and would have taken the USMLE step 1 as well if I wasn't going through a bad spate of nonacademic related issues that I'm still kind of recovering from. I scored a 32 on the MCAT. I wish I had been able to put the things affecting me to the back of my mind during second year since now that I'm on rotations, I'm finding it very hard to study for the USMLE step 1 at the same time.

I tentatively plan on taking the USMLE step 1 in January either before or just as the spring semester begins. At this point, I think I can realistically shoot for a 200-210 or a 220 at the highest on the step 1. Does this still look more favorable to the majority of residencies over just having a COMLEX score? I also plan on studying hardcore for the USMLE step 2 and blowing it out of the water come July. Should I just forget about the USMLE step 1 and focus on my clinical rotations and studying for the USMLE step 2? Does having only a high USMLE step 2 score and no Step 1 score still give me an advantage over having only COMLEX scores?

My goals are to just do the best I can and have a variety of options to choose from when it comes to residencies. I am currently interested in Internal Medicine(Infectious Diseases), EM, Pathology, and Psychiatry. Thanks in advance!!!

The average USMLE Step 1 score for all takers is 228. Charting Outcomes in the Match has tables of average scores by specialty but a score of 200 is just barely above the passing score of 192; 210 isn't much better. The average for those who matched into EM is 230 so a score below that isn't going to impress anyone. You can see the tables yourself here:
http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

Remember that all Allo students have taken Step 1 so it's the standard by which every one is compared; not everyone has a Step 2 score by the time of application but I would find it odd to see a Step 2 without a 1.

 

[Smurfette]

Moving to Osteo forum as OP is still a med student.

 

[AMEHigh]

I think the general advice is to take usmle if you can do well on it. Don't take it if you might pass or just barely pass. I would make sure to do all of uworld and several nbme practice tests.

I personally didn't take it because I'm not the best test taker and didn't want to shoot myself in the foot. I'm applying obgyn and researched over 50 programs that accept the comlex and have DOs in their program. I wish I were a stronger test taker to take the usmle, but like I said, I didn't want to risk it and have no regrets on my decision. I have several interview invites so far.

I know a few people that only took step 2 and I also thought about that as well. I havent heard of it negatively affecting people, but I guess that is program dependent.

 

[Darkskies]

Moving to Osteo forum as OP is still a med student.

I might understand why my thread was moved, but the reason I posted it in the General Residency Forum is because people who have already gone through the process would be the ones to respond. By moving it to the medical student forums, I think I am more likely to be receiving conjectures from med students who might not really have an inside scoop on the residency process or what programs are actually looking for..

 

[Dharma]

Moving to Osteo forum as OP is still a med student.

Really?

 

[Darkskies]

Again, my specific question is whether a middling or even low step 1 score still looks better than a slightly above average COMLEX score when applying to residencies. My follow-up question to that is whether having a very high USMLE Step 2 score WITHOUT a step 1 score still looks more favorable than only having COMLEX scores.

I know it's bandied about by med students on the osteo forum that taking the USMLE step 1 is only helpful if you do well on it, but based on other threads I've read on the residency forums, actual opinion is divided. Even if I were to score a 200-210 on the USMLE step 1 but then followed that up with a stellar step 2 score, would that constitute a better application than only having COMLEX scores or only having a very high Step 2 score without a Step 1?

I understand that seeing an applicant who has a Step 2 score but no Step 1 score may look strange but considering that I'm a DO student, I would like to know whether that puts me at an advantage over other applicants.. See, these are the questions that I don't think med students would be in a fair position to answer correctly without just going off of what they believe to be the case..

I do appreciate any advice regardless and many thanks in advance!

 

[Smurfette]

If you are applying to Allopathic residency programs, you should take USMLE step 1 and step 2 (CK and CS). A great step 2 will help you look better app-wise if you have a low step 1. However, most Allo programs will screen based on USMLE step 1 scores (most will also require a step 1 score when you review their "complete" app requirements on their websites) and many PDs are not overly familiar with COMLEX (and may not know what score is slightly above vs. below average). If your app is not considered complete, you are unlikely to get an interview and even less likely to match. Skipping step 1 altogether would IMO be a detriment to you getting interviews and matching, regardless of how well you do on step 2CK. However, for programs that will accept either COMLEX or USMLE scores, you may be ok just doing step 2. Taking step 1 gives you more options.

I can't speak for how this would look to Osteo residency programs.

 

[laconfidential]

I'm going to disagree with Smurfette a little here. A 520 COMLEX is above average. A 200 or 210 Step 1 is like 25th percentile, at best. I think the 520 comlex will get you through more doors than a really pitiful step 1 score.

I'm not so sure why you think you can knock step 2 out of the park if you can only get a 210 on step 1, but hey, you know more about yourself than I do. I also think (anecdotal evidence here) that people who take the usmle several months after comlex are generally disappointed in their score.

My advice would be focus all your energy on kicking butt your third year of school, taking step 2 early (July) and doing really well on it. Better to leave programs with a stellar step 2 score, with the unknown potential on step 1 ("well he/she did super on step 2, they probably would have done well on step 1") than giving them evidence to the contrary.

 

[lal4life]

Part of the problem with just taking the COMLEX is there is not really any good conversion to USMLE. It might also mean nothing to some program directors to have just a COMLEX score. If you want to apply to any ACGME programs, take the USMLE unless you're practice tests (NBMEs) aren't scoring above the 210 mark. You don't want to fail the real one.

On a side note, you can do just fine on the USMLE even with a lot of distractions. I had a premature baby in April who was in the NICU for 50 days. I'm a student that's average in my class. I took the boards early June and got a 227. Study when you can, do as many practice questions that you can in your spare time, and even with your personal life getting in the way, you can still score just fine. Especially if you don't really care about those super competitive residencies.

 

[MLT2MT2DO]

If you are applying to Allopathic residency programs, you should take USMLE step 1 and step 2 (CK and CS). A great step 2 will help you look better app-wise if you have a low step 1. However, most Allo programs will screen based on USMLE step 1 scores (most will also require a step 1 score when you review their "complete" app requirements on their websites) and many PDs are not overly familiar with COMLEX (and may not know what score is slightly above vs. below average). If your app is not considered complete, you are unlikely to get an interview and even less likely to match. Skipping step 1 altogether would IMO be a detriment to you getting interviews and matching, regardless of how well you do on step 2CK. However, for programs that will accept either COMLEX or USMLE scores, you may be ok just doing step 2. Taking step 1 gives you more options.

I can't speak for how this would look to Osteo residency programs.

This is dependent on specialty, but MOST residencies do not require a step 1 USMLE.

As said above if you're not going to get at least an average USMLE you're probably better off not wasting your time.

And for God's sake don't take step 2 CS unless the program specifically asks for it. That is horrible advice. If you want to throw away $2000 dollars I take PayPal donations.

 

[Darkskies]

I really appreciate all the replies. Thank you. The reason I'm confident I can do better on Step 2 is because it correlates with rotations and shelf exams(what I'm doing now) and this time I know I will be studying in a devoted manner. The issue with Step 1 is that I realistically only have 3-4 hours to study at the most since I am on rotations during the day, have projects and assignments, and then I have to wake up at the crack of dawn to get to the hospital in time. The material for Step 1 is not really reinforced on rotations to the extent that you need to know it for the boards. As of now, I'm leaning towards taking the Step 1 but with the idea that I won't be scoring as high as I potentially could had I not had the nonacademic issues during 2nd year(and actually somewhat continuing into this year).


I know some here are stating a low or middling step 1 score looks worse than only having a COMLEX score but again there doesn't seem to be a consensus. Does anyone know this for sure? I know from experience on these boards that certain ideas that are hearsay are repeated ad nauseam as facts when in fact they are not. Especially with the added hypothetical that I score very high on the Step 2. My line of thinking is that by having a 210-215 Step 1 score, it would get me through the door at residencies that normally don't consider or don't know how to evaluate COMLEX scores. After that, my hypothetically high Step 2 score could sway them to invite me for an interview..

I also find it kind of telling that in the responses the attendings who have replied on this thread have given, it's rather obvious that they don't understand the match process for DO students, how to evaluate us, or interpret COMLEX scores. It makes me wonder if many PDs would be the same. Isn't that even more reason to take the Step 1?