Tips for matching with low step 1

[EM1357]

Hi everyone. Rising MS4 interested in matching EM. I did poorly on step 1 (211), go to a top 50 US allopathic school, clinical grades are near honors.

From reading past posts as well as looking at Charting the Outcomes, I realize I still have a good chance of matching. My question is for those individuals who marched into EM with low step 1. What was the process like for you? How did you do on Step 2 and your aways? Was it difficult to obtain interviews? Did you email programs to express interest when trying to obtain those interviews?

I'm hoping that a strong step 2 and honors on my away rotations will allow me to be competitive. Or is this not the case? Will low step 1 mean that I won't get many interviews? Thank you very much!

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[gman33]

If the rest of your app is strong, and you apply broadly, you will match somewhere.

A good step 2 will help.
This will show programs you can test well and will pass your boards.

 

[racerwad]

Hi everyone. Rising MS4 interested in matching EM. I did poorly on step 1 (211), go to a top 50 US allopathic school, clinical grades are near honors.

From reading past posts as well as looking at Charting the Outcomes, I realize I still have a good chance of matching. My question is for those individuals who marched into EM with low step 1. What was the process like for you? How did you do on Step 2 and your aways? Was it difficult to obtain interviews? Did you email programs to express interest when trying to obtain those interviews?

I'm hoping that a strong step 2 and honors on my away rotations will allow me to be competitive. Or is this not the case? Will low step 1 mean that I won't get many interviews? Thank you very much!

I'm not sure what else you want from us, as you have already outlined the path to success in your own post. You have access to the same data that we would offer to you to help assess your chances.

The process is not any different for you than anyone else, even those that did well on Step 1. They also still have to do well on Step 2 (arguably, doing great on Step 1 and poorly on Step 2 is worse than an upward trend), they still have to do well on auditions, and they still have to hustle and network to maximize their opportunities, just like you.

Assuming the only red flag is your 211 and anxiety, you will be fine if you follow your own advice above.

There is nothing else left but to make it happen.

 

[pushthatepi]

One of the guys I did an away rotation with was a DO student and had a step score of 215. He applied broadly, practiced his interview skills with multiple people, sent thank-you cards/follow up emails to every program he interviewed at. On March 18, he matched into his number 3 pick at an allopathic program.

 

[IH8ColdWeath3r]

One of the guys I did an away rotation with was a DO student and had a step score of 215. He applied broadly, practiced his interview skills with multiple people, sent thank-you cards/follow up emails to every program he interviewed at. On March 18, he matched into his number 3 pick at an allopathic program.

Where did you guys rotate if you don't mind me asking?

 

[The White Coat Investor]

Hi everyone. Rising MS4 interested in matching EM. I did poorly on step 1 (211), go to a top 50 US allopathic school, clinical grades are near honors.

From reading past posts as well as looking at Charting the Outcomes, I realize I still have a good chance of matching. My question is for those individuals who marched into EM with low step 1. What was the process like for you? How did you do on Step 2 and your aways? Was it difficult to obtain interviews? Did you email programs to express interest when trying to obtain those interviews?

I'm hoping that a strong step 2 and honors on my away rotations will allow me to be competitive. Or is this not the case? Will low step 1 mean that I won't get many interviews? Thank you very much!

Don't screw up the process and you'll probably be okay. Just having insight into the fact that you have one red flag and need to avoid having another one is probably adequate. If it were me, I'd apply to all the programs and go to at least 15 interviews if I could get them. I'd also bust my butt to make sure my Step 2 score, which I'd take as early as possible, is top notch and my grade in EM is honors.

 

[deleted720339]

My Step 1 was <220 but higher than yours. I'm sure this screened me out of a few programs. Then got nearly 250 on Step 2 and my Step 1 became irrelevant. Got nearly 20 interviews...applied to about 50 programs. Several PDs commented on my score jump. Crush Step 2 and your Away Rotations. Don't look back!

 

[ucbsmd]

Low score + jump in Step2 + do reasonably well on EM acting internship + apply broadly (you can spend 3 years in any city) + don't be weird or super awkward at your interviews and you'll be fine.

 

[GatorCHOMPions]

A few years ago, I had a step 1 in the 210s, step 2 in the 230s, and H/HP EM rotation grades. I ended up applying to about 40 programs and received interviews at 13. Based on my experience and more recent trends in EM applications, here are a few tips: do well on step 2 (240s+ ideally), apply to 50-60 programs, do at least 2, probably 3 EM rotations if you can fit it in your schedule (and be a rock star), and don't be afraid to send "interest" e-mails to programs when interviews start rolling in - this worked to land me a few additional invites.

Now having almost completed residency, I was elected chief and got a top 10% in-service score. I mention this because I doubted myself during the application cycle and I think it impacted me on some of the interview days. Don't let one score, albeit an important one, bring you down for long.

 

[ineedadoctor89]

I just matched into EM this year with an identical step 1 score as you. My Step 2 score only increased slightly to 220. I applied broadly, ended up with 16 interviews, went to 14, and ended up matching at my #2 program and couldn't be happier. Only advice I can offer you is to work hard on your EM clinical and aways to receive good SLOEs. They hold a ton of weight. Don't be discouraged and good luck!

 

[IH8ColdWeath3r]

I just matched into EM this year with an identical step 1 score as you. My Step 2 score only increased slightly to 220. I applied broadly, ended up with 16 interviews, went to 14, and ended up matching at my #2 program and couldn't be happier. Only advice I can offer you is to work hard on your EM clinical and aways to receive good SLOEs. They hold a ton of weight. Don't be discouraged and good luck!

Wow, this is encouraging! Could you provide more insight? Were you a DO or MD student, and did you honors a lot of your 3rd year clerkships? How many programs did you apply to, and what geographical location were they located in? Thanks for the uplifting post!

 

[ineedadoctor89]

Wow, this is encouraging! Could you provide more insight? Were you a DO or MD student, and did you honors a lot of your 3rd year clerkships? How many programs did you apply to, and what geographical location were they located in? Thanks for the uplifting post!

Sure thing. I'm a MD student, didn't honor a single clerkship but did have a few HP (including EM), applied to 90 programs all across the US (I know it's a lot but I had lower end Step scores and mediocre clerkship grades), did one away rotation, and got interviews mostly in the Midwest, with a couple interviews in the Northeast and Southeast.

The only positives I had going for me were good feedback for SLOEs, success with research, and leadership in extracurriculars. Also highly recommend an away rotation. After I uploaded my away letter, I got an interview from every EM program in that state. I have to admit I was doubtful of my own chances but ended up matching into the same city my SO lives in and was ecstatic when I opened that envelope. Step scores are important but if they are low, look for other ways to supplement your application. Best of luck!

 

[WeeBay]

I matched my number 1 choice with a very below average application across the board. My class rank, step1 and step 2 were well below average and I failed the CS on my first attempt.

Not only did I match my number one, but I know that I was ranked to match at my number 2, because on match day they called me to talk about why I didn't rank them first.


Heres what I can offer for advice- if you are in my position, or a similar position, you WILL be screened out for a lot of programs. I scheduled my electives in EM during application season, and here is what you need to do.

1) arrive on time for every shift, introduce yourself to your resident/attending, shake their hand, ask if there is anybody that needs to be seen.

2) See your patients right when they arrive. If they will need an ultrasound, get the machine in the room and take a look prior to presenting. If they will need suturing, get the supplies...etc.

3) Even when you have no idea how to formulate a differential, try. come up with a full assesment and plan for every patient, no matter what.


if you can do these three things, you are showing the staff that you are willing to work hard, willing to learn, and don't need to have your hand held.


Outside of the super competitive programs, those three things will get you an interview.

Show up on time, Work hard, Don't make the resident ask you "so what do you want to do for this patient?".

 

[HLxDrummer]

I got a 219 on step 1, 240 on step 2, and 4th quartile ranking with one preclinical honors. One away rotation, one non-published research project. Got 9 EM interviews and matched at (I think) #6. I figured out what I did wrong on Step 1 (too much reading and not enough question banks), and improved my Step 2. Probably could have done another away but my advisors said it wasn't needed. I applied to FM as a back up. I also emailed programs I was especially interested in that I didn't receive an interview for. This netted me one or two extra interviews. I also sent hand-written, customized thank you letters to secretaries, and everyone who interviewed me. Not sure if this helped, and it took a lot of time, but I figured it was worth it given my situations.

Everyone says work hard on your away. That is obviously something you should do, but I found it difficult to do. Looking back I think the best thing is to obviously read and study, but more importantly, be yourself. If you become friends with attendings/residents, work hard, and show up on time I think that leaves a great impression. I worked really hard to have a good knowledge base but ended up being really stressed and I think it showed. I agree with the above posted regarding giving a plan everytime. People really liked when I just went straight from my H&P to my A&P.

I think only one, maybe two, people brought up my Step 1 score.

Overall, apply broadly, have a back up plan, find out where you went wrong on Step 1, and follow up with PDs if you don't get an interview. Good luck!

 

[WeeBay]

Everyone says work hard on your away. That is obviously something you should do, but I found it difficult to do

Agreed. In a rotation that is ~20 shifts long, it is very hard to give off the impression that you are a hard worker without just looking like a total brown-noser. You definitely don't want to look like another gunner student begging to do all the rectal exams in the department.

 

[link2swim06]

I got a 199 on step 1 and matched to my second choice out of 15 interviews.

It's your entire application that matters.

 

[spicysoup55]

How did you guys explain the low step score on the application or during interviews? Is it better to just honestly admit having weak foundations at one point or try to spin it some way?

 

[HLxDrummer]

How did you guys explain the low step score on the application or during interviews? Is it better to just honestly admit having weak foundations at one point or try to spin it some way?

Only two people asked about my score. I told them I chose the wrong study method and couldn't sleep the night before. I actually got super sick halfway through (got freezing cold and shakes) but didn't wanna seem like I was making excuses so didn't mention that.

 

[House911MD]

A few years ago, I had a step 1 in the 210s, step 2 in the 230s, and H/HP EM rotation grades. I ended up applying to about 40 programs and received interviews at 13. Based on my experience and more recent trends in EM applications, here are a few tips: do well on step 2 (240s+ ideally), apply to 50-60 programs, do at least 2, probably 3 EM rotations if you can fit it in your schedule (and be a rock star), and don't be afraid to send "interest" e-mails to programs when interviews start rolling in - this worked to land me a few additional invites.

Now having almost completed residency, I was elected chief and got a top 10% in-service score. I mention this because I doubted myself during the application cycle and I think it impacted me on some of the interview days. Don't let one score, albeit an important one, bring you down for long.

Thanks for your words of wisdom. Quick question - I have heard a lot about about sending "interest" emails to PDs, but I am not sure what exactly these should say or should be titled or when they should be sent. I've heard both before and during interview season and even both (before and during) so one shows early interest and one is a reminder that you submitted/shows continued interest). Any tips on this would be great. I would hate to send an email that could hurt my application.

 

[deleted720339]

I sent a few interest emails to PDs and got great results. For example, I got the interview for the program I ended up matching at based on a interest email. Got 2 more interviews one day to two weeks after sending emails.

I sent mine around early to mid-November since there was a huge coordinated interview invite mid-October. I reasoned that if I hadn't been rejected, hadn't heard back after a month of the first wave, and REALLY liked the program, I had nothing to lose with an interest email. I also sent one in January to get off a waitlist and it worked, too.

As far as content, be genuine and SPECIFIC about what you like about their program. DO NOT MAKE COOKIE CUTTER EMAILS. If you have a tie to the area/school that isn't obvious in your application, tell them in the email. For the email subject, I said something like "Letter of Interest - NAME (SCHOOL)". Keep it short and to the point. Only one email is sufficient...sending too many or having a cookie cutter email is probably the only thing that could hurt you.

 

[DO2016EM]

I had a low step 1 (210-215) range and matched. I'm a DO student, step 2 mod 230's, never honored an EM rotation (got HP/HP/P) and matched. Although I didn't match my top choice, if I can do it, you can too. Make of list of programs that are not brand name or not in desirable locations. Apply to these. Then add in any place you would like to go. The only limiting factor is how much you're willing to spend in apps. I ended up applying to 80+ programs and received 15 interviews. Since you're an MD you should have no problem. You probably won't need to apply to 80 programs either. Maybe 50.

 

[cofcemt]

Failed step 1, right around 200 on the second go around, high-230s on step 2. HP (home), Honors (away). Only had 1 honors rotation in 3rd year.

Applied to 80-90, invited to 13, only went to 11 because my med school wouldnt give me any more time off for interviews. Matched my #2. Chief my last year and just passed boards no problem.

Be prepared to answer to your step score (or any deficiency for that matter). I was honest and just said I burned out and didn't really study and obviously did poorly. I was young and never took more than 18 hours a semester in college and seriously flamed out as far as caring about anything in 2nd year of MS.

I was heavily involved in interviewing when chief and poor board scores was a serious red flag as people still believe it correlates with board pass rate. I went to bat for a lot of people and when asked why, my attendings were shocked at my scores. Just goes to show its just a number, but you have to stratify people somehow.

 

[gamerEMdoc]

Medical students put way to much emphasis on board scores, and grossly over-inflate the importance of the scores in the application process. I'm not saying some programs don't use scores to screen applicants, some do. But by and large, the board scores make little difference in a programs rank list. Clinical performance (EM Grades) and SLOEs, along with a good interview, will make all the difference. Good clinical grades/SLOEs with low board scores beats out Average clinical grade/SLOEs with good board scores any day of the week.

 

[EMHopeful9012]

.

 

[alpinism]

Its a lot easier for EM PDs to "look at you as a person rather than a board score" if you go to a T20 med school and have mostly Honors in rotations.

Just saying.

 

[Got Em]

So I had sub 220 Step 1, >240 Step 2, aced my 3 SLOEs, H in most rotations with a couple HP at a T20 med school. I got interviews at almost all the programs I applied to (including ones where I didn't meet the supposed cutoffs) and matched to my #1. One thing that I love about EM is that it really emphasizes who you are as a person and how you interact with others over board scores. My step score was mentioned at one interview and it was mentioned in a positive light. Work hard on your away rotations and your step 1 score won't even matter. Good luck and PM me if you want more specific advice

The 1st bolded part would get you into many places alone. Not only that, but you go to a top 20 school and received mostly H's in clerkships. Which PD wouldn't want that? Come on man, you were CLEARLY a great applicant.

 

[DetectiveAlonzo]

So for DOs....

I take it that you would need a high step 2 to offset a lackluster step 1... as well as honor every EM rotation AND garner excellent SLOEs ?

 

[doggydog]

So for DOs....

I take it that you would need a high step 2 to offset a lackluster step 1... as well as honor every EM rotation AND garner excellent SLOEs ?

Don't forget the four first authored pubs and the Nobel prize

 

[firejones2000]

You can totally do it.. Check out these red flags
210-220 step 1/250-260 step 2
Non top Med school MD school from the south
25th percentile of class
A class that almost failed which was noted on my transcripts
Otherwise pretty much passes throughout all three years
1 very minor mark on deans letter
EM months were only HP but the programs were known to only give 10% honors and one also said only next 20 or 30% hp (I had the idea that I should prove my worth by shooting for the moon if I could do it over again I probably would have rotated at a top 1/2 program but not top 1/4 per say granted EM doesn't really have tiers but only based on difficulty to match there). Got a fantastic letter from the first program except for one minor comment but they pride themselves in being honest. Other slor(s) no clue but they were at prestigious places so I probably didn't stand out as much. I still got invites after they were uploaded

Things I had going for me
Consistent interest in EM and lots of leadership/volunteer
Did the whole fire gig for a while (hey girls love firefighters (sarcasm))
Minor research which was so trivial didn't matter
Awesome personal statement (a couple people commented that they wanted to meet me because of it)
1 stellar letter of rec no clue how great the other non EM letter was

Initially based on grades and step 1 advisor told me to go on 20 plus IVs then said he said I needed to be in 15-20 range


I had somewhere around 20 invites with just 1 slor and 2 non EM. Eventually had more than 23 interviews.. Attended 21. Matched at number 10. Not surprised my first five were out of region on the coast like in Cali land.

 

[Spikebd]

So for DOs....

I take it that you would need a high step 2 to offset a lackluster step 1... as well as honor every EM rotation AND garner excellent SLOEs ?

TBH I was thinking about EM for a long time. Sent in my VSAS apps to ~7 ACGME programs and didn't get a single bite. These weren't all California places either. I'm thinking our generation is hooked on the EM lifestyle. I have a feeling it's going to get as competitive as some surgical specialties.

 

[IH8ColdWeath3r]

TBH I was thinking about EM for a long time. Sent in my VSAS apps to ~7 ACGME programs and didn't get a single bite. These weren't all California places either. I'm thinking our generation is hooked on the EM lifestyle. I have a feeling it's going to get as competitive as some surgical specialties.

I agree. I had a difficult time setting stuff up as well, with respect to the number of places that I applied to.

 

[doggydog]

A large chunk of people from my school are having serious issues as well. It's not limited to DOs.

 

[alpinism]

You can totally do it.. Check out these red flags
210-220 step 1/250-260 step 2
Non top Med school MD school from the south
25th percentile of class
A class that almost failed which was noted on my transcripts
Otherwise pretty much passes throughout all three years
1 very minor mark on deans letter
EM months were only HP but the programs were known to only give 10% honors and one also said only next 20 or 30% hp (I had the idea that I should prove my worth by shooting for the moon if I could do it over again I probably would have rotated at a top 1/2 program but not top 1/4 per say granted EM doesn't really have tiers but only based on difficulty to match there). Got a fantastic letter from the first program except for one minor comment but they pride themselves in being honest. Other slor(s) no clue but they were at prestigious places so I probably didn't stand out as much. I still got invites after they were uploaded

Things I had going for me
Consistent interest in EM and lots of leadership/volunteer
Did the whole fire gig for a while (hey girls love firefighters (sarcasm))
Minor research which was so trivial didn't matter
Awesome personal statement (a couple people commented that they wanted to meet me because of it)
1 stellar letter of rec no clue how great the other non EM letter was

Initially based on grades and step 1 advisor told me to go on 20 plus IVs then said he said I needed to be in 15-20 range


I had somewhere around 20 invites with just 1 slor and 2 non EM. Eventually had more than 23 interviews.. Attended 21. Matched at number 10. Not surprised my first five were out of region on the coast like in Cali land.

Sorry but this is ridiculous and your advisor is an idiot.

Unless you were couples matching there's no reason to go on over 20 interviews.

Even with your below average step 1 and near class failure, you still crushed step 2 and passed all your classes (plus had solid ECs and LORs).

 

[alpinism]

TBH I was thinking about EM for a long time. Sent in my VSAS apps to ~7 ACGME programs and didn't get a single bite. These weren't all California places either. I'm thinking our generation is hooked on the EM lifestyle. I have a feeling it's going to get as competitive as some surgical specialties.

Start calling and/or emailing programs until you get a bite.

It never hurts to ask about available spots as long as you do it respectfully.

 

[Spikebd]

A large chunk of people from my school are having serious issues as well. It's not limited to DOs.

Interesting. It seems to have reached a peak these days.

 

[Shorin-Ryu]

You can totally do it.. Check out these red flags
210-220 step 1/250-260 step 2
Non top Med school MD school from the south
25th percentile of class
A class that almost failed which was noted on my transcripts
Otherwise pretty much passes throughout all three years
1 very minor mark on deans letter
EM months were only HP but the programs were known to only give 10% honors and one also said only next 20 or 30% hp (I had the idea that I should prove my worth by shooting for the moon if I could do it over again I probably would have rotated at a top 1/2 program but not top 1/4 per say granted EM doesn't really have tiers but only based on difficulty to match there). Got a fantastic letter from the first program except for one minor comment but they pride themselves in being honest. Other slor(s) no clue but they were at prestigious places so I probably didn't stand out as much. I still got invites after they were uploaded

Things I had going for me
Consistent interest in EM and lots of leadership/volunteer
Did the whole fire gig for a while (hey girls love firefighters (sarcasm))
Minor research which was so trivial didn't matter
Awesome personal statement (a couple people commented that they wanted to meet me because of it)
1 stellar letter of rec no clue how great the other non EM letter was

Initially based on grades and step 1 advisor told me to go on 20 plus IVs then said he said I needed to be in 15-20 range

I had somewhere around 20 invites with just 1 slor and 2 non EM. Eventually had more than 23 interviews.. Attended 21. Matched at number 10. Not surprised my first five were out of region on the coast like in Cali land.

Congratulations on matching! Agree with your advisor and disagree with @alpinism. Had you gone on less interviews, it may have been not such a happy ending. Even though my story is somewhat different from yours, I followed a similar pattern.

Applied to Six-Year Integrated Cardiothoracic Surgery Residency Program.

Pros:
- AMG (MD)
- Steps in 250s
- Outstanding LORs from the top cardiothoracic surgeons in the country (as I was told by the impartial third parties while on the interview trail)
- AOA
- GHHS
- good number of 1st and 2nd name publications (one in a highly reputable journal, 2nd name publication)
- honored all clerkships except Peds (missed honors by one point)
- ranked 4th in my class

Cons:
- my medical school is amazing and nurturing with 100% match and many of our incredible students match at the top big name schools BUT it is barely a mid-tier ranked school
- my school, which is located in a rural area, is partners with a community-based residency-training hospital on the outskirts of a mid-size city
- my school does not have a CTS department
- only one of my publications was related to CTS

My advisors and my own gut-feeling told me to go to the best in the CTS field away rotations, get the best LORs and show my continuous interest in CTS.
I applied broadly to 60+ programs, went to 26 interview (mostly CT I6 plus a few GS), ranked 20 programs and matched to my top choice (an incredible CT I6 program). I was blessed with the best medical school and best professors and advisors (at my school and during my away rotations), who made me believe that I could do it. I have to admit that a scary thought crossed my mind not once that the integrated CTS programs were designed for the students coming from the top-tier medical schools.

Only it was not true. Dare to Dream the Impossible and work hard to achieve it.

Congratulations, @firejones2000.

P.S. Maybe my story is not exactly related to this thread but, again, I went through the same type of motions and your post, @firejones2000, spoke to me. I am very happy for you and I am very happy that your school has amazing and caring advisors.

 

[Psai]

One of these posts is not like the others