Does a 260-270 Step 1 really give much advantage over a 240-250?

jlimback · Feb 23, 2012

To clarify, I'm looking for feedback from people who are on the residency interview trail, or have knowledge of the matter. What sort of benefits come with the 20 point difference? When I look at the NRMP data, even plastics (which, i'm not interested in) has a range of matcher's between ~220-270. Does it all really come down to: "yea, we know you're smart, now, we want to know if we like you?" Does a higher score translate to more interviews, or does it have diminishing returns? At the point that you meet the initial program cutoffs for score, does it even matter?

I do pretty well in school, and I'm interested in some of the more competitive residencies, and would like to stay in Florida. So, i'm trying to decide if it's worth more time away from the wife and kids, to put more effort into board prep (June 4th is when I take my step 1). UW/FA seems to work well for me. However, I've read the accounts of people in the 260/270's and tried their methods. It simply takes that much more time and effort. I also know I'm gonna have to really put in lots of effort next year, to honors as much as possible and don't want to burn the candle at both ends for too long!

Sheldor · Feb 23, 2012

jlimback said:
To clarify, I'm looking for feedback from people who are on the residency interview trail, or have knowledge of the matter. What sort of benefits come with the 20 point difference? When I look at the NRMP data, even plastics (which, i'm not interested in) has a range of matcher's between ~220-270. Does it all really come down to: "yea, we know you're smart, now, we want to know if we like you?" Does a higher score translate to more interviews, or does it have diminishing returns? At the point that you meet the initial program cutoffs for score, does it even matter?

I do pretty well in school, and I'm interested in some of the more competitive residencies, and would like to stay in Florida. So, i'm trying to decide if it's worth more time away from the wife and kids, to put more effort into board prep (June 4th is when I take my step 1). UW/FA seems to work well for me. However, I've read the accounts of people in the 260/270's and tried their methods. It simply takes that much more time and effort. I also know I'm gonna have to really put in lots of effort next year, to honors as much as possible and don't want to burn the candle at both ends for too long!

So in the interest of full disclosure I am not on the "inside" or have any special knowledge, but I can share a little. I researched this quite a bit before I started studying for Step 1 and found an almost unanimous opinion that there is very little difference in your future career goals when comparing a 240-250 to a 260-270. Especially, when you compare it to the amount of effort required to make that jump. Ultimately I ended up prioritizing my wife and children over that bump and am extremely thankful to have done so. I don't apply for residency until this Fall so I won't know for sure until then, but based on my experience thus far I think it will go well!

All of this to say, work hard, spend time with your family, and be happy when you score around a 250.

C5toC9 · Feb 23, 2012

The hard part is that you can't predict that if you put X amount of time, you get one score, and if you put in X+Y amount of time, you get a higher score. Ultimately, I think you should just aim to do your best. You have one shot at it. Might as well make it good.

jlimback · Feb 23, 2012

Thanks for the quick reply! I definitely prioritize the wife & kids.

Just wondering, was it here on SDN that you got the info, and, if so, which forum was it?

2012mdc · Feb 23, 2012

jlimback said:
To clarify, I'm looking for feedback from people who are on the residency interview trail, or have knowledge of the matter. What sort of benefits come with the 20 point difference? When I look at the NRMP data, even plastics (which, i'm not interested in) has a range of matcher's between ~220-270. Does it all really come down to: "yea, we know you're smart, now, we want to know if we like you?" Does a higher score translate to more interviews, or does it have diminishing returns? At the point that you meet the initial program cutoffs for score, does it even matter?

I do pretty well in school, and I'm interested in some of the more competitive residencies, and would like to stay in Florida. So, i'm trying to decide if it's worth more time away from the wife and kids, to put more effort into board prep (June 4th is when I take my step 1). UW/FA seems to work well for me. However, I've read the accounts of people in the 260/270's and tried their methods. It simply takes that much more time and effort. I also know I'm gonna have to really put in lots of effort next year, to honors as much as possible and don't want to burn the candle at both ends for too long!

It depends on what specialty you want and where you want to end up in that specialty. I can only speak on Radiology - personal experience and discussions with classmates and people I meet on the trail.

There is a significant difference between a 240 and a 260 if you're looking at competitive rads programs. The average for radiology is 240 and competitive programs have interview averages in the 250s+ and match averages ~260. Some of this info is coming directly from PD's. Since 240 is the average for all matched US seniors, having a 240 will not impress a lot of programs and will be below average for many.

In summary I dont think there's a huge difference between 240 and 260 in terms of matching somewhere but I think it has a large effect on where you match. I personally think the effort is worth it. I haven't come across someone who regrets studying too much for Step 1 (is there even such a thing? :laugh:

)

drizzt3117 · Feb 23, 2012

2012mdc said:
It depends on what specialty you want and where you want to end up in that specialty. I can only speak on Radiology - personal experience and discussions with classmates and people I meet on the trail.

There is a significant difference between a 240 and a 260 if you're looking at competitive rads programs. The average for radiology is 240 and competitive programs have interview averages in the 250s+ and match averages ~260. Some of this info is coming directly from PD's. Since 240 is the average for all matched US seniors, having a 240 will not impress a lot of programs and will be below average for many.

In summary I dont think there's a huge difference between 240 and 260 in terms of matching somewhere but I think it has a large effect on where you match. I personally think the effort is worth it. I haven't come across someone who regrets studying too much for Step 1 (is there even such a thing? )

I'd agree with this. I've had PDs say their averages were in the 260s and some even higher for competitive programs in desirable locations.

Dirt · Feb 23, 2012

There is definitely a difference between 240 and 260.

And

"yea, we know you're smart, now, we want to know if we like you?"

Is a common misconception. Even after the interview grades continue to play a large role in who programs choose to rank highly.

That being said, the difference between getting a 240 and a 260 is probably not something that can be made up with more "effort". When you are talking about numbers that high I really think that it's more about your inherent skills as a test taker and your natural ability than anything else.

In the end it's pretty simple, put in as much hardwork as you feel comfortable doing.

Sheldor · Feb 23, 2012

2012mdc said:
It depends on what specialty you want and where you want to end up in that specialty. I can only speak on Radiology - personal experience and discussions with classmates and people I meet on the trail.

There is a significant difference between a 240 and a 260 if you're looking at competitive rads programs. The average for radiology is 240 and competitive programs have interview averages in the 250s+ and match averages ~260. Some of this info is coming directly from PD's. Since 240 is the average for all matched US seniors, having a 240 will not impress a lot of programs and will be below average for many.

In summary I dont think there's a huge difference between 240 and 260 in terms of matching somewhere but I think it has a large effect on where you match. I personally think the effort is worth it. I haven't come across someone who regrets studying too much for Step 1 (is there even such a thing? )

Just wanted to add that I agree with 2012mdc, despite my use of large ranges in my previous post. So I thought I would clarify my view point slightly: Higher is always better. Some programs, ie The top 10 of any specialty will have much higher Step 1 averages the most other programs in the field. At those programs a higher score will help a lot. I think the difference is much less perceptible when comparing a score in the 250's to one in the 260's, which is what I truly meant.

I think that some people can "control" what score they get, to a point. I purposely monitored my progress with frequent practice tests, and chose to study a few hours less each day to have time with my family. I could have not seen them for a two weeks, gotten in that extra time and likely seen a score bump of 5-10 points, but in the end, I have no regrets.

I think the safest bet is to combine all of the advice in this thread to the following: Work as hard as possible as no one ever feels like they studied too much, however, be sure to take a couple hours a day for yourself/your family, as that is time you can't get back, and in the end if you score in the 250's, instead of the 260's, you'll still have a rewarding career.

jlimback · Feb 23, 2012

Thanks for all of the good advice! I'll be happy with anything in the 250+ range. From what I've found/read, FL programs aren't really at the top of many lists, so I may have caught a break there.

As far as seeing a score change, I can definitely tell with UWorld. The blocks I put in the time to read BRS physio, RR, Listen to Goljan, read FA, and go thoroughly through lectures, etc, I easily score in the 80's-90's. The blocks that I take a more relaxed effort towards, I find myself in the 60-70's. So, as most probably do, I'll try to find that happy medium.

Sheldor · Feb 23, 2012

jlimback said:
Thanks for all of the good advice! I'll be happy with anything in the 250+ range. From what I've found/read, FL programs aren't really at the top of many lists, so I may have caught a break there.

As far as seeing a score change, I can definitely tell with UWorld. The blocks I put in the time to read BRS physio, RR, Listen to Goljan, read FA, and go thoroughly through lectures, etc, I easily score in the 80's-90's. The blocks that I take a more relaxed effort towards, I find myself in the 60-70's. So, as most probably do, I'll try to find that happy medium.

Anecdotally, the few people I know who we're scoring in the 80's and 90's on uworld scored >260, so you may not have a problem after all 😉

jlimback · Feb 23, 2012

Sheldor said:
Anecdotally, the few people I know who we're scoring in the 80's and 90's on uworld scored >260, so you may not have a problem after all 😉

From what I've seen on SDN, that's true. However, I've been doing it by sections (e.g. GI w/ GI block in class), which infers advantages. Also, it's immediately following or even during that block. So, props to the people who get to that average after it's all said and done...I only hope I will!

armybound · Feb 23, 2012

my buddy took the UWorld practice exams and says he was consistently scoring within 3-5 points of his real score (260). I feel like they are good predictors of real performance.

I can't really give much insight into the original question. My residency program director of interest told me that they have a cutoff (235) and everyone who scores above it is seen as equal.

I also think it's weird that we see so many of these high scores that we start to think of them as not very competitive. It's like getting a 38 MCAT and thinking that's what everyone else makes. I know when I got my Step 1 score I was super excited, but the first classmate I talked to was the 260 above.. I immediately started thinking I shouldn't be as happy with my score as I was.

Valadi · Feb 23, 2012

You guys also have to figure that kids with 260+ scores are also probably gunning everything else out as well.

On my research year for a specialty than generally accepts ~2 residents/institution, I've had residents/fellows/attg's who participated in making the rank list talk to me afterward about what went into decisions. It was interesting that younger residents tended to value step scores a lot more than attendings, who were looking at overall fit, work ethic, and research. Like I said above, though, it just happened that many kids with high scores also killed it in everything else. Contrastingly, people with lower step scores who managed an invite ranked equally highly if they fit well or brought something else great to the table.

Not sure if this is how it is in bigger specialties where scores/grades might be the only way to sort through 100+ applicants, but in smaller ones (plastics, derm, vascular) the step score gets your foot in the door but people are on more or less equal playing ground after that.

Moral of the story. 240 and kill everything else (publications, awards, killer work ethic) is generally > 270 and that's it.

For example, I know several people with 220-240 scores getting phone calls from PDs at top 10 institutions because their other attributes were very locked up.

2012mdc · Feb 23, 2012

Valadi said:
You guys also have to figure that kids with 260+ scores are also probably gunning everything else out as well.

On my research year for a specialty than generally accepts ~2 residents/institution, I've had residents/fellows/attg's who participated in making the rank list talk to me afterward about what went into decisions. It was interesting that younger residents tended to value step scores a lot more than attendings, who were looking at overall fit, work ethic, and research. Like I said above, though, it just happened that many kids with high scores also killed it in everything else. Contrastingly, people with lower step scores who managed an invite ranked equally highly if they fit well or brought something else great to the table.

Not sure if this is how it is in bigger specialties where scores/grades might be the only way to sort through 100+ applicants, but in smaller ones (plastics, derm, vascular) the step score gets your foot in the door but people are on more or less equal playing ground after that.

Moral of the story. 240 and kill everything else (publications, awards, killer work ethic) is generally > 270 and that's it.

For example, I know several people with 220-240 scores getting phone calls from PDs at top 10 institutions because their other attributes were very locked up.

I agree. My experience was with a number driven specialty where popular programs get 500+ applicants easily. A 240 won't even get you past the first filter at a lot of places without a strong connection. Smaller fields definitely seem to be less number oriented.

kaleerkalut · Feb 24, 2012

2012mdc said:
I agree. My experience was with a number driven specialty where popular programs get 500+ applicants easily. A 240 won't even get you past the first filter at a lot of places without a strong connection. Smaller fields definitely seem to be less number oriented.

This makes me think of Plastics where I have repeatedly heard that it is the only small field where numbers are HUGE. Is this not true then?

Valadi · Feb 24, 2012

kaleerkalut said:
This makes me think of Plastics where I have repeatedly heard that it is the only small field where numbers are HUGE. Is this not true then?

I'm speaking from plastics.

Numbers ARE huge... for getting you in the mix. When everyone has 240+ though what I heard through the grapevine is that they really didn't pay attention to it once interviews were granted. Rather, letters of rec, research, how you performed on your away, and how people thought you fit on the interview were thought of more. That being said, don't bank on scores alone getting you plastics interviews for exactly this reason. Last year's average was a 249. There really isn't any score number you could show them that they aren't seeing from everyone else.

Programs care about scores because it means you'll be able to pass your step 3 and get certified. When you're at a point when everyone is at the "highly likely to pass" mark I guess it makes sense that other things matter more.

GoSpursGo · Feb 24, 2012

Since anecdotes are fun: a friend of mine told me that a PD at a competitive derm program said that they don't even look at applications from people with <260.

The point is, as with everything, the amount that your score will matter depends on what specialty you're looking at and where you want to go. Higher is always better, but if location isn't that big of a deal to you, then something in the 240-250 range should get you a pretty solid shot even for a competitive specialty. And let's not be silly--a 240 is still a fantastic score no matter how you look at it.

drizzt3117 · Feb 24, 2012

kaleerkalut said:
This makes me think of Plastics where I have repeatedly heard that it is the only small field where numbers are HUGE. Is this not true then?

I think numbers are huge in every competitive field. Also, in a field like that, there are people who have the numbers AND "everything else".

Phyozo · Feb 24, 2012

This is a silly question. Of course a 260 is going to be better than a 240. The question is how much better. And yes specialty makes a difference, but you shouldn't aim lower just because you don't want to go into a competitive specialty...the numbers in the upper echelon of even less competitive specialties are still competitive across the board.

Also, this may have been mentioned above, but it's a common myth that once you're invited to interviews you're "all the same". Your primary app including step scores, clinical grades, LOR, etc will place you somewhere into a tentative rank list. From there, you'll move depending on your interview day.

2012mdc · Feb 24, 2012

Phyozo said:
This is a silly question. Of course a 260 is going to be better than a 240. The question is how much better. And yes specialty makes a difference, but you shouldn't aim lower just because you don't want to go into a competitive specialty...the numbers in the upper echelon of even less competitive specialties are still competitive across the board.

Also, this may have been mentioned above, but it's a common myth that once you're invited to interviews you're "all the same". Your primary app including step scores, clinical grades, LOR, etc will place you somewhere into a tentative rank list. From there, you'll move depending on your interview day.

This probably varies by specialty and program but I agree. I saw things like Step 1 score and AOA status on some of my interviewer's notes they brought with them into the interview.

bigcat9 · Feb 24, 2012

Why are you operating under the notion that you can study your way to a >260? Lots of confidence in yourself I guess. I have seen excellent students with 37+ MCAT scores (no dummies) study their tail off and get a 250, after putting in 6-8 hours a day for 2 years then 12 hours a day studying for 5 weeks before step one. These people are good students = junior AOA at a top 25 med school, studied hard in their preclinical years, and rocked the MCAT (>36). I love your confidence that studying hard will get you a 260+ but I am unsure of your wisdom, I think it is a flawed assumption you are working under. There is no magic formula to a 260, a lot of it is luck, my buddy and I both got 37 MCATs, and were identical in percentage in our first two years of med school, he got a 251 and I got a 268 not because I studied harder or knew more, I just had a better test day. You get 344 random questions pulled from a bank of 20000, everyone gets a different sample of these questions, I got a test that did not exploit my weaknesses while he got a test that exploited his. Study hard and hope for the best but don't assume that getting a 260 will result from hard study, you need a lot of luck too.

Phyozo · Feb 24, 2012

bigcat9 said:
Why are you operating under the notion that you can study your way to a >260? Lots of confidence in yourself I guess. I have seen excellent students with 37+ MCAT scores (no dummies) study their tail off and get a 250, after putting in 6-8 hours a day for 2 years then 12 hours a day studying for 5 weeks before step one. These people are good students = junior AOA at a top 25 med school, studied hard in their preclinical years, and rocked the MCAT (>36). I love your confidence that studying hard will get you a 260+ but I am unsure of your wisdom, I think it is a flawed assumption you are working under. There is no magic formula to a 260, a lot of it is luck, my buddy and I both got 37 MCATs, and were identical in percentage in our first two years of med school, he got a 251 and I got a 268 not because I studied harder or knew more, I just had a better test day. You get 344 random questions pulled from a bank of 20000, everyone gets a different sample of these questions, I got a test that did not exploit my weaknesses while he got a test that exploited his. Study hard and hope for the best but don't assume that getting a 260 will result from hard study, you need a lot of luck too.

I'll agree with you to a certain degree. Firstly, it's ridiculous to propose that there are actually students who study 6-8 hours for the first 2 years just for the step1, though studying 12 hours a day for 5 weeks is not unreasonable. Secondly, there is a certain point where the importance of luck and natural test taking ability begin to outshadow knowledge. In my opinion, that happens somewhere around the mid 250 range, and I think most program directors would agree that the difference between 255 and 265 is much smaller than 240 and 260. Having been through the step1 study grind with my friends, I am one to believe that 250+ is achievable through hard work. Everyone in med school works hard, but some are willing to work harder than others to get what they want.

bigcat9 · Feb 24, 2012

Step 1 is based on the first two years of med school, I was refering to putting in 6-8 hours a day five days a week studying for the classes Step 1 is based on. 240 to 260 is almost a standard deviation, of course it is a bigger difference than 245 to 255. My only point is that you can be a great student (junior AOA), great test taker (36+ MCAT) and work hard studying your first two years as well as with your step 1 prep and not get to a 260, it takes some degree of luck. Just hope you do not get a random sample of questions that exploit your weaknesses. I am sure there are brilliant students who will always get >260 no matter how many times they test but they are an exception not the rule. It is naive to think you can break 260 with hard study, a lot of factors need to come together for that to happen, if you look at charting outcomes in 2009 there were fewer than 500 people with over a 260 out of >16000 resident applicants listed, don't tell me only 1 out of 32 med students studied hard on what they thought was the most important test of their life.

ArcGurren · Feb 24, 2012

I don't know if it makes a huge difference (I personally scored in the 250s) but I'm fairly sure that if you get any score that high, you should be damn happy you did.

2012mdc · Feb 24, 2012

bigcat9 said:
Step 1 is based on the first two years of med school, I was refering to putting in 6-8 hours a day five days a week studying for the classes Step 1 is based on. 240 to 260 is almost a standard deviation, of course it is a bigger difference than 245 to 255. My only point is that you can be a great student (junior AOA), great test taker (36+ MCAT) and work hard studying your first two years as well as with your step 1 prep and not get to a 260, it takes some degree of luck. Just hope you do not get a random sample of questions that exploit your weaknesses. I am sure there are brilliant students who will always get >260 no matter how many times they test but they are an exception not the rule. It is naive to think you can break 260 with hard study, a lot of factors need to come together for that to happen, if you look at charting outcomes in 2009 there were fewer than 500 people with over a 260 out of >16000 resident applicants listed, don't tell me only 1 out of 32 med students studied hard on what they thought was the most important test of their life.

Luck definitely plays a role. There are people who under or over perform their practice tests by 20+ points.

I do think some folks don't focus enough on test taking stragey/skills and spend too much time trying to learn EVERYTHING which is impossible. The USMLE/NBME tests a very specific way and beasting Step 1 requires strategy specific to their style IMO and that's part of the reason why the MCAT is a weak predictor.

Also addressing your weaknesses, not just knowledge ones, but skill ones is a big thing. Over half my study time was spent doing questions and reviewing them and figuring out how to master their style.

Phyozo · Feb 24, 2012

2012mdc said:
Luck definitely plays a role. There are people who under or over perform their practice tests by 20+ points.

I do think some folks don't focus enough on test taking stragey/skills and spend too much time trying to learn EVERYTHING which is impossible. The USMLE/NBME tests a very specific way and beasting Step 1 requires strategy specific to their style IMO and that's part of the reason why the MCAT is a weak predictor.

Also addressing your weaknesses, not just knowledge ones, but skill ones is a big thing. Over half my study time was spent doing questions and reviewing them and figuring out how to master their style.

Totally agree with this. I would take this a step further and say that THIS is what step 1 is about...it's definitely not about learning everything from the first 2 years. In fact, I know classmates who relied on their classwork without doing questions and without using first aid and failed their step1. Doing well on this test involves not just having the knowledge necessary, but have the specific knowledge needed to do well on this test, including understanding inner workings of how the test is written, which topics and questions are high yield, what common pitfalls are and how to avoid them, all the while mastering the high yield knowledge that is on the test and avoiding the lower yield stuff. You can't learn this from the first two years of med school, it has to be repetition with thousands and thousands of practice questions with focused review to do well. Or you can just be really bright.

Having said all that, if you understand this, you will score >250. Most people just don't want to put in the effort required, or study inefficiently, don't care as much, or some combination of the aforementioned.

Phyozo · Feb 24, 2012

bigcat9 said:
Step 1 is based on the first two years of med school, I was refering to putting in 6-8 hours a day five days a week studying for the classes Step 1 is based on. 240 to 260 is almost a standard deviation, of course it is a bigger difference than 245 to 255. My only point is that you can be a great student (junior AOA), great test taker (36+ MCAT) and work hard studying your first two years as well as with your step 1 prep and not get to a 260, it takes some degree of luck. Just hope you do not get a random sample of questions that exploit your weaknesses. I am sure there are brilliant students who will always get >260 no matter how many times they test but they are an exception not the rule. It is naive to think you can break 260 with hard study, a lot of factors need to come together for that to happen, if you look at charting outcomes in 2009 there were fewer than 500 people with over a 260 out of >16000 resident applicants listed, don't tell me only 1 out of 32 med students studied hard on what they thought was the most important test of their life.

I will admit that not everyone can break 260, but I think 250 is doable with enough work. I consider myself a fairly mediocre (possible even less than average level) med student, but I busted my butt. Also, there's different levels of studying hard. Everyone studies hard in med school, but some study and worker harder than others. It's all about how much you want it. Sure natural talent/luck comes into play, but so does good preparation.

LiveUninhibited · Feb 24, 2012

https://www.aamc.org/students/download/62400/data/chartingoutcomes.pdf

There are graphs for matching odds by specialty given different characteristics, including step 1 scores.

To find your graph quickly do control F for: "Graph XX-2", where X is the abbreviation for your desired specialty.

Ctrl+F for "Chart 3" gives some context to it (the overall match rate for the specialties).

For example diagnostic radiology on page 54 for US seniors it looks like those with a 260 have a 99% chance of matching, while a 240 has a 95% chance, 220 @ 82%, 200 @ 55%. Although keep in mind some of these people might have made up for a lower score with step 2 or other strengths. In comparison, for Independent grads the differential is 68% @ 260 and 49% @ 240 - sucks to be them.

I guess it depends on how you look at it. Your probability of matching to DR only increases by 4% for the huge gap between those scores, but that also means you're 5 times less likely to not match to it, allowing you more room to suck in other parts of your application.

But it depends on specialty. Most are even more forgiving than DR, but plastics, not so much: 260: 65%, 240: 45%, 220: 25%... 240 to 260 makes a big difference there.

drizzt3117 · Feb 24, 2012

We're not talking about simply matching; within reason, most MD students can match most specialties by applying to enough programs unless their step score is way below the averages (unless it's plastics/derm). Matching at top programs is hard and generally requires top step scores.

LiveUninhibited said:
https://www.aamc.org/students/download/62400/data/chartingoutcomes.pdf

There are graphs for matching odds by specialty given different characteristics, including step 1 scores.

To find your graph quickly do control F for: "Graph XX-2", where X is the abbreviation for your desired specialty.

Ctrl+F for "Chart 3" gives some context to it (the overall match rate for the specialties).

For example diagnostic radiology on page 54 for US seniors it looks like those with a 260 have a 99% chance of matching, while a 240 has a 95% chance, 220 @ 82%, 200 @ 55%. Although keep in mind some of these people might have made up for a lower score with step 2 or other strengths. In comparison, for Independent grads the differential is 68% @ 260 and 49% @ 240 - sucks to be them.

I guess it depends on how you look at it. Your probability of matching to DR only increases by 4% for the huge gap between those scores, but that also means you're 5 times less likely to not match to it, allowing you more room to suck in other parts of your application.

But it depends on specialty. Most are even more forgiving than DR, but plastics, not so much: 260: 65%, 240: 45%, 220: 25%... 240 to 260 makes a big difference there.

jlimback · Feb 25, 2012

drizzt3117 said:
We're not talking about simply matching; within reason, most MD students can match most specialties by applying to enough programs unless their step score is way below the averages (unless it's plastics/derm). Matching at top programs is hard and generally requires top step scores.

This is where my concern lies. I'll essentially be applying to 3 highly competitive residencies in the state of Florida (total of 8 spots). To be sure, I've got less competitive back-up plans, and i'm sort of waiting on 3rd year to see if I really could make it in another specialty, while staying happy with what I do (i.e. if I should apply to other states).

For those who say you can't study to a 260, I've seen it done, personally, and on SDN. Look at the USMLE experiences posts of those people getting over 260. They put in an abnormal effort, going above and beyond the UW/FA combo. Although I do agree that a person needs a baseline capability and a little bit of luck with the exam questions, I cannot see the latter making more than 5-10 points difference. The problem is: time. It's not that I haven't started board studying early enough, it's more that I juggle family time, exercise, and "sane" time with school. Sorta hard to take away from these, but it will be much more worth it to have 4 years closer to family and a lifestyle that accommodates life beyond medicine.

I wish there was a way to see the averages of the individual programs, to get a feel for their actual competitiveness compared to the rest of the nation. I have noticed a few graduates from my school are in these programs. Do you guys thing it would be abnormal/awkward/indecent to contact these people to ask?

Phyozo · Feb 25, 2012

jlimback said:
This is where my concern lies. I'll essentially be applying to 3 highly competitive residencies in the state of Florida (total of 8 spots). To be sure, I've got less competitive back-up plans, and i'm sort of waiting on 3rd year to see if I really could make it in another specialty, while staying happy with what I do (i.e. if I should apply to other states).

For those who say you can't study to a 260, I've seen it done, personally, and on SDN. Look at the USMLE experiences posts of those people getting over 260. They put in an abnormal effort, going above and beyond the UW/FA combo. Although I do agree that a person needs a baseline capability and a little bit of luck with the exam questions, I cannot see the latter making more than 5-10 points difference. The problem is: time. It's not that I haven't started board studying early enough, it's more that I juggle family time, exercise, and "sane" time with school. Sorta hard to take away from these, but it will be much more worth it to have 4 years closer to family and a lifestyle that accommodates life beyond medicine.

I wish there was a way to see the averages of the individual programs, to get a feel for their actual competitiveness compared to the rest of the nation. I have noticed a few graduates from my school are in these programs. Do you guys thing it would be abnormal/awkward/indecent to contact these people to ask?

It's not abnormal/awkward/indecent, but it may not be helpful since your sample size will be relatively small. I'd say that there are no guarantees to this...higher scores will give you better chances, but you have to outweigh how important family time/exercise/sane time is. This is the same thing every medical student goes through except some require less family time and more exercise/sane time. Higher score will be better, but you'll have to decide at what cost.

Law2Doc · Feb 25, 2012

The med student views in this thread are more interesting than informative. There's absolutely a law of diminishing returns, and the interview (and other interpersonal interactions) looms HUGE. Sure, to be considered, you need to have at least a certain number to make the program look competitive (and that number varies by specialty and within programs in each specialty), but after that point (and a LOT of people still meet that point), whether or not the program "likes you" is all important. The attendings and residents have to work with YOU, not your board scores. So away rotations where you hit it off with people, and the pre-interview dinners with the residents, and good evaluations and LORs saying you are a joy to work with in a clinical setting are huge. More huge than an extra 10 points, once you break a certain threshold. There's really no question here. Speaking as a resident, we nix applicants all the time who come across poorly in their interactions with the residents. The PD couldn't care less if the person has 10 points higher than the average applicant, if the chief resident comes to him and says this guy came across badly at the pre-interview dinner, or was a PITA during his away rotation, he's simply not going to be on the final rank list. Someone with a lower board score will take his place. Other things besides his score simply matter more in the work setting.

Bob California · Feb 25, 2012

Only for the most competitive programs.

jlimback said:
To clarify, I'm looking for feedback from people who are on the residency interview trail, or have knowledge of the matter. What sort of benefits come with the 20 point difference? When I look at the NRMP data, even plastics (which, i'm not interested in) has a range of matcher's between ~220-270. Does it all really come down to: "yea, we know you're smart, now, we want to know if we like you?" Does a higher score translate to more interviews, or does it have diminishing returns? At the point that you meet the initial program cutoffs for score, does it even matter?

I do pretty well in school, and I'm interested in some of the more competitive residencies, and would like to stay in Florida. So, i'm trying to decide if it's worth more time away from the wife and kids, to put more effort into board prep (June 4th is when I take my step 1). UW/FA seems to work well for me. However, I've read the accounts of people in the 260/270's and tried their methods. It simply takes that much more time and effort. I also know I'm gonna have to really put in lots of effort next year, to honors as much as possible and don't want to burn the candle at both ends for too long!

2012mdc · Feb 25, 2012

Law2Doc said:
The med student views in this thread are more interesting than informative. There's absolutely a law of diminishing returns, and the interview (and other interpersonal interactions) looms HUGE. Sure, to be considered, you need to have at least a certain number to make the program look competitive (and that number varies by specialty and within programs in each specialty), but after that point (and a LOT of people still meet that point), whether or not the program "likes you" is all important. The attendings and residents have to work with YOU, not your board scores. So away rotations where you hit it off with people, and the pre-interview dinners with the residents, and good evaluations and LORs saying you are a joy to work with in a clinical setting are huge. More huge than an extra 10 points, once you break a certain threshold. There's really no question here. Speaking as a resident, we nix applicants all the time who come across poorly in their interactions with the residents. The PD couldn't care less if the person has 10 points higher than the average applicant, if the chief resident comes to him and says this guy came across badly at the pre-interview dinner, or was a PITA during his away rotation, he's simply not going to be on the final rank list. Someone with a lower board score will take his place. Other things besides his score simply matter more in the work setting.

Of course there's diminishing returns. The difference between a 260 and a 245 isn't the same as the one between a 285 and a 270.

Of course once you get the interview it's a more of level playing field but not everyone is created equal at certain programs either. This info is coming straight from PD's.

Dr. USMLE · Feb 25, 2012

Since several MS3's have PMed me regarding transitional years, I will add that at about half of the 11 places I interviewed for TY, the TY stats were all 260+ Step 1. I would bet that about a quarter of them had 270+. Even at the other half of the TYs, 90% of the my fellow interviewees were derm, rad onc, and ophtho applicants.

Valadi · Feb 25, 2012

Insane as it sounds, that makes sense. A 260 is a little less than 2 standard deviations from the mean, so at least 2.5% of all applicants have > 260. 16,559 senior us students applied in the 2011 match, which means that at least 414 had a score > 260.

I find that fairly crazy. It's no wonder some places can use that as a cut-off :/

Asp · Feb 26, 2012

GoSpursGo said:
Since anecdotes are fun: a friend of mine told me that a PD at a competitive derm program said that they don't even look at applications from people with <260.

I think your friend exaggerates. SDN self-selection and USMLE World fueled score inflation notwithstanding, 260+ is still fairly uncommon and will represent <10% of the applicant pool even in dermatology.

Asp · Feb 26, 2012

Dumb said:
Since several MS3's have PMed me regarding transitional years, I will add that at about half of the 11 places I interviewed for TY, the TY stats were all 260+ Step 1. I would bet that about a quarter of them had 270+. Even at the other half of the TYs, 90% of the my fellow interviewees were derm, rad onc, and ophtho applicants.

You can't be serious.

Asp · Feb 26, 2012

To answer the original question, I do think there is a difference between a 245 and a 265. If you work hard enough, you can get a 245. A 265 is a score that requires both hard work and test taking ability (high verbal IQ), which at this point in your educational career is immutable.

To reliably match at a top program in a competitive specialty you need way more than a high Step 1 score, though.

2012mdc · Feb 26, 2012

Asp said:
I think your friend exaggerates. SDN self-selection and USMLE World fueled score inflation notwithstanding, 260+ is still fairly uncommon and will represent <10% of the applicant pool even in dermatology.

I could see a derm program with only 3 or 4 residents per year getting away with this as they only would have to interview 20 or 30 folks to fill.

Asp said:
You can't be serious.

I believe it and this isn't the first time I've heard this. TY's can be insanely competitive. I had more toruble getting TY interviews than rads ones and I had 260 and AOA. The most coveted TY's are insanely competitive.

princess peach · Feb 26, 2012

jlimback said:
To clarify, I'm looking for feedback from people who are on the residency interview trail, or have knowledge of the matter. What sort of benefits come with the 20 point difference? When I look at the NRMP data, even plastics (which, i'm not interested in) has a range of matcher's between ~220-270. Does it all really come down to: "yea, we know you're smart, now, we want to know if we like you?" Does a higher score translate to more interviews, or does it have diminishing returns? At the point that you meet the initial program cutoffs for score, does it even matter?

I do pretty well in school, and I'm interested in some of the more competitive residencies, and would like to stay in Florida. So, i'm trying to decide if it's worth more time away from the wife and kids, to put more effort into board prep (June 4th is when I take my step 1). UW/FA seems to work well for me. However, I've read the accounts of people in the 260/270's and tried their methods. It simply takes that much more time and effort. I also know I'm gonna have to really put in lots of effort next year, to honors as much as possible and don't want to burn the candle at both ends for too long!

Just from my experience this season, in the competitive fields at top programs, >250 is a filter, >260 is impressive, >270 really turns heads. 245 is way different than 265 no question. My Step scores were mentioned at the majority of my interviews, so when you do well people take notice. However, I had other things going for me and I don't think my 270+ alone would have guaranteed me the interviews I got, you need to be well rounded. If you need to sacrifice a couple pubs or the chance to go on some awesome international experience to study and get the 265 vs 255 then its not worth it.

Also, I've never met anyone that said "gee I wish I had studied less for step 1 and not done so well." Its only for, max, a few months of your life that you may have to make some sacrifices and you don't want a number to limit what you can do with the rest of your life.

drizzt3117 · Feb 26, 2012

I think there's pretty diminishing returns at a certain point; I think that point is somewhere in the mid 260s. My PI (who is a former chair and current selection committee member) said that extremely high scores are looked at with a little suspicion, especially if the rest of the app isn't well-rounded. Obviously not everyone with high stats is weird, but certain specialties seem to attract strange people. pp is cool and seemed well-adjusted and nice in person but some of the high-stat people (and/or research candidates) I ran into on the interview trail were really odd people (my MIR research track interview was like that) with whom conversation just seemed really awkward even with the other interviewees. He said that every year a bunch of people who are awesome on paper get thrown out because they're just weirdos IRL.

That being said, obviously get the highest score you can. Having the deal with acting normal to avoid suspicion about your extremely high step scores is definitely a first world problem.

princess peach said:
Just from my experience this season, in the competitive fields at top programs, >250 is a filter, >260 is impressive, >270 really turns heads. 245 is way different than 265 no question. My Step scores were mentioned at the majority of my interviews, so when you do well people take notice. However, I had other things going for me and I don't think my 270+ alone would have guaranteed me the interviews I got, you need to be well rounded. If you need to sacrifice a couple pubs or the chance to go on some awesome international experience to study and get the 265 vs 255 then its not worth it.

Also, I've never met anyone that said "gee I wish I had studied less for step 1 and not done so well." Its only for, max, a few months of your life that you may have to make some sacrifices and you don't want a number to limit what you can do with the rest of your life.

username456789 · Feb 26, 2012

2012mdc said:
I believe it and this isn't the first time I've heard this. TY's can be insanely competitive. I had more toruble getting TY interviews than rads ones and I had 260 and AOA. The most coveted TY's are insanely competitive.

Yeah, I'm kinda worried/disappointed about my chances at my top two choices for TYs. I was fairly geographically constrained for TY programs, but fortunately have two that aren't terribly far away and seem really amazing. At first I was thinking "well I'm a decent candidate, of course I'll be able to match at one of these two", but the further I went in this process and the more I thought about it, the more I realized there are a hell of a lot more impressive applicants I'm sure. And, since after my top 2 TYs on my ROL are a bunch of prelim medicine programs I don't particularly care for, I'm now stuck trying to convince myself that it's only one year and it can't suck THAT bad....

kaleerkalut · Feb 26, 2012

GuyWhoDoesStuff said:
Yeah, I'm kinda worried/disappointed about my chances at my top two choices for TYs. I was fairly geographically constrained for TY programs, but fortunately have two that aren't terribly far away and seem really amazing. At first I was thinking "well I'm a decent candidate, of course I'll be able to match at one of these two", but the further I went in this process and the more I thought about it, the more I realized there are a hell of a lot more impressive applicants I'm sure. And, since after my top 2 TYs on my ROL are a bunch of prelim medicine programs I don't particularly care for, I'm now stuck trying to convince myself that it's only one year and it can't suck THAT bad....

Sorry maybe somebody could help me understand. TY = Transition Year if I'm not mistaken, right? Also, why is this so highly sought after? Are there any benefits or positives to this that I'm not seeing? Thanks.

drizzt3117 · Feb 26, 2012

kaleerkalut said:
Sorry maybe somebody could help me understand. TY = Transition Year if I'm not mistaken, right? Also, why is this so highly sought after? Are there any benefits or positives to this that I'm not seeing? Thanks.

Bc they're easy. I'm actually far more concerned about matching my TYs than my rads programs even though the rads programs I ranked were almost all top 15.

Phyozo · Feb 26, 2012

Law2Doc said:
The med student views in this thread are more interesting than informative. There's absolutely a law of diminishing returns, and the interview (and other interpersonal interactions) looms HUGE. Sure, to be considered, you need to have at least a certain number to make the program look competitive (and that number varies by specialty and within programs in each specialty), but after that point (and a LOT of people still meet that point), whether or not the program "likes you" is all important. The attendings and residents have to work with YOU, not your board scores. So away rotations where you hit it off with people, and the pre-interview dinners with the residents, and good evaluations and LORs saying you are a joy to work with in a clinical setting are huge. More huge than an extra 10 points, once you break a certain threshold. There's really no question here. Speaking as a resident, we nix applicants all the time who come across poorly in their interactions with the residents. The PD couldn't care less if the person has 10 points higher than the average applicant, if the chief resident comes to him and says this guy came across badly at the pre-interview dinner, or was a PITA during his away rotation, he's simply not going to be on the final rank list. Someone with a lower board score will take his place. Other things besides his score simply matter more in the work setting.

Everything you say is true. The only thing I'd add is that getting a higher step1 shouldn't come at the cost of all those important things...so lets put this into perspective. You need to be personable, likable, able to work with people, have amazing LOR, get good clinical grades AND in this setting, snag a 265 over a 245...and it will make a difference. It's a lot easier for some people to study harder for the steps than to learn interpersonal skills...but studying hard for the boards should be done in lieu of all those other important aspects of the application (which I'm assuming the OP has...cause no 270+ board score will save you if you can't work with people in this profession).

XRanger · Feb 26, 2012

kaleerkalut said:
Sorry maybe somebody could help me understand. TY = Transition Year if I'm not mistaken, right? Also, why is this so highly sought after? Are there any benefits or positives to this that I'm not seeing? Thanks.

I heard some TY programs are so easy it's basically like a vacation year, so top applicants from all the top specialties (derm, rad onc, rad, ophto) are gonna apply there so it's super competitive

GoSpursGo · Feb 26, 2012

Asp said:
I think your friend exaggerates. SDN self-selection and USMLE World fueled score inflation notwithstanding, 260+ is still fairly uncommon and will represent <10% of the applicant pool even in dermatology.

*shrug* Could be. Like I said, it was an anecdote, and one that I'd heard secondhand. Take it for what you will. You can nit-pick about the exact details, but the point was that for competitive residencies in competitive specialties, the cut-off to be considered is higher because as another poster mentioned, many of them have way fewer spots to fill than interested applicants.

drizzt3117 · Feb 26, 2012

Asp said:
I think your friend exaggerates. SDN self-selection and USMLE World fueled score inflation notwithstanding, 260+ is still fairly uncommon and will represent <10% of the applicant pool even in dermatology.

Uci rads PD mentioned their average for interviewees was > 260. Keep in mind that there's a ton of overlap of applicants between interviews. In 2009 there were about 80 people with 260+ in rads, I imagine most of them interviewed at the same places.

Dirt · Feb 26, 2012

Law2Doc said:
The med student views in this thread are more interesting than informative. There's absolutely a law of diminishing returns, and the interview (and other interpersonal interactions) looms HUGE. Sure, to be considered, you need to have at least a certain number to make the program look competitive (and that number varies by specialty and within programs in each specialty), but after that point (and a LOT of people still meet that point), whether or not the program "likes you" is all important. The attendings and residents have to work with YOU, not your board scores. So away rotations where you hit it off with people, and the pre-interview dinners with the residents, and good evaluations and LORs saying you are a joy to work with in a clinical setting are huge. More huge than an extra 10 points, once you break a certain threshold. There's really no question here. Speaking as a resident, we nix applicants all the time who come across poorly in their interactions with the residents. The PD couldn't care less if the person has 10 points higher than the average applicant, if the chief resident comes to him and says this guy came across badly at the pre-interview dinner, or was a PITA during his away rotation, he's simply not going to be on the final rank list. Someone with a lower board score will take his place. Other things besides his score simply matter more in the work setting.

"yea, we know you're smart, now, we want to know if we like you?"

Even after the interview grades continue to play a large role in who programs choose to rank highly.

The truth is that the truth lies somewhere in between these two points.

Of course if you are an oddball they won't care about your score. But, if they have two applicants who they love, one who scored 240 and the other 260, guess who they are going to put higher on the list.

Again, we can debate the finer points all we want but the answer is simple. Put in as much work as you are willing to.

Does a 260-270 Step 1 really give much advantage over a 240-250?

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