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Crayola227

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forget it snowflake
 
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I think you already know the answer to this question. If not, you have to be more realistic. Unfortunately a 224 is not only over 20 points below the fields you are interested in, but it's below the national avg in general. It's not a competitive score - not even an average score. But have people matched into those specialties with similar scores? Sure, very rarely. Fortunately for you, it likely would be students with similar CV (top school, pubs) - however you need to start drawing the line somewhere. Those top 10 schools you strive for are more likely to take students with the FULL package ( your research + 250+). So, realize the situation you're in.. you can theoretically still match if you bust your ass off.. but don't come here asking if you can still go to Harvard or Stanford. Not saying it's impossible, but.....highly highly highly unlikely. Just be happy if you get chance to match into your specialty.
 
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I think you already know the answer to this question. If not, you have to be more realistic. Unfortunately a 224 is not only over 20 points below the fields you are interested in, but it's below the national avg in general. It's not a competitive score. But have people matched into those specialties with similar scores? Sure, very rarely. Fortunately for you, it likely would be students with similar CV (top school, pubs) - however you need to start drawing the like somewhere. Those top 10 schools you strive for are more likely to take students with the FULL package ( your research + 250+). So, realize the situation you're in.. you can theoretically still match if you bust your ass off.. but don't come here asking if you can still match at Harvard. Not saying it's impossible, but.....highly highly highly unlikely. Just be happy if you get chance to match into your specialty.
PS - you better honor Surgery and/or Medicine.
 
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Gorne

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Extremely unlikely. You need to honor everything, amazing LoRs and you need a top 15% score on step 2 to offset your below average step 1 for you to have any chance at top 10 programs in competitive specialities.
 

Dermpire

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I would think that it would be risky to even expect to match into any competitive specialty with a step score that low, let alone match a top program in the hardest to match specialties.

Like someone else said, you do have a ton of research and go to a name brand school, so there may still be some programs that you could match into, but the idea of matching a top program where they have their choice of students with your same resume/pedigree (or better) all with 250s+ is almost none.
 
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bashwell

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1) First, I'm not sure why you're asking this question before you have even taken Step 2, before you have done your rotations, and before you have gotten LORs. Give us some hard data to work with. For example, I got a 224 on Step 1, I got a 260 on Step 2, I honored all my rotations, I have great LORs one from the PD and one from the chair, etc. I say this because if you don't improve on Step 2, if you don't honor your rotations, if you don't get good LORs, then all this is moot. You'll already have screened yourself out.

2) However, after you get all this done, and assuming you improve on Step 2, honor your rotations, and get great LORs, then there's still really only one answer: Just apply! Just apply to the top 10-20 programs after you get your Step 2 scores back, after you have done all your rotations, and after you get your LORs. That's the only way to be sure. And if you apply to the top 10-20 programs, then I strongly suggest you should also apply to a whole bunch of "safety" programs!
 
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sliceofbread136

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Well, these posts are not the pick-me-up I was looking for but I appreciate the candidness. I am already starting to care less about having to do residency at a top 10 place. If I decide to do one of the super competitive specialties I mentioned, I will have to be happy with matching at a decent program. If I decide to go the IM route, I hope I still have a shot at one of these places, but if I end up at a good program that isn't top-top, it wouldn't be end of the world.

I'm mostly bitter at my whole step experience and to be honest at my school for not emphasizing material on step 1 in the curriculum (I didn't fail a single exam yet felt utterly unprepared for step). Hard to believe one score could have that much impact on my future. Up until this point, I've never had to deal with a poor score/grade/etc, so it is difficult to swallow.
Top 10 Im is extrememly competitive. Maybe a top 20 if you get all your other ducks in a row. You can pursue ent ortho etc, just apply to a back up
 

Syncrohnize

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Well, these posts are not the pick-me-up I was looking for but I appreciate the candidness. I am already starting to care less about having to do residency at a top 10 place. If I decide to do one of the super competitive specialties I mentioned, I will have to be happy with matching at a decent program. If I decide to go the IM route, I hope I still have a shot at one of these places, but if I end up at a good program that isn't top-top, it wouldn't be end of the world.

I'm mostly bitter at my whole step experience and to be honest at my school for not emphasizing material on step 1 in the curriculum (I didn't fail a single exam yet felt utterly unprepared for step). Hard to believe one score could have that much impact on my future. Up until this point, I've never had to deal with a poor score/grade/etc, so it is difficult to swallow.
Even IM is extremely competitive at the top. While being an Internist isn't the most sought after career, IM unlike other primary care fields like family/EM selects for cerebral personalities and many with outstanding research pedigrees apply. You'll need Derm level Step 1/2 scores, solid research, and everything else to have a shot at top 10 IM.
 

sloop

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Well, these posts are not the pick-me-up I was looking for but I appreciate the candidness. I am already starting to care less about having to do residency at a top 10 place. If I decide to do one of the super competitive specialties I mentioned, I will have to be happy with matching at a decent program. If I decide to go the IM route, I hope I still have a shot at one of these places, but if I end up at a good program that isn't top-top, it wouldn't be end of the world.

I'm mostly bitter at my whole step experience and to be honest at my school for not emphasizing material on step 1 in the curriculum (I didn't fail a single exam yet felt utterly unprepared for step). Hard to believe one score could have that much impact on my future. Up until this point, I've never had to deal with a poor score/grade/etc, so it is difficult to swallow.
Look, top places in any specialty are very competitive. Your pubs and pedigree will help you but people do care about Step performance and it will hurt you significantly at top programs in any specialty.

If you didn't do well on Step 1, you have to take some more responsibility, especially if you're going to try to do better on Step 2. People from all sorts of medical schools are able to do well on Step 1. Blaming your school might help you feel like this was less of a personal failing but I don't think it's the best approach, especially if you're going to try to learn from this experience going forward.

Also, for what it's worth, assuming you actually wanted to be at a top place, you would have to get used to feelings of inadequacy. I'm an intern at a very brand name residency that I think would be considered one of the elite places in my field and every day I feel completely stupid. Everyone around me is so smart and talented that I sometimes feel like I'm doing my patients a disservice by treating them instead of one of my peers. I feel this way despite being told I'm doing a good job by residents and attendings. I've talked to my peers and I think a lot of us feel the same way. Ironically, going to a great place I've been forced to try to lose as much of the ego as possible in order to try to learn as much as I can from the brilliant people I work with rather than just feel bad about how I don't measure up.

So this was a long post but here are my summary recommendations:

1) Take more responsibility for your own performance, as this is the only way you will have a drive to do better in the future.

2) Get used to feeling inadequate as I think this is a constant feeling of every physician who cares deeply about providing high quality medical treatment and surrounds himself with talented peers. You just have to try not to let this paralyze or depress you, but instead use it as motivation to improve.
 

Ophthoseidon

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The brand name will help you a lot, and may help you match in your desired field if you have connections, but unlikely not at a top 25 program unless your home institution loves you or you impress on an away. I also think your perception about "If I can't do these specialties at least I can go to top IM program" is way off base and shows lack of insight. Granted they don't have the pedigree that you necessarily do, I know many people withe 250+, multiple pubs, AOA, great letters, mostly honors from schools near me getting like 3-5 interviews from top 25 programs in internal medicine. The top is tough everywhere. Your school will help, your research will help, but I think you do need to start getting away from the "I need to be at a top place" attitude as there are MANY fine places to train outside the top 5 lol. I wish you luck, kill your rotations and step 2.
 
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bashwell

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Anyone else have experiences of students matching at good programs in competitive specialities with Step in the 220-230 range? Thanks!
You mentioned a bunch of different specialties above. Let's focus on one or two. If you want IR, then you could still get into DR with Step 1 in the 220-230 range, then apply for an IR fellowship. As a US MD, you should have no problem getting into a DR program somewhere as long as you apply broadly. You can still go from, say, a community DR program, then into IR. That depends on how well you do in your DR residency. But it's a possibility for you.

Another specialty you mentioned was cardiology. You can get into a decent IM program with 220-230 on Step 1. Probably a mid-tier academic program. As long as you work hard, are likeable, try to do some research, and so on, then you should be able to match into a cardiology fellowship somewhere.

What you will have to give up is your dream of going to the MGHs and Hopkins of the world for your specialty. But there's absolutely nothing wrong with a mid-tier program. You're still going to come out a physician and most likely in the specialty or subspecialty of your choice. You're still going to be able to work almost anywhere in the US and most likely make plenty of money. You could probably even work in academia if that's what you want. A lot of people would love to be in your position.
 
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failedatlife

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Research, school name, and who you know (and what they say about you) matters a lot more than you may think for these big names. But honestly, having rotated at a top 3 hospital for one of my sub Is, I didn't enjoy it nearly as much as I did at a lower ranked (but top 10) hospital and an even lower ranked (top 25) hospital. Go where you fit in, you will be a much happier person for 6+ years working close to 88 hours a week.
 
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PugsAndHugs

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Let's focus on one or two. If you want IR, then you could still get into DR with Step 1 in the 220-230 range, then apply for an IR fellowship
I think now there are some direct IR residencies where you don't have to go through DR. Not 100% sure though.
 

Osteoth

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1) First, I'm not sure why you're asking this question before you have even taken Step 2, before you have done your rotations, and before you have gotten LORs. Give us some hard data to work with. For example, I got a 224 on Step 1, I got a 260 on Step 2, I honored all my rotations, I have great LORs one from the PD and one from the chair, etc. I say this because if you don't improve on Step 2, if you don't honor your rotations, if you don't get good LORs, then all this is moot. You'll already have screened yourself out.

2) However, after you get all this done, and assuming you improve on Step 2, honor your rotations, and get great LORs, then there's still really only one answer: Just apply! Just apply to the top 10-20 programs after you get your Step 2 scores back, after you have done all your rotations, and after you get your LORs. That's the only way to be sure. And if you apply to the top 10-20 programs, then I strongly suggest you should also apply to a whole bunch of "safety" programs!
So, what are you applying to? Are you taking a backup? What has your school administration/departmental leadership said regarding your situation?

Well, these posts are not the pick-me-up I was looking for but I appreciate the candidness. I am already starting to care less about having to do residency at a top 10 place. If I decide to do one of the super competitive specialties I mentioned, I will have to be happy with matching at a decent program. If I decide to go the IM route, I hope I still have a shot at one of these places, but if I end up at a good program that isn't top-top, it wouldn't be end of the world.

I'm mostly bitter at my whole step experience and to be honest at my school for not emphasizing material on step 1 in the curriculum (I didn't fail a single exam yet felt utterly unprepared for step). Hard to believe one score could have that much impact on my future. Up until this point, I've never had to deal with a poor score/grade/etc, so it is difficult to swallow.
If you were expecting a pick-me-up you wouldn't have had to ask the question you did, right?

You mentioned a bunch of different specialties above. Let's focus on one or two. If you want IR, then you could still get into DR with Step 1 in the 220-230 range, then apply for an IR fellowship. As a US MD, you should have no problem getting into a DR program somewhere as long as you apply broadly. You can still go from, say, a community DR program, then into IR. That depends on how well you do in your DR residency. But it's a possibility for you.

Another specialty you mentioned was cardiology. You can get into a decent IM program with 220-230 on Step 1. Probably a mid-tier academic program. As long as you work hard, are likeable, try to do some research, and so on, then you should be able to match into a cardiology fellowship somewhere.

What you will have to give up is your dream of going to the MGHs and Hopkins of the world for your specialty. But there's absolutely nothing wrong with a mid-tier program. You're still going to come out a physician and most likely in the specialty or subspecialty of your choice. You're still going to be able to work almost anywhere in the US and most likely make plenty of money. You could probably even work in academia if that's what you want. A lot of people would love to be in your position.
Was actually having this discussion with a friend of mine the other day. So from my understanding, and I'm not interested in IM so its fairly superficial, cards/GI/heme onc are very competitive in the IM world. As a result, research/dedication to the idea/connections/institutional ties are huge. My question is, how many IM programs give you the exposure/faculty/brand recognition to successfully get into a fellowship like this? I know there are a ton of IM residency spots, but at the same time when you have a class of 15 it makes the actual number of programs shrink considerably. What percent, or total number of academic programs (I assume they would be the ideal here) would offer the resources to mold a successful IM resident into a successful fellowship applicant?

Basically my question boils down to, if all you need to do as an IM resident is go to an academic program to get into a competitive fellowship, obviously everyone would do it. I just wonder how competitive one would be going into a lower ranked academic program vs. a higher ranked program. Obviously you can do it from either, but how stark is the difference?
 

bashwell

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Was actually having this discussion with a friend of mine the other day. So from my understanding, and I'm not interested in IM so its fairly superficial, cards/GI/heme onc are very competitive in the IM world. As a result, research/dedication to the idea/connections/institutional ties are huge. My question is, how many IM programs give you the exposure/faculty/brand recognition to successfully get into a fellowship like this? I know there are a ton of IM residency spots, but at the same time when you have a class of 15 it makes the actual number of programs shrink considerably. What percent, or total number of academic programs (I assume they would be the ideal here) would offer the resources to mold a successful IM resident into a successful fellowship applicant?

Basically my question boils down to, if all you need to do as an IM resident is go to an academic program to get into a competitive fellowship, obviously everyone would do it. I just wonder how competitive one would be going into a lower ranked academic program vs. a higher ranked program. Obviously you can do it from either, but how stark is the difference?
1) You make it really hard to help you. Sorry to say but your attitude is offputting.

2) Also I didn't just say "all you need to do as an IM resident is go to an academic program to get into a competitive fellowship."

3) I didn't say anything about GI or heme/onc. Originally I was only referring to cards since that's what you mentioned.

4) However, if you're "not interested in IM so its fairly superficial," then I'm not sure why I should spend my time trying to help you to obtain something you aren't even interested in?

5) But I'll try this one last time. Take a look at the NRMP data (2017) for "US Grads" for cards, GI and heme/onc:

Cards
US Grad 482/537 (89.8%) matched

GI

US Grad 319/377 (84.6%) matched

Heme/onc
US Grad 287/332 (86.4%) matched​

So, while there aren't any guarantees, it's also not completely unlikely for you to match into a competitive subspecialty like cardiology if you are coming from a mid-tier academic program, if you work hard, if you are likeable (this might be a serious challenge for you unless you're very different in real life and honestly it could make or break your application if you are not a likeable person or rub people the wrong way), if you do some research, if you get strong LORs especially from your IM PD and subspecialty PD, and so on.
 
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Osteoth

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1) You make it really hard to help you. Sorry to say but your attitude is offputting.

2) Also I didn't just say "all you need to do as an IM resident is go to an academic program to get into a competitive fellowship."

3) I didn't say anything about GI or heme/onc. Originally I was only referring to cards since that's what you mentioned.

4) However, if you're "not interested in IM so its fairly superficial," then I'm not sure why I should spend my time trying to help you to obtain something you aren't even interested in?

5) But I'll try this one last time. Take a look at the NRMP data (2017) for "US Grads" for cards, GI and heme/onc:

Cards
US Grad 482/537 (89.8%) matched

GI

US Grad 319/377 (84.6%) matched

Heme/onc
US Grad 287/332 (86.4%) matched​

So, while there aren't any guarantees, it's also not completely unlikely for you to match into a competitive subspecialty like cardiology if you are coming from a mid-tier academic program, if you work hard, if you are likeable (this might be a serious challenge for you unless you're very different in real life and honestly it could make or break your application if you are not a likeable person or rub people the wrong way), if you do some research, if you get strong LORs especially from your IM PD and subspecialty PD, and so on.
1. What attitude is that?
2.
Another specialty you mentioned was cardiology. You can get into a decent IM program with 220-230 on Step 1. Probably a mid-tier academic program. As long as you work hard, are likeable, try to do some research, and so on, then you should be able to match into a cardiology fellowship somewhere.
3. I understand, but from my understanding Cards/GI/Heme onc are the three most competitive IM fellowships. Is this a misunderstanding?
4. Because I'm sure there are people looking at this thread who are interested.
5. Again with the ad hominem. I don't really understand what I've done to offend you so much, but please explicate.

The basis of my post was to analyze what were the reasons the people who were unable to match ended up in that situation. In your experience, has institutional weaknesses been a trend among unmatched applicants, or have other factors been seen to be predominantly more important?
 

ChordaEpiphany

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I think you guys would be surprised at what OP's options are from a top school. Match lists tell the whole story. Top 5 schools don't boast a 100% step 1 pass rate, but they still boast pretty much 100% success in getting students into top 20 IM programs. I think OP's options are limited if he/she is only willing to work at the pinnacle of academia, and ENT/IR/Ophtho are probably not options at those types of institutions (even top 20) with this step score without a call from a big name physician. Connections like that are hard to manufacture though.

I think OP does have a shot at a top 20 IM program, because IM is notoriously snooty at the top and tends to prefer average students from top schools over great students from anything ranked below top 20. OP probably does not have a shot at a top 4 without big connections. OP definitely doesn't have a shot at a top 20 program in IR, ENT, or ophtho. Those programs want people who will pass their boards, and they have applicants lined up out the door who will do so.

However, OP's problem really isn't his/her step score. It's the very apparent obsession with rankings. Don't get me wrong, I understand. I was bummed when my Ivy League 4.0 and 38 MCAT failed to get me into a top med school. A lot of my friends got into better schools with far less effort, and it hurt my ego, but after getting any significant amount of clinical exposure I can't contemplate even thinking about giving up on a specialty because I would match at a seemingly "inferior" institution. What you're doing every day and the type of medicine you are practicing are so much more important than where you do it, unless of course the satisfaction you take from medicine is a silent sense of superiority whenever you tell people that you practice at [top hospital]. OP doesn't even have specific programs in mind, just a vague sense of "maybe this or that, but only at a top 10." The good news for OP is that he/she got lucky. Med school isn't fair, and students who are very clearly average can match extremely well from a top school, and even with a below average step score, no doors are closed. OP needs to pick the specialty that makes him/her happy and use the leverage of a top name school to find a spot somewhere. Obsession over top programs is going to seem meaningless when you're actually practicing unless, as I said above, the pleasure you derive from medicine is only from being at the top. If that's the case, there are bigger problems going on.
 

bashwell

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1. What attitude is that?
I explicitly quoted some of the things you said.
3. I understand, but from my understanding Cards/GI/Heme onc are the three most competitive IM fellowships. Is this a misunderstanding?
Yes and I cited NRMP match data for you.
4. Because I'm sure there are people looking at this thread who are interested.
If others are interested, they can ask. But I was replying to you.
5. Again with the ad hominem. I don't really understand what I've done to offend you so much, but please explicate.
I was stating facts about you, not ad hominem. Just because I state personal facts (even if unflattering) about someone's personality does not ipso facto make what I state a personal attack. If I point out someone lacks basic knowledge about a topic, that does not ipso facto make what I said a personal attack, for I could be doing so in order to see them improve their knowledge, for example.
The basis of my post was to analyze what were the reasons the people who were unable to match ended up in that situation.
That depends on what the person did and did not do. You have to look at their individual case to see what happened in their particular case. It's difficult to make generalizations.
In your experience, has institutional weaknesses been a trend among unmatched applicants, or have other factors been seen to be predominantly more important?
If you want to know if you'll get into a particular specialty at a particular program given your Ivy League or similar credentials, then all you have to do is apply, and you'll have your answer.
 
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Osteoth

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I explicitly quoted some of the things you said.

Yes and I cited NRMP match data for you.

If others are interested, they can ask. But I was replying to you.

I was stating facts about you, not ad hominem. Just because I state personal facts (even if unflattering) about someone's personality does not ipso facto make what I state a personal attack. If I point out someone lacks basic knowledge about a topic, that does not ipso facto make what I said a personal attack, for I could be doing so in order to see them improve their knowledge, for example.

That depends on what the person did and did not do. You have to look at their individual case to see what happened in their particular case. It's difficult to make generalizations.

If you want to know if you'll get into a particular specialty at a particular program given your Ivy League or similar credentials, then all you have to do is apply, and you'll have your answer.
I saw you quoted my post, but what about that post explicitly offended you?

And to your last point, of course, but at the same point in that situation n=1. One of the big advantages to sites like these in my opinion is the ability to see how other people have fared before/after you to determine if your situation was typical or atypical, and to be able to plan in either circumstance.
 
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bashwell

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I saw you quoted my post, but what about that post explicitly offended you?
I wasn't "offended." I find your attitude offputting, but what's offputting is not equivalent to what's offensive.

As for reasons, one of the reasons is because you mischaracterized what I've actually said.

Another reason is because you say you're "not interested in IM so its fairly superficial." That's like if someone asked me what I thought about a particular car, for example, so I told them what I thought about the car, but then they just shrugged and said, "I don't really care all that much anyway."
And to your last point, of course, but at the same point in that situation n=1. One of the big advantages to sites like these in my opinion is the ability to see how other people have fared before/after you to determine if your situation was typical or atypical, and to be able to plan in either circumstance.
You can't truly gauge whether your situation is typical or atypical just by asking a bunch of people on SDN. At best, that's only representative of what people who are on SDN say.

Also, even if turns out your situation is atypical, if you apply and get accepted despite being atypical, then you still got accepted. So what does it even matter if your situation is atypical as long as you get accepted? In this respect, your n=1 is all you need.

Bottom line: Just apply, and see what happens.
 
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Ophthoseidon

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I wasn't "offended." I find your attitude offputting, but what's offputting is not equivalent to what's offensive.

As for reasons, one of the reasons is because you mischaracterized what I've actually said.

Another reason is because you say you're "not interested in IM so its fairly superficial." That's like if someone asked me what I thought about a particular car, for example, so I told them what I thought about the car, but then they just shrugged and said, "I don't really care all that much anyway."

You can't truly gauge whether your situation is typical or atypical just by asking a bunch of people on SDN. At best, that's only representative of what people who are on SDN say.

Also, even if turns out your situation is atypical, if you apply and get accepted despite being atypical, then you still got accepted. So what does it even matter if your situation is atypical as long as you get accepted? In this respect, your n=1 is all you need.

Bottom line: Just apply, and see what happens.
I'm confused about your interactions with osteoth. Your comments almost make it seem like you think he's the OP or something lol.
 

failedatlife

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:yawn: Love listening to underclassmen medical student talk about what residency program directors are looking for.
 
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AnatomyGrey12

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Don't get NYC. Smells. $20s fly out of your pocket left and right. People are rude and pretentious as all hell. Summers brutal, winters brutal. Ridiculous cost of living.
Aren't you from SF?
 

Anicetus

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Anyone else have experiences of students matching at good programs in competitive specialities with Step in the 220-230 range? Thanks!
Not likely. Look, you're gonna have to do an important psychological exercise where you'll have to scrap the way you think about top 10 programs and just block it out of your mind because it's unlikely. Unfortunately we live in a country with this system that is cut throat for this exam score and pretty unforgiving. The step 1 opens/closes doors and the rest of the app modifies the chances from there. Your step 1 score unfortunately closes doors for even most top 10 IM residencies.

However, if you would like nothing more than to be in a competitive specialty, you may need to apply broadly (Alabama, Mississippi, Arkansas, Nebraska, South Dakota, Idaho). For instance, I knew someone who matched optho with a 230 step1 but it was in one of those middle of nowhere programs with cow dung filling the air.
 

Snoopy2006

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I think you're miscalculating how competitive the top 10 residencies in a "non-competitive" field (like IM) can be. Those residents are almost all sitting on derm/ENT/plastics level applications. Your application should (playing the odds) land you at a solid mid-tier IM residency or perhaps a lower-level residency in a competitive specialty, assuming your app holds steady. If you blow Step 2 out of the water + honor everything + get stellar LoRs from bigwigs, you may have a puncher's chance of getting the type of residency you're looking for. The X factor is the name brand of your medical school, and whether or not that recognition will open doors to getting bigwig LoRs, which would make a tremendous difference in smaller fields like ophtho. I have friends in smaller fields whose stellar LoRs (from well-connected attendings) definitely made their relatively mediocre (read: 230s Step 1) applications stand out.

Long story short: while the odds are against you, it could potentially happen, if everything breaks just right for you.
 
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