6 ii's, kind of panicking

[504196]

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Hello everyone,

I'd consider myself a decently strong applicant, step I 237, step II CK 247, decent amount of research (few posters and papers, one first author case report). I'm from an MD school. Have no red flags. 3 LORs (one from psych, one from a surgeon as I was previously going into surgery then switched into psych in August, one from a researcher).

I only have 6 ii's so far. Applied to 60 programs. I just got another LOR from a psychiatrist today from a rotation I did in September. I have not taken step II CS yet and will take it next week. Has not taking step II CS prevented me from ii's? Do schools assume I failed? I was planning on sending some schools I'm interested in an email detailing that I have uploaded a new LOR and will be taking step II CS next week in case they were wondering. Also include a line about my interest in the program. What do you all think?

Kind of panicking and need some advice!

 

[clausewitz2]

Hello everyone,

I'd consider myself a decently strong applicant, step I 237, step II CK 247, decent amount of research (few posters and papers, one first author case report). I'm from an MD school. Have no red flags. 3 LORs (one from psych, one from a surgeon as I was previously going into surgery then switched into psych in August, one from a researcher).

I only have 6 ii's so far. Applied to 60 programs. I just got another LOR from a psychiatrist today from a rotation I did in September. I have not taken step II CS yet and will take it next week. Has not taking step II CS prevented me from ii's? Do schools assume I failed? I was planning on sending some schools I'm interested in an email detailing that I have uploaded a new LOR and will be taking step II CS next week in case they were wondering. Also include a line about my interest in the program. What do you all think?

Kind of panicking and need some advice!

6 is not a terrible position, especially if you have no CS score yet. Probably emails of interest are legit but be a mensch and keep it limited. If you send out twenty of 'em I will haunt you.

 

[Stagg737]

Why did you not take CS earlier? Because there are hundreds of individuals with complete and strong apps, some programs just don't interview people who aren't complete. I wouldn't panic in your shoes as there's still plenty of time to get ii's and even with only 6 your odds are still good considering the rest of your app. I would make sure you're being as expedient as possible when you get those results back though.

 

[whackamole21]

I took CS three weeks ago, no result in yet. Based on my experience this far this season I wouldn’t say that them assuming you failed is holding ya back from ii’s.

I know you made the switch pretty late, do you feel like your letters and PS did a good job of explaining your interest in the field? This process can obviously be so random though

 

[504196]

Thanks for the advice. I felt that my letters explained my switch into psychiatry quite well. I even had comments in my MSPE from my surgery rotation in August saying I will be switching into psychiatry and that I did a great job. I wish I would have realized how important it is to get step II CS done earlier. I was told by my school that it really doesn't matter when you do it, just to get it done at some point.

 

[whackamole21]

All that matters is that the passing result is in by the time rank lists are due in February.

 

[ridethecliche]

I was also told that I just needed to get CS in by the end of the cycle but I think not having the passing score on my application may also be a factor for my not having more interviews as well. My stats aren't as great as the OPs but my application also reads like I was going to go for surgery.

I have a similar percent of interviews relative to applications and I'm taking CS in November because I had some scheduling complications during the end of third and the start of fourth year and by the time it was all settled everything was booked. I got my date off the waitlist...

 

[Old&InTheWay]

My school also basically said to just take CS before November. My scores won't be in until December but do not feel I am having a problem with # of interview invites (I have 9 but applied to less than 20). My stats are not quite as good as the OPs with the difference being that I had been strongly considering psych since 2nd year and have 3 really positive LORs from psychiatrists I worked with during 3rd year and on electives over this past summer.

OP, If I were in your shoes, I would definitely update all programs informing them of your new LOR and would send more personalized letters to 5-10 programs which you genuinely feel would be a good fit for you. That said, you are likely fine with 6 interviews: last year, USAMGs with your step scores who ranked 5-10 programs had a 96% chance of matching.

 

[504196]

Thanks everyone for the feedback. I should also mention that my potential red flags are two misdemeanors that are no longer are on my record but nonetheless I listed them to be honest. I was caught underage age drinking at age 19 at a college party and age 20 I was caught driving without insurance (my dad forgot to put insurance papers in the car I was driving without me knowing). These seem relatively minor to me however perhaps programs look at any way possible to screen and this may be one of them.

 

[Mad Jack]

Thanks everyone for the feedback. I should also mention that my potential red flags are two misdemeanors that are no longer are on my record but nonetheless I listed them to be honest. I was caught underage age drinking at age 19 at a college party and age 20 I was caught driving without insurance (my dad forgot to put insurance papers in the car I was driving without me knowing). These seem relatively minor to me however perhaps programs look at any way possible to screen and this may be one of them.

The cycle is just really crazy this year. Programs are so flooded with good applicants that it is almost like applying to medical school all over again- they can only invite so many people and some of that comes down to chance. Hopefully with 6 interview invites you'll be fine though, I'm the only person I know that matched outside of that number

 

[Stagg737]

All that matters is that the passing result is in by the time rank lists are due in February.

I was also told that I just needed to get CS in by the end of the cycle

My school also basically said to just take CS before November

Not to burst people's bubbles, but I had 2 PDs straight up tell me last year that they didn't interview anyone without a complete app (all scores and LORs submitted). The logic was basically that those without complete apps weren't as organized/proactive and that they didn't need to worry about that when they had 700+ other applicants whose apps were complete. I was also told by a few PDs and attendings to make sure my app was 100% complete by Sept 15th. I'm also a DO with mediocre scores though, so that could have played a role in their advice.

Would be interested to hear what PDs like @MacDonaldTriad and @OldPsychDoc have to say about it though.

 

[psychattending]

I would think that not having a CS score is having a minimal impact on getting interviews. I don't keep formal stats but I bet 50% of the people that I have invited don't have the CS score back at the time of invitation and probably something like 25% don't have it back by their interview day. Your misdemeanors might be causing a bigger issue. While a program might ignore 1, 2 would likely give people pause as to whether there is a suggestion of something else.

 

[Old&InTheWay]

Not to burst people's bubbles, but I had 2 PDs straight up tell me last year that they didn't interview anyone without a complete app (all scores and LORs submitted). The logic was basically that those without complete apps weren't as organized/proactive and that they didn't need to worry about that when they had 700+ other applicants whose apps were complete. I was also told by a few PDs and attendings to make sure my app was 100% complete by Sept 15th. I'm also a DO with mediocre scores though, so that could have played a role in their advice.

Would be interested to hear what PDs like @MacDonaldTriad and @OldPsychDoc have to say about it though.

But 100% complete does not mean you have done everything required for graduation. It means you have satisfied the requirements to be eligible to apply for a program (and this varies program to program). I doubt that it is even logistically possible for every medical student in the country to take CS before September 15th. What if programs started requiring that applicants complete all of the 4th year credits prior to their application being reviewed (just to be sure you would be graduating in time to start residency)?

That said, I get it that programs are inundated with applications and need to use arbitrary methods of whittling down their list. Just admit that it's arbitrary though and don't pretend you are getting some sort of useful info about someone based upon when they take an exam that tells you next to nothing about a person's abilities.

 

[Old&InTheWay]

Thanks everyone for the feedback. I should also mention that my potential red flags are two misdemeanors that are no longer are on my record but nonetheless I listed them to be honest. I was caught underage age drinking at age 19 at a college party and age 20 I was caught driving without insurance (my dad forgot to put insurance papers in the car I was driving without me knowing). These seem relatively minor to me however perhaps programs look at any way possible to screen and this may be one of them.

Were these actual convictions or charges that were later dismissed?

 

[Stagg737]

But 100% complete does not mean you have done everything required for graduation. It means you have satisfied the requirements to be eligible to apply for a program (and this varies program to program). I doubt that it is even logistically possible for every medical student in the country to take CS before September 15th. What if programs started requiring that applicants complete all of the 4th year credits prior to their application being reviewed (just to be sure you would be graduating in time to start residency)?

That said, I get it that programs are inundated with applications and need to use arbitrary methods of whittling down their list. Just admit that it's arbitrary though and don't pretend you are getting some sort of useful info about someone based upon when they take an exam that tells you next to nothing about a person's abilities.

100% complete means you have all documents uploaded onto ERAS and nothing more to add. That includes test scores, LORs, transcripts, and the application itself. Transcripts up to application are required, completed transcripts are not so your point about 4th year credits is moot. The bolded is a valid point which I believe is accurate.

It certainly is a somewhat arbitrary standard, however the exam is not completely useless. The most common reason for failure of CS/PE exam is not clinical skills, it's the humanistic and communication domains. So when someone fails the exam it brings into question if they have appropriate communication skills or are able to appropriately interact with their patients, which is essential for psychiatry. So not completely arbitrary or useless at all.

As a side note, I think your demographic as an applicant also plays a role in how important getting this done is. If you're a USMD it's probably not as big of a deal as long as the rest of your app is strong and you'll have it done in time. If you're a DO it's more of an issue as I can attest from personal experience. I think FMGs and IMGs would be foolish not to have a P score when submitting their apps as they're already at a massive disadvantage.

Again, this is based on my personal experiences and irl conversations with a few PDs. So it may be true for a few programs but not the norm.

 

[OldPsychDoc]

Would be interested to hear what PDs like @MacDonaldTriad and @OldPsychDoc have to say about it though.

In general--
We're willing to offer interviews if still waiting for CS--unless there's a failed CS already on the transcript.
We offer a few interviews without a CK score, if the Step 1 score indicates they're at least average-ly decent test takers. If there's a failure or a "barely passed" we'll wait and see.
Basically--show us the data.

If either Step 2 isn't passed by early February, your chances of getting ranked become miniscule.

Look at it this way--we're basically rewarding those who have done well, passed their tests, and gotten them in on time. Interviews are a scarce commodity--we're rationing them out to those most likely to complete the process, who will be someone we want to rank. You've got too understand that there are hundreds of complete, unambiguous applications in line ahead of yours. We'll give preference to the "sure thing" everytime.

 

[Old&InTheWay]

It certainly is a somewhat arbitrary standard, however the exam is not completely useless. The most common reason for failure of CS/PE exam is not clinical skills, it's the humanistic and communication domains. So when someone fails the exam it brings into question if they have appropriate communication skills or are able to appropriately interact with their patients, which is essential for psychiatry. So not completely arbitrary or useless at all.

Again, this is based on my personal experiences and irl conversations with a few PDs. So it may be true for a few programs but not the norm.

This is actually not true. Among USAMGs, 2/3 of the failures are in the ICE (integrated clinical skills component) and this trend holds true even among students from non-US medical schools: United States Medical Licensing Examination | Performance Data

Edit:
Regardless of the above stats, and perhaps this exposes my lack of understanding of this process, but I would think the the comments students receive on their clinical evals as well as LORs would be a much better indicator of someone's real and genuine ability to interact with patients.

I do however agree with you that CS is not completely useless; it does do a wonderful job of generating revenue for the NBME.

 

[texpsys]

In general--
We're willing to offer interviews if still waiting for CS--unless there's a failed CS already on the transcript.
We offer a few interviews without a CK score, if the Step 1 score indicates they're at least average-ly decent test takers. If there's a failure or a "barely passed" we'll wait and see.
Basically--show us the data.

If either Step 2 isn't passed by early February, your chances of getting ranked become miniscule.

Look at it this way--we're basically rewarding those who have done well, passed their tests, and gotten them in on time. Interviews are a scarce commodity--we're rationing them out to those most likely to complete the process, who will be someone we want to rank. You've got too understand that there are hundreds of complete, unambiguous applications in line ahead of yours. We'll give preference to the "sure thing" everytime.

I

This is actually not true. Among USAMGs, 2/3 of the failures are in the ICE (integrated clinical skills component) and this trend holds true even among students from non-US medical schools: United States Medical Licensing Examination | Performance Data

That is totally my experience, I failed because of typing speed not patient interaction or spoken English proficiency.

 

[504196]

Were these actual convictions or charges that were later dismissed?

they were misdemeanor convictions that later went off my record after several years according to a lawyer I talked to; just felt the need to list them to be honest and I was advised to be honest about them even if no longer on my record; kind of don't seem like a big deal to me especially the driving without insurance one

Maybe another reason why I'm not getting ii's is that I applied quite broadly to programs outside my region of the country and only 5 schools in my region of the country; I did apply to a good amount of safety schools, schools I'm a good fit for; and a decent amount of reaches although I was told I was a pretty competitive applicant. Just very frustrated right now!

I sent some emails to schools this morning detailing my interest in them, that I uploaded my new letter and will be taking step II CS next week. Heard back from one school saying they are still reviewing applicants. Heard back from another saying they are done extending ii's at this time. Should I keep updating schools? Or hold off and wait? I also don't even know if I should talk to my program director at my school, which I interviewed at, about this issue of lack of ii's because wouldn't it seem weird if I'm concerned about ii's yet I interviewed with them about going to their program.

 

[Stagg737]

This is actually not true. Among USAMGs, 2/3 of the failures are in the ICE (integrated clinical skills component) and this trend holds true even among students from non-US medical schools: United States Medical Licensing Examination | Performance Data

Edit:
Regardless of the above stats, and perhaps this exposes my lack of understanding of this process, but I would think the the comments students receive on their clinical evals as well as LORs would be a much better indicator of someone's real and genuine ability to interact with patients.

I do however agree with you that CS is not completely useless; it does do a wonderful job of generating revenue for the NBME.

Interesting, hadn't seen that page before, thanks for posting it. I can say from the DO side that the most common reason for failing the PE is the "humanistic domain", basically the two non-ICE domains combined, and that almost no one fails d/t lack of clinical skills.

PD Survey data shows the clinical evals and LORs are two of the most important parts of the psych app (moreso than Step or research) likely for the reason you stated, but that does not mean CS/PE are useless in assessing patient interactions. Frankly, I'd like to see them scored on a scale like Step 1 and given more actual weight instead of what it is now, but I think I'm in the minority on that one.

Maybe another reason why I'm not getting ii's is that I applied quite broadly to programs outside my region of the country and only 5 schools in my region of the country

This is probably playing a far greater role than you think. What's your school's tier/reputation and how many of your ii's are from your region?

 

[yanks26dmb]

for reference, I have 2 interviews in my region...10 outside of it. DO student.

 

[504196]

Interesting, hadn't seen that page before, thanks for posting it. I can say from the DO side that the most common reason for failing the PE is the "humanistic domain", basically the two non-ICE domains combined, and that almost no one fails d/t lack of clinical skills.

PD Survey data shows the clinical evals and LORs are two of the most important parts of the psych app (moreso than Step or research) likely for the reason you stated, but that does not mean CS/PE are useless in assessing patient interactions. Frankly, I'd like to see them scored on a scale like Step 1 and given more actual weight instead of what it is now, but I think I'm in the minority on that one.



This is probably playing a far greater role than you think. What's your school's tier/reputation and how many of your ii's are from your region?

Large academic MD program, probably upper/middle tier. 2 ii's from my region, 4 from outside my region

 

[ridethecliche]

Interesting, I currently have 6 from my region and 2 from a region I have ties to. Totally nothing from anywhere else in the country.

 

[504196]

Well I emailed my PD at my home institution asking for some advice/recommendations. We'll see what they say. I'm holding off on sending other schools updates but there are some that I'm genuinely interested in. Maybe I'll send more emails later this week after I talk with my PD.