About to start residency, just found out I failed step 2 Ck--need advice

[folieatrois]

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I can't believe it but I just found out I failed Step 2CK, 3 weeks before I start residency. My med school did not require it for graduation, and my residency program has never asked me anything about my plans for taking it or my score. I was able to receive a training license without having taken or passed Step 2 CK. I'm hoping this means I will not have a problem starting residency? Do I need to inform my program director of the failing score? If not I'd prefer to keep it quiet--it will hardly assure them that I'm getting off to a good start.

I need to figure out why I failed and regroup. I'll have to study and pass it as soon as possible, but I'll be busy as a resident! I got a horrible score. I was stunned by how low it was. I was doing USMLE world and getting average scores on the questions there both in timed and untimed modes. I might not have done enough timed questions to be prepared for the test environment, is what I'm thinking. I'm planning to redo all of USMLE world both in tutor and timed mode, and do the NBME practice tests, as well as Kaplan Qbook and First Aid for Step 2. Any other suggestions?

Thanks.

 

[ohai647]

Sorry to hear that...It may be because you took the test kinda late in the 4th year when we all suffer from brain atrophy. but in any case, sounds like you have a good plan. Just wanted to add that the NBME forms are pretty accurate. I took 2 of them and they were within single digits of my actual step 2 score. I took them a couple of weeks prior to my test date. Also, you may want to mark the most difficult/wrong answers from USMLEWORLD and repeat them a couple of times, and maybe even write them down to commit them to memory.

 

[folieatrois]

Thanks--that's good to know. I'm going to be more structured this time around. I hope this won't cut too much into residency itself. If anyone has comments about whether I need to inform my program, that would be greatly appreciated. Yeah, I'm going to have to take more written notes as well this time. I have a great deal of difficulty remembering things when I just see it go by on a computer screen, I guess.

 

[Impromptu]

I advise that you talk to your program. It may be painful, but it is better than attempting to hide it, for your own sanity's sake and for possible legal reasons (I don't know the legal ramifications, but I tend to plan for the worst and hope for the best). If they find out you had been hiding it and it does affect you, you are going to feel their wrath for the rest of your residency (however short that may then be).

 

[Iladelphia]

Definitely, without a doubt, tell them that you failed. I can almost guarantee you that they will find out anyway, and when they do they will also discover that you hid it from them. Talk about not starting your residency out on the right foot. Not only will they think you are not up-to-par knowledge wise (BTW I'm not saying this is true), they will also think you are dishonest. The latter is far worse than anything that can happen if you tell them. My guess is that they will 1.) Ask you why it happened and 2.) Give you the appropriate amount of time/elective/whatever so you can pass the test. Good luck and I hope your 2nd attempt @ CK goes well.

 

[DarthNeurology]

I can't believe it but I just found out I failed Step 2CK, 3 weeks before I start residency. My med school did not require it for graduation, and my residency program has never asked me anything about my plans for taking it or my score. I was able to receive a training license without having taken or passed Step 2 CK.

I need to figure out why I failed and regroup. I'll have to study and pass it as soon as possible, but I'll be busy as a resident! I got a horrible score. I was stunned by how low it was. I was doing USMLE world and getting average scores on the questions there both in timed and untimed modes. I might not have done enough timed questions to be prepared for the test environment, is what I'm thinking. I'm planning to redo all of USMLE world both in tutor and timed mode, and do the NBME practice tests, as well as Kaplan Qbook and First Aid for Step 2. Any other suggestions?

Thanks.

I would inform your program director about the failing score as the residency program might have rules about passing Step 2 CK within a certain amount of time, like perhaps within the first 9 months or something AND there are also rules about passing Step 3 too at some programs where you have to have it passed by the end of intern year.

You need your program director's help to figure out what the rules are and when to re-take Step 2 CK, it is probably required for more than an interns license in a lot of states.

USMLEWorld is good, but shouldn't be a primary source of studying for the boards, IMHO. The best mix I think is using a primary source for 75% of the time and then doing questions perhaps 25% of the time, but consistently on a daily basis before the examination. If you do usmleworld questions and don't understand something then you need to re-read that subject. The best primary studying for Step 2 CK is studying well for third year clerkships and studying on elective too. If you take a cardiology elective then you need to buy a couple basic cardiology texts, I highly recommend Lange for everything, and you need to read it and know it well, (except for ob/gyn I think blueprints is great) that way when you do Step 2 CK you will blow it away on the cardiology questions, and so on. . .

I did usmleworld 1.5 times, maybe very few of the questions were similar, but studying solidly on clerkships was what helped me as I already had that knowledge base and got 99/260+ . . . you should study so much during clerkships that FA for Step 2 CK should be a review and nothing new in it. . . some people like questions, but for me it wasn't a good primary source of info. I've always felt that doing questions helps marginally with passing the exam in terms of fund of knowledge, but does help some with the test taking format. Step 2 CK is long, but you just have to answer each question as best as possible based on your knowledge. Don't focus on the time requirement, but focus on doing a good job.

I think that doing just usmleworld and FA for step 2 CK is "OK" if you don't have a lot of time, i.e. a couple weeks. But if you want to build a quality foundation for clinical practice it takes a lot more planning and more hardwork, I would read after clerkships and electives when studying for Step 2 CK and pretty much my focus was on learning the material well and not on what would be on the exam as you need a good knowledge base for Step 3 and clinical medicine as well.

 

[folieatrois]

Thanks for the helpful advice, everyone. I will plan to tell them. Certainly I would not wish to hide such a thing--just don't want them to see that as the first thing they learn about me! I'd prefer to wait until I arrive at orientation in a couple weeks rather than email from afar with this news--does that seem reasonable?

Alas, I can't study from clerkships since I'm past that. I'm going to start studying right this week from books though. I wonder how long people usually study before retaking it? If I have a retake date scheduled soon, that will get me going. What books do people recommend?

 

[DarthNeurology]

Thanks for the helpful advice, everyone. I will plan to tell them. Certainly I would not wish to hide such a thing--just don't want them to see that as the first thing they learn about me! I'd prefer to wait until I arrive at orientation in a couple weeks rather than email from afar with this news--does that seem reasonable?

I don't know about what might seem reasonable, but I think it is prudent to tell the residency program immediately as you are already going to have to tell them and time is not on your side at this point. They already gave you a contract, but they might want you submit passing Step 2 CK at a certain point, if you wait too long and you don't get this info and can't register in time to take it again then it is your fault for not telling them in time. Some residency programs do require the residents to have passed Step 2 CK by the time they start residency (this may be independent of what the state licensing board says about Step 2) or to have submitted passing scores by a certain deadline. You don't want to show up to orientation and be told that you can't start because you haven't given your Step 2 paperwork yet. If you tell them now or later their response will be the same so it is best to try to get that information now.

 

[dragonfly99]

I would wait until you have signed the residency contract, and then tell them.
I agree w/above about not waiting until you get there. If you tell them now, they can give you ER or some easy elective the first month, so that you'll have time to study and retake the test. I know it's painful, but just tell them now (or at least soon). Don't spring it on them on July 1st.

I'd also check the GME web site and possibly the program's own departmental web site to see if there is anything on there about specific date(s) by which you have to pass the Step 2.

 

[folieatrois]

I've already signed the contract. The question is, whether they have. They sent them out to us, and we signed them, but the department chair was going to sign them later I think. Don't they need to sign them for them to be valid? But would they really want to fire me this close to the start? I might pass it if I take it again. I will say, I had extenuating circumstances that are quite valid, not that it matters.

Thanks again, I'll follow up on the suggestions!

 

[DarthNeurology]

But would they really want to fire me this close to the start? I might pass it if I take it again.

A lot of residency programs require that the resident have passed Step 2 CK prior to July 1st, and make this a requirement of hiring somebody. The reason being that you might or might not pass Step 2 CK if you re-take the examination AND some states require you to pass Step 3 before finishing residency or perhaps even after internship year. No doubt your program has a timetable when they want you to have passed Step 2 and Step 3. It is more a question of not wanting to take a resident who has deficient knowledge base and/or might not pass Step 2 or 3 in time to be promoted in residency and thus they would lose a resident. They could probably still easily scramble and find someone who has passed Step 2 and probably Step 3 too, to fill your spot and they would be assured that this person would be able to go on to PGY-2 and the other years.

I don't know about contract law, but your program may have a stipulation that all incoming interns have to have passed Step 2 prior to starting, many do. Sadly, if true then you may not have a residency position at all no matter what happens and it is in your best interests to find out now rather than waiting until July 1st. The early you talk to them the sooner they can perhaps make special accomodations . . . the longer you wait the more likely they will feel you didn't give THEM enough time to do what they need to do. I totally agree with DF that you should contact them ASAP

If your residency program does not hire you then it might be a blessing in disguise as you will have more time to study for Step 2, pass it, and could even take and perhaps pass Step 3 and re-apply for residency next cycle.

Worst Case Scenario: Your residency program hires you, gives you six months to pass Step 2 CK, you find internship very hard and you can't find enough time to study and you fail Step 2 CK a second time. Your residency program then *fires* you, different from not being hired in the first place, and you have to try to get a second residency which is very hard to do and you come on SDN a year from now saying how you failed Step 2 CK again and had to leave your internship and now nobody will hire you. Believe me, you best option might be not to start residency, study up for Step 2 CK for a good while and re-apply next year. If you really got a very low score then something might be very wrong with your studying style or material and you are in danger of failing again. Also, say you barely pass Step 2 CK and then start residency and then can't pass Step 3 and therefore can't finish residency and are *fired*, yikes. You would have to get another residency and perhaps start over or do a third year again or something, not pretty. This is why residency programs want people who have passed Step 2 already as it puts the resident and the program in a very bad place.

Also, if your clinical grades are borderline or you barely passsed Step 1 then you might even struggle in residency and be fired for lack of clinical knowledge and poor clinical decision making OR if you have to take inservice examinations you could fail those as well and then be in a bad place during residency. Some of the worst residents get by on personality for a year or so and then when they are a PGY-2 or above the lack of studying really catches up with them and they get fired. Your really need to talk to your PD ASAP, i.e. schedule a meeting and see how he/she would proceed in your case and take their advice as they have faced this problem before and will do what they have done in the past.

Be glad that you can fix this with more studying and such and that if you are diligent you can pass Step 2 and a year off isn't a big deal.

 

[folieatrois]

Ok, thanks--I see your reasoning and agree. I'm going into psych and believe I'll be starting with the psych months. Psych is not so grueling that we should not have a little time to study--I just don't want my PD to think I won't also be learning psych while I'm there. I'll work at this night and day if need be.

I will contact them ASAP--but Monday would be preferable to tomorrow because it gives me the weekend to think about what I'll say.

We received a long list of required paperwork after the Match, and I already have my training license for the state I'm going to (on paper, stamped). We weren't asked anything at all about Step 2. I'm absolutely positive. I remember checking because I was taking it so late.

 

[DarthNeurology]

I will contact them ASAP--but Monday would be preferable to tomorrow because it gives me the weekend to think about what I'll say.

I would suggest:

Dear [insert name of psychiatry program coordinator],

I am very happy to have matched to your program. However, recently I became aware that I did not pass Step 2 CK and therefore must re-schedule to take this examination. I was wondering what effect, if any, this would have on my intern rotations.

Sincerely,

Folieatrois

You gotta get the ball rolling on this. It doesn't really matter *what* you say, the PD isn't going to care if you promise to study real hard either, they have a policy for what to do in this case, and it won't be tailored to your situation likely as this happens a lot. They will either tell you:

1. We can't hire you, sorry, we require our interns to have passed Step 2 CK, we wish you success in your new life.

2. You have to pass it in three months or we won't keep you on as a resident.

3. You have to pass it by the end of intern year.

4. Pass it when you like, i.e. in the next three years and tell us how it went! (Just kidding, some gallows humor).

They want to know and how you break it to them won't matter. But when you do will. The program coordinator, probably not the PD even, will be able to tell your their policy, probably by the end of tomorrow and you can relax easy if it is good info. If not, then you have the weekend to recharge and plan on re-applying OR perhaps registering ASAP to take it again. You are wasting time worrying more on the weekend which is what you are doing.

I don't think it makes sense to say that your PD will be worrying that you won't be learning psych during internship if studying for Step 2. . . The learning in internship is more hands on and active learning, and psychiatry takes a lot of time learning which patients are a danger to themselves and some of the more finer aspects of patient care, i.e. it is stuff you don't learn in a textbook. Most of the important stuff you will learn in internship for psychiatry is more medicine, there are a lot of medical disorders that may present psychiatrically so studying and doing well on Step 2 is very important for psychiatry in general and they want you to known medicine very well to be a good psychiatrist.

There was one patient I saw on psych who had the classic signs of Wilson's disease, Kayser-Fleischer rings, and had been misdiagnosed as having schizophrenia for years, very sad. If you don't have medicine down well your psychiatry PD will note this and this would hurt you in a psychiatry program, as he/she will want you to be very familiar with general medical conditions and neuropsychiatric conditions as well. Ironically, psychiatrists get only a small amount of medicine training, but it is very crucial to be a good psychiatrist to also be a good internist as well. Your fund of knowledge problem, if there is a problem, will hurt you more in pscyhiatry in a way as IM residents get three years to learn the stuff and you really need to know if from the get-go.

Remember that the stuff you will need to manage well in residency as a psychiatrist are often very medically related problems that could result in a lawsuit if not done properly, such as recognizing neurolpetic malignant syndrome, caring for patients who are detoxing or on various illicit drugs, etc . . . and you will need to function well on medicine rotations in internship such as MICU rotations. I have seen a psychiatry resident who was terminated due to failure to perform well on such a rotation in internship, NOT for not being able to "talk to" psych patients. Your most valuable assets to a program director in a psychiatry residency are having good inpatient psych skills AND excellent fund of knowledge in medicine, not your personality or how well you related to patients.

 

[folieatrois]

Ok, well, I see your point. Thanks again. The only thing is, it's kind of past the point of "I've matched to your program" at this time! We've all exchanged dozens of emails on every subject. In fact I already have my schedule for the year, starting out with psych.

No doubt they required I'll pass it at some point before long; it just seems weird that if they demanded I pass it by July 1st they wouldn't have requested all our scores yet. I'm just saying. I'm not going to delay in telling them. I'll email tomorrow. The thing is, they could have some vague policy as well, and my telling them on a Friday will instigate a weekend of waiting.

In fact I will be studying as much as possible from now until orientation so as to not waste time; maybe I can take it very early in the fall. I'm not sure if this was a knowledge gap or a failure to do enough timed practice tests. I was very bleary-eyed the day of the test.

 

[folieatrois]

Ok, now I must be in the state of denial, but I just want to ask people something. My score was a whole 40 points below my Step 1 score, which itself was pretty bad. I'm just amazed I could get such a bad score. I'm not THAT lacking in knowledge. I was getting upper 50s, low 60s on USMLE world. I wasn't doing enough questions fast enough, for sure, but how could I have bombed it that badly I wonder.

The test center I was at is known for at least a couple computer problems that affected students' scores. I didn't notice anything that day, but I wonder if there could have been some scoring issue? It's just a thought... I could do a NBME practice test to see if it matches up with what I got. Although it's been weeks since I've studied, and either way I'd still have to retake it.

 

[DarthNeurology]

Ok, now I must be in the state of denial, but I just want to ask people something. My score was a whole 40 points below my Step 1 score, which itself was pretty bad. I'm just amazed I could get such a bad score. I'm not THAT lacking in knowledge. I was getting upper 50s, low 60s on USMLE world. I wasn't doing enough questions fast enough, for sure, but how could I have bombed it that badly I wonder.

Probably if your Step 1 score was "pretty bad", or "barely passing" as you said then it makes sense you might be in jeopardy of failing Step 2. You should have enough time to finish the blocks on Step 2, I felt I had more time on Step 2 than Step 1. Do you mean you didn't have time to finish some of the blocks? I think that would really bring down a score, I am guessing your Step 2 was in the range of 145 to 155 (assuming you got 180 to 190 or so on Step 1?).

If you did around 190 or so on Step 1 and failed Step 2 CK then I would say that you have a clinical knowledge deficit as a lot of the questions are pretty much have you seen this disorder or recognize this contellation of symptoms or do you know that next best step type of thing.

 

[DarthNeurology]

The thing is, they could have some vague policy as well, and my telling them on a Friday will instigate a weekend of waiting.

Believe me, there is no vague policy when it comes to passing usmle's for residency, there is clear deadline for every residency program for ALL of the USMLEs, you need a Step 1 to interview at all places basically, and many programs require you to have passed Step 2, both parts, prior to July 1st. Your programs may give you some wiggle room, i.e. have a deadline past July 1st, but believe me that they have a deadline. Licensing examinations are important and if you don't pass them in time then you can't progress in your residency training as per state laws in many states, i.e. it is a big deal having passed them on time.

 

[folieatrois]

Believe me, there is no vague policy when it comes to passing usmle's for residency, there is clear deadline for every residency program for ALL of the USMLEs, you need a Step 1 to interview at all places basically, and many programs require you to have passed Step 2, both parts, prior to July 1st. Your programs may give you some wiggle room, i.e. have a deadline past July 1st, but believe me that they have a deadline. Licensing examinations are important and if you don't pass them in time then you can't progress in your residency training as per state laws in many states, i.e. it is a big deal having passed them on time.

Right, they would have a deadline, but how can mine be July 1 when I have the Training Permit in my hand and it's only early June? So if they are going to fire me, it's not going to be because I missed a non-existent July 1st deadline for licensing in the state I'm going to; it would be because I informed them of the failure, they had a non-July 1st deadline they felt I couldn't make, or they thought I was not qualified for their program. But that would be up to them, and it would be less clear cut than the obvious inability to meet a July 1st deadline. Even if the deadline was September 1st, I might be able to meet that.

I also don't see how they could have a July 1 deadline that's even program specific and not have requested the scores from us by now. They've requested every other document under the sun.

 

[Law2Doc]

I would wait until you have signed the residency contract, and then tell them....

I'm not sure this is good advice (although it is not relevant to OPs issue since he had a contract signed earlier). Most of the contracts are full of conditions precedent -- that before it becomes a "contract" it indicated that you have to (1) graduate, (2) pass Step 2, (3) pass a physical, etc. So signing is pretty irrelevant -- the program still gets to decide if they want you if you come up short on any of these conditions, and a piece of paper does nothing to protect you. But if you sign a contract and shortly thereafter tell them -- "by the way, I need to retake CK", they are going to feel hoodwinked (and they will see the date on your score report and know when you knew). that's probably putting the worst foot forward.

 

[DarthNeurology]

Right, they would have a deadline, but how can mine be July 1 when I have the Training Permit in my hand and it's only early June? So if they are going to fire me,

Well, they haven't hired you yet, so it wouldn't be "firing" you, it would just be not hiring you. If the deadline for your program is NOT July 1st, then they wouldn't move it up just to spite you. Whatever the deadline is, the deadline is, period. If the deadline IS July 1st, they might call you a couple weeks before hand asking for the score report for Step 2 CK. I forget how the residency program gets the scores though. If you applied via ERAS and asked scores to be sent automatically to your residency program then maybe they did this, and maybe not. In the end the residency program does care a great deal about an incoming resident not passing Step 2 CK, and likely might want to help them or have to sadly inform them that because you couldn't make the deadline you can't start and therefore won't be hired.

 

[DarthNeurology]

Even if the deadline was September 1st, I might be able to meet that.

Again, this might be a blessing in disguise if the residency program does not hire you as it gives you time to actually study and do well on Step 2. Residency is tricky in that in your situation your are not "OK" if you get into the psychiatry residency only to really be "fired." If you screw up a residency for whatever reason, it will be very hard to get another residency.

Say for example your residency program does hire you AND gives you three months to take and pass Step 2 CK. Ok, so you set a test date for the end of September. Say that the psychiatry month becomes hectic and you don't study as well as you thought and then you do a medicine wards month which totally wipes you out and you have to take Step 2 CK in September and all you have done is re-doing some test questions. September rolls around, another hard month, and you take Step 2 CK and fail it big time again.

If your residency program director is nice, and you better hope that he/she will nice because you will need a LOR from this person when you apply for another internship, then he/she will say how you did well or OK on the wards. Perhaps the PD will want to look closer at you because you failed Step 2 CK and they or medicine attendings may make some negative comments, well that goes into your letter from the PD.

You apply again for ERAS and yes you have to answer that you have had a prior residency, which may negatively affect your funding, AND you have to say that you failed Step 2 twice, and hopefully you will have passed step 2 the third time. Many residency programs won't read your application because you failed your Step 2 CK but mostly because you were indeed "fired" from a residency position (worse than not being hired). At this point you had better also have passed Step 3 to show PDs that they don't need to worry about you during residency passing that, which some programs require at the end of internship and what many licensing boards require as well.

Even if you could say that the you signed the contract your feet will be against the fire during internship as you may be required to pass both Step 2 and Step 3 within a year. This is NOT a great place to be during internship which is very hard, and this is why many residency programs want someone who passed Step 2 prior to starting. It may very well be in the fine print somewhere.

If you wait until next week or longer it doesn't help your case. If given enough time then perhaps the schedule can be changed to give you an elective, nobody likes it when they get a surprise like this on short notice and have to change plans. You should on some level feel the need to be considerate to the residency program AND get the information to them as quicky as possible so they have time to make whatever changes they may or may not need.

 

[folieatrois]

Ok, good news--I contacted the PD, and he/she does not know of any deadlines or even requirements for either Step 2 or 3, though of course it is in my best interest to pass Step 2 as soon as possible. I agree with that, obviously, though I also need to study adequately so as not to fail it a second time. I guess there is some variability from state to state on this?

Thanks for helping me with this, everyone. I am glad to have not put it off and waited around worrying. I can study in a less stressed out mode, now.

 

[dragonfly99]

OP,
I think Darth was hanging the black crepe paper a little more so than was necessary. It's definitely true that some states and some residencies don't have nearly as strict rules about when you have to pass the steps. I think for my residency, passing Step 3 was only required to graduate (or perhaps to pass to 3rd year?) but definitely was not required to pass, or even to take it, before end of intern year. In fact, tons of us never took the test until 2nd year, simply because there was no time during intern year. I honestly wonder about medical schools that don't require or urge their students to take and pass Step 2 by a reasonable time, though...we were urged to take Step 2 during the fall, or winter at latest, of 4th year. Part of the reason for this is that if you have a problem, at least you have time to study and retake the test.

OP, in my opinion it does look like you have some knowledge deficits, if you scored low on Step 1 and then failed the Step 2 by that much. Basically, you were on the evil side of the bell curve, and significantly so. I doubt the problem was the test center computer(s) though if you thought that then you should have investigated that when you first got your scores...given your overall story it doesn't sound like that is what happened.

I would focus on re-reviewing some of the material, and not just on timing or practice questions (though the latter is important too). I don't know anything about USMLE World, but several years ago when I took the Step 2 I found Rx for Boards as well as First Aid for Step 2 to be helpful...they have some questions in the books but mainly the books review the important concepts and subjects on the test. You have to honestly also ask yourself what are your weak areas...were there areas of the test where you scored particularly poorly? If so, study those more. With the score you got, you probably will need more than just the First Aid book and a few practice questions...might want to get the abridged Kelly's or another IM textbook and keep it there while reviewing Rx for Boards or First Aid, and then whenever you read something you don't understand, go for the IM book to read more about it.

 

[Logitech]

To pass step 2 CK:

- need to know all info in "USMLE Step 2 Secrets" by Adam Brochert
- do USMLEWorld questions by topics and not a mixed test, that way you get a sense of what areas you still need to work on. You need to read all the answers and explanations for each question, to know why an answer choice is correct as well as why it is incorrect. Answering a question isn't as important as understanding what concept the question is trying to test, and you can do this by reading the detailed explanations.
- finally, do the free practice questions from USMLE.org and the paid NBME just to see where you stand.

GOOD LUCK.

 

[dragonfly99]

I remember using a couple other books where Adam Brochert was one of the authors and they were very helpful.

 

[gutonc]

I remember using a couple other books where Adam Brochert was one of the authors and they were very helpful.

Crush Step 3 is the one to use. He's also the author of a nearly identical book (content-wise), the name of which escapes me at the moment, but Crush is the better organized of the two.

 

[silentwarrior]

Hey Guys, I am in the same situation. Just found out that I did not make it through the Step 2 CK and hence can not get license before the July1st date. I read the posts but I am still unsure how to tackle this. any advice.?

My scores were 183/74. So disappointing.

 

[gutonc]

Hey Guys, I am in the same situation. Just found out that I did not make it through the Step 2 CK and hence can not get license before the July1st date. I read the posts but I am still unsure how to tackle this. any advice.?

My scores were 183/74. So disappointing.

How can you be unsure how to deal with this? All the advice here says "tell your PD immediately." Do that. Now.