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Currently a 3rd year DO student really needing any kind of advice.

Ended up failing USMLE (189) and got a 450 on COMLEX level 1. I don't really know what happened because I had been averaging high 220s on my NBME practice exams but that's all in the past. I'm looking to do better and improve on things that I can control from this point on such as rotation grades, COMLEX level 2, auditions, etc. (worked hard and received Honors on my first rotation).

I'm very interested in pursuing EM or IM but I really have no idea what to do. If I were to do IM, I would prefer to have some specialty options in case I wanted to pursue one. Some questions I had were...

1) Should I re-take the USMLE step 1, study very hard, and shoot for a 225+ so that I can apply for ACGME EM or IM programs? Or would I already be pre-screened from being able to match into any ACGME programs due to the failed 1st attempt?
2) Should I only focus on AOA match from this point onwards go for EM or IM in AOA programs (with ACGME pre-accredited status)? I did not know if my score was competitive enough to match into a decent program in the EM or IM AOA (with ACGME pre-accredited status).
3) Is it possible to apply to ACGME programs with only using your COMLEX score? Of course if they ask for my USMLE, I would send them that.

I just want to say thank you to everyone in advance. Just a lot of anxiety and sleepless nights ever since all my scores came out.
 

hallowmann

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This is obviously only my personal advice:

1) I would not recommend this. If you're even considering this, you might be better off just taking Step 2, and if you do well, just hoping Step 1 will be overlooked. The truth is, I doubt either will particularly help with ACGME IM or EM programs

2) I would do this. You can apply to any osteopathic programs, whether pre-accredited, initial accredited, or dual accredited provided they have an "osteopathic" app on ERAS. As of right now, you cannot assign USMLE scores in ERAS to osteopathic applications.

3) No this is not possible. Its an official requirement now, since I think 2013 or something that if you apply through the "MD" side of ERAS you are required to submit your USMLE scores.

At this point, I wouldn't worry about this. Just focus on applying AOA and getting past it. If you want specialties, I would aim for community IM programs with in house fellowships that are known for taking their own. Work hard throughout this year, do well on Level 2, get strong LORs, and hopefully none of this will matter.
 
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starri

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I try not be one of the doom and gloom types, because there are exceptions to every rule, but ACGME EM is probably out of reach now.

I'm not a wizard at these kinds of strategies, but I would think your best option would be to focus on an AOA IM program and crush Level 2. I don't think it's worth paying the money for another try at the USMLE brass ring.
 

MrChance2

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I'm having a hard time understanding going from high 220s to 189 AND a 450 Comlex. I think a retake is fine if you know you'll do well on it and have an easy rotation to study for it. Plenty of time to focus on step 2 also which can partially negate your step 1.

There may still be some EM programs out there for you I think. Or you may decide you don't want to do it after having an EM rotation.
 

hallowmann

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I'm having a hard time understanding going from high 220s to 189 AND a 450 Comlex. I think a retake is fine if you know you'll do well on it and have an easy rotation to study for it. Plenty of time to focus on step 2 also.
Test anxiety?

The real question is what will a retake really do practically in terms of increasing OP's chances at ACGME EM or university IM? I don't really know the answer, but I don't think it will make an appreciable difference.
 
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I'm having a hard time understanding going from high 220s to 189 AND a 450 Comlex. I think a retake is fine if you know you'll do well on it and have an easy rotation to study for it. Plenty of time to focus on step 2 also which can partially negate your step 1.

There may still be some EM programs out there for you I think. Or you may decide you don't want to do it after having an EM rotation.
I try not to label myself as a "bad test taker" but I have always had a hard time with standardized exams (even with MCAT; had to re-take the MCAT 3 times).

I really appreciate the inputs though. The biggest problem I have is that our school does not allow you to do an EM rotation until you are in your 4th year. By that time, I would have had to already had my audition rotations set up. The quickest way I can do an EM rotation is at the very beginning of 4th year, which will be in June of next year. And you're right, maybe I might not want to do EM after the rotation but that is exactly where I am struggling to decide right now (either to pursue EM or IM).
 
OP
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I try not be one of the doom and gloom types, because there are exceptions to every rule, but ACGME EM is probably out of reach now.

I'm not a wizard at these kinds of strategies, but I would think your best option would be to focus on an AOA IM program and crush Level 2. I don't think it's worth paying the money for another try at the USMLE brass ring.
Thank you for the input. Yeah, thinking about sitting through that exam another time makes me cringe but I am definitely taking a different approach for Level 2. You think I still have a chance in some decent AOA EM or IM programs though?
 
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Test anxiety?

The real question is what will a retake really do practically in terms of increasing OP's chances at ACGME EM or university IM? I don't really know the answer, but I don't think it will make an appreciable difference.
That is exactly where I am stuck right now. If a re-take and doing extremely well on USMLE step 1 does not really change my chances much on ACGME EM or university IM programs, I find it a waste of my money and effort to even go that route. Thank you for all the input.
 

group_theory

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Test anxiety?

The real question is what will a retake really do practically in terms of increasing OP's chances at ACGME EM or university IM? I don't really know the answer, but I don't think it will make an appreciable difference.

For my University IM program, IF (big IF) you were invited for an interview and impressed all the interviewers - it still wouldn't make up for the failed USMLE score. When it comes time to rank, you would be near the bottom of the rank list IF you are ranked at all (the low COMLEX as well as failed USMLE would be an issue) regardless of how well you did on the retake. Some of the faculty might even push to drop you from our rank list. The exception would be if you had multiple residents and faculty members advocating for you at the rank meeting. That's just at my place, not every residency program do the same thing. While there are MD students who fail USMLE and manage to get into university acgme IM programs ... you're at a disadvantage being a DO student having failed Step 1

My opinion/advice (for what it's worth)

Focus on doing well your 3rd year. Don't divert your attention/resources/attention on retaking USMLE Step 1 since it will not make up for the failed attempt. You also did poorly on COMLEX 1, so the prospect of suddenly doing well on USMLE 1 (after failing it the first time and scoring below average on COMLEX) is slim.

Try to get good LORs from attendings who may be willing to go to bat for you (ie make phone calls to PDs of programs you are interested in to say that you will be an awesome resident). Try to do an audition rotation OR subI/AI at a couple programs that you are really interested in, and do well.

You must do well on COMLEX 2 to alleviate any fears that PDs will have that you might not pass COMLEX 3 or eventually, the real "boards" (board certification exam)

Apply broadly. Don't restrict yourself geographically. Go to as many interviews that you can reasonably afford (without sacrificing your 4th year education)

Don't just apply to 10 programs in California and hope for the best - apply to 20+ (or even 30+) and across the country (where you can picture yourself doing residency). Apply smartly - don't apply to UCSF, MGH, Hopkins, etc (obvious exaggeration/hyperbole for examples). Some of the low tier university IM programs may give you a look. Some AOA IM programs also have in-house fellowships - take a look at them as well. Almost all the AOA IM program will be ACGME accredited in the near future anyway (and those that won't will be shutting down and not taking on new students). Start here

opportunities.osteopathic.org/search/search.cfm

Look under fellowship and see the programs that have fellowships that you may be interested in

The above applies to IM. Not sure about EM.
 

starri

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Thank you for the input. Yeah, thinking about sitting through that exam another time makes me cringe but I am definitely taking a different approach for Level 2. You think I still have a chance in some decent AOA EM or IM programs though?
I don't know about EM with a 450. A lot of programs want to see at least a 500. But that is also going to come down to SLOEs and how you perform on auditions. But you might be screened out of auditions, because a lot of programs ask for your Level 1 score. Like I said, I think there are exceptions to every rule.

OTOH, I did a rotation in July where one of the residents, as I was freaking out waiting for my Level 2 score to release, told me he'd barely passed it and still managed to match. But you're going to have to show improvement in Level 2.

I would also suggest figuring out which speciality really appeals to you more. And don't repeat my mistake of choosing the one you thought you wanted when you started school as opposed to the one you liked best when you actually did it.
 
OP
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For my University IM program, IF (big IF) you were invited for an interview and impressed all the interviewers - it still wouldn't make up for the failed USMLE score. When it comes time to rank, you would be near the bottom of the rank list IF you are ranked at all (the low COMLEX as well as failed USMLE would be an issue) regardless of how well you did on the retake. Some of the faculty might even push to drop you from our rank list. The exception would be if you had multiple residents and faculty members advocating for you at the rank meeting. That's just at my place, not every residency program do the same thing. While there are MD students who fail USMLE and manage to get into university acgme IM programs ... you're at a disadvantage being a DO student having failed Step 1

My opinion/advice (for what it's worth)

Focus on doing well your 3rd year. Don't divert your attention/resources/attention on retaking USMLE Step 1 since it will not make up for the failed attempt. You also did poorly on COMLEX 1, so the prospect of suddenly doing well on USMLE 1 (after failing it the first time and scoring below average on COMLEX) is slim.

Try to get good LORs from attendings who may be willing to go to bat for you (ie make phone calls to PDs of programs you are interested in to say that you will be an awesome resident). Try to do an audition rotation OR subI/AI at a couple programs that you are really interested in, and do well.

You must do well on COMLEX 2 to alleviate any fears that PDs will have that you might not pass COMLEX 3 or eventually, the real "boards" (board certification exam)

Apply broadly. Don't restrict yourself geographically. Go to as many interviews that you can reasonably afford (without sacrificing your 4th year education)

Don't just apply to 10 programs in California and hope for the best - apply to 20+ (or even 30+) and across the country (where you can picture yourself doing residency). Apply smartly - don't apply to UCSF, MGH, Hopkins, etc (obvious exaggeration/hyperbole for examples). Some of the low tier university IM programs may give you a look. Some AOA IM programs also have in-house fellowships - take a look at them as well. Almost all the AOA IM program will be ACGME accredited in the near future anyway (and those that won't will be shutting down and not taking on new students). Start here

opportunities.osteopathic.org/search/search.cfm

Look under fellowship and see the programs that have fellowships that you may be interested in

The above applies to IM. Not sure about EM.
Thank you for your honest and great input. Just one clarification, when you mentioned the "some low tier university IM programs may give you a look," are you referring to the current ACGME accredited programs (MD match)? I would need to re-take and do well to be able to go this route for IM right?

I am definitely looking to apply broadly (most likely 40+ programs) and not restricting myself to specific region. As long as it is a decently close a big city and/or airport, I would be okay.
 
OP
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I don't know about EM with a 450. A lot of programs want to see at least a 500. But that is also going to come down to SLOEs and how you perform on auditions. But you might be screened out of auditions, because a lot of programs ask for your Level 1 score. Like I said, I think there are exceptions to every rule.

OTOH, I did a rotation in July where one of the residents, as I was freaking out waiting for my Level 2 score to release, told me he'd barely passed it and still managed to match. But you're going to have to show improvement in Level 2.

I would also suggest figuring out which speciality really appeals to you more. And don't repeat my mistake of choosing the one you thought you wanted when you started school as opposed to the one you liked best when you actually did it.
So I am assuming the best thing I can do is get in contact with the visiting student coordinator for the specific AOA EM programs and ask them if they will accept my application for auditions? Or are you saying that I will be pre-screened out when I apply for AOA EM residency on ERAS later?

All I really want is an audition and for them to give me a legit chance on proving to them that yes, I was not the best exam taker for my Level 1 but I will make out to be a great EM physician.
 

starri

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So I am assuming the best thing I can do is get in contact with the visiting student coordinator for the specific AOA EM programs and ask them if they will accept my application for auditions? Or are you saying that I will be pre-screened out when I apply for AOA EM residency on ERAS later?

All I really want is an audition and for them to give me a legit chance on proving to them that yes, I was not the best exam taker for my Level 1 but I will make out to be a great EM physician.
I get that, but it's usually not the coordinator making those kinds of decisions, it's the DME or PD. And as much as it sucks, it often comes down to cold numbers. I don't remember which program it was, but they make it clear not to both applying for a rotation with less than a 500. I'm not saying don't try for it, I'm just saying to temper your expectations.
 

Rekt

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I agree with Hollow. Do AOA only. Don't retake the step.

I think your dead in the water for EM due to increased competitiveness and you'll likely have difficulty getting audition rotations. Trying to match EM with that history is a gamble you don't want to lose.
 

Dr Dazzle

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For my University IM program, IF (big IF) you were invited for an interview and impressed all the interviewers - it still wouldn't make up for the failed USMLE score. When it comes time to rank, you would be near the bottom of the rank list IF you are ranked at all (the low COMLEX as well as failed USMLE would be an issue) regardless of how well you did on the retake. Some of the faculty might even push to drop you from our rank list. The exception would be if you had multiple residents and faculty members advocating for you at the rank meeting. That's just at my place, not every residency program do the same thing. While there are MD students who fail USMLE and manage to get into university acgme IM programs ... you're at a disadvantage being a DO student having failed Step 1

My opinion/advice (for what it's worth)

Focus on doing well your 3rd year. Don't divert your attention/resources/attention on retaking USMLE Step 1 since it will not make up for the failed attempt. You also did poorly on COMLEX 1, so the prospect of suddenly doing well on USMLE 1 (after failing it the first time and scoring below average on COMLEX) is slim.

Try to get good LORs from attendings who may be willing to go to bat for you (ie make phone calls to PDs of programs you are interested in to say that you will be an awesome resident). Try to do an audition rotation OR subI/AI at a couple programs that you are really interested in, and do well.

You must do well on COMLEX 2 to alleviate any fears that PDs will have that you might not pass COMLEX 3 or eventually, the real "boards" (board certification exam)

Apply broadly. Don't restrict yourself geographically. Go to as many interviews that you can reasonably afford (without sacrificing your 4th year education)

Don't just apply to 10 programs in California and hope for the best - apply to 20+ (or even 30+) and across the country (where you can picture yourself doing residency). Apply smartly - don't apply to UCSF, MGH, Hopkins, etc (obvious exaggeration/hyperbole for examples). Some of the low tier university IM programs may give you a look. Some AOA IM programs also have in-house fellowships - take a look at them as well. Almost all the AOA IM program will be ACGME accredited in the near future anyway (and those that won't will be shutting down and not taking on new students). Start here

opportunities.osteopathic.org/search/search.cfm

Look under fellowship and see the programs that have fellowships that you may be interested in

The above applies to IM. Not sure about EM.
In this case, would one have had a better chance with just a low comlex? Would a 450 even meet the threshold for any university ACGME IM or strong AOA IM programs?
 

hallowmann

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In this case, would one have had a better chance with just a low comlex? Would a 450 even meet the threshold for any university ACGME IM or strong AOA IM programs?
I think a low COMLEX only would be better if we're talking about applying ACGME. Applying AOA, I don't think it would make any difference. The question really isn't about university ACGME IM, because that will be hard even with only the 450. The real question is what about some of those midwest community ACGME IM programs with in house fellowships? Would some of those have looked at a 450 COMLEX? I think its certainly possible.

No point for OP to worry about that now, because I still think they'll be fine with AOA IM.
 
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Dr Dazzle

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I think a low COMLEX only would be better if we're talking about applying ACGME. Applying AOA, I don't think it would make any difference. The question really isn't about university ACGME IM, because that will be hard even with only the 450. The real question is what about some of those midwest community ACGME IM programs with in house fellowships? Would some of those have looked at a 450 COMLEX? I think its certainly possible.

No point for OP to worry about that now, because I still think they'll be fine with AOA IM.
Are there AOA IM programs with in house fellowships? Or, are you referring to combined AOA/ACGME programs? I would think those would still require 500-550 COMLEX minimum.
 

Drrrrrr. Celty

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Are there AOA IM programs with in house fellowships? Or, are you referring to combined AOA/ACGME programs? I would think those would still require 500-550 COMLEX minimum.
He will graduate from an acgme residency after the merger is over. While he's utterly got no chance the competitive IM fellowships he probably still has a shot at nephro, rhuem, and infectious disease, or endo if he gets research under his belt and is willing to go anywhere.
 

hallowmann

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Are there AOA IM programs with in house fellowships? Or, are you referring to combined AOA/ACGME programs? I would think those would still require 500-550 COMLEX minimum.
Yeah, there definitely are AOA IM programs with in-house fellowships. Check out the AOA opportunities website for details about them.

Both dual-accredited and AOA only, and honestly it varies. If he does well in IM, makes connections in the fellowship department, etc. then it might be enough to land a spot.
 

Dr Dazzle

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He will graduate from an acgme residency after the merger is over. While he's utterly got no chance the competitive IM fellowships he probably still has a shot at nephro, rhuem, and infectious disease, or endo if he gets research under his belt and is willing to go anywhere.
Why? Do competitive(cardio, GI) fellowships still require solid USMLE/comlex scores whereas other fellowships don't?
 

Drrrrrr. Celty

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Why? Do competitive(cardio, GI) fellowships still require solid USMLE/comlex scores whereas other fellowships don't?
They require good pedigrees, high amounts of research, and generally are difficult to get into unless you're coming from a residency that is strong. Even good MD candidates from good mid tier university programs are going to struggle to get in unless they have groomed applications.

The others aren't as competitive, their pay is significantly lower, and idk. Then again I don't fully understand why more people aren't interested in endo or rheum.
 
OP
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Why? Do competitive(cardio, GI) fellowships still require solid USMLE/comlex scores whereas other fellowships don't?
I'm pretty sure at this level, connections / recommendations from well known physicians of that specific fellowship matters the most plus research. I don't think they will go digging for your COMLEX/USMLE step 1 score.

But thank you to everyone for the reply. Just trying to take it one step at a time right now (do well on COMLEX level 2 and rotations) but I am looking into the AOA EM / IM programs.
 
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My friend was so afraid about this, i remember she wasn't sure about many things but she passed thank God..
I'm sorry about your situation, did you found what to do?
 

starri

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But thank you to everyone for the reply. Just trying to take it one step at a time right now (do well on COMLEX level 2 and rotations) but I am looking into the AOA EM / IM programs.
Are you talking about the dual programs? Those are even more competitive.

Honestly, if your heart is still set on EM, the path of least resistance is probably a TRI at a hospital with an EM residency, then working your ass off. Or FM with an EM fellowship. I'm not trying to crap all over your dreams, because you should still pursue a categorical EM program if that's what you want, but you need to slow your roll and be willing to honestly and realistically evaluate your situation.

You said that you just need to get through the door because you can show them what an outstanding EM doc you can be. I don't doubt that you would, but just like a med school ad com would have some skepticism that a potential outstanding doctor with a 20 MCAT would struggle to pass boards, a PD would do the same with one with a 450 COMLEX and in-service.
 

irJanus

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To a broader point, this is the trouble with dual exams. Even if you are excellent, you are spread too thin between dual boards and rotations. This is the worst case result... Baring failing both.

Sorry to hear this.
To echo the above, acgme EM is out.
Osteo EM may work, but you need early step 2 and need to kill it coupled with stellar auditions. With the merger, aim as high tier as you can w those auditions to try and ensure survivability.

GL!