Advice Needed: Step 1 Delay

[resp228]

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I am currently scheduled to take my Step 1 exam in one week. Due to family financial and health problems my dedicated study period was significantly affected. My latest NBME score is a 180.

I spoke with one of the deans of student affairs at my school and the dean is saying if I delay my first rotation (6 wk fam med) I will not graduate with my class, but instead will graduate either 6 mo's or a yr late as there may not be a spot available at the start of 4th year. The dean prefers that I take the exam next week.

I believe I am a good student who has received a fair number of honors/high passes, but I am going through a difficult time. I know I need to delay the exam as I am not passing, but I am worried about the repercussions. Some upperclassmen have suggested that I speak to the senior dean as I should be able to graduate on time. However, I do not want to appear as if I am trying to circumvent the first dean.

Please advise and give thoughts on how to proceed. Thank you.

 

[ridethecliche]

You need to look out for yourself here. I wouldn't hesitate to speak to the senior dean. If the first dean says anything, then you can say that you wanted to get more opinions on the situation. Or just tell them to talk to their boss.

Realistically there's no weird chain of command here that you're going around. You are fully within your right to discuss your situation with the folks in the deans office. I would be shocked if the first dean actually cared about it because it probably happens all the time.

 

[Entadus]

If your dean prefers you sit for boards in ONE WEEK with a most recent practice test that is NOT PASSING then he is demonstrating incredibly poor judgement on YOUR behalf.

 

[Ismet]

Talk to the 2nd dean.

 

[jurisburger]

Agreed with Entadus. Your dean is not the one who will face the consequences should you not pass step 1. That said, do what you need to do to try and delay within whatever boundaries your school will allow.

 

[Keona]

do not take this exam in 1 week. There is almost always extra time built into the 4th year, it will make it so you don't have as much elective time or time off but just do not take this exam when you are that far away from passing. It is better to delay graduation than it is to fail this exam

 

[EM2Be2017]

I know there are many things that occur behind the scenes to get med students to perfectly fit into all the different rotations, but frankly your dean is not looking out for you at all. If you are consistently scoring around the 180's, even low 200's, you are on the express way to fail Step 1 or at the very best barely pass it. Neither of which will be a good outcome.

Honestly I'm extremely surprise that your dean is encouraging you to take the test in a week (unless the 180 was a fluke and you previously were scoring much better on the NBME's). You should be persistent and try to start your third year one rotation late, and then finish up the last third year rotation in the beginning of fourth year. I don't see why this would be a problem. As stated above most schools have a significant amount of free time built into the fourth year. Worst case scenario you have to delay graduation, but you can use that time productively if you do it right.

Bottom line:

Graduating a year late is expensive and you will need to do something productive in order to turn it into a positive thing.
However, failing Step 1 will virtually kill your chances to match and you will have to fight tooth and nail to land any residency position. Scoring very low on Step 1 is not much better.

 

[operaman]

You are going to delay regardless of what people say. Either you take it now, almost certainly fail, and have to delay to re-take. Or you delay, study, and pass the first time when you're ready.

Do whatever it takes to pass this thing. Talk to whoever you must.

It doesn't matter at all when you take this thing. Since nothing looks worse and hurts you more than a step failure, your decisions all become no-brainers. No matter what you have to do, as long as you pass, it will look better than a failure.

Your original post betrays a complete lack of insight into your current situation. You've had 2 years of school and at least a couple hours of dedicated study and you are still hitting a 180. This means you are blowing many of the "gimme" questions and are nowhere near ready to take this test. Not only are you nowhere near ready to test in a week, I think you're nowhere near ready to test in a month. Or two. Your knowledge base has some serious holes. This will take time to fix.

 

[W19]

I disagree with some of the comments above. A low 200 (or even 192) is a HECK of a lot better than failing that exam. You definitely need more time because miracle doesn't usually happen on test day; your last NBME +/- 10 is very predictive on what will happen on test day. Based on your last practice exam, you might need a least another 6 wks to bring up that score to a comfortable margin where you don't have to worry about failing.

Maybe you should talk to another dean because I don't think 6 wks LAO would put someone one year behind because most schools have a short 4th year curriculum (usually 8 months).

 

[resp228]

Thank you everyone for the thoughtful replies. After taking in all of your advice I am going to speak to the 2nd dean regarding delaying my first rotation, regardless of if I have to graduate late.

I will have approximately two months to study. I will do whatever it takes to get my score up. Do any of you have specific reccomendations on what I should focus on/how to structure my studying/resources to use.

All advice is greatly appreciated.

 

[LyMed]

I think you're making a good decision. Graduating late is not the end of the world, and it's a whole lot better than failing the STEP.

Cj_cregg brings up a lot of great questions. Answering those will let us help you do better on the test.

 

[operaman]

Good questions to think through above. My gut sense is that you would probably benefit from some sort of commercial course that would give you a good thorough review of the material. I would argue that self-study may be problematic given your current predicament. Agree with utilizing all the resources at your disposal through your school. Maybe having someone go through some practice questions with you to understand why you are struggling would be helpful. I used to do this for people and sometimes I would be able to pinpoint some issues that they could easily correct with a little practice. Others simply had massive knowledge gaps that would take more time to address.

For you, the name of the game is going to "low hanging fruit." Find where you can pick up the insanely easy points. Things like biostats are super easy to get a quick grasp of (at a step 1 level). If you blew enough points there, it may be easier to get your score to passing than you think. At 180 you're definitely missing lots of super easy high yield stuff.

Were I in your shoes, my strategy would be utilize a shorter commercial comprehensive review course for 2-3 weeks and see if I could nudge my score up to comfortably passing. If still not quite there (>205 on NBMEs), try and more comprehensive course that goes longer. If your score is comfortably passing after the first course, switch to a more traditional UFAP style prep and see if you can't pick up a few more points before test day.

 

[Caltechstud]

Delaying graduation is really no big deal. At least 5% of each class in my school delays a year to do research, MPH, MBA, or even just take a year off to breath. What I suggest you do now is to take a year off - and in this year kill both Step1 and Step2CK along with a bit of research (as your excuse as to why you took a year off) - that way you will be a rock star in your M3 year with all your advanced medical knowledge and have padded your CV.

Just to give you an example of how bad failing Step 1 is - my friend failed Step 1, came back with a 220s Step2CK, and some high-passes during his M3 year - and he struggled to get interviews even in family medicine - eventually he matched about number 6 on his rank list. I have another friend who got 250+ Step 1 and Step 2CK along with similar M3 grades, but took a year off after M3 year to spend time with his family, and his interview invite rate for EM is 20/40.

Delay a year, kill that Step 1. It will be the best decision you have ever made.

 

[Redpancreas]

I am currently scheduled to take my Step 1 exam in one week. Due to family financial and health problems my dedicated study period was significantly affected. My latest NBME score is a 180.

I spoke with one of the deans of student affairs at my school and the dean is saying if I delay my first rotation (6 wk fam med) I will not graduate with my class, but instead will graduate either 6 mo's or a yr late as there may not be a spot available at the start of 4th year. The dean prefers that I take the exam next week.

I believe I am a good student who has received a fair number of honors/high passes, but I am going through a difficult time. I know I need to delay the exam as I am not passing, but I am worried about the repercussions. Some upperclassmen have suggested that I speak to the senior dean as I should be able to graduate on time. However, I do not want to appear as if I am trying to circumvent the first dean.

Please advise and give thoughts on how to proceed. Thank you.

I'm not a PD. I haven't even applied yet. I'm just speaking from what I think people will see which frankly I think is OK because even among PDs you'll experience diverging thoughts as I experienced last year when I delayed Step and at the end of the day there's no data to address this with good power.

So, your sole focus should be finding someone to give you the green-light to delay. It could be your dean but even maybe your counselors because I believe they're there because LCME wants to see fair student advocates.You say you're scoring well on school exams and 180 on NBME so something's not right and you need to delay. Your school is doing you a disservice. It's unfortunate that after high school, undergrad, and finally medical school all the success and hard work boils down to your second/third year performance and a big chunk of that is Step and if you fail that will throw a wrench into your plans. The good news is there's definitely a larger hazard with scoring very low than upside to scoring above POE (plastics/Ortho/ent) specialty averages high. That may sound bad at first but the overall message is that if you can survive the exam with -15 or so pts. of your desired field, you are still somewhat in the running because while the Step is important, its not like it stands for a running sum of your performance every day of third year. It's a scaled score off one day and adcoms know that which is why they use it for cut-offs which typically don't run about 240s even at competitive places as opposed to allowing it to impress them and offer automatic rank b/c these days 30% of students have a 240+. Therefore, your job is to survive Step rather than to be forced to be on the offensive and beat a certain score.

Now, secondly it's unfortunate (assuming you know for sure there's no way, otherwise it's in your best answer to figure out if there's a way) your school doesn't have a delayed track. At some schools, they let you start 4th year late and give up a month's vacation by taking a May elective next fall or taking something easier for interview month so you can afford to interview and fulfill credit simultaneously (that account Ms for two months). At other schools they offer pre-Clerkship electives (like business in medicine, law/humanity classes) which are the equivalent to 4th year electives which allow students to get make up the difference 4th year. The 1 yr. delay + average step score >> fail/borderline pass step score as everyone has pointed out. That being said, don't go into this delay trying to do too much like trying to get 270+ step 1 or be superman and try to do Step 1/CK/publish 5 papers ina year. Since they've given you a year take a nice long time take 4 months for Step 1 but still go at fast pace and don't aim for the stars because that year delay will erase any benefit of a superb score so if you're plateauing at 230, just get it done. Then spend the rest of the time on research because taking a year off with nothing to show for it besides even a great step score doesn't look good (again my apologies your school i.e. screwing your with no delayed track). Find one dedicated project and work to get published and don't do anything else. If your passion isn't research or if you find you're not seeing anything, there are opportunities in curricular development and innovation that you can receive similar recognition for undertaking challenging projects if you can code, work hard, or have a passion in a unique skill set. Try doing twenty things and you'll do none well. Taking Step 2 CK during this time is doable but I wouldn't recommend it.

The subjective number cutoff I'm willing to say you should feel confident to go on and take the test is 230 if you're aiming for anything competitive (I'm talking really comp. like Ortho ENT level) and a 210ish if you're aiming for IM/EM and 200 if you're certain about FP. The reason is that while the average scores may be higher a year off is a solid red flag that is worth those points. Now for anyone reading this, this applies to a year delay not something that doesn't delay graduation.

 

[resp228]

Thank you again everyone for the thoughtful replies.

After speaking to the 2nd dean, my school is going to allow me until the end of July to take the exam. They have stated that as I am delaying a rotation, I may graduate late, however there is a possibility that I can still graduate on time if space in the rotation is available at the start of fourth year. I recognize some may disagree with this, but I would prefer not to take a full year off if there is a possibility I can graduate on time.

In terms of studying I have done:
- 1 Pass of First Aid
- ~1000 questions in UWorld, 55% average (random mode)
- Pathoma
- ~40% of DIT (started recently after I recognized how far behind I was falling)

I know I have a lot of work to do. I will complete DIT in the next 1.5 weeks and then take another NBME. Following that, I will focus on the UFAP method and supplement with sketchy micro. One of the areas I am particularly poor in is pharmacology. I am considering using sketchypharm, but I am not sure if this is the the most time efficient resource out there.

I would appreciate any advice/thoughts on my study plan, as well as recommendations on a resource for pharmacology.

 

[W19]

If you are not aiming for a competitive specialty (i.e derm, plastics, ENT, rad onc, urology, ophthal, or ortho etc...), I don't think you need to take a year off. But the problem is that you might go into 3rd year and find out that you like one of these competitive specialties...

Now that you are successful in getting 6 extra wks to study for that beast, you should try to make the most of it. I think Kaplan videos and lecture notes were good for pharm...

 

[Keona]

You need to do all ou uworld. I feel like the questions on the exam were very similar. No day should go by that you haven't done multiple blocks. I made mind maps of the questions. Basically just word vomiting onto the pages. Memorize bio stats. Those are sometimes easy points you might accidentally throw away. I am speaking from view point of having failed this exam the first time. I passed the rest all on the first try. (Current resident and I do fine on intraining exams). The more questions I do the better my score. I would do them on random timed tutor mode because I would rush otherwise. I switched a few days before exam to random timed. I also played audio lectures continuously. As in while falling asleep and waking up. If I took a video game break I listened to lectues, outside walking, listening, gardening, listening. I used apollo audio but the other things that exist now may be better. Brainwashed myself for the usmle. Also get an eye exam. Eye issues often come up during medical school and are ignored. This exam will bring them out even if you've compensated for years. I learned the hard way. My vision got blurrier the longer I studied each day.

 

[Poit]

Your last point isn't true. There is a mile of difference between scoring a 191 and scoring a 193 on this exam. If you're a US MD, a passing step score will more likely than not get you into some residency. Failing it will not. Speaking of which, OP, I would do what you need to do to not have to take this exam. The risks are too high.

I know there are many things that occur behind the scenes to get med students to perfectly fit into all the different rotations, but frankly your dean is not looking out for you at all. If you are consistently scoring around the 180's, even low 200's, you are on the express way to fail Step 1 or at the very best barely pass it. Neither of which will be a good outcome.

Honestly I'm extremely surprise that your dean is encouraging you to take the test in a week (unless the 180 was a fluke and you previously were scoring much better on the NBME's). You should be persistent and try to start your third year one rotation late, and then finish up the last third year rotation in the beginning of fourth year. I don't see why this would be a problem. As stated above most schools have a significant amount of free time built into the fourth year. Worst case scenario you have to delay graduation, but you can use that time productively if you do it right.

Bottom line:

Graduating a year late is expensive and you will need to do something productive in order to turn it into a positive thing.
However, failing Step 1 will virtually kill your chances to match and you will have to fight tooth and nail to land any residency position. Scoring very low on Step 1 is not much better.

 

[Redpancreas]

Thank you again everyone for the thoughtful replies.

After speaking to the 2nd dean, my school is going to allow me until the end of July to take the exam. They have stated that as I am delaying a rotation, I may graduate late, however there is a possibility that I can still graduate on time if space in the rotation is available at the start of fourth year. I recognize some may disagree with this, but I would prefer not to take a full year off if there is a possibility I can graduate on time.

In terms of studying I have done:
- 1 Pass of First Aid
- ~1000 questions in UWorld, 55% average (random mode)
- Pathoma
- ~40% of DIT (started recently after I recognized how far behind I was falling)

I know I have a lot of work to do. I will complete DIT in the next 1.5 weeks and then take another NBME. Following that, I will focus on the UFAP method and supplement with sketchy micro. One of the areas I am particularly poor in is pharmacology. I am considering using sketchypharm, but I am not sure if this is the the most time efficient resource out there.

I would appreciate any advice/thoughts on my study plan, as well as recommendations on a resource for pharmacology.

Congratulations. A year vs. a 2 month delay is huge. Once you are done with Step, find out how to graduate on time by all means necessary. I'm thinking electives where you can interview and get credit if your school normally gives you months off and you'll definitely be doing a May elective. In terms of strategy, forget first aid passes. Continue DIT and that'll be your pass until the last week where you're at the point where you can just read FA. Grind out UWorld with 80 a day. Leave FA open but no need to write much (if anything) down on paper or FA.

When I was granted a delay, i felt a huge burden fall off, but that wasn't the best thing in the short term because I wasted some time after that experimenting with resources. Don't skip a beat. The end of July will come before you know it (not to stress you out but figured it should be said).

SketchyPharm is not something I'd recommend for Pharm because of the sheer time. Just grill the MOA/Clinical Use/Side Effects as FA has that outlined for you by organ systems. Now there are some subtleties to Autonomic Pharmacology you need to understand so I recommend watching the Beta drugs in SketchyPharm or just pay attention when DIT explains it.