Advice on last minute switch to competitive specialty with high step score

[joshuaaw]

TLDR: late M3 year, step1 268, did very little in the way of shadowing or research M1-M3, now considering more competitive options and worried about my application.

I go to a new school with a fairly small program that doesn’t have departments for many subspecialties (derm, ENT, ophtho, rad, etc). We take step 1about halfway into 3rd year.

I did a gen surg elective M1year and didn’t like it much so never considered doing anything surgical. For most of med school I was thinking EM or IM. However I am currently on my M3 surgical rotation and I like some aspects of it and can see myself doing some procedural/surgical stuff (just not gen surg). We also just got step scores back and I got a 268, which obviously opens a lot of doors.

im now considering applying to a more competitive specialty with a procedural/surgical component (derm, ophtho, less likely ENT), but I’m worried about the rest of my application. We dont have any of these programs so I haven’t had any clinical experience in the field (yet) nor have I had any related research.

based on discussion with advisors and classmates, it wouldn’t be impossible to match if I really go big on 4th year what with research and all that, but I’m wondering if anyone was ever in a similar boat and can comment on how feasible it is to match a competitive specialty with a very high step 1 but from a small school without a corresponding department or much prior experience.

any advice would be appreciated!

more info about me: honored most 3rd year Clerkships, 2 research experiences so far, generally a pretty good interviewer.

thanks!

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[GoSpursGo]

I think the advice you've gotten is probably correct--it's not IMPOSSIBLE for you to match as-is if you go in hard on research over the next 6 months, but it's a risk. Having no home institution to advocate for you in these small fields is probably as much of a drawback as the lack of publications. That said, 268 is 268--87% of US seniors with a score >250 matched into derm over the last 5 years. Your odds of matching are probably not quite that high since you lack some of the other hallmarks of those highly competitive applicants, but overall I think it's safe to say that your odds are better than 50/50.

You likely will get some advice to take a research year to solidify your application by getting more research, going to conferences, making connections, etc. If you care about going to a "highly competitive" program, you probably should. Personally, I'd go all-in on research over the next 6 months, get as much mentoring as you can in the field etc, and roll the dice--if you don't match, then you can potentially delay graduation by a year, do your research year then, and re-apply. While having to apply and interview twice sucks, this gives you a chance to match next year.

 

[FindersFee5]

TLDR: late M3 year, step1 268, did very little in the way of shadowing or research M1-M3, now considering more competitive options and worried about my application.

I go to a new school with a fairly small program that doesn’t have departments for many subspecialties (derm, ENT, ophtho, rad, etc). We take step 1about halfway into 3rd year.

I did a gen surg elective M1year and didn’t like it much so never considered doing anything surgical. For most of med school I was thinking EM or IM. However I am currently on my M3 surgical rotation and I like some aspects of it and can see myself doing some procedural/surgical stuff (just not gen surg). We also just got step scores back and I got a 268, which obviously opens a lot of doors.

im now considering applying to a more competitive specialty with a procedural/surgical component (derm, ophtho, less likely ENT), but I’m worried about the rest of my application. We dont have any of these programs so I haven’t had any clinical experience in the field (yet) nor have I had any related research.

based on discussion with advisors and classmates, it wouldn’t be impossible to match if I really go big on 4th year what with research and all that, but I’m wondering if anyone was ever in a similar boat and can comment on how feasible it is to match a competitive specialty with a very high step 1 but from a small school without a corresponding department or much prior experience.

any advice would be appreciated!

more info about me: honored most 3rd year Clerkships, 2 research experiences so far, generally a pretty good interviewer.

thanks!

I don't know as much about ophtho, but derm is very research heavy. Would definitely be worthwhile to take a research year there as, with your score, it would open a lot of doors. Wouldn't it be worthwhile to put residency off for a year if you knew it would give you a lot more say about where you did residency?

With regards to going hard on research now - you basically only have 7 months left to get any projects out, because ERAS goes out in september. Could be tough to find mentors, jump on projects and actually have tangible results (abstracts/posters/presentations/papers) in that time frame.

 

[Cawolf]

I can only speak from an ophthalmology perspective, and will start out by saying that your Step 1 and clinical grades will set you up to get past any screen. The challenge is that in these small fields, who you know (objectively through your three LORs) are even more important than grades. If you get to work setting up some quality away rotations (at least 2) where you can find a mentor and generate some ophthalmology research experiences, I think you still have time to do quite well in the match. You would need to start that soon though, because SF Match goes in earlier than ERAS, so only rotations or things through Summer will make it on the app. Best of luck, and congrats!

 

[LoGo]

Either way, you’d need to pick between derm and ophtho and gun hard. Will be impossible if both are still options on the table. Need to cut one.

 

[mistafab]

You need to decide what you are actually interested in.

 

[CherryRedDracul]

Either way, you’d need to pick between derm and ophtho and gun hard. Will be impossible if both are still options on the table. Need to cut one.

I'm not in either field, but it might be worthy to look for places that offer a research fellowship for those specialties as a back-up in case you don't match. They can act as a nice pipeline to match into those specialties the next time around. You'd typically be doing these fellowships after graduation (and after intern year because you probably matched into your prelim program) as far as I know.

 

[Oedipa Maas]

You need to decide what you are actually interested in.

Agree. First and foremost figure this out. Also, start shadowing in some of these question mark fields as soon as possible. I entered medical school thinking I wanted to do one of the specialities you mentioned because I like working with my hands. When I started shadowing and finally did a rotation in it, I hated it and couldn't see myself doing it. You'll have to figure out other priorities too - is it important to you to graduate with your class, is it important to do a research year, do you like doing research, does it matter what part of the country you go to for residency, do you want to go to a top program or does it not matter if you leave board certified in your field of choice? Another alternative is being a top candidate for EM or IM residencies, both of which have some procedural components. You could set yourself up nicely to be competitive for a cardiology fellowship (also procedural). Just keep in mind that all of these different specialities are going to have different requirements, EM has SLOEs and all programs have a different number of letters they want from different specialities so you need to start signing up for aways as your program does not have some of these options.

 

[Newyawk]

PM me OP, similar story to yours

 

[jw3600]

You need to decide what you are actually interested in.

I think they already did? $$$

 

[VincentAdultman]

OP do you actually like those fields or do you just like the idea of them because you got a 268?

 

[Pepe18]

.

 

[Phloston]

TLDR: late M3 year, step1 268, did very little in the way of shadowing or research M1-M3, now considering more competitive options and worried about my application.

I go to a new school with a fairly small program that doesn’t have departments for many subspecialties (derm, ENT, ophtho, rad, etc). We take step 1about halfway into 3rd year.

I did a gen surg elective M1year and didn’t like it much so never considered doing anything surgical. For most of med school I was thinking EM or IM. However I am currently on my M3 surgical rotation and I like some aspects of it and can see myself doing some procedural/surgical stuff (just not gen surg). We also just got step scores back and I got a 268, which obviously opens a lot of doors.

im now considering applying to a more competitive specialty with a procedural/surgical component (derm, ophtho, less likely ENT), but I’m worried about the rest of my application. We dont have any of these programs so I haven’t had any clinical experience in the field (yet) nor have I had any related research.

based on discussion with advisors and classmates, it wouldn’t be impossible to match if I really go big on 4th year what with research and all that, but I’m wondering if anyone was ever in a similar boat and can comment on how feasible it is to match a competitive specialty with a very high step 1 but from a small school without a corresponding department or much prior experience.

any advice would be appreciated!

more info about me: honored most 3rd year Clerkships, 2 research experiences so far, generally a pretty good interviewer.

thanks!

Thanks for the TLDR. I didn't read except for the top line. With a 268, yes, just apply wherever. You'll beat out Mr. 245 who has 8 papers.

 

[joshuaaw]

Thanks for the advice everyone! After a lot of soul-searching I think I'm gonna stick with my original plan of applying EM. I'm actually probably going to do dual EM/IM, but that's a discussion for another post.

I'm still going to do some shadowing for derm and ophtho in the next couple of weeks just to be sure that I want to rule them out, but I don't anticipate that I'll suddenly discover a passion for those fields.

Thanks again.