Advice on whether to transmit a bad step 2 CK score

[Eventhorizon88]

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I'd like to start off by saying that this is my first time posting in these forums, so I apologize if this isn't considered a unique enough situation to merit its own thread. I tried looking for similar situations to mine, but most of the threads here about "bad" step 2 ck scores refer to either failed scores or scores that are slightly below average but freak someone out because he or she is applying to a very competitive field, neither of which fit my situation.

I'm a 4th year medical student at a mid-tier American allopathic medical school. I've earned all high pass and honors grades aside from a pass in general surgery. I've chosen to go into internal medicine, and I'm not deadset on going to an elite program, just a good academic program that helps me get into a solid fellowship if I choose to subspecialize.

I sent out my internal medicine residency applications a month ago, and I was told by my advisor that my clinical grades put me around the 85th percentile at my school (I love clinical work), but my shelf grades are roughly average, and my step 1 score was 218, which is not a glaring redflag for internal medicine but is still below average. My school requires Step 2 CK be taken before November 1st, and I thought a mid-August test date would give me time to study while not being so late that I'd forget stuff from 3rd year. Unfortunately, I had personal issues (parents' divorce, girlfriend and I broke up) come up, and those limited my time and effectiveness studying for CK. I pushed back the test by a month, but I learned this week that my score was just a 223, far below average.

So I'm torn as to whether to retransmit my USMLE transcript or not at this point. On the one hand, my Step 2 CK score is further below average than my Step 1 score. On the other hand, I didn't fail it, and many of the programs I applied to "allegedly" require step 2 CK grades before sending out interview invites. I use the term "allegedly" because 3 of those programs that "require" Step 2 CK grades actually sent me invites anyway even without me transmitting my score yet. However, I haven't heard from all of those programs, and I'm worried the lack of response is because they're waiting for me to send them a Step 2 CK grade before they consider my application.

My medical school advisor is dealing with a serious health issue and understandably, he hasn't been responsive to e-mails for the past couple of weeks. If anyone here could offer me insight, I would really appreciate it.

 

[thesauce]

I vote that you send it out. It's not that bad…

 

[mvenus929]

Your programs that sent you invites without the score probably require it for ranking. You should look into that.

 

[Eventhorizon88]

I vote that you send it out. It's not that bad…

Thank you for your response. That's what I'm leaning towards.

I know it's not a terrible score, but it seems like all of my classmates going into IM that I talk to say they scored a solid 15-25 points more than me, which is a bigger gap than for my Step 1 score.

I guess I'm just worried that my "low but not terrible" score could scare off potential interview invitations. The fact that my application without the score is good enough to get me interviews so far makes me nervous about damaging it by transmitting the score.
At the same time, I don't want programs to ignore my application because it lacks a Step 2 score...so I'll probably send it unless a few people warn me that it would be crazy/stupid to do it.

 

[Eventhorizon88]

Your programs that sent you invites without the score probably require it for ranking. You should look into that.

Thanks. I was warned about that, and I definitely intend to transmit the score before the rank lists are made.
The debate I'm having is whether to send the score now, while applications are being reviewed and interview invitations are still being sent out, or if I should wait until December or January before doing that.

If I wait to transmit, programs will have the score on hand in time to rank me but not early enough to deny me an interview based on that "bad" score. On the flipside, programs that are serious about requiring the score for interview invitations might not give me an interview at all if I don't give them a score. That's my conundrum.

(I'm aware that I'm probably over-thinking this. I'm just a little on edge since my advisor isn't reachable, so I'm "flying blind" on this issue without any real guidance)

 

[mvenus929]

Thanks. I was warned about that, and I definitely intend to transmit the score before the rank lists are made.
The debate I'm having is whether to send the score now, while applications are being reviewed and interview invitations are still being sent out, or if I should wait until December or January before doing that.

If I wait to transmit, programs will have the score on hand in time to rank me but not early enough to deny me an interview based on that "bad" score. On the flipside, programs that are serious about requiring the score for interview invitations might not give me an interview at all if I don't give them a score. That's my conundrum.

(I'm aware that I'm probably over-thinking this. I'm just a little on edge since my advisor isn't reachable, so I'm "flying blind" on this issue without any real guidance)

The bottom line is that if they are going to care about your Step 2 score, it's not going to matter whether it's now or when they are finalizing their rank list.

 

[thesauce]

The bottom line is that if they are going to care about your Step 2 score, it's not going to matter whether it's now or when they are finalizing their rank list.

And if they don't care about it, there's no reason not to release it

 

[Sheldor]

The bottom line is that if they are going to care about your Step 2 score, it's not going to matter whether it's now or when they are finalizing their rank list.

I actually disagree. Personally, I'd wait. If you release now then people can choose not to give you interviews based solely on numbers. However, if they find out later after you've interviewed you are now a person to them, not an application. If they loved you, a slightly low step 2 won't change that!

I'd split the difference, maybe wait a couple/few more weeks to see who else will give you an invite without it?

 

[Eventhorizon88]

I actually disagree. Personally, I'd wait. If you release now then people can choose not to give you interviews based solely on numbers. However, if they find out later after you've interviewed you are now a person to them, not an application. If they loved you, a slightly low step 2 won't change that!

I'd split the difference, maybe wait a couple/few more weeks to see who else will give you an invite without it?

Those were my exact concerns, so thank you for writing them better than I could. My worry was that programs might see the Step 2 CK grade and use it as an excuse to not closely review my application at all, which would mean my strong clinical evaluations and research accomplishments wouldn't be taken into consideration before my application went into the recycling bin.

However, the more that I think about it, the more I'm inclined to agree with thesauce and mvenus.
Programs that make a big deal out of Step 2 CK would probably refuse to interview me without the score or they would hold the score against me "eventually" as they try to find metrics to differentiate applicants on their rank list in February.

Programs that don't care much about Step 2 won't care since my score isn't "that bad." If I had gotten a 210, barely above a pass, that would give them some pause, but ultimately I've passed both Step exams on my 1st attempt, so I shouldn't be considered that high of a risk to fail Step 3.

 

[Eventhorizon88]

I actually got an e-mail response from an IM resident friend of mine that makes a lot of sense. I'm going to share it here just in case someone else is in a similar situation as me and would like some guidance.

My friend just told me that while a 230+ score would have been better for IM, 223 shouldn't be a deal breaker at most places. If a program *really wants* to see above average Step scores, me hiding my Step 2 CK grade while allowing them to see my score of 218 on Step 1 isn't going to get me an interview anyway since I'm below average on Step 1.

Meanwhile, delaying the release of my score further could prevent me from getting interview invitations at programs who require a score but would be willing to interview me despite my 220+ grade, so long as they're able to see the grade in time to offer me an interview.

Hiding the grade for too long presents more downside than upside, especially since applications were sent out on September 16th, meaning programs have already had a chance to review my application for a month without a Step 2 CK score. There's too much risk that my lack of an interview invite from some programs could be due to the lack of Step 2 CK on my application. Ultimately, the programs will see the grade eventually, so it's better to let programs either include me or exclude me based on the grade now than try to game the system. Programs will have already seen the rest of my application by this point since interview spots are filling up.

Therefore, I'm going to transmit the score today. Thank you all for your responses. It was really helpful to have others help me consider the pros and cons. I hope this thread helps out other people in a similar situation as mine!

 

[mvenus929]

I actually disagree. Personally, I'd wait. If you release now then people can choose not to give you interviews based solely on numbers. However, if they find out later after you've interviewed you are now a person to them, not an application. If they loved you, a slightly low step 2 won't change that!

I'd split the difference, maybe wait a couple/few more weeks to see who else will give you an invite without it?

Most of the time, your place on the rank list is determined before you go to interview. If you have an outstanding interview, you may move up a couple places, but it's unlikely that you'll go from very lowly ranked to ranked to match. If you have a poor interview, you could easily drop down. There's not much advantage to hiding numbers in the hopes that a program will interview you without them.

 

[Sheldor]

Most of the time, your place on the rank list is determined before you go to interview. If you have an outstanding interview, you may move up a couple places, but it's unlikely that you'll go from very lowly ranked to ranked to match. If you have a poor interview, you could easily drop down. There's not much advantage to hiding numbers in the hopes that a program will interview you without them.

Admittedly, I only know about IM what I heard from the PD at my TY year, and there interviews were a huge part. Also, in my field the interview is the most important component (arguably), so I will defer to your expertise on IM if my TY experience was not representative.

 

[rokshana]

Admittedly, I only know about IM what I heard from the PD at my TY year, and there interviews were a huge part. Also, in my field the interview is the most important component (arguably), so I will defer to your expertise on IM if my TY experience was not representative.

no i agree…in IM, the interview plays a big part…it can get you on the DNR list even if your written applicant makes you loo like a rock star…you spend a lot…A LOT of time with these people…you want to make sure they fit in with the culture of the program…you can be smart as all get out, but if you don't get along well with others in the program, well…and sure you may not see that right off the bat in a one day interview, but if its blatantly obvious on that interview day...

 

[gutonc]

Most of the time, your place on the rank list is determined before you go to interview. If you have an outstanding interview, you may move up a couple places, but it's unlikely that you'll go from very lowly ranked to ranked to match. If you have a poor interview, you could easily drop down. There's not much advantage to hiding numbers in the hopes that a program will interview you without them.

Admittedly, I only know about IM what I heard from the PD at my TY year, and there interviews were a huge part. Also, in my field the interview is the most important component (arguably), so I will defer to your expertise on IM if my TY experience was not representative.

no i agree…in IM, the interview plays a big part…it can get you on the DNR list even if your written applicant makes you loo like a rock star…you spend a lot…A LOT of time with these people…you want to make sure they fit in with the culture of the program…you can be smart as all get out, but if you don't get along well with others in the program, well…and sure you may not see that right off the bat in a one day interview, but if its blatantly obvious on that interview day...

This will of course vary widely between programs but in my IM and subspecialty experience (on both sides of the table), the interview usually makes only a small difference one way or the other in where you fall on a program's rank list. But occasionally it does make a difference and when it does, it's huge. I've seen people go from being ranked to match prior to interview to being "DNR" afterwards and the other way around as well. The former is much easier and more common than the latter thought. I'd say it happens to somewhere between 5-10% of candidates every year (at least in the programs I've been a part of).

That said, since the question is whether to transmit a Step 2 score or not (and do we really need 10 different threads asking the same question?), the answer is yes, submit and move on.

 

[J ROD]

I would submit it now for the reasons mentioned above. I think it looks better also. It may not be the score you want, but you passed on the first attempt. I do not think the interview day will make that huge of a difference in the positive way as compared to not being invited to interview by some schools due to the lack of a Step 2 score. I think the interview day will affect someone more if the day goes negatively. Almost all of us know how not to mess up the interview. So, I would think they would be like he/she was nice and maybe if you wowed someone you could move up a few spots but if you went in there and really messed up the interview, I bet that would drop you a hell of a lot faster than making a great impression. The numbers are the numbers. You did your best and that is that. I bet you still can get into a good program and get to where you want to go.

 

[dozitgetchahi]

If anything, I would think you're potentially missing out from getting a load of invites right now from programs that need a step 2 score to make your file 'visible' in ERAS. When I applied, one of my letters didn't get entered in until about 3 weeks after the date when invites started going out and I got a surge of invites that very day.

 

[c/o2015]

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[rokshana]

I think programs need to change the language on their websites if it is true that interview offers will hinge on whether or not a step 2 score is there. None of their websites (in the EM world, n > 40 that I looked at) say that it is required for an interview; applicants shouldn't have to guess what is and isn't required to make their application complete for review. The fact is most advice up to now has been that a strong step 1 score is sufficient to get you in the door. Not everyone has the same 4th yr schedule or can take step 2 right away. If the norm has changed, then that should be spelled out loud and clear on websites, long before ERAS application season so that students can reprioritize things.

you know the spoon feeding stops when you become an intern…

if they don't spell it out to your satisfaction…CALL THEM…and ask for clarification.

 

[mvenus929]

Admittedly, I only know about IM what I heard from the PD at my TY year, and there interviews were a huge part. Also, in my field the interview is the most important component (arguably), so I will defer to your expertise on IM if my TY experience was not representative.

My IM experience comes directly from one of the members of the selection committee at my school. Granted, I'm not IM, so my experience may not be representative either, and may only affect a single program.

 

[ElwayFan]

Assuming the worst case and that everything you say is correct.... you have 2 options.

Release your Step 2, and only programs that don't mind a low Step 2 will interview you, but they'll rank you based on how much they like you.

Don't release your step 2 yet, go on 5 extra interviews at places that require a step 2, then release your poor step 2. These programs will then rank you poorly since they cared about the Step 2. You won't match at these programs. As a result, you now have wasted time, money, and energy on interviews that are going to rank you poorly and that you won't match at anyway.

So extra wasted time/money on dead end interviews? Or just interview based on your real merits at programs that don't mind your score?