Anyone do poorly on step 1, but overcome it? Need advice

[radiculopath]

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So...

I am sure this topic has come up a million times before, but anyone out there (current 4th years, residents, attendings) that did poorly on step 1, but still made it into a field they were interested in?

If so, what did you do to help out your residency apps? Any advice would be great.

My situation : Typical mid-west school. Did ok through med I/II, lettered in a few things, did research, overall nothing stellar and nothing bad, attributed some of that to problems with depression (organic causes; end of a loooong term relationship of 8 years, and death of a sibling who was very supportive). Studied for step 1, seemed to be in the average-above average range of things. Nerves were pretty racked the day of the exam (had only been able to sleep ~3 hours combined the two nights before the exam). Took it. Time was not an issue. Waited nervously for weeks.

Got my score....189/77...ouch.

Contemplated dropping out.

Decided I was too interested to see if I would enjoy 3rd year and all the clinical experiences. Anything had to be better than med I/II right (..zzzz..)?

So far have done fairly average in my clinical rotations.

Trouble is, it is time to start thinking about scheduling for 4th year...stress..

I haven't hated anything (well, IM rounds kind of bore me, to tears). But overall I think I have been able to find the positives/interesting parts of each rotation and view the experience as such.

The two areas I have felt most intense about have been General Surgery and Psych. I know. Odd combo. Of the two, Gen Surg really stood out to me. I love the material..all the classic surgical topics, hands on procedures, concise rounding, and it gave me that proud/motivated feeling to think about working in the field. Psych on the other hand, besides the fact that every day seems very different, appeals to my "social aspect" side. I am very interested in substance abuse and mental health issues. I liked that you can actually spend time with patients getting to know them, and actually trying to build a trusting relationship. Not to mention all the attendings I encountered (and residents) were fairly happy, well adjusted, smart, fun people, who still seemed to have time to enjoy life.

My problem now is

A) The obvious. A bad step 1 score will make Surgical (or really any) programs run for the hills. Attendings have voiced that to me, in spite of thinking I did well on their service, that I gave good presentations, was very interested, had no qualms about staying late, and did very well when pimped. Even on Psych although I did well, my attending seemed to take two steps back when I approached this topic. Obviously I would at least be a little more of a consideration for a Psych program. But generally my problem has been received in the same way.

B) These reactions have really set me back, and have once again made me question whether or not I should continue to move forward with my studies. Not a good mindset to be in. It is making me feel like even though I have kept on trucking and done decent, the bitter reality (and label) is just always around me despite having a good attitude. All of the advice I have sought has either been negative, in terms of "sorry, you just didn't do well, and therefore you are not competitive for this or that", or really just misguiding (consider a specialty you think you will match into...bad advice).

C) Loans...I know some are lucky enough to not have them. But more than half of current students are in my position. Reliant on them. As of right now I am ~$160k in debt. If I finish school I will be somewhere between $220-240k. Given my situation, which I think is referred to as "a rock and a hard place", I am pretty confused. Big money was never really a driving goal for me, but this Sisyphean boulder in the form of loans is really complicating my decisions. Loan payments of ~$2000 a month, if one is not earning a "doctor's wage", are no joke. To even be able to live normally (say $36-48k per year) I would have to earn $60-72k per year.

Do I keep the boat afloat and just finish out as well as possible? I know a decent step 2 score can be somewhat redeeming, but it is not a fix-all. I had a friend who was a few years ahead of me who was in a similar boat and didn't match on his first try. Ended up having a pretty rough year (unemployed) reapplying for the match, only to end up in a specialty he wasn't really passionate about (and is subsequently thinking about leaving medicine). I do not want to end up applying to something out of necessity, because I know myself, and know that would be the same case for me.

Any advice would be great!

 

[Instatewaiter]

There are a few reasons you should stay in:
You seem to like medicine in general but are discouraged about the score and you have loads of debt that would be hard to pay off.

Why don't we look at the data and maybe that will make you feel better.
In anesthesia, a competitive specialty 60% with scores between 182-190 matched
In EM 70% with your score matched
In FM 90% with your score matched
In IM 85% with your score matched
In neuro 70% with your score matched (which i am surprised it is so low)
In OB/GYN 80% with your score matched
In pathology 90% with your score matched
In Peds 91% with your score matched
In PM&R 67% matched
In Psych 86% matched
Unfortunately in Gen Surg and things like derm, plastics, rad onc 1/3 or fewer matched

So at this point you need to do things that will make you stand out and also make that score seem more like a fluke.
- Do research
- Get good clinical grades
- Volunteer and beef up your extra curriculuars
- Take step 2 and do better on it. I'd recommend taking it as early after 3rd year as you can so that you can get the score out there.
- Anything else that will make you more competitive or seem like an interesting candidate

Really almost nothing except the most competitive fields are closed to you

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

 

[radiculopath]

cool, thanks.

i was hoping someone would post the data you put up. that is definitely somewhat of a relief. or at least somewhat hopeful.

i guess i was just letting things that are not within my control (opinions) get me off track.

 

[Taurus]

I don't see a problem. So you scored low. Other people fail the steps. Sometimes multiple times. You're more likely to get psych than surg but anything is possible. If you drop out, there aren't too many fields that can give you the income you need to pay off your loans. Even in psych, you're going to make in the 6 figures easily.

 

[silas2642]

So...

I am sure this topic has come up a million times before, but anyone out there (current 4th years, residents, attendings) that did poorly on step 1, but still made it into a field they were interested in?

If so, what did you do to help out your residency apps? Any advice would be great.

My situation : Typical mid-west school. Did ok through med I/II, lettered in a few things, did research, overall nothing stellar and nothing bad, attributed some of that to problems with depression (organic causes; end of a loooong term relationship of 8 years, and death of a sibling who was very supportive). Studied for step 1, seemed to be in the average-above average range of things. Nerves were pretty racked the day of the exam (had only been able to sleep ~3 hours combined the two nights before the exam). Took it. Time was not an issue. Waited nervously for weeks.

Got my score....189/77...ouch.

Contemplated dropping out.

Decided I was too interested to see if I would enjoy 3rd year and all the clinical experiences. Anything had to be better than med I/II right (..zzzz..)?

So far have done fairly average in my clinical rotations.

Trouble is, it is time to start thinking about scheduling for 4th year...stress..

I haven't hated anything (well, IM rounds kind of bore me, to tears). But overall I think I have been able to find the positives/interesting parts of each rotation and view the experience as such.

The two areas I have felt most intense about have been General Surgery and Psych. I know. Odd combo. Of the two, Gen Surg really stood out to me. I love the material..all the classic surgical topics, hands on procedures, concise rounding, and it gave me that proud/motivated feeling to think about working in the field. Psych on the other hand, besides the fact that every day seems very different, appeals to my "social aspect" side. I am very interested in substance abuse and mental health issues. I liked that you can actually spend time with patients getting to know them, and actually trying to build a trusting relationship. Not to mention all the attendings I encountered (and residents) were fairly happy, well adjusted, smart, fun people, who still seemed to have time to enjoy life.

My problem now is

A) The obvious. A bad step 1 score will make Surgical (or really any) programs run for the hills. Attendings have voiced that to me, in spite of thinking I did well on their service, that I gave good presentations, was very interested, had no qualms about staying late, and did very well when pimped. Even on Psych although I did well, my attending seemed to take two steps back when I approached this topic. Obviously I would at least be a little more of a consideration for a Psych program. But generally my problem has been received in the same way.

B) These reactions have really set me back, and have once again made me question whether or not I should continue to move forward with my studies. Not a good mindset to be in. It is making me feel like even though I have kept on trucking and done decent, the bitter reality (and label) is just always around me despite having a good attitude. All of the advice I have sought has either been negative, in terms of "sorry, you just didn't do well, and therefore you are not competitive for this or that", or really just misguiding (consider a specialty you think you will match into...bad advice).

C) Loans...I know some are lucky enough to not have them. But more than half of current students are in my position. Reliant on them. As of right now I am ~$160k in debt. If I finish school I will be somewhere between $220-240k. Given my situation, which I think is referred to as "a rock and a hard place", I am pretty confused. Big money was never really a driving goal for me, but this Sisyphean boulder in the form of loans is really complicating my decisions. Loan payments of ~$2000 a month, if one is not earning a "doctor's wage", are no joke. To even be able to live normally (say $36-48k per year) I would have to earn $60-72k per year.

Do I keep the boat afloat and just finish out as well as possible? I know a decent step 2 score can be somewhat redeeming, but it is not a fix-all. I had a friend who was a few years ahead of me who was in a similar boat and didn't match on his first try. Ended up having a pretty rough year (unemployed) reapplying for the match, only to end up in a specialty he wasn't really passionate about (and is subsequently thinking about leaving medicine). I do not want to end up applying to something out of necessity, because I know myself, and know that would be the same case for me.

Any advice would be great!

I think that you're going to be fine... definitely don't drop out. You didn't do well on step I (neither did I), you're doing fine on your clinical rotations, which means that you're probably going to be a competent physician.

 

[njbmd]

Your best shot for anything is going to involve taking Step II early in 4th year and doing extremely well on that exam (both parts). I say take it early because you want your scores to be on your ERAS when you apply for residency (Non-ROADs most likely). A less than distinguished Step I coupled with a stellar Step II sure looks better than just that Step I.

 

[OpalOnyx]

-

 

[allergisttobe]

i matched into one of the most competitive subspecialties in internal medicine (cards, GI, allergy/immunology are top 3) last year with no issues and i only scored slightly higher than you. just work hard from now on. no program will base everything on only one score.

 

[radiculopath]

thanks again for the replies everyone. i appreciate the words of encouragement, but for brevity's sake if anyone has specific suggestions (ideal study programs for step 2, good advice given to them, or application strategies; i.e. the match statistics reply, that was helpful) please post those, otherwise please limit the "hang in there buddy" posts.

 

[Instatewaiter]

The best way to study for step 2 is to study hard for your rotations and do well on your shelf exams. That will give you the best background info because the review books are a bit 'bare-bones.' PM me if you want suggestions on books for rotations.

Specifically for step 2, I would recommend either First Aid or Secrets for Step 2 and USMLE world. If you really want some excellent background, the best book I can think of is "Step up to Medicine." Knowing that cover to cover will get you a good score. Most of the exam is from internal medicine (75%)

Estimate that it takes 6 weeks to get your score back for Step 2 CK. You want that score to be part of your ERAS when you send it out and you want to send your ERAS within a few weeks of when it opens (opens on Sept 1).

I took 3 weeks to study and that was a bit too long for me because I had just come off of Internal Medicine. As I said before that was most of the exam. I would recommend taking between 3-4 weeks so that you can get through Step Up To Medicine as well (I had already read it for the IM shelf)

 

[Knicks]

There are a few reasons you should stay in:
You seem to like medicine in general but are discouraged about the score and you have loads of debt that would be hard to pay off.

Why don't we look at the data and maybe that will make you feel better.
In anesthesia, a competitive specialty 60% with scores between 182-190 matched
In EM 70% with your score matched
In FM 90% with your score matched
In IM 85% with your score matched
In neuro 70% with your score matched (which i am surprised it is so low)
In OB/GYN 80% with your score matched
In pathology 90% with your score matched
In Peds 91% with your score matched
In PM&R 67% matched
In Psych 86% matched
Unfortunately in Gen Surg and things like derm, plastics, rad onc 1/3 or fewer matched

So at this point you need to do things that will make you stand out and also make that score seem more like a fluke.
- Do research
- Get good clinical grades
- Volunteer and beef up your extra curriculuars
- Take step 2 and do better on it. I'd recommend taking it as early after 3rd year as you can so that you can get the score out there.
- Anything else that will make you more competitive or seem like an interesting candidate

Really almost nothing except the most competitive fields are closed to you

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

Interesting statistics, there.

 

[penguin24]

The big study material for Step 2CK is:

1) FA for Step 2 ck
2) USMLE Step 2 Secrets, by Adam Brochert
3) USMLE World q-ban

You are at the top of your knowledge-base at the end of your M3 year, so take Step 2 CK at the beginning of your M4. Gen Surg & Psych are not competitive, so as long as you apply to many (>60 programs in either one) you will have many interviews to choose from. Don't let anybody convince you to apply to less programs, they will say 'oh no, you'll be fine, you don't need to apply to more programs', but if you don't match they will say, 'well it's your fault, you should have applied to more programs'. Don't forget to apply to small community programs in the middle of nowhere, b/c believe me, you would rather be there than scrambling for a spot come match day.

Also, don't think you will be a lousy doctor just b/c you barely passed Step 1. If you think about it, that means according to the National Board of Medical Examiners you have enough knowledge to be a competent physician. A low Step 1 score just means that you will have a tough time getting a Derm/Plastic Surg residency, but that has nothing to do w/ being a great doctor.

 

[Momentum70]

I was in similar situation with step 1. I got really stressed out and slept about an hour the night before. Needless to say I got much lower than my practice tests showed and got about the same grade as yourself. The above posters suggestions with usmle world is good, but id add this. Relax, try not to stress. I didnt study or look at a single thing a couple days before step 2 and just did activities to relieve stress. I ran a lot the evening before and tired myself out and got a good night of sleep. Also apply to a lot of programs. I applied to way more than many of my friends on the advice of my advisor. Some programs I wanted rejected me and it was because I had sub 200 step 1 and you will run into that, but there will be enough that wont hold it too much against you. As someone already stated take step 2 early enough to have your score back before you apply. I raised mine just over 35 points. I got asked about the low step 1 score in a lot of interviews as it didnt match my academic performance in my rotations and step 2 and most programs seemed cool with my explanation that I had just gotten really stressed out and corrected it for subsequent tests. A couple program directors even said it was a mark for me because it showed I could handle stress and make changes. So to Recap

1) Relax and try to get as stress free as possible before step 2
2) Kick butt on Step 2
3) Apply to MANY programs to get around those with step 1 cutoffs

 

[penguin24]

Oh yeah, I forgot to mention the cutoff Step 1 score that some programs use. The reason you need to apply to many programs is b/c you most likely won't know which programs are using them (as this info is not usually public). Gen Surg is more likely than Psych to use cutoffs as it is more competitive. Remember, you can always decline interviews if you apply too much.

PS: Don't let the Step 1 cutoffs discourage you, there are many programs that don't use them. However, some programs (ex: UCSF) get way too many applications and need a quick way to screen out applications, and Step 1 is the most convenient way to do it as it is standardized throughout the nation and comes in a nice easy to read number, and everybody will have it on their applications.