Becoming Competitive with a Low Step 1 Score

[lovelearning]

Hi all,
I'm an M3 who just got his Step 1 score back. I was predicted at 229 but ended up significantly underperforming that on test day and got a 202. Still, I'm happy to be past that hurdle. It's still early in the M3 year, but my two biggest interests going into the year are psych and IM. I'm wondering how realistic my hopes are of matching into a psych residency (or IM if any of you have experience with that). I've seen the recent Charting the Outcomes data and know that the percentage of applicants matching into psych has decreased, but the average scores are still not super high (although higher than mine), so I wonder how much of that is not applying broadly enough given the increase in competitiveness. I'm a nontraditional student at a mid/low tier US allopathic school in the Midwest and previously lived on the West Coast (both my family and spouse's are still there) but I'm VERY flexible geographically. Are lower tier academic programs mostly going to screen me out even if I worked hard to do much better on 2 CK? Besides doing better on Step 2, honoring whatever rotations I can, and getting good evals, any thoughts on things I can do to best set myself up for success?

Also, does non-psych research matter at all to most programs? I'm doing some heme/onc retrospective research and have two first-author poster presentations at national conferences (plus one regional one as a second author) and hopefully a first-author publication (started writing that but put it on hold for Step 1).

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[Central_SOULcus]

I matched into psychiatry in 2018 in a highly desirable, very large urban city. I too significantly underperfomed on Step 1 (compared to my "predicted" scores on practice test). Of course we can never really know what helped our applications most, but I honored almost all my clerkships (and the ones I didn't honor were high pass), did nearly 30 points higher than Step 1 on Step 2 CK, honored both of my psychiatry sub-Is, got excellent letters (I didn't get to read them but I heard from interviewers on the trail they were great) and had research in both psychiatry and a non-psych field (with multiple posters between M1 and M4). If your 202 on Step 1 is the only "blip" on your application, I don't see why you would have an issue matching to academic programs. Sure you might get filtered out from the extremely competitive ones, but who really knows! You have a solid year and change to up your game. Work hard, don't focus on the past (i.e. your Step 1 score), and get to it! Good luck!

 

[J ROD]

Yeah you will need to make up for it on CK. And do well on psych rotations. Personally, research outside of psych makes me wonder if psych was your backup.

 

[Central_SOULcus]

Yeah you will need to make up for it on CK. And do well on psych rotations. Personally, research outside of psych makes me wonder if psych was your backup.

I can see in general how some might think this is the case. For OP, I think if your app has nothing really geared towards psych, then research in another field might be construed as psych being your backup. For me, I was first author on my psych posters and second author on my non-psych posters. Even so, my "non-psych" posters were in a different specialty but they dealt with a topic that we actually deal with in psychiatry all the time. @J ROD makes a good point, ultimately, the main thing we want to see in psychiatry is commitment to the field. At least in my program, if it seems psych is an applicant's backup, we're not too interested.

 

[doc-doc-goose]

I matched at a "top 10 psych program" a few years back with a Step 1 score a few points below yours. I had not planned on psych so I had a lot of projects and academic work in a totally different specialty. Psych was my final clerkship of 3rd year and it was during that clerkship that I realized psych was what I wanted (now cannot believe I ever consider anything else). Programs inquired about my research and interest in this other field and I explained honestly how I came to fall in love with psych late in the game. None of them questioned it. I performed significantly better on Step 2 relative to Step 1 and honored almost all of my third year clerkships. That plus doing a lot of community service work helped me a lot. I was offered an interview at every top NE program to which I applied. I have friends at various "top 10 psych programs" with below average step 1 scores. Most psych programs still consider the applicant as a whole.

 

[FlowRate]

As everyone else said, crush everything else.

Yeah you will need to make up for it on CK. And do well on psych rotations. Personally, research outside of psych makes me wonder if psych was your backup.

People change their minds, it's normal and expected.

 

[sunshower]

I just went through the last cycle - I had a similar step 1 score and matched at a great academic program in a "desirable city" on the west coast. I think the biggest thing for me was doing well on step 2 (I scored like 40-50 points higher). I did apply to a decent number of programs and didn't receive interviews from some that I thought were more "mid or low tier" programs, while a few bigger names decided to take a chance on me and interview me. Psych is more holistic in their application reviews, but I'm sure a good amount of programs probably have cutoffs for step scores to auto screen people, especially as the number of applicants has been significantly increasing.