MD & DO Came to medical school to be a surgeon. Then I got a 201 on step 1.

[premed_mamba]

Is my dream over? I’ve worked really hard but was dealt a crappy hand dealing with multiple deaths in my family during dedicated. Ended up extended my test date but didn’t help. Not one for excuses so it is what it is. I really don’t enjoy IM/FM at all. I hate the switching of hours of the ED. Not interested in the slightest in OB. Honestly don’t know what to do. Don’t have much experience with gas but CRNA creep has always worried me. Any help would be great.

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[GadRads]

So sorry about the losses in your family. The circumstances surrounding the lower Step 1 score can be addressed in your personal statement. The next steps would be to do very well in M3 and score better on Step 2 CK. All hope isn't lost.

 

[Dr G Oogle]

You can still kill step 2, write a good personal statement and kill it on you surgery rotation. I know people who got into ENT with scores in the 200s and we often match people into our urology program with lower scores a few in recent memory had similar stories to your’s.

 

[ACSurgeon]

If you’re that disinterested in anything else you have to be willing to try, understanding you might end up in a prelim spot that may or may not take you to the finish line.

most important thing for now: networking and finding a good mentor who will go to bat for you. Remember all you need is one program to like you and rank you high. If people at home program love you, that might be the easiest way in

Other things: research (+\- dedicated research year after second or third year) and killing step 2. Also, away rotations should be considered.

 

[Chelsea FC]

Is my dream over? I’ve worked really hard but was dealt a crappy hand dealing with multiple deaths in my family during dedicated. Ended up extended my test date but didn’t help. Not one for excuses so it is what it is. I really don’t enjoy IM/FM at all. I hate the switching of hours of the ED. Not interested in the slightest in OB. Honestly don’t know what to do. Don’t have much experience with gas but CRNA creep has always worried me. Any help would be great.

Which part of med school are you now?? Surgeons and the OR can be a .....*special place/group* so u might do your rotation and end up hating it like alot of students.

 

[NotAProgDirector]

Looking at Interactive Charting Outcomes, based on USMD and S1=201 your chances of getting a GS spot are about 30%. So not zero, but not great either. At this point, you need to maximize the rest of your application. You need to do as well clinically as you can. You need to do as well on S2 as you can, and you need to have that score available the day apps open.

Playing around with Charting outcomes, you can see the effects of various options. Having no research = zero chance of matching. To really boost your chances of matching you need >10 publications, likely from a research year. A S2 score of >230 boosts your chances, and >240 increases to over 70%.

You do need to be honest with yourself. You blame your S1 score on external factors, which may be the case. But how did you do on your prelinical courses? Your prior posts mention you're at a P/F school, but if you've been in the bottom quartile of your class preclinically this S1 score might not be a fluke.

 

[futureapppsy2]

Playing around with Charting outcomes, you can see the effects of various options. Having no research = zero chance of matching. To really boost your chances of matching you need >10 publications, likely from a research year. A S2 score of >230 boosts your chances, and >240 increases to over 70%.

Does this differentiate actual peer-reviewed pubs from posters/presentations and/or “research experiences”?

 

[BidingMyTime]

IM's can go on to fellowship in areas that are have a lot of surgical. If you can work with kids, you could go into pediatrics, then look into a surgical residency/fellowship after that. Perhaps not the pathway you planned. but if you are excited about surgery, there are alternate pathways.

 

[operaman]

OP your best shot at anything right now is going to be your home program. Your mission on rotations and possibly even a research year is to be a rockstar and endear yourself to your surgery department such that they all want to train you.

You will obviously have to do very well on step 2 as well as your shelf exams. You don’t have an easy road ahead as you clearly have some foundational knowledge deficits. Do try and keep a very open mind on rotations and see if there are other fields where you can find something to like.

 

[Wordead]

IM's can go on to fellowship in areas that are have a lot of surgical. If you can work with kids, you could go into pediatrics, then look into a surgical residency/fellowship after that. Perhaps not the pathway you planned. but if you are excited about surgery, there are alternate pathways.

Learn something every day. How many years is the surgery fellowship after pediatrics residency? What is the surgical IM fellowhsip?

 

[flasheroonie]

You can still do much better on Step 2 and explain in your personal statement what happened in your life to affect your Step 1 score.

 

[ACSurgeon]

Learn something every day. How many years is the surgery fellowship after pediatrics residency? What is the surgical IM fellowhsip?

The surgery fellowship after a peds residency is 5 years of residency, 2-4 years of research and and 2 more years of peds surgery fellowship.

The surgical IM fellowship is what Doug did in scrubs…. Autopsies

 

[mrbreakfast]

Here's what I would do:

1) Take a deep breath. This sucks, but it's also in the past now. You can't change it, but it doesn't have to ruin the future.
2) Do your best on your clerkships. You came to med school to do surgery; so did half your classmates. Statistically, you'll decide it isn't for you anyway. I spent the first 2.5 years of med school thinking I'd never want to do anything other than ortho. By the end of third year it was low on my list.
3) Kill step 2, obviously, but also work on research and try to scrub cases in your free time. I have a buddy who matched ortho despite a pretty low step 1 score because he scrubbed into any case he could, even during his free time or while on other rotations. His letters outweighed his step score.
4) Apply broadly, and dual apply to IM. At worst, you don't match surgery and match IM. You can do a second residency after finishing IM. That's a long road, but you'd likely match where you want, and can work for a year or two as a hospitalist in the interim and pay off your loans. And even if you apply to surgery as a 30 year old, you likely won't be the oldest person in your class.

 

[dienekes88]

Just take a deep breath and keep your eyes open to other things. GI. Cards. IR. Etc.

 

[DOVinciRobot]

IM's can go on to fellowship in areas that are have a lot of surgical.If you can work with kids, you could go into pediatrics, then look into a surgical residency/fellowship after that.

Uh…. No….

OP if you really want to be a surgeon then go for it and create a plan B in case it doesn’t work out. Get some research, be a workhorse on ALL rotations and not just surgery, get a mentor or two who will go to bat for you, and I would do aways at realistic programs (I.e community places maybe not in the most popular locales).

 

[Banco]

A lot of good advice has been given already - you will have to make up for your step 1 with a very high step 2 and good research/letters/aways. You can see here the success rates of someone with a step 1 in your range, and that success increases with better step 2/other factors: Interactive Charting Outcomes in the Match - The Match, National Resident Matching Program

I think the IM -> procedural fellowship like GI/Pulm/Cards is also a viable route if you aren't absolutely wed to surgery and like doing things with your hands that have a direct impact.

So ultimately reflect on what you want and set yourself towards that goal (with a plan B in place).

 

[premed_mamba]

A lot of good advice has been given already - you will have to make up for your step 1 with a very high step 2 and good research/letters/aways. You can see here the success rates of someone with a step 1 in your range, and that success increases with better step 2/other factors: Interactive Charting Outcomes in the Match - The Match, National Resident Matching Program

I think the IM -> procedural fellowship like GI/Pulm/Cards is also a viable route if you aren't absolutely wed to surgery and like doing things with your hands that have a direct impact.

So ultimately reflect on what you want and set yourself towards that goal (with a plan B in place).

Do you think that my score will prevent me from getting an academic IM spot? I wouldn’t mind doing a procedural IM field. But I’m equally afraid of not matching for fellowship if I can’t get an academic spot

 

[paki20]

Do you think that my score will prevent me from getting an academic IM spot? I wouldn’t mind doing a procedural IM field. But I’m equally afraid of not matching for fellowship if I can’t get an academic spot

Do cardiology and then specialize in interventional (fixing coronaries, putting in mechanical support systems for cardiogenic shock), peripheral vascular (fixing acute limb ischemia or fixing patients with critical limb ischemia and/or claudication) and/or structural (fixing valves, PFO, VSD). You'll be seeing similar patients to CT surgery and vascular surgery and be able to intervene on them. Great variety from critical care, to outpatient, inpatient, imaging, procedures and very evidence based. Not many fields where a patient is coming in about to die, you intervene within 1-2 hours and patient is able to go home 2 days later. The pay is pretty decent too..although they do make you work hard for that money..just like a surgeon

 

[Dave1980]

IM's can go on to fellowship in areas that are have a lot of surgical. If you can work with kids, you could go into pediatrics, then look into a surgical residency/fellowship after that. Perhaps not the pathway you planned. but if you are excited about surgery, there are alternate pathways.

WTF are you talking about?!?! a surgical fellowship after peds? there is no such thing.

 

[BidingMyTime]

WTF are you talking about?!?! a surgical fellowship after peds? there is no such thing.

Maybe I used the wrong terminology, and its actually another residency? Looking at this list of pediatric fellowships, I guess Gen Surgery isn't one, but someone doing a fellowship in cardiology or gastroenterology would surely be doing surgery?

fellowships after pediatric residency?

yea guys, so what are all the fellowships you can do after a pediatric residency? can you do cards gastro , surgery ect or would you have to do those residencies, and then the peds fellowship? how would it go?:):zip:

forums.studentdoctor.net

 

[Dave1980]

Maybe I used the wrong terminology, and its actually another residency? Looking at this list of pediatric fellowships, I guess Gen Surgery isn't one, but someone doing a fellowship in cardiology or gastroenterology would surely be doing surgery?

fellowships after pediatric residency?

yea guys, so what are all the fellowships you can do after a pediatric residency? can you do cards gastro , surgery ect or would you have to do those residencies, and then the peds fellowship? how would it go?:):zip:

forums.studentdoctor.net

gen surg would be a new residency. cards and GI don't do surgery. GI does scope...peds cards is pretty hands off. adults cards does a lot of cath.

i know you are trying to help the OP but maybe don't chime in with advice on something you know nothing about?

 

[DOVinciRobot]

Maybe I used the wrong terminology, and its actually another residency? Looking at this list of pediatric fellowships, I guess Gen Surgery isn't one, but someone doing a fellowship in cardiology or gastroenterology would surely be doing surgery?

fellowships after pediatric residency?

yea guys, so what are all the fellowships you can do after a pediatric residency? can you do cards gastro , surgery ect or would you have to do those residencies, and then the peds fellowship? how would it go?:):zip:

forums.studentdoctor.net

GI and Cardiology don’t do surgery. Procedures aren’t the same thing as surgery.

 

[Dral]

Gas -> Pain or PMR -> Pain could get you some hands on stuff. My first personal thoughts on Pain are 'turn and run far far away' but I see people posting on the forum about how they enjoy their practice.

IR is another thought.

IR and gas would also be a little tougher with your low step I, but if you decide on a path now and get going on research/involvement (as aforementioned) you could pull it off.

Maybe explore critical care? You can get there via IM, EM, or Gas. EM is also a pathway to Pain, but not sure how much you want to go through an EM residency and risk not getting a fellowship spot.

 

[BidingMyTime]

GI and Cardiology don’t do surgery. Procedures aren’t the same thing as surgery.

My non-physician error, I didn't realize they were classified differently.

 

[mailloxe]

Can you possibly take an extra year? Like apply to various Med student research fellowships or get funding some other way? I’m assuming you’re a 3rd year now, if you push graduation back a year you’ll graduate with people who had p/f step 1

 

[7331poas]

Gas -> Pain or PMR -> Pain could get you some hands on stuff. My first personal thoughts on Pain are 'turn and run far far away' but I see people posting on the forum about how they enjoy their practice.

IR is another thought.

IR and gas would also be a little tougher with your low step I, but if you decide on a path now and get going on research/involvement (as aforementioned) you could pull it off.

Maybe explore critical care? You can get there via IM, EM, or Gas. EM is also a pathway to Pain, but not sure how much you want to go through an EM residency and risk not getting a fellowship spot.

If you cannot do gen surg due to a low step 1 score, how are you going to get IR?

 

[Dral]

If you cannot do gen surg due to a low step 1 score, how are you going to get IR?

AH, thanks for pointing that out. I was under the assumption that the radiology -> IR fellowship pathway was still viable. I see that recently that pathway has closed. I was thinking the OP could get into a low tier rads program and work their butt off and hope for IR after that, but I guess that's no longer an option.

I take that advice back a bit, OP. If you know someone in the radiology/IR world who could help you out, then maybe, but otherwise that would be an uphill climb as well.

 

[Wolvvs]

AH, thanks for pointing that out. I was under the assumption that the radiology -> IR fellowship pathway was still viable. I see that recently that pathway has closed. I was thinking the OP could get into a low tier rads program and work their butt off and hope for IR after that, but I guess that's no longer an option.

I take that advice back a bit, OP. If you know someone in the radiology/IR world who could help you out, then maybe, but otherwise that would be an uphill climb as well.

There are still independent IR fellowships, and ESIR is available at places most students would consider low tier. But I think it's going to be easier and a better option for OP to go IM into a procedural subspecialty because in order to do IR you really need to be interested in radiology first and foremost. IM opens up a lot more options.

 

[Dave1980]

There are still independent IR fellowships, and ESIR is available at places most students would consider low tier. But I think it's going to be easier and a better option for OP to go IM into a procedural subspecialty because in order to do IR you really need to be interested in radiology first and foremost. IM opens up a lot more options.

ESIR isn't lower tier at all. No clue where you got that idea.

IR fellowship is still available after DR but it is now a 2 year fellowship if done as a stand alone thing.

 

[Dave1980]

AH, thanks for pointing that out. I was under the assumption that the radiology -> IR fellowship pathway was still viable. I see that recently that pathway has closed. I was thinking the OP could get into a low tier rads program and work their butt off and hope for IR after that, but I guess that's no longer an option.

I take that advice back a bit, OP. If you know someone in the radiology/IR world who could help you out, then maybe, but otherwise that would be an uphill climb as well.

IR fellowship is still available but it is 2 years after DR now. thats a tough pill to swallow if you are already 5 years deep into training

 

[collegestud2013]

Is my dream over? I’ve worked really hard but was dealt a crappy hand dealing with multiple deaths in my family during dedicated. Ended up extended my test date but didn’t help. Not one for excuses so it is what it is. I really don’t enjoy IM/FM at all. I hate the switching of hours of the ED. Not interested in the slightest in OB. Honestly don’t know what to do. Don’t have much experience with gas but CRNA creep has always worried me. Any help would be great.

First make sure you really want to be a surgeon. Remember that General Surgery residency has a brutal lifestyle and has by far the highest attrition rate when compared to residency programs in other specialties. And your schedule only gets slightly better as an attending surgeon. Make sur

If surgery is what you want to do, besides trying to do well in M3 and Step 2, you may consider taking a research year and then applying for General Surgery when most applicants will have a P/F step 1. There's still a lot of debate how programs will use Step 1 scores for those who have them during this transition period, but many suspect there will be significantly less emphasis on your step 1 score (but possibly still a bit so your low step 1 score can still hurt a bit, but not has much as if you applied when most people will have a higher score than you). The research year can also help with making connections and building up your CV. But be prepared for the possibility of not matching into General Surgery even with a research year.

Some people have suggested IM and then a procedural subspecialty like cardiology or GI. The problem with that will still be the low Step 1 score, which will likely will leave open only lower tier community IM programs open (those that are often populated by mostly IMGs) if OP applies prior to the transition to P/F step 1. Some of them do have in-house cardiology or GI fellowships so it may be possible route, but getting into the competitive IM fellowships is an uphill battle when coming from a lower tier IM program.

 

[Wolvvs]

ESIR isn't lower tier at all. No clue where you got that idea.

IR fellowship is still available after DR but it is now a 2 year fellowship if done as a stand alone thing.

I'm definitely not an expert in this so if I'm wrong please let me know but I can give an example. Lahey Clinic in Burlington MA according to FREIDA is currently about 72% IMG, 10% DO, and 18% USMD--I don't want to insinuate that any program is poor quality and I'm sure you'll get great training, but that doesn't look like an ultra competitive program. They offer 5 diagnostic spots per year and have 1 ESIR spot per year.

 

[collegestud2013]

I'm definitely not an expert in this so if I'm wrong please let me know but I can give an example. Lahey Clinic in Burlington MA according to FREIDA is currently about 72% IMG, 10% DO, and 18% USMD--I don't want to insinuate that any program is poor quality and I'm sure you'll get great training, but that doesn't look like an ultra competitive program. They offer 5 diagnostic spots per year and have 1 ESIR spot per year.

Having a high percentage of IMGs and DOs doesn't necessarily mean the program is easy to get into. They could be all IMGs with killer Step 1 scores end extensive research and maybe some were radiologists in their home country. Also some programs will actually prefer IMGs; this can especially be the case if the PD is an IMG and may prefer trainees from the same home country as the PD.

 

[Dave1980]

I'm definitely not an expert in this so if I'm wrong please let me know but I can give an example. Lahey Clinic in Burlington MA according to FREIDA is currently about 72% IMG, 10% DO, and 18% USMD--I don't want to insinuate that any program is poor quality and I'm sure you'll get great training, but that doesn't look like an ultra competitive program. They offer 5 diagnostic spots per year and have 1 ESIR spot per year.

that has nothing to do with esir and has to do with the program overall.

top residencies also have esir.

 

[Wolvvs]

that has nothing to do with esir and has to do with the program overall.

top residencies also have esir.

My understanding is that in most cases you apply for ESIR after you've been accepted/during your DR training, you don't usually apply directly to an ESIR track.

 

[Dral]

that has nothing to do with esir and has to do with the program overall.

top residencies also have esir.

Yep, from a quick google search, it looks like there is a good mix of programs with ESIR with a good number of them at strong training institutions.

Society of Interventional Radiology - Early Specialization in Interventional Radiology (ESIR)

Early Specialization in Interventional Radiology (ESIR) is a training option for diagnostic radiology residents and medical students who identify an early desire to specialize in interventional radiology.

www.sirweb.org

 

[Fatalis]

Ex G/F of mine had a similar score, studied hard for step 2, drastically improved and she matched from what I heard without issue.
Doable, yes, but you can’t be picky where you want to train and it will probably be a community hospital. You can do it!