Can step 2 destroy your chances for residency

[adamMD]

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So I just got my step 2 score, 216/92. My step 1 was 238/99. I want path and always have. I've done research, earned a masters, and have a publication. I go to a decent school and am in the running for AOA. Did I just destroy my chances for a "good" residency? What does a bad step 2 score mean for path? 🙁(. Step 2 was total BS. It never even hinted at immunohistochemistry or frozen sections. Kinda biased in my opinion... Well, I definitely appreciate any advice. Thanks!

 

[Ombret]

Nah, you're probably fine if everything else is solid. Everyone is allowed to have a bad day once in a while and path residency directors understand that USMLE content is not most of their applicants' cup of tea. Same for shelf exams, while we're at it. They do want to see that you have been a decent medical student overall, but path is just not that competitive. What programs don't want is someone whose record suggests they will have problems completing their work and passing pathology boards. But you just passed step 2 by a pretty wide margin.

 

[mlw03]

no, you didn't. relax. and what the heck are you talking about, IHC or frozens? step 2 is a clinical knowledge test, not a pathology test. step 3 is very, very similar to step 2, so get over your hatred of clinical medicine for another year and a half until you get past step 3.

you asked for advice, here's mine. don't be this uptight on your interviews - that'll be far more damning than a slightly below average step 2 score.

So I just got my step 2 score, 216/92. My step 1 was 238/99. I want path and always have. I've done research, earned a masters, and have a publication. I go to a decent school and am in the running for AOA. Did I just destroy my chances for a "good" residency? What does a bad step 2 score mean for path? 🙁(. Step 2 was total BS. It never even hinted at immunohistochemistry or frozen sections. Kinda biased in my opinion... Well, I definitely appreciate any advice. Thanks!

 

[Ombret]

HC or frozens? step 2 is a clinical knowledge test, not a pathology test.

Sounded like a joke to me...

 

[formulovin]

I'm glad this issue was brought up. I'm in the exact same boat with almost identical step 1 and step 2 scores, 4 publications, 5 yrs. of research, solid class rank, leader of path interest group. The issue I had during my study time for step 2 was that I was going through a divorce and felt very little motivation. You are definitely in good company for this application cycle.

 

[adamMD]

Sounded like a joke to me...

That is was, that it was indeed.

I'm glad this issue was brought up. I'm in the exact same boat with almost identical step 1 and step 2 scores, 4 publications, 5 yrs. of research, solid class rank, leader of path interest group. The issue I had during my study time for step 2 was that I was going through a divorce and felt very little motivation. You are definitely in good company for this application cycle.

I'm sorry to hear about the divorce. I was also dealing with some difficult issues days before the exam (nothing as tough as a divorce...). Residencies should put more emphasis on the entire application rather than one isolated day of poor performance. Let's hope this process isn't like medical school in that score cut-offs are set to determine interviews...

 

[mlw03]

Score cut-offs do exist. What they are varies, but many places have them. Sorry.

 

[KCShaw]

Sometimes these "cut-offs" are pretty fluid -- and sometimes they may not be. Most aren't published, and there are a lot more rumors about them than realities, IMO. On the first few days of going through the applicant pool a program may be fairly aggressive and focus only on those with very high numbers, and as the season wears on their ambitions & expectations change as reality sets in. Frankly, no program really wants to not fill each year, while at the same time no program wants to say none of their seniors passed the boards that year. It's sometimes a tough balancing act to get people with a history of doing well on exams (independent of teaching quality), people who know what they're getting into so won't drop out, and covering the service obligations of the residency.

 

[Autopsy Sweet]

I'm glad this issue was brought up. I'm in the exact same boat with almost identical step 1 and step 2 scores, 4 publications, 5 yrs. of research, solid class rank, leader of path interest group. The issue I had during my study time for step 2 was that I was going through a divorce and felt very little motivation. You are definitely in good company for this application cycle.

This would be a great opportunity for you to use your personal statement (even just a little sentence or two) to explain. You don't have to discuss it, but it's an easy way to explain it away well before they see you face-to-face. We had an applicant last year who failed one of the steps first time around. This is a huge red flag, but since she let us know about the death of her parent just before taking it, it wasn't a big deal to us. Had we not known, we may not have interviewed her.

Be honest about it and I think people will look right past it to your great Step I score and (presumably) your good medical school grades. Good luck!

 

[kiki the alto]

I'm a little worried myself...I'm a little non-trad (transitioning into Path after realizing that Pediatrics wasn't for me) and while my step 2 CK score and Step 1 score were fine, I failed CS the first time due to crushing anxiety. Promptly passed it on a retake four months later, and I've convinced myself that a prompt pass on the second try isn't going to make programs do more than bat an eyelid.

Am I delusional about that? Is my transition out of Peds and failed initial CS one red flag too many?

 

[mlw03]

Am I delusional about that? Is my transition out of Peds and failed initial CS one red flag too many?

i wouldn't think so.

 

[KCShaw]

(about the delusions or the red flags?)

I think it depends on the program. Sure, if you're already on the cusp then it may be a little too much for some programs to be comfortable with. On the other hand I don't think the CS carries quite the same weight as say Step 1, but there are people who ended up in decent programs who didn't pass Step 1 the first go. Realize it will probably be a question on interview day, but for the most part I doubt it's an automatic dealbreaker. I'd suggest doing whatever you did to deal with anxiety when preparing for the CS retake, because at this point the best you can do is work on the rest of your application, then interview well -- and some calm/self-confidence goes a long way in those.

 

[kiki the alto]

Thanks so much for your support, guys. Don't mean to hijack the thread, just thought I'd include this in the more general Step 2 inquiry.
To clarify, the rest of my app is strong and I've been led to believe that having prior clinical experience may actually work to my benefit. I had totally forgotten about my CS experience until I had to fill out ERAS. Despite the panic mode I went into that first CS day, interviews tend to show me in a better light and I've actually been able to answer questions about my old residency and CS in interview-type situations without panicking or crying. I agree that some extra "Zen" between now and interview day will help a lot...meditative prayer, positive thinking, and a few milligrams of metoprolol interview morning will be just the ticket.

Carry on! Forgive the brief detour.

 

[Euchromatin]

I don't want to seem like an @sshole, but I think trying to be honest with those posting questions is important. So, I will say that I, personally, think failing CS would definitely be a red flag, if only because so many people pass it with no problem the first time (like 98%?). I could see if you had some life-altering event happening right before-hand (like one of the prior posters going through a divorce) maybe explaining it, but otherwise it seems odd. After already passing much more rigorous clinical skills exams at my med school, reading First Aid for CS to get some tips, and going into it knowing that the vast majority pass, I wasn't very stressed out at all about CS. I found the experience to be more tedious and inconvenient than anything else.

Trying to think like a program director, I would be worried your ability to pass the pathology boards, which are undoubtedly more anxiety-producing than CS. If the rest of your app is good, you interview well and you have a good explanation for why you were so anxious (and what you have done/will do to prevent it from being a problem again), I suspect plenty of programs would still be interested in you, however.

 

[2121115]

Why are you taking Step 2 this early anyway? It could only hurt you. If you make a strong Step 1 score there is no reason to take a chance on Step 2 before your ERAS application is complete. Only take Step 2 early if you need to prove something before application season; otherwise there is no upside and huge downside. If you did well on Step 1 programs will assume you will do well on Step 2 so taking it can only hurt you.

 

[kiki the alto]

Don't worry, Euchromatin...I appreciate the honesty. I agree with you that if I had a good explanation for why that one day sucked so hardcore, that would be better, but I don't. Real patients don't scare me, and no other test has ever scared me. I admittedly was anxious during OSCE's, but I always passed them. I had absolutely no reason to suspect that I wouldn't pass until the day came. Because I dealt with my specific issues with standardized-patient anxiety and passed easily on time #2, I had actually kind of forgotten about it. Now that I'm reMatching, it kind of opened that old wound, and I'm worried all over again. What if I only matched the first time because programs didn't know about it? What if I'm completely screwed by it this time? Aaaack.

 

[kiki the alto]

Oh, and in cased you missed it, 2121115, I'm re-Matching. I graduated med school a couple years ago, and I took CS in February of the year I graduated, far too late for it to affect the match the first time. Now, sadly it does...I have to be honest on my ERAS record and admit that I didn't pass first try, which I would totally ignore for everything I'm worth if I could.

 

[Autopsy Sweet]

Oh, and in cased you missed it, 2121115, I'm re-Matching. I graduated med school a couple years ago, and I took CS in February of the year I graduated, far too late for it to affect the match the first time. Now, sadly it does...I have to be honest on my ERAS record and admit that I didn't pass first try, which I would totally ignore for everything I'm worth if I could.

Well, one alternative is that you could try to go outside the match and start interviews well before the rest of the field (assuming you start ASAP) and have a chance to explain your situation in an application that is a little less standardized as the ERAS application. (you could highlight other great parts of the application with font style/size, and make that part less highlighted)

I think it's possible that you may not get all of the interviews you may have gotten had you not failed it, but I don't think it will be an issue once you've gotten the interview. Usually people who fail CS are people with very poor communication skills (which is not your problem) and I think once people meet you they'll forget about it or pass it off as a fluke.

Edit: I forgot to say that clinical experience will only help you, but be sure you can give a reasonable explanation for the switch and be able to convince people that pathology is the last career change! (no program wants someone who might switch out again)

 

[kiki the alto]

Thanks so much for the advice. I never really quite considered going outside the Match, because I just assumed that it would be slim pickin's. Never assume - it makes an...you know the rest. I'm in the Match now, though...not quite sure if I'm allowed to go outside it now that I'm in.

Anyone following the Interview Offers thread knows I'm being kind of paranoid about interview offers this time. I'm trying to cool it, but with this stretch of the process being out of my hands, it is a good opportunity to get those feelings aired out so I can be confident and sell myself during interview season. Totally agree that, once the interview is scheduled, I know that I'm going to have a dandy forum in which to explain my "journey".

Advice to re-matchers, non-trads, and folks disappointed by Step 2 at this point: Remember that it happens. It really does. Who are we kidding to think that every SINGLE graduating MD will be blissfully happy and suited for Career Choice #1? Or that preparation (via OSCE's, First Aid, etc.) and speaking American accented English and washing your hands will nearly guarantee a pass on CS? I know that's what I was told the first time.

 

[zao275]

Sweet: So when applying outside the Match, you don't use ERAS? I assumed one would use ERAS but not NRMP. Interesting.

Kiki: Regarding going outside the Match, my understanding is that you can take a spot outside the Match (essentially, you can drop out of the Match) anytime before the Rank Order List deadline (this year, it is 9:00 PM Eastern, February 22, 2012. See here: http://www.nrmp.org/res_match/yearly.html). If you do it after you have submitted your ROL and after the deadline, you are in violation of the Match and bad things will happen...