Chances for Anesthesiology? Low COMLEX, Okay Step 1

[oOKawaiiOo]

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Just a little background.......
3rd year student
No volunteer hrs or student body/government involvement
Ranked top quarter of class
COMLEX: <480
STEP 1: 246
I have not done an anesthesiology rotation yet. I plan on getting one in during early 4th year.
What are my chances?

Any feedback is appreciated.
Cheers.

 

[UnoMas]

Take Step 2 CK and Level 2 PE early, do Anesthesiology rotation to get letters, do aways. Apply broadly, go on 12+ interviews with 3-4 'lower tier' and/or in undesirable locations and be a normal, humble human being. You will be fine.

And since when a Step 1 of 246 is 'Okay?'

 

[oOKawaiiOo]

Take Step 2 CK and Level 2 PE early, do Anesthesiology rotation to get letters, do aways. Apply broadly, go on 12+ interviews with 3-4 'lower tier' and/or in undesirable locations and be a normal, humble human being. You will be fine.

And since when a Step 1 of 246 is 'Okay?'

Awesome. I'll try to get those in early. I don't mind doing rotations in "undesirable" locations. Is there an online list that shows all of the anesthesiology programs and their respective tier?

 

[UnoMas]

Awesome. I'll try to get those in early. I don't mind doing rotations in "undesirable" locations. Is there an online list that shows all of the anesthesiology programs and their respective tier?

Unfortunately there isn't. And to clarify what I meant by undesirable locations, I meant interview at those places, dont turn them down. Do aways at reaches that took DOs before, dont waste your time auditioning at an 'undesirable' program. Shoot me a message sometimes this summer when you prep your application, I dont want to do it right now as I dont know where I matched at yet dont want to jinx it.

 

[Spectreman]

Just a little background.......
3rd year student
No volunteer hrs or student body/government involvement
Ranked top quarter of class
COMLEX: <480
STEP 1: 246
I have not done an anesthesiology rotation yet. I plan on getting one in during early 4th year.
What are my chances?

Any feedback is appreciated.
Cheers.

any quick word for us 2nd Year Students as to how the <480 COMLEX happened despite such solid everything else? Fluke day? Everyone lies about COMLEX being easy as long as you prep for Step?

 

[oOKawaiiOo]

COMLEX is easier than Step, by 3 folds.

-If you can memorize First Aid +/- OPP [Cranial, Sacral, Spinal HVLA segments, tenderpoints], You can easily hit +580.
-Biostats/Public health--> COMBANK nailed it. Disclaimer: I didn't use Comquest.
-Understand basic concepts: What happens to HR / Venous capacitance / Preload / Afterlod when you go from supine to standing?
-Microbiology: I did well in micro in preclinical courses. So I had a strong foundation. Know what is gram positive, negative, catalase positive, indole positive, PYR positive, oxidase, blah blah......

Step is a "thinking" exam. Know the concepts and application/indication of such. Lots of question on "What is the MOST likely diagnosis?" Tricky, so you have to know your diseases in and out; Uworld covers most and supplement with Giojlan High-yield for minor details.

I'm on the edge with Pathoma. Didn't think it helped much with step. Sketchy pharm didn't help with step either; n=1. Don't take my word for it.

 

[Spectreman]

COMLEX is easier than Step, by 3 folds.

-If you can memorize First Aid +/- OPP [Cranial, Sacral, Spinal HVLA segments, tenderpoints], You can easily hit +580.
-Biostats/Public health--> COMBANK nailed it. Disclaimer: I didn't use Comquest.
-Understand basic concepts: What happens to HR / Venous capacitance / Preload / Afterlod when you go from supine to standing?
-Microbiology: I did well in micro in preclinical courses. So I had a strong foundation. Know what is gram positive, negative, catalase positive, indole positive, PYR positive, oxidase, blah blah......

Step is a "thinking" exam. Know the concepts and application/indication of such. Lots of question on "What is the MOST likely diagnosis?" Tricky, so you have to know your diseases in and out; Uworld covers most and supplement with Giojlan High-yield for minor details.

I'm on the edge with Pathoma. Didn't think it helped much with step. Sketchy pharm didn't help with step either; n=1. Don't take my word for it.

Judging by what you said I’ve gotta assume your COMLEX being low is a freak accident since your step is so dang solid, or maybe you delayed step and crushed it during 3rd year? Either way, congrats on hitting that 246, sounds like you’ll certainly be able to get where you want to go.

 

[oOKawaiiOo]

Judging by what you said I’ve gotta assume your COMLEX being low is a freak accident since your step is so dang solid, or maybe you delayed step and crushed it during 3rd year? Either way, congrats on hitting that 246, sounds like you’ll certainly be able to get where you want to go.

I did delay my Step exam. It was probably the best decision, yet worst time, of my life.

Why? 2 reasons

1)Who has the highest Step scores by school? Baylor @ 246 (last time I checked; it might be different now) because they delay their step to the end of 3rd year. It goes back to my previous posts about how Step is a thinking exam. Having some clinical experiences can help you solidify how to diagnosis, treat, and manage diseases which is high yield on Step 1.

2)I asked a handful of 3rd year students in my class who already have taken the test & 4th year students on "What would you do differently if you could go back and retake step 1?" Most common response: Delay the exam. Most of the students went thru Uworld once +/- redid Incorrects. Some students said reread First AID.

I read First Aid 3x. The only exception was Micro chapter with 1x pass.
I did UWorld 2.5x (64% first pass [System based], 86% 2nd pass [Timed, random])

Now If I could go back and retake Step 1, what would I do differently? I would tell myself to "Trust your studies. You got this."

 

[UnoMas]

I did delay my Step exam. It was probably the best decision, yet worst time, of my life.

Why? 2 reasons

1)Who has the highest Step scores by school? Baylor @ 246 (last time I checked; it might be different now) because they delay their step to the end of 3rd year. It goes back to my previous posts about how Step is a thinking exam. Having some clinical experiences can help you solidify how to diagnosis, treat, and manage diseases which is high yield on Step 1.

2)I asked a handful of 3rd year students in my class who already have taken the test & 4th year students on "What would you do differently if you could go back and retake step 1?" Most common response: Delay the exam. Most of the students went thru Uworld once +/- redid Incorrects. Some students said reread First AID.

I read First Aid 3x. The only exception was Micro chapter with 1x pass.
I did UWorld 2.5x (64% first pass [System based], 86% 2nd pass [Timed, random])

Now If I could go back and retake Step 1, what would I do differently? I would tell myself to "Trust your studies. You got this."

I preach the exact same thing.
DO students have the advantage that they can delay Step 1 to the end of 3rd year. The clinical knowledge from 3rd year makes Step 1 very very manageable and by studying for Step 1 at the end of 3rd year, it also helps a bit with Step 2 CK.
The downside is a very painful 3rd year but the rewards are definitely worth it

 

[Spectreman]

I did delay my Step exam. It was probably the best decision, yet worst time, of my life.

Why? 2 reasons

1)Who has the highest Step scores by school? Baylor @ 246 (last time I checked; it might be different now) because they delay their step to the end of 3rd year. It goes back to my previous posts about how Step is a thinking exam. Having some clinical experiences can help you solidify how to diagnosis, treat, and manage diseases which is high yield on Step 1.

2)I asked a handful of 3rd year students in my class who already have taken the test & 4th year students on "What would you do differently if you could go back and retake step 1?" Most common response: Delay the exam. Most of the students went thru Uworld once +/- redid Incorrects. Some students said reread First AID.

I read First Aid 3x. The only exception was Micro chapter with 1x pass.
I did UWorld 2.5x (64% first pass [System based], 86% 2nd pass [Timed, random])

Now If I could go back and retake Step 1, what would I do differently? I would tell myself to "Trust your studies. You got this."

Oh my gosh lol, just the thought of delaying makes me want to cry. Only because I’m in hardcore cram mode trying to get through the rest of Zanki and Uworld before dedicated in May. My averages are low right now though (in the 50’s atm). Going through every day feeling so doomed. I guess I’ll see how I’m doing when dedicated comes, but considering I’m middle of my class in terms of rank and generally (I think) a poor-to-avg test taker, it’s nice to know that IF I DON’T feel ready then delaying is a real option. My core site assignment is a notoriously chill place too, so it wouldn’t be hard to find study time.

 

[Espressso]

I made sure to schedule my step exam before comlex and already booked a post-boards vacay before third year begins. It's my way to not delaying it and pushing it back. My thought is the first round of boards are the worst experience of medical school. Why delay it? If you can get make it through with a good score after two years, why would you make 3rd year that much worse? Prepping for the PE, level 2 (and potentially step 2), and on top of that, taking step 1 somewhere during third year? With monthly comats? Man, just the thought of that is my hell. Like if I die and go to hell, i'll be forced to sit and think about that potential situation 24/7

 

[oOKawaiiOo]

Oh my gosh lol, just the thought of delaying makes me want to cry. Only because I’m in hardcore cram mode trying to get through the rest of Zanki and Uworld before dedicated in May. My averages are low right now though (in the 50’s atm). Going through every day feeling so doomed. I guess I’ll see how I’m doing when dedicated comes, but considering I’m middle of my class in terms of rank and generally (I think) a poor-to-avg test taker, it’s nice to know that IF I DON’T feel ready then delaying is a real option. My core site assignment is a notoriously chill place too, so it wouldn’t be hard to find study time.

I understand. I mean it is a risky choice to push it back, but plan accordingly. The common saying goes "Don't take Step until you hit your target score." I usually let my preceptor know about my situation and they have all been chilled about it, and let me go study whenever there was downtime. Made me look good in some cases, since other students would just be on their phones and social media. Be nice and humble. Laugh at all of their jokes, even if it wasn't funny. Your preceptors will work with you. If not, then you gotta make scarifies.

For example when I was on my psych rotation, my preceptor didn't like the fact I was studying if anything if it wasn't psych. I would wake up every morning at 630AM and be at the clinic by 7:45. My rotation wouldn't end until 3-5PM. I spent all of my nights studying at the local panera bread until 9:30PM, then head over to Denny's to study until 2-3AM. Get about 3-4 hours of sleep every night.

Was it hell? Yes.
Was it worth it? Yes, but I'm used to it.

Also, don't use UWORLD% to gauge your performance on the real test. Use it as a learning tool. As long as you learned the concept, you will outperform your classmates/peers. NBME is a better predictor, tends to under predict. It did for me by 8 pts.

I made sure to schedule my step exam before comlex and already booked a post-boards vacay before third year begins. It's my way to not delaying it and pushing it back. My thought is the first round of boards are the worst experience of medical school. Why delay it? If you can get make it through with a good score after two years, why would you make 3rd year that much worse? Prepping for the PE, level 2 (and potentially step 2), and on top of that, taking step 1 somewhere during third year? With monthly comats? Man, just the thought of that is my hell. Like if I die and go to hell, i'll be forced to sit and think about that potential situation 24/7

I agree with you. Hell isn't for everyone.

 

[BorntobeDO?]

I understand. I mean it is a risky choice to push it back, but plan accordingly. The common saying goes "Don't take Step until you hit your target score." I usually let my preceptor know about my situation and they have all been chilled about it, and let me go study whenever there was downtime. Made me look good in some cases, since other students would just be on their phones and social media. Be nice and humble. Laugh at all of their jokes, even if it wasn't funny. Your preceptors will work with you. If not, then you gotta make scarifies.

For example when I was on my psych rotation, my preceptor didn't like the fact I was studying if anything if it wasn't psych. I would wake up every morning at 630AM and be at the clinic by 7:45. My rotation wouldn't end until 3-5PM. I spent all of my nights studying at the local panera bread until 9:30PM, then head over to Denny's to study until 2-3AM. Get about 3-4 hours of sleep every night.

Was it hell? Yes.
Was it worth it? Yes, but I'm used to it.

Also, don't use UWORLD% to gauge your performance on the real test. Use it as a learning tool. As long as you learned the concept, you will outperform your classmates/peers. NBME is a better predictor, tends to under predict. It did for me by 8 pts.



I agree with you. Hell isn't for everyone.

This is the part most people ignore when they talk about taking step 1 in third year. 3rd year is easy compared to second to do the stuff your 'supposed to' do, but when you add in step 1 on top of that, it can become much more challenging. Great post.

 

[thegrind577]

Does it even matter what your comlex scores are if you apply to an ACGME residency?(also I dont even think you have to send comlex scores to an ACGME program? that is an amazing score you can easily match into anesthesia with those stats.

 

[DO2015CA]

It still matters for former AOA programs who have been interpreting those scores for years and are well versed. Being that they are in the minority and most DO students go full blown ACGME, they don’t matter if put in absolute terms

There is also the reputation to never apply to AOA gas programs.

 

[Angus Avagadro]

I had a student with similar Step score, matched well. Just a note he didnt have his first interview until Dec. Not sure why, but when the interviews started, he had several good programs offer interviews.

 

[oOKawaiiOo]

Does it even matter what your comlex scores are if you apply to an ACGME residency?(also I dont even think you have to send comlex scores to an ACGME program? that is an amazing score you can easily match into anesthesia with those stats.

Really? Please tell me this is true.

There is also the reputation to never apply to AOA gas programs.

I never heard of this. Can you explain?

I had a student with similar Step score, matched well. Just a note he didnt have his first interview until Dec. Not sure why, but when the interviews started, he had several good programs offer interviews.

Awesome. Any tips on performing well on Anesthesiology rotation/auditioning rotation?

 

[Angus Avagadro]

Really? Please tell me this is true.



I never heard of this. Can you explain?



Awesome. Any tips on performing well on Anesthesiology rotation/auditioning rotation?

Like any rotation, be helpful, show up early, stay late, try to read ahead and anticipate questions you might be asked. Project warmth and especially try to get along with everybody. The OR is a small community with lots of different personalities. Being easy going is an important skill for Anesthesia.

 

[68PGUN]

Arrive 1 hr early, set up the rooms, and be ready to answer a ton of physiology pimp questions at a notice. All answers must be quoted from Morgan and Mihail Clinical Anesthesiology or no extra point toward your evaluation. At the end of the day, all rooms must be restocked, and all patients must be pre-screened by you and ready for discussion tomorrow morning. That's the status quo for a pass evaluation.

In order to get to the Honor level, you must cook breakfast, lunch, and baked cookies for the team at a min of 3 times a week, in addition to keeping up a conversation and making people laugh. How good you are at these intangibles will earn you a High Pass or a Honor with an automatic acceptance recommendation to the PD!

Good luck.

 

[Dr.Bruh]

You’ll easily match anesthesiology. Average matched DO had a <230.

 

[DrWhozits]

Really? Please tell me this is true.

Everyone in the field that I’m applying to (not anesthesia, TIFWIW) has told me universally that with a Step score they will not even look at your COMLEX.

Now If you are going up against another DO with the same Step score and are essentially the same as an applicant otherwise, who knows, maybe then it could be used but I doubt that’s gonna hurt you much

 

[WoundupKnight]

Really? Please tell me this is true.

Here's the PD survey. This was from 2018, so some of these programs are probably AOA

Page 15-16: https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf

 

[Neopolymath]

Arrive 1 hr early, set up the rooms, and be ready to answer a ton of physiology pimp questions at a notice. All answers must be quoted from Morgan and Mihail Clinical Anesthesiology or no extra point toward your evaluation. At the end of the day, all rooms must be restocked, and all patients must be pre-screened by you and ready for discussion tomorrow morning. That's the status quo for a pass evaluation.

In order to get to the Honor level, you must cook breakfast, lunch, and baked cookies for the team at a min of 3 times a week, in addition to keeping up a conversation and making people laugh. How good you are at these intangibles will earn you a High Pass or a Honor with an automatic acceptance recommendation to the PD!

Good luck.

I can never tell if you are being sarcastic. Did you do machine checks or not bother because most people want to do it for themselves anyways (in my experience)?

 

[Spectreman]

Will OP’s delayed Step be an issue? I’m not hitting my target and am getting worried, one month till test day.

 

[68PGUN]

I can never tell if you are being sarcastic. Did you do machine checks or not bother because most people want to do it for themselves anyways (in my experience)?

Setting up the room means doing all the machine checks, make sure the room is supplied with adequate supply for all the cases, and everything...

On a serious note, I'm pretty sure that you will honor at most places if you just do my status quo for a pass evaluation. But, there could be testy Anesthesiologists that will prescreen you for the right personality, as in sucking up 24/7 to most physicians. For these people, you must do all the listed things that I said. Before it or not, you have to do a lot of sucking up as an Anesthesiology physician in order to maintain your sanity as well as long term job security. Perhaps my preceptor was doing me a favor

Long story short. I'm not going into Anesthesiology, but I did an elective with a demanding Anesthesiologist whom I did learn a ton. I did all the above and maintain my dignity by refusing to do the sucking up part. A pass in a field that you're not going to isn't going to kill your application especially when you have comments from all rotations saying somewhere along the following:

"68PGUN is hard working, passionate, intelligent, quick to learn, team player, and a pleasant person to work with..."

While clinical grades and board scores do matter to a point, I'm certain that the only reason why third year performance matters a ton bc institutions are trying to get a feel for you as a person before they extend that interview invite to you.

 

[Dr.Bruh]

Will OP’s delayed Step be an issue? I’m not hitting my target and am getting worried, one month till test day.

When you take it doesn’t really matter considering some MD school have their students taking step a semester into their clinical rotations.

 

[cgk]

You’ll easily match anesthesiology. Average matched DO had a <230.

What if both COMLEX and STEP 1 are below average? Comlex 450 and Step 1 210? Do chances of matching diminish significantly in your opinion?

 

[DrWhozits]

What if both COMLEX and STEP 1 are below average? Comlex 450 and Step 1 210? Do chances of matching diminish significantly in your opinion?

This isn’t intended to be mean, but isn’t this obvious? Is it impossible to match with that? No, But it’s definitely different to be ~15 points above average vs ~20 points below.

 

[cgk]

This isn’t intended to be mean, but isn’t this obvious? Is it impossible to match with that? No, But it’s definitely different to be ~15 points above average vs ~20 points below.

Do you think it's so improbable that it's not worth a try? Not really interested in SOAPING.

 

[DrWhozits]

Do you think it's so improbable that it's not worth a try? Not really interested in SOAPING.

http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Osteo.pdf

I can’t decide that for you and neither can anyone else. The best thing you can do for yourself is read that link above, which is the best available data we have and make an informed decision.

Everyone you ask on the Internet is either just giving you an opinion or just making stuff up. I would suggest you speak to an advisor but since you (and I) are a DO, that would be worse than knowing nothing.

Read that data, take some time to truly analyze what that data means. The only other thing you can really do is talk to PDs on away rotations (which IMO you should absolutely be doing)

 

[WoundupKnight]

Well, if you go by just Step 1/2 scores, the average matched DO student had a 227/239 while the average matched USMD had a 232/244 average.

 

[68PGUN]

What if both COMLEX and STEP 1 are below average? Comlex 450 and Step 1 210? Do chances of matching diminish significantly in your opinion?

Very slim. You literally have do do 4-6 auditions, and kill all of them to even have a fighting chance. All of the people that I know who matched into Anesthesia for this past year have Step 1 220-230 with some in 240.

I know of one person without Step 1 but COMLEX high 500s who went unmatched for Anesthesiology this year. At the end of the day, it really comes down to your attitude to FM vs IM. If you're someone who doesn't mind doing FM, I would go all out for Anesthesiology and then SOAP into FM if things don't go as planned. But, if you are someone who feels strongly against FM and wants to do IM -> specialization as an option, I personally would focus my attention of auditioning at solid IM places and forget about Anesthesiology.

 

[cgk]

Very slim. You literally have do do 4-6 auditions, and kill all of them to even have a fighting chance. All of the people that I know who matched into Anesthesia for this past year have Step 1 220-230 with some in 240.

I know of one person without Step 1 but COMLEX high 500s who went unmatched for Anesthesiology this year. At the end of the day, it really comes down to your attitude to FM vs IM. If you're someone who doesn't mind doing FM, I would go all out for Anesthesiology and then SOAP into FM if things don't go as planned. But, if you are someone who feels strongly against FM and wants to do IM -> specialization as an option, I personally would focus my attention of auditioning at solid IM places and forget about Anesthesiology.

Thanks for the good advice. Lots to think about considering the fact that Anesthesia is probably going to be even more competitive this application cycle than last year.

 

[oOKawaiiOo]

Like any rotation, be helpful, show up early, stay late, try to read ahead and anticipate questions you might be asked. Project warmth and especially try to get along with everybody. The OR is a small community with lots of different personalities. Being easy going is an important skill for Anesthesia.

So noted. Thanks for the head up.

Arrive 1 hr early, set up the rooms, and be ready to answer a ton of physiology pimp questions at a notice. All answers must be quoted from Morgan and Mihail Clinical Anesthesiology or no extra point toward your evaluation. At the end of the day, all rooms must be restocked, and all patients must be pre-screened by you and ready for discussion tomorrow morning. That's the status quo for a pass evaluation.

In order to get to the Honor level, you must cook breakfast, lunch, and baked cookies for the team at a min of 3 times a week, in addition to keeping up a conversation and making people laugh. How good you are at these intangibles will earn you a High Pass or a Honor with an automatic acceptance recommendation to the PD!

Good luck.

This is the perfect response. No lie, I went ahead and bought Morgan and Mihail Clinical Anesthesiology from amazon. The book is massive. Thanks for the advice!

You’ll easily match anesthesiology. Average matched DO had a <230.

Just checked. The avg was 227 for DO.
I hope I get in somewhere.
Thanks for the input!

Everyone in the field that I’m applying to (not anesthesia, TIFWIW) has told me universally that with a Step score they will not even look at your COMLEX.

Now If you are going up against another DO with the same Step score and are essentially the same as an applicant otherwise, who knows, maybe then it could be used but I doubt that’s gonna hurt you much

Awesome. I heard the same from the upperclassmen but wasnt sure if it was true or not. Good to hear it from you. Thank you.

Will OP’s delayed Step be an issue? I’m not hitting my target and am getting worried, one month till test day.

Havent heard anything negative about a delayed Step.

Life happens, it's fine to delay your test. Again, most of my classmates wished they had done the same. If i were you, I would delay it until I hit my target score with at an avg of least 2 NBMEs.

Goodluck. Trust your studies.

 

[Spectreman]

Havent heard anything negative about a delayed Step.

Life happens, it's fine to delay your test. Again, most of my classmates wished they had done the same. If i were you, I would delay it until I hit my target score with at an avg of least 2 NBMEs.

Goodluck. Trust your studies.

Thank you! Gonna keep pushing like I’ll make it by June 17, my goal is gen surge and I’m pretty convinced I can do it with a 230. I’m excited to follow your story, I’m sure you’ll match where you want.