Chances in academic general surgery with low step 1

[gtgith2016]

Long-time lurker looking for assessment. My STEP 1 score is quite low, at 214. I have excuses but nothing earth-shattering - I was taking care of my newborn child and was also a tired third-year clerk at the time I took the test. I am doing my best to study for STEP 2 to improve that score, but it is what it is.

As has been mentioned in several other SDN threads, for US seniors the score range of 211-220 corresponds to a 75-80% chance of matching into general surgery according to the published match outcomes. However, what I am not clear on is whether these low-scorers like myself are mostly matching into community programs that are not attached to academic centers. My guess is that most of them are. My goal is to go to a strong academic surgical center for residency, or at the very least, a community program in a city that also has an academic center where I can do my research years as a resident (because of my family, it's not going to work for me to do my general research research years in another city).

The rest of my application is I think generally strong. I have finished my third-year at a top 10 medical school and received honors in all clerkships. My evaluations have been strong, with the strongest in surgery. Currently, I have 4 publications in public health (infectious diseases) (1 first authorship) and 4 in health policy (3 first authorships). I have had 5 conference abstracts (1 first-author basic science). This year I am taking a gap year and received a competitive research fellowship for 1-year of research at a top 10 hospital with a cardiac transplant surgeon. Recently I submitted another first-author basic science abstract for a national conference. I will also be publishing a first-author translational research paper in a highly-cited neurosurgery research journal and the PI is the former department chair of neurosurgery and former medical school dean. My goal is to have 4 surgical letters - 1 from the senior neurosurgeon I just mentioned, 1 from a department head in thoracic surgery who mentored me during surgical clerkship, 1 from my current cardiothoracic transplant surgeon research mentor (who is also a former president of the main national organization), and a last one from my sub-internship experience in the future. Also, for what it's worth, I went to a top-ten for undergrad (although I know people don't really care about undergrad at this level anymore).

I am trying to figure out whether all of my strengths, in a best-case scenario, could offset such a low STEP 1 score if I want to attend a top-tier academic research program. I am looking (in no particular order) at: Mayo, Columbia, BWH, MGH, BI, Hopkins, UT Southwestern, Duke, Stanford, Northwestern, Penn, Yale, Cleveland Clinic, Emory, and Baylor.

In general, I know that I need to crush STEP 2 and do well on my Sub-internships, as well as continue to try to publish and submit abstracts. Other specific advice is greatly appreciated.

However, I would also like to have realistic expectations. Would anyone be willing to hazard a guess as to my chances at either a top-tier academic hospital or at least a strong community program affiliated with one?

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[Favoritefarm]

For reference, my friend in an academic center says his gen surg programs intern class last year all had step 1s above 250. Its geting too competitive and theres not a lot of room for error.

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[noegrus1on]

It seems like your application has quite a few strengths as well, so I would talk to your advisors about the best way to approach your application. Based on the advice I've heard, these would be my suggestions:

1) Consider having the bulk of your letters come from general surgeons. Typically one of the 4 should be your chair. Ask your mentors/letter writers whether they think it would be worthwhile to address your score in a letter or personal statement.

2) Continue to work hard to do well on your clerkships and study as much as you can for Step 2 CK. It may be worthwhile to take this early, so results are in before applications are sent out. I would take enough time to study beforehand. Most people that I've known in this situation have taken a vacation month/online course/at the very minimum an extremely easy elective to study. If you have a choice between doing well in a clerkship or acing Step 2 and doing another research project, I would argue that you research should become a lower priority. You have already demonstrated a great track record in this area, so it'll be important to make sure your numbers look as good as they can. If you're able to do it all though, go for it!

3) Apply broadly. The typical strategy is like college, with reach programs, well-matched programs, and safeties. Ask a LOT of people at your institution about where they think you should apply. Also include those top tier schools you're reaching for as well as some community programs. Also consider applying to more programs than is typically recommended to maximize your chances of getting "enough" interviews to match. The NRMP book typically says people who have ranked 11-13 programs have a very high chance of matching. Also check FREIDA to see whether programs to which you're applying have published minimum Step 1 scores. This can help you figure out where you might be most competitive and maybe minimize the number of programs to which you apply that might disqualify you based on your score. I will say that a number of highly ranked programs state that they consider your entire application, so if everything except Step 1 is stellar, you may just be asked to explain it during interviews. Again, your mentors will be able to help the most in this area.

You will not be the first person to apply with a low Step score. Other people have had other issues, including not getting honors in surgery or having one bad evaluation. However, from what I've seen, hard work does not go unnoticed, so keep working hard to make sure the other aspects of your application are as good as they can be, talk to your mentors, and hope for the best. Good luck!

 

[thedrjojo]

Long-time lurker looking for assessment. My STEP 1 score is quite low, at 214. I have excuses but nothing earth-shattering - I was taking care of my newborn child and was also a tired third-year clerk at the time I took the test. I am doing my best to study for STEP 2 to improve that score, but it is what it is.

As has been mentioned in several other SDN threads, for US seniors the score range of 211-220 corresponds to a 75-80% chance of matching into general surgery according to the published match outcomes. However, what I am not clear on is whether these low-scorers like myself are mostly matching into community programs that are not attached to academic centers. My guess is that most of them are. My goal is to go to a strong academic surgical center for residency, or at the very least, a community program in a city that also has an academic center where I can do my research years as a resident (because of my family, it's not going to work for me to do my general research research years in another city).

The rest of my application is I think generally strong. I have finished my third-year at a top 10 medical school and received honors in all clerkships. My evaluations have been strong, with the strongest in surgery. Currently, I have 4 publications in public health (infectious diseases) (1 first authorship) and 4 in health policy (3 first authorships). I have had 5 conference abstracts (1 first-author basic science). This year I am taking a gap year and received a competitive research fellowship for 1-year of research at a top 10 hospital with a cardiac transplant surgeon. Recently I submitted another first-author basic science abstract for a national conference. I will also be publishing a first-author translational research paper in a highly-cited neurosurgery research journal and the PI is the former department chair of neurosurgery and former medical school dean. My goal is to have 4 surgical letters - 1 from the senior neurosurgeon I just mentioned, 1 from a department head in thoracic surgery who mentored me during surgical clerkship, 1 from my current cardiothoracic transplant surgeon research mentor (who is also a former president of the main national organization), and a last one from my sub-internship experience in the future. Also, for what it's worth, I went to a top-ten for undergrad (although I know people don't really care about undergrad at this level anymore).

I am trying to figure out whether all of my strengths, in a best-case scenario, could offset such a low STEP 1 score if I want to attend a top-tier academic research program. I am looking (in no particular order) at: Mayo, Columbia, BWH, MGH, BI, Hopkins, UT Southwestern, Duke, Stanford, Northwestern, Penn, Yale, Cleveland Clinic, Emory, and Baylor.

In general, I know that I need to crush STEP 2 and do well on my Sub-internships, as well as continue to try to publish and submit abstracts. Other specific advice is greatly appreciated.

However, I would also like to have realistic expectations. Would anyone be willing to hazard a guess as to my chances at either a top-tier academic hospital or at least a strong community program affiliated with one?

My program, which is an academic one, but not an academic powerhouse, basically won't review an application with a step 1 below 230 unless my PD gets a call from someone at your institution saying they should take a look at you. The program lets them filter out applications with scores below X. Most academic programs will use this, and thus you will be filtered out of essentially every major academic residency.
Does your medical school have a residency and do they like you there? Cause that's probably your best and damn near only chance of an academic residency unless you get your chair or PD or some big name at your program to make a bunch of calls for you, and even that might not be enough to get interviews at those places you listed.

Doing an away rotation will possibly get your foot in the door at many places, but I know some places don't automatically give interviews for people that did aways, but at least if you are as stellar as you say you are, they will see that and thus be more inclined to want to keep you.

I don't know if medical schools impression upon students the fact that step 1 is literally more important than essentially the entire sum of the entire 4 years of medical school.

 

[Hangry]

My goal is to go to a strong academic surgical center for residency, or at the very least, a community program in a city that also has an academic center where I can do my research years as a resident (because of my family, it's not going to work for me to do my general research research years in another city).

I am trying to figure out whether all of my strengths, in a best-case scenario, could offset such a low STEP 1 score if I want to attend a top-tier academic research program. I am looking (in no particular order) at: Mayo, Columbia, BWH, MGH, BI, Hopkins, UT Southwestern, Duke, Stanford, Northwestern, Penn, Yale, Cleveland Clinic, Emory, and Baylor.

In general, I know that I need to crush STEP 2 and do well on my Sub-internships, as well as continue to try to publish and submit abstracts. Other specific advice is greatly appreciated.

However, I would also like to have realistic expectations. Would anyone be willing to hazard a guess as to my chances at either a top-tier academic hospital or at least a strong community program affiliated with one?

No, you almost certainly won't get into (or have the opportunity to interview at) the absolute best academic programs.

However, you have not given a good reason why you want to go to one of them. From your pedigree, it sounds like you are extremely prestige driven and think the world will end if you have to *gasp* go to a mid-tier academic surgery program for training!?!

This is reinforced by the fact that your "ideal program list" is missing some of the absolute best surgery programs in the country and contains some mediocre ones...reads more like a USNWR research based med school ranking than anything else.

Let the prestige scales fall from your eyes and realize that you can get FANTASTIC surgical training, including great research opportunities at so many programs across the country that you would probably stick your nose up at now, where you would only be limited by your own personal willingness to work hard. If you are as good as you think you are then you can certainly be one of the great residents at a non name brand program (at least to those outside the surgical community) that does fantastic research and matches into an incredible fellowship.

Now hopefully I've misjudged your thought process and just gone on a completely misguided anti-prestige rant, but I'm just trying to echo some good advice you've gotten above. As a current applicant I'm seeing this process first hand and have been fortunate enough to interview all the way from solid mid tiers to the top of the top prestige wise and I will tell you that I haven't seen a program yet that I wouldn't be thrilled to train at. Set your sights appropriately, play your cards right with aways and you can certainly still match at a place that will not shut any doors for your down the road.

 

[deleted123544]

Hey guys, happy holidays! Im kind of in the same boat. do you guys know how I can find out about decent general surgery programs? Also, I talked with our general surgery program director and let's not forget to mention doing well in Step 2. I too desire to go into academic surgery and the advice I got was to keep doing well in 3rd year and 4th year as well as to scoring above a 240 on step 2. The only advice I can give with a grain of salt is to keep working hard. I have worked extremely hard and that is what has gotten me where I am right now. I say work hard, kill step 2, get some publishing out there, apply broadly and reach out to PDs. Anything is possible if you just work hard at it. Thank you all and Merry Christmas to everyone!