Change in desired specialty due to step 1?

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engineerd

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This might be similar to a high-schooler worrying about the MCAT, but I would like some feedback please.

I'm working as an ophthalmic technician and love the field. I'm going to med school with a good home program this August, and I would like to pursue ophtho. Lets say I pass all my courses my first 2 years, get a few case studies/posters/maybe publications out there, develop good relationship with my home ophtho department, etc.

The thing that's worrying me is step 1. Lets say I have all this background in ophtho, but receive a low score. National average for successful match in 2016 was 244, average for unmatch was 229. Lets say I get a 229. What then? I know that people could probably match ophtho with 229, but chances are slim statistically.

I also have an interest in psych. Would the smarter choice be to switch to psych at this point? How would I explain all this ophtho experience, and not make psych seem like a backup?

No, I don't plan on pre-studying anatomy this summer. No, I won't start Step 1 prep during MS1. I'm just trying to play out scenarios for the future.

Thanks!
 
engineerd said:
This might be similar to a high-schooler worrying about the MCAT, but I would like some feedback please.

I'm working as an ophthalmic technician and love the field. I'm going to med school with a good home program this August, and I would like to pursue ophtho. Lets say I pass all my courses my first 2 years, get a few case studies/posters/maybe publications out there, develop good relationship with my home ophtho department, etc.

The thing that's worrying me is step 1. Lets say I have all this background in ophtho, but receive a low score. National average for successful match in 2016 was 244, average for unmatch was 229. Lets say I get a 229. What then? I know that people could probably match ophtho with 229, but chances are slim statistically.

I also have an interest in psych. Would the smarter choice be to switch to psych at this point? How would I explain all this ophtho experience, and not make psych seem like a backup?

No, I don't plan on pre-studying anatomy this summer. No, I won't start Step 1 prep during MS1. I'm just trying to play out scenarios for the future.

Thanks!
Click to expand...

As another incoming M1 who has absolutely no idea what she wants (so I might like a competitive specialty but who knows), I'd just say treat your studies and experiences as if you're going into a competitive specialty, but always keep your mind and options open for other less competitive specialties.

My impression after lurking about here and residency forums is that the only time as a pre-clinical student you're going to get any meaningful research done is the summer between m1-m2 anyway, and it's more useful to use that time to try and get a pub. Apparently people can take research electives to try and get some more productivity out of their research in the last two years? I think once you find out your step score doesn't cut it for a competitive specialty, it still leaves you some time to gather your app together for other specialties?
 
Why think about falling short of your step goal before starting med school? Be open to other specialties but don't shoot yourself in the foot going into the exam thinking you won't get a good score. Learn all you can your first 2 yrs, study hard, and do your best then worry about specialties.
 
Your strongest chance of matching any competitive field is building a great relationship with your home program. Start early and be awesome throughout. Ideally they'll want to keep you there to train, and if they think that highly of you, will also be writing you great letters. There is no more assured match than the home student who is truly beloved by all. Don't forget that can go the other way too - if you rub people the wrong way, you may kill your chances completely. Assume from day one that everyone you encounter in med school - student or resident or attending regardless of field - will ultimately have a say in your match, and treat them accordingly.

A low step one hurts but doesn't necessarily kill your chances. If it's the ONLY blemish on an otherwise stellar app, you'll be fine. If it's clearly part of a pattern, then you've got more trouble.
 
Your step 1 score does not determine your specialty! and you definitely shouldn't be worrying about Step 1 before starting med school.

If you know what you want to do early on, that's great. You have lots of time to build your application and make lots of connections to match somewhere solidly. Study hard in every class and the good grades/step score should come naturally.

If you do have a weakness in your application (like a low step score), you'll have to compensate for it elsewhere (grades, publications, LORs, etc).
 
Thanks for the advice everyone. Of course I plan on doing the best I can on step 1, but at the end of the day, not everyone can hit 240+.

I guess I'm just worried about putting all my eggs in 1 basket from beginning, then bombing step 1, and have to figure out a backup plan.

I do plan on keeping an open mind in med school. I also have interests in psych, IM, and anesthesiology. Ophtho just happen to be on top of the list. Who knows what other field will capture my attention once I get more exposure.

musicalfeet said:
My impression after lurking about here and residency forums is that the only time as a pre-clinical student you're going to get any meaningful research done is the summer between m1-m2 anyway, and it's more useful to use that time to try and get a pub. Apparently people can take research electives to try and get some more productivity out of their research in the last two years? I think once you find out your step score doesn't cut it for a competitive specialty, it still leaves you some time to gather your app together for other specialties?
Click to expand...

Yea this is a little confusing to me as well. I plan on using this summer to do research/pubs if possible. But I've also read (on SDN) about people deciding on a specialty during MS III, and THEN doing research in the field? Maybe they took a research year?
 
I know of some people who matched with a less than stellar app by making great friends with the residents who advocated for them. I also know of people who had a solid app that didn't get accepted. Step 1 is just part of the game, everything matters. Do as well as you can in class and everything will fall in line. Some people focus on "studying for the boards" and it's all crap. Just work hard, don't worry about others and you'll be fine.

Also psych seems to be pretty competitive this year. I expected it as it is a versatile field, decent hours for residency, interesting cases and lots of practice opportunities. There were few open spots for soap
 
operaman said:
Your strongest chance of matching any competitive field is building a great relationship with your home program. Start early and be awesome throughout. Ideally they'll want to keep you there to train, and if they think that highly of you, will also be writing you great letters. There is no more assured match than the home student who is truly beloved by all. Don't forget that can go the other way too - if you rub people the wrong way, you may kill your chances completely. Assume from day one that everyone you encounter in med school - student or resident or attending regardless of field - will ultimately have a say in your match, and treat them accordingly.

A low step one hurts but doesn't necessarily kill your chances. If it's the ONLY blemish on an otherwise stellar app, you'll be fine. If it's clearly part of a pattern, then you've got more trouble.
Click to expand...
How does one do this? Just impress during rotations?
 
engineerd said:
Yea this is a little confusing to me as well. I plan on using this summer to do research/pubs if possible. But I've also read (on SDN) about people deciding on a specialty during MS III, and THEN doing research in the field? Maybe they took a research year?
Click to expand...

A research year is one option, but not always needed. Many students get involved in clinical research projects that, if you choose wisely and put in a good effort, take a lot less time to complete than bench work or prospective randomized trials. A motivated student could easily do start-to-finish work on thinks like case series or other retrospective chart reviews.
 
asdf123g said:
How does one do this? Just impress during rotations?
Click to expand...

If, like the OP, you arrive on day 1 knowing what you want to do, you can get started immediately. Doing research within a department is a surefire way to get plugged in. Doing it really well and being super productive is a way to impress. Shadowing and socializing sporadically with people in the department as the opportunity arises is part of it. Going to conferences and grand rounds and such things is another way to show your face along the way and stay plugged in. Doing electives in 3rd year is yet another. By the time you do your sub-i, you would already be a well-liked and well-known quantity; ideally your stellar performance on the rotation would simply be icing on the cake the confirms what everyone already thought about you. They will surely rank you to match at your home program and also write you glowing letters as you apply elsewhere. Even then, your most surefire match is with that home program that knows you so well. Even if you blow all your interviews, you would still have that hometown love to fall back on.

Naturally, this can work against you too if you're annoying or lazy or, heaven forbid, come across as entitled. No more surefire way to assure you DON'T match somewhere than to demonstrate what a tool you are! However, if you're a hard worker and a superstar over 3-4 years around the department, you are very likely to be ranked well. Even if you have a rough go of step 1, there is nobody more likely to overlook one bad day than a department which has already seen you at your best time and time again.
 
You can explain your ophtho experience on your psych interview by saying that the eye is the window to the soul.
 
Although Step 1 is definitely an important part of your application, it is in no way the only determinant of whether or not you can get into a competitive specialty. I just matched into Radiation Oncology, and my numbers were definitely not at the mean for matched applicants. In fact, my Step 1 score was even lower than the mean for unmatched applicants, and I did not have nearly as many publications/presentations/etc. as the mean for matched applicants. Get to know the faculty and the department early-on so that they know who you are. The residents in rad onc at my school told me to make the department like my home and just drop by whenever I wanted to. If you get involved in the department, they'll remember you, and then make sure to impress them during your rotation in your 4th year. They'll forget about Step 1 once they realize you're hardworking and easy to get along with.
 
OP: Don't worry about it now. I suspect that if you don't end up in ophto it will be more likely due to your finding something you like better, rather than because of your Step scores, your prior experience in the field notwithstanding.

That said, all the above advice is excellent.
 
Board scores are important but who you know is arguably more important. Since you know you want ophthalmology, network like crazy both at your school and anywhere else you can. Study hard, network and go for it.
 
engineerd said:
I also have an interest in psych. Would the smarter choice be to switch to psych at this point? How would I explain all this ophtho experience, and not make psych seem like a backup?
Click to expand...

"I came into med school really interested in optho, but after pre-clinical coursework and starting clinical rotations I found myself more drawn to ___."

It's not a big deal. Don't make it a big deal. People change their minds about specialties all the time.
 
engineerd said:
This might be similar to a high-schooler worrying about the MCAT, but I would like some feedback please.

I'm working as an ophthalmic technician and love the field. I'm going to med school with a good home program this August, and I would like to pursue ophtho. Lets say I pass all my courses my first 2 years, get a few case studies/posters/maybe publications out there, develop good relationship with my home ophtho department, etc.

The thing that's worrying me is step 1. Lets say I have all this background in ophtho, but receive a low score. National average for successful match in 2016 was 244, average for unmatch was 229. Lets say I get a 229. What then? I know that people could probably match ophtho with 229, but chances are slim statistically.

I also have an interest in psych. Would the smarter choice be to switch to psych at this point? How would I explain all this ophtho experience, and not make psych seem like a backup?

No, I don't plan on pre-studying anatomy this summer. No, I won't start Step 1 prep during MS1. I'm just trying to play out scenarios for the future.

Thanks!
Click to expand...

Where did you get these stats
 
MS1 is not the time to worry about Step 1 besides studying hard, let alone someone who hasn't even started school yet.

OP, whether you are interested in a competitive field or not, it doesn't change the fact that you should focus on enjoying your time now before school starts and get ready for adjusting to the heavy workload in August. Step 1 should not be even in your mind right now: just learn as much as you can, and the rest will take care of itself. It is also acceptable to shadow physicians from various specialties when you start school so that you can get the sense of what you are interested in. From there, then you can start narrowing down your research interests and start contacting faculty.
 
Medical students naturally start to really decide what they want to do and change their minds most frequently at the beginning of third year. That's usually when the relevation hits them and they will start advocating for peds/family med when just 3 months ago they were gung-ho about ophtho and urology. It's a natural process of medical school and simply a change in mindset and totally doesn't have to do with an exam that takes place before third year starts.
 
Anicetus said:
Medical students naturally start to really decide what they want to do and change their minds most frequently at the beginning of third year. That's usually when the relevation hits them and they will start advocating for peds/family med when just 3 months ago they were gung-ho about ophtho and urology. It's a natural process of medical school and simply a change in mindset and totally doesn't have to do with an exam that takes place before third year starts.
Click to expand...

Alternatively there is the rare primary care warrior that suddenly has an interest in derm/ortho
 
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