Devastated...Need Help with Specialty Decision!

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adoniah

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To give a little background, I made some huge mistakes when studying for step 1. In hindsight, I would have done things quite differently, but sadly there's nothing I can do about that now. I had been pulling low 200's (mind you, I'm always well above average on standardized tests and in my med school class). In the last 2.5 weeks, I switched around my study method, told my study partner I had to start studying alone, and I jumped into the low to mid 230's on practice exams. My actual test, though, was awful; from question #1, I knew I was in for a long day. My exam was loaded with very detailed biochemistry; and I do mean detailed. And I'm sure everyone can talk about how their exam was weighted in one direction or another, but biochem was the last thing I needed. So, I pulled a not-so-impressive 216. I was devastated; I felt so confident going into the exam only to pull a sub-average performance.

My specialty interest is kind of odd. I really despise rounds, clinic; I like procedural specialties, but I don't want to be a surgeon (I know, I'm too particular). I've had an interest in anesthesia for a long time, but lately I've been thinking that I might not be good at making decisions on the fly that could kill a patient. A lot of times I like being able to think about things, at least briefly. So that leaves the following: path and rads, right? I got into rads last year, and the more I thought about it throughout my 2nd year, the more I realized how it fits my personality and learning style. As much as I loved anesthesia, I just don't know if it is the BEST fit for me.

So, I had my eyes on rads. But now I feel like that is completely unrealistic. I talked with a rads resident today, and he was being optimistic. He said take step 2 early, do well on it and apply broadly. I have a publication in a rads journal and am presenting at a rads conference in the coming weeks. I can get good letters, and all of that isn't a problem. The rest of my academic record is good; above average, scholarships etc...

My question is simple: did my study mistakes for step 1 cost me a chance at rads? The resident today made it sound like if I apply broadly enough and don't act like an idiot in interviews, then I should get in somewhere. But I'm just not sure if I believe him. I'm hoping someone on here can offer some advice. I was so disappointed in my score, because I know I'm capable of much more. Thanks in advance for any advice.
 
It seems like a lot of threads lately have been regarding unwanted Step 1 + competitive aims + what can be done or are the chances shot?

The thing is, if you know what you want, I believe there's always an open path to get there. It may not be the path that was your #1 choice - it may take longer and may not involve the same check points along the way, but you will eventually get to where you want to go.

Instead of focusing on the Step 1 score, I think you should look at all the positives you have going for you. Being a published author and presenting your research is awesome. And shows your dedication/interest in the field. Do your best in clinical rotations, get those great letters, study well for step 2, do your best and I'm certain it will work out - if you want it to.

I mean, do you really think you posted here to hear "No your chances are shot, go do something else?" I think the resident has already given you great advice.
 
Mean USMLE was 238 but at the same time 67% of US seniors with a score between 211 and 220 matched (n=99). I'm sure you could be one of those people. Apply broadly!
 
I don't think 216 is low enough to completely kill an otherwise strong application. If you look at Charting Outcomes in the Match, in 2009 2/3rds of US seniors with Step 1 scores between 211 and 220 successfully matched in radiology.

The advice the rads resident gave you was on the money--take Step 2 early and do well on it, apply broadly and realistically, publish in rads journals, get known around your home program and get good LORs, etc.
 
The mean USMLE is 218-222

The OP is right around the mean and hardly doomed.

But Rads is a different story
 
K31 said:
I don't think 216 is low enough to completely kill an otherwise strong application. If you look at Charting Outcomes in the Match, in 2009 2/3rds of US seniors with Step 1 scores between 211 and 220 successfully matched in radiology.

The advice the rads resident gave you was on the money--take Step 2 early and do well on it, apply broadly and realistically, publish in rads journals, get known around your home program and get good LORs, etc.
Click to expand...

With a 216, it's closer to an 80% chance of matching. With publications and good letters, and good grades, I would imagine that number would be even higher.
 
Just look at the match data, it's been done.
 
adoniah said:
To give a little background, I made some huge mistakes when studying for step 1. In hindsight, I would have done things quite differently, but sadly there's nothing I can do about that now. I had been pulling low 200's (mind you, I'm always well above average on standardized tests and in my med school class). In the last 2.5 weeks, I switched around my study method, told my study partner I had to start studying alone, and I jumped into the low to mid 230's on practice exams. My actual test, though, was awful; from question #1, I knew I was in for a long day. My exam was loaded with very detailed biochemistry; and I do mean detailed. And I'm sure everyone can talk about how their exam was weighted in one direction or another, but biochem was the last thing I needed. So, I pulled a not-so-impressive 216. I was devastated; I felt so confident going into the exam only to pull a sub-average performance.

My specialty interest is kind of odd. I really despise rounds, clinic; I like procedural specialties, but I don't want to be a surgeon (I know, I'm too particular). I've had an interest in anesthesia for a long time, but lately I've been thinking that I might not be good at making decisions on the fly that could kill a patient. A lot of times I like being able to think about things, at least briefly. So that leaves the following: path and rads, right? I got into rads last year, and the more I thought about it throughout my 2nd year, the more I realized how it fits my personality and learning style. As much as I loved anesthesia, I just don't know if it is the BEST fit for me.

So, I had my eyes on rads. But now I feel like that is completely unrealistic. I talked with a rads resident today, and he was being optimistic. He said take step 2 early, do well on it and apply broadly. I have a publication in a rads journal and am presenting at a rads conference in the coming weeks. I can get good letters, and all of that isn't a problem. The rest of my academic record is good; above average, scholarships etc...

My question is simple: did my study mistakes for step 1 cost me a chance at rads? The resident today made it sound like if I apply broadly enough and don't act like an idiot in interviews, then I should get in somewhere. But I'm just not sure if I believe him. I'm hoping someone on here can offer some advice. I was so disappointed in my score, because I know I'm capable of much more. Thanks in advance for any advice.
Click to expand...

Are you a current 3rd year or a 4th year?

Honors in multiple rotations + good step 2 can definitely make up for the below avg step 1. There are something like 180 rads programs. Apply broadly and you should be fine
 
adoniah said:
My specialty interest is kind of odd. I really despise rounds, clinic; I like procedural specialties, but I don't want to be a surgeon (I know, I'm too particular). I've had an interest in anesthesia for a long time, but lately I've been thinking that I might not be good at making decisions on the fly that could kill a patient. A lot of times I like being able to think about things, at least briefly. So that leaves the following: path and rads, right? I got into rads last year, and the more I thought about it throughout my 2nd year, the more I realized how it fits my personality and learning style. As much as I loved anesthesia, I just don't know if it is the BEST fit for me.
Click to expand...

you don't like making decisions of the fly that could kill a patient yet you want to do rads or path?! those are two specialties where you will most likely be making life or death decisions under a time constraint. In rads you are deciding whether this obscure shadow looks normal or is something that will kill the patient or whether that black line is an artifact or will this person become paralyzed when they move their neck. path is very similar ....in one of the goljan lectures he talks about how stressful path is for precisely that reason (and why he couldn't take it and quit ..combined with the fact that he says he wasn't very good at it)

that being said i think your score can get you into a rads program somewhere but as others said apply broadly ....you should also have a backup!
 
I appreciate the replies. In hindsight, should have left "devastated" out of the title. That's completely inaccurate, as others have pointed out. Apologies for that.

And I hadn't thought of looking at the match data, which makes things look a little more optimistic. I just know how competitive rads is, and it's only getting more competitive. I'm MS-3 currently, so I'm doing my best to do as well as I can in my clerkships. Regardless, step 1 scores do play a big role, and that's what really concerns me. I don't want to end up at some program I hate simply because they are the only place that accepts me. But "beggars can't be choosers", right?

And to respond to another comment, anesthesia and rads couldn't be further apart. Perhaps I should clarify. When I say I'm not sure I could make decisions on the fly, I mean this: patient's BP starts crashing suddenly or patient codes intra-op, I'd fear that I'd freeze up. And I know, how could I possibly make that determination when I'm only a med student? I'm sure at some point algorithms become second nature, and when a pt. becomes hypotensive, it just becomes second nature what to reach for. Nevertheless, I'm not sure I'd want to make those life/death decisions day after day (depending on where you do anesthesia).

Rads is a whole different universe. Are you making life/death decisions? Sure, I guess in some far stretch of the imagination I am. But by that logic, by ordering an increase in my pt's lasix I'm also making that type of decision. By extension, pretty much every branch of medicine forces you to make decisions like that. By definition, that's medicine! But, anesthesia is incredibly time dependent; waiting 20 seconds could kill someone. In rads, or path for that matter since it was brought up, you have the luxury of taking an extra minute if you need it to make sure you got everything. If you're really unsure, you have the added bonus of being able to turn around and ask a colleague to look at the film. In anesthesia, when a patient codes, you don't exactly have time to go find your partner and ask them what they think is the right course of action. Why do you think anesthesiologists pay malpractice through the roof?

In short, I'm not sure I want to be in that kind of position day in and day out. I'd rather have the comfort of knowing if I want to take a second look, or if I need to ask for a second opinion, I've got it. I'm an incredibly visual learner/person, and I've always been very good with anything visual. Rads has always piqued my interest because of it.
 
might make sense to look at this.

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf


adoniah said:
I appreciate the replies. In hindsight, should have left "devastated" out of the title. That's completely inaccurate, as others have pointed out. Apologies for that.

And I hadn't thought of looking at the match data, which makes things look a little more optimistic. I just know how competitive rads is, and it's only getting more competitive. I'm MS-3 currently, so I'm doing my best to do as well as I can in my clerkships. Regardless, step 1 scores do play a big role, and that's what really concerns me. I don't want to end up at some program I hate simply because they are the only place that accepts me. But "beggars can't be choosers", right?

And to respond to another comment, anesthesia and rads couldn't be further apart. Perhaps I should clarify. When I say I'm not sure I could make decisions on the fly, I mean this: patient's BP starts crashing suddenly or patient codes intra-op, I'd fear that I'd freeze up. And I know, how could I possibly make that determination when I'm only a med student? I'm sure at some point algorithms become second nature, and when a pt. becomes hypotensive, it just becomes second nature what to reach for. Nevertheless, I'm not sure I'd want to make those life/death decisions day after day (depending on where you do anesthesia).

Rads is a whole different universe. Are you making life/death decisions? Sure, I guess in some far stretch of the imagination I am. But by that logic, by ordering an increase in my pt's lasix I'm also making that type of decision. By extension, pretty much every branch of medicine forces you to make decisions like that. By definition, that's medicine! But, anesthesia is incredibly time dependent; waiting 20 seconds could kill someone. In rads, or path for that matter since it was brought up, you have the luxury of taking an extra minute if you need it to make sure you got everything. If you're really unsure, you have the added bonus of being able to turn around and ask a colleague to look at the film. In anesthesia, when a patient codes, you don't exactly have time to go find your partner and ask them what they think is the right course of action. Why do you think anesthesiologists pay malpractice through the roof?

In short, I'm not sure I want to be in that kind of position day in and day out. I'd rather have the comfort of knowing if I want to take a second look, or if I need to ask for a second opinion, I've got it. I'm an incredibly visual learner/person, and I've always been very good with anything visual. Rads has always piqued my interest because of it.
Click to expand...
 
muhali3 said:
Have you shadowed an anesthesiologist?

I'd suggest shadowing or setting up an elective rotation.

I think you might be over-exaggerating how stressful it is. The large majority of cases go fine and properly trained anesthesiologists will prevent such crashes from happening in the first place. That is their job, to monitor the patient and make sure the surgery goes as smoothly as possible. A well-trained anesthesiologist rarely deals with crashes, due to thorough pre-operative assessment of the patient and constant intraoperative monitoring. Anesthesiologists never scrub into a surgery expecting a crash, because they've done their homework on the patient and know what they need to do to prevent that from happening.
Click to expand...
Real life is not necessarily that rosy of a picture.

Actually, while most scheduled cases go smoothly, there are cases that are anticipated to go poorly. It's not like every patient is a great surgical candidate; quite the opposite. There are cases where a patient is crashing from the onset, or is anticipated to not do well given the nature of the case. Traumas, transplants, emergency abdominal disasters, emergency vascular cases (AAA) etc. are just a few of the cases where things can take a dramatic turn for the worse in a very short period of time. The anesthesiologist relies on his/her training during a case, but also is prepared to deal with a potentially crashing patient. There are unanticipated difficult airways, sudden hemorrhages, sepsis, intraop MIs that happen to even the best anesthesiologists. Some patients won't make it no matter how excellent their anesthesiologist is.

Thankfully, the vast majority of cases are uneventful and the average case does not seem to be full of big life/death decisions, but anesthesia does have it's moments as well. Some people don't like the stress of having to anticipate and react to sudden changes in the patient's status, even if it isn't very often, and choose other fields.
 
Last edited:
heres the best advice you will ever read on this forum:


ready?

leave the computer. pick up the phone. call your med schools affiliated hospital and connect to the radiology department. get the secretary for PD of the radiology residency program and schedule an appointment. talk to him/her about it and what you can do over the next 1.5 years to boost your app.

half of the people on SDN don't know what they are talking about, and the other half are using anecdotal evidence or hearsay as support for their claims. SDN is the last place you should be going for advice right now.

oh wait, then why would you listen to me? crap, paradox...
 
airmax said:
heres the best advice you will ever read on this forum:


ready?

leave the computer. pick up the phone. call your med schools affiliated hospital and connect to the radiology department. get the secretary for PD of the radiology residency program and schedule an appointment. talk to him/her about it and what you can do over the next 1.5 years to boost your app.

half of the people on SDN don't know what they are talking about, and the other half are using anecdotal evidence or hearsay as support for their claims. SDN is the last place you should be going for advice right now.

oh wait, then why would you listen to me? crap, paradox...
Click to expand...

exactly why should he listen to you? You are still a pre-med and have no real experience with any of this stuff or medical school at all. You make it sound so easy to just get a meeting with the PD of a residency...

OP, yes your step 1 score will hold you back. That doesn't mean you can't match but it does make it much more difficult. I suggest just moving on and doing your best from here on out. You may find that once you start rotations your interest will change. If not then you should meet with your deans/advisors and discuss your options. If there is time for research do it to help pad your cv. Also honestly you won't get any experience in rads unless you do an elective which at my school anyway can't be done until 4th year. So just keep an open mind. You may find you like other things. I am assuming you just got your step 1 score back by the way.

Also anesthesia is def not out of your step 1 range. "Making decisions on the fly" is something that you learn in residency. I assume we all have some sort of anxiety about being in charge of patients in the future but again it is a process that is learned throughout school. Also being a rads or path doc can actually be very stressful if you think about it because LOTS of people are depending on what you say. In fact your read on an image or specimen will often drastically affect patient care.
 
officedepot said:
exactly why should he listen to you? You are still a pre-med and have no real experience with any of this stuff or medical school at all.
Click to expand...

if you took a second to look at his post history before being a d-bag you'd realize that he's a 2nd/3rd year
 
officedepot said:
exactly why should he listen to you? You are still a pre-med and have no real experience with any of this stuff or medical school at all. You make it sound so easy to just get a meeting with the PD of a residency...

OP, yes your step 1 score will hold you back. That doesn't mean you can't match but it does make it much more difficult. I suggest just moving on and doing your best from here on out. You may find that once you start rotations your interest will change. If not then you should meet with your deans/advisors and discuss your options. If there is time for research do it to help pad your cv. Also honestly you won't get any experience in rads unless you do an elective which at my school anyway can't be done until 4th year. So just keep an open mind. You may find you like other things. I am assuming you just got your step 1 score back by the way.

Also anesthesia is def not out of your step 1 range. "Making decisions on the fly" is something that you learn in residency. I assume we all have some sort of anxiety about being in charge of patients in the future but again it is a process that is learned throughout school. Also being a rads or path doc can actually be very stressful if you think about it because LOTS of people are depending on what you say. In fact your read on an image or specimen will often drastically affect patient care.
Click to expand...

Actually I'm pretty sure he's a 3rd year, and he's absolutely right. The best source of information is the people who are familiar with this i.e. program directors, attendings, etc.

Also read the OP's post... he put his step 1 score there, so yes he got it back.
 
Just a thought..why not pathology? It's a great field, great hours, and also very visually oriented. You do minimal procedures, and if you're interested in anatomic pathology, get to use a scalpel regularly (on specimens) without any consequence of acheiving hemostasis 🙂
 
airmax said:
heres the best advice you will ever read on this forum:


ready?

leave the computer. pick up the phone. call your med schools affiliated hospital and connect to the radiology department. get the secretary for PD of the radiology residency program and schedule an appointment. talk to him/her about it and what you can do over the next 1.5 years to boost your app.

half of the people on SDN don't know what they are talking about, and the other half are using anecdotal evidence or hearsay as support for their claims. SDN is the last place you should be going for advice right now.

oh wait, then why would you listen to me? crap, paradox...
Click to expand...

Your perception of SDN is pretty terrible and inaccurate. You basically say that 100% of people on here have no worthwhile experience and/or nothing worthwhile to say. If you have spent any time on SDN it should be very obvious that there are many students, residents, attendings, etc. on SDN that can speak from real life experience not hearsay. I have gotten a lot of great advice from SDN over the years and much of it has been better than advice I got from my deans/advisers. I'm not saying that every post/poster is worth listening to, but telling someone that SDN has nothing for them is pretty ridiculous.
 
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