Disappointed with Step 1 outcome

[libertyyne]

Honestly I think one of the worst things to happen to the steps are "practice exams" that give you a predicted score.

To be fair the practice exams say they have a SD of 10, so realistically people should expect to fall +- 20 points of the predicted score. Which in all actuallity most people do, its just that those 20 points either way give a shock to the system if you are on the losing end of that coin toss.

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[GoSpursGo]

To be fair the practice exams say they have a SD of 10, so realistically people should expect to fall +- 20 points of the predicted score. Which in all actuallity most people do, its just that those 20 points either way give a shock to the system if you are on the losing end of that coin toss.

Yeah... sadly, those are not the kind of stats questions asked on Step 1!

This is an excellent illustration of why the steps will be P/F in the future. Yeah, it's good for PDs to have an objective measure of an applicant's ability, but the problem is that one's score is at least partly beholden to the content that happened to show up on your specific exam day. Ideally the solution would be that students could get meaningful critiques on their rotations that could go on their MSPE, but A) Schools are invested in making it appear that all of their students are the most amazing future doctor that has ever applied to any residency program ever; B) Students bitch and moan any time they get a comment that is less than glowing; and C) When you're an attending, nobody has time to do anything other than give straight 4/5 and "Great job, keep reading!"

 

[usmd2022]

This is why future generations will navigate a pass/fail Step system.

Yes this whole process has definitely disillusioned me.

 

[efle]

Honestly I think one of the worst things to happen to the steps are "practice exams" that give you a predicted score.

Yeah, especially since a lot of people study from flashcard decks that include cards based on the practice form questions.

People literally pre-study exact test questions and then are shocked that the practice tests over predict.

 

[QuizzicalApe]

I did a lot worse than this on Step 1 and I'm a heme/onc attending now, so... meh

Condolences to your dreams of doing a joint neurosurg + plastic surgery residency at MGH, though, I guess.

 

[Lawpy]

I did a lot worse than this on Step 1 and I'm a heme/onc attending now, so... meh

Condolences to your dreams of doing a joint neurosurg + plastic surgery residency at MGH, though, I guess.

Does heme/onc have Step 1 cutoffs?

 

[QuizzicalApe]

Does heme/onc have Step 1 cutoffs?

I'm doubtful they even bothered to dust the cobwebs off that part of my CV. However, it demonstrates that you can do not so amazingly on Step 1, get into a residency and a fairly competitive fellowship, and succeed. I'm just getting into my 2nd year as an attending now so this stuff isn't too far in my rearview mirror quite yet.

 

[usmd2022]

Yeah, especially since a lot of people study from flashcard decks that include cards based on the practice form questions.

People literally pre-study exact test questions and then are shocked that the practice tests over predict.

Yeah this is a good point, though I will say I basically stopped keeping up with my Anki reviews 2-3 months before the bulk of my practice exams and Step 1. And during my exam, I really didn't feel like I was thinking hard for discrete facts (except one or two questions). Perhaps subconscious memory plays a big role though. Anyways, who knows what happened. Just hope I don't have a similar situation with expectations vs. outcome for Step 2.

 

[Rogue42]

You should've told us that you got a 222 and you wanted ENT, then you could've continued @failedatlife's legacy

Jesus christ, I just went through that dudes feed. Solid example of why you don't go into medicine for one field....also solid example of someone who always wants something more. Those people will never be happy.

 

[treatem-and-streetem]

What is wrong with you

Anyway a 250 literally still means you can apply any specialty

 

[aCellsLife]

This is why step 1 is going P/F. I always liked having this test around so I was opposed to the change. Now I agree with it, but just hope the transition is smooth. I wouldn't be at the med school I am if step 1 were P/F for me. There is so much variability on this test that I could very likely get anywhere from a 230 to 255 on my upcoming exam. There are so many topics it is impossible to condense it into a 280 Q form, especially with newer step exams trying to have more difficult content. The anxiety surrounding step (which is valid in some ways and invalid in others) is the nail in the coffin.

OP, I actually get where you're coming from. I'm interested in top IM programs too and hope I get 250+. It sounds like you attend a top 40 institution, which matches well to IM as a whole. I go to a mid tier institution and have heard of folks going to nearby top 20s in IM with "just" a 235. Step is just one part of the equation. You're 25% of the way there from being application-ready, with a 250 or 260. Keep going.

 

[Luftwaffle]

Is this a satire of sdn? If so it's perfect.

 

[usmd2022]

This is why step 1 is going P/F. I always liked having this test around so I was opposed to the change. Now I agree with it, but just hope the transition is smooth. I wouldn't be at the med school I am if step 1 were P/F for me. There is so much variability on this test that I could very likely get anywhere from a 230 to 255 on my upcoming exam. There are so many topics it is impossible to condense it into a 280 Q form, especially with newer step exams trying to have more difficult content. The anxiety surrounding step (which is valid in some ways and invalid in others) is the nail in the coffin.

OP, I actually get where you're coming from. I'm interested in top IM programs too and hope I get 250+. It sounds like you attend a top 40 institution, which matches well to IM as a whole. I go to a mid tier institution and have heard of folks going to nearby top 20s in IM with "just" a 235. Step is just one part of the equation. You're 25% of the way there from being application-ready, with a 250 or 260. Keep going.

I appreciate the words of encouragement. I agree with your assessment. This whole process has increased my support for the eventual p/f transition. Nothing makes that more clear than the fact that your score report gives a 16 point confidence interval. A 242 is treated very differently than a 258!

 

[Matthew9Thirtyfive]

Keep this thread professional. Feel free to share your feelings about whether OP should be worried or not, but personal attacks are not acceptable. One post has already been deleted.

 

[usmd2022]

Another thing I have been wondering, especially as I look to study for Step 2, is whether I should stick with the same strategy as I did for Step 1 or try to find ways to improve my prep strategy? Scoring below my most recent practice scores has shaken my confidence a bit. Should I change things up or stick with the same strategy and chalk up my lower than predicted score to luck?

 

[Ho0v-man]

Another thing I have been wondering, especially as I look to study for Step 2, is whether I should stick with the same strategy as I did for Step 1 or try to find ways to improve my prep strategy? Scoring below my most recent practice scores has shaken my confidence a bit. Should I change things up or stick with the same strategy and chalk up my lower than predicted score to luck?

Studying in third year is drastically different so you’re probably going to change strategies even if you don’t want to.

 

[ArteryStudyPainting]

I'm becoming convinced this is a troll.

 

[usmd2022]

Studying in third year is drastically different so you’re probably going to change strategies even if you don’t want to.

Fair enough. I suppose I'm wondering whether discontinuing my Anki reviews 2 months out was wise in hindsight and whether I should stick to it more for Step 2.

 

[Ho0v-man]

Fair enough. I suppose I'm wondering whether discontinuing my Anki reviews 2 months out was wise in hindsight and whether I should stick to it more for Step 2.

I’m a huge Zanki step 1 fanboy and I’ll be the first to admit that anki takes a backseat to uworld in third year. I still used it. But getting your soul destroyed by uworld is much higher yield this go round imo.

 

[echidna001]

So I'm making this post at the risk of sounding very ungrateful, and that's not my intention. I've just had lingering disappointment since I got my score back recently. I was really aiming for a 260, and all of my practice tests within the last few weeks of my prep period were in that range. 275 on UW1 (over predict I know), 265 on NBME 18, and 264 on UWSA2. I don't get test taking anxiety, and my real exam honestly felt like the easiest set of questions I'd encountered for a long time. In hindsight, that was probably a red flag because the curve was probably brutal.

Anyway, I scored a 250, which is at the absolute bottom of my confidence interval of 250-267 (predicted 260). I know that objectively this is a good score, but I was really disappointed to not meet my goal. I poured my heart and soul into this test and it just feels bad not hitting your goal. I'm in clerkships now which are going fine and going to apply for the match next year. I go to a medical school with a good reputation but it's no John Harvard. I'm interested in academic IM at a top 20 program to be competitive for fellowship, but honestly with how competitive top programs in IM have become, I'm skeptical this will help me stand out much.

Anyway, if anyone happens to be reading this post and hasn't taken Step yet, I'd advise that they mentally prepare themselves to be happy with any score within the confidence interval. I know some people even end up scoring below that which is really disheartening. I really wasn't prepared for anything below a 255 and that was my own fault. I just hope the strong foundation I've developed helps me score higher for Step 2.

Sure it feels bad not hitting your goal but a 250 isn't shutting any doors at a top 20 or even top 5 IM programs. I scored in the low 240's and matched into the top 10. This score is not going to limit you at all.

 

[usmd2022]

Sure it feels bad not hitting your goal but a 250 isn't shutting any doors at a top 20 or even top 5 IM programs. I scored in the low 240's and matched into the top 10. This score is not going to limit you at all.

Very reassuring to hear, thank you!

I’m a huge Zanki step 1 fanboy and I’ll be the first to admit that anki takes a backseat to uworld in third year. I still used it. But getting your soul destroyed by uworld is much higher yield this go round imo.

Haha sounds about right.

 

[Ludwig2000]

I would just quit med school now if I was you...and start flipping burgers.

A lot of places won’t let you flip the burgers with <255. It’s called score creep. You MAY be able to cook the fries with a 250

 

[Summer3867]

Hey, I get it. Honestly the worrying never stops. I was like you and worked my butt off for Step 1, and I did end up getting >260. The whole time I was telling myself once I hit my goal score, everything will be easier and I'll let myself relax more. However, I can tell you I'm just as worried today about other stuff (CV, AOA, research, letters, etc)....

You set a really high goal for yourself and just because you didn't reach it, you still ended up with a good score and most importantly it's not going to close any doors for you. Keep on working and don't let this get you down!!

 

[usmd2022]

Hey, I get it. Honestly the worrying never stops. I was like you and worked my butt off for Step 1, and I did end up getting >260. The whole time I was telling myself once I hit my goal score, everything will be easier and I'll let myself relax more. However, I can tell you I'm just as worried today about other stuff (CV, AOA, research, letters, etc)....

You set a really high goal for yourself and just because you didn't reach it, you still ended up with a good score and most importantly it's not going to close any doors for you. Keep on working and don't let this get you down!!

Hey I appreciate the words of encouragement but this doesn't really make me feel better. Fact is I have to worry about those things too but without the benefit of an insanely high score that could potentially make up for not achieving some of the other goals.

Honestly the release of Charting the Outcomes 2020 has discouraged me a bit again. Seems like there is a big difference between the 250-260 range and the 260+ range for IM, with zero un-matched applicants in the 260+ pool (which has less than 200 applicants) where as over 500 people have scores between 250-260 and a few of those didn't even match. And then I'm sure these differences are further amplified for the top tier programs, plus it's only going to be more competitive by the time I apply next year.

 

[Kardio]

Honestly the release of Charting the Outcomes 2020 has discouraged me a bit again. Seems like there is a big difference between the 250-260 range and the 260+ range for IM, with zero un-matched applicants in the 260+ pool (which has less than 200 applicants) where as over 500 people have scores between 250-260 and a few of those didn't even match. And then I'm sure these differences are further amplified for the top tier programs, plus it's only going to be more competitive by the time I apply next year.

This is discouraging information?

 

[usmd2022]

View attachment 314588

This is discouraging information?

From the perspective of matching IM period? No

From the perspective of matching top tier IM? A little bit. I'm not foolish, I recognize that I won't be getting screened out or anything with my score at top programs, but I also don't think it will help me stand out and otherwise grant me an interview by default. Honestly I feel like that's a huge advantage, and probably one that's afforded to 260+ just because there's so few of them.

Obviously I know this doesn't mean that a 260+ is all you need, but just from that chart it seems to be a huge distinguishing factor just at the first glance of your app. I'd be happy to be convinced otherwise though. And honestly just seeing others online who had similar practice scores as me consistently getting 260+ has me questioning what the heck actually happened during my exam.

 

[deleted1022040]

Fellow student doctor, I barely understand your disappointment. I'm trying though. It does suck to not reach a goal, but you got pretty damn close. You have solid pieces in play right now to get Top 20 IM. From what I understand there can be a point of diminishing returns when it comes to scores.

Rejoice in your victory, be brave and practice hope for the future.

That being said, if you were an applicant to my program and I found out about this thread...

 

[ArteryStudyPainting]

Shtap.

 

[altblue]

From the perspective of matching IM period? No

From the perspective of matching top tier IM? A little bit. I'm not foolish, I recognize that I won't be getting screened out or anything with my score at top programs, but I also don't think it will help me stand out and otherwise grant me an interview by default. Honestly I feel like that's a huge advantage, and probably one that's afforded to 260+ just because there's so few of them.

Obviously I know this doesn't mean that a 260+ is all you need, but just from that chart it seems to be a huge distinguishing factor just at the first glance of your app. I'd be happy to be convinced otherwise though. And honestly just seeing others online who had similar practice scores as me consistently getting 260+ has me questioning what the heck actually happened during my exam.

I mean, after 3 pages of this you're still concerned about your score after over a dozen people reassured you, either through being direct or jokingly poking fun at what by all means is an enviable score. I'm interested in IM as well, and as someone a year away I'd be thrilled with a score ten points lower than yours. That would be enough for a solid program /w competitive fellowship placement and diverse options for 80+% of specialties (zero interest in surgery/derm either).

Is a 250 borderline for a "top" IM program while lacking AOA/top 20 pedigree? Probably, but it also probably won't even matter for you since you'll likely have a fulfilling career with all the options available to you. I'm only preclinical but I think you'll be alright in that regard

Honestly I'd calm down and reevaluate my situation. Talk to somebody in person who can reassure you, because this mindset isn't helpful.

 

[Dwan]

From the perspective of matching IM period? No

From the perspective of matching top tier IM? A little bit. I'm not foolish, I recognize that I won't be getting screened out or anything with my score at top programs, but I also don't think it will help me stand out and otherwise grant me an interview by default. Honestly I feel like that's a huge advantage, and probably one that's afforded to 260+ just because there's so few of them.

Obviously I know this doesn't mean that a 260+ is all you need, but just from that chart it seems to be a huge distinguishing factor just at the first glance of your app. I'd be happy to be convinced otherwise though. And honestly just seeing others online who had similar practice scores as me consistently getting 260+ has me questioning what the heck actually happened during my exam.

Your obsession with this is a bit too extreme, especially as someone who potentially hopes to become a chair one day, as you prior mentioned. If that is truly your goal, you will need to learn to move past many more significant failures than this in the future. And top 20 IM -> Chair is a far less likely outcome than 250 step-> top 20. Most people from top 20 IM end up doing the same thing as everyone else who attended solid academic programs, when they are post-fellowship.

 

[TrueRenegade]

Hey, it gotta be tough to score lower than you expected, but you scored well enough to be in contention for top tier IM programs. Take some time to reflect on how you could have done differently to prepare and implement it during your Step 2 CK and try to kill it. It appears Step 2 is becoming more important anyways. You still have a few more objectives to reach to reach your goals: AOA status, H in IM clerkship, great LORs, and Step 2 CK. Try to hit as many of these as possible! No use lamenting on your score anymore, only thing to do is to look forward and give it your all.

 

[biobukowski]

Yeah, I knew that I'd be more than ok for IM in general. But I am really interested in academic IM at a top 20 program to get into a good fellowship. If I were at a T10 school I don't think I'd have been as concerned.

What good fellowship are we talking about?

 

[Laradd]

All things can be done, just put some spirit on it.