Disappointed with Step 1 outcome

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usmd2022

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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.
 
usmd2022 said:
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.
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Dear OP,

it is really hard for me to be a mature adult while reading this post, and to give you a positive mature feedback vs snapping at you. Especially since, being a rising M2 and worrying about the step, i would literally shave my hair off (i am female) if it meant scoring even 240. There are other sacrifices i would be ready for for 250, some of which include time in jail on some sort of weird exchange program, a weekend in a haunted mansion, etc.

Majority of people in the country dont get anywhere near this score, and i think your post automatically caused a spike in blood pressure in a lot of M2s who are reading this. And i am sure a few are experiencing worsening depression as well, identity crisis, etc.

But i will try to use this as a learning experience and be positive:

1) how did you prepare that got you to score so high on both practice exams and on the actual exam?
2)Have you tried talking to current hopkins and harvard residents and find out what could make you stand out?
 
Don't worry your predicted score of 260 wasn't gonna cut it for IM either. Anything below 280 is trash for any IM program. Good thing, you can still match community FM in Jonesboro, Arkansas. My advise would be to apply very broadly to community FM programs (I'm talking more than 150 programs here) and hopefully that yields you at least 5 interviews. You can add another 100 community peds programs as backup.
 
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Ok, guys, lets try to be nice. I know half of us are pissed off, the other half is probably amused, but at the off chance that the OP is seriously upset, lets try to be understanding 🙂)).

I mean, lets TRY..... i honestly do not know how to. But it must be very disappointing to not get the result you were hoping for....
 
M&L said:
Dear OP,

it is really hard for me to be a mature adult while reading this post, and to give you a positive mature feedback vs snapping at you. Especially since, being a rising M2 and worrying about the step, i would literally shave my hair off (i am female) if it meant scoring even 240. There are other sacrifices i would be ready for for 250, some of which include time in jail on some sort of weird exchange program, a weekend in a haunted mansion, etc.

Majority of people in the country dont get anywhere near this score, and i think your post automatically caused a spike in blood pressure in a lot of M2s who are reading this. And i am sure a few are experiencing worsening depression as well, identity crisis, etc.

But i will try to use this as a learning experience and be positive:

1) how did you prepare that got you to score so high on both practice exams and on the actual exam?
2)Have you tried talking to current hopkins and harvard residents and find out what could make you stand out?
Click to expand...

Thanks, I really appreciate your feedback. And honestly I expected some of the reactions here -- and I do understand where they're coming from.

I think what has contributed to my neuroticism is posts on SDN, especially "what are my chances threads" in the IM forum where people with scores 245+ are told they should apply broadly and they aren't very competitive for top IM programs. And I know people often retort with "well matching into a top program isn't the end all be all," but SDN is also the place where you see people constantly emphasize the importance of coming from a top medical school to provide a significant advantage for matching to competitive specialties.

I know I have a lot to be grateful for. I know I have a score a lot would kill for. And because of that I did count my blessings after getting my score. But if I'm just being 100% honest about my actual emotional reaction to my outcome, I was disappointed. And that's why I posted here. Maybe I do deserve the sarcastic and snappy reactions, but I've seen very similar posts over the past few years on here and just wanted some advice on where this leaves me.
 
usmd2022 said:
Thanks, I really appreciate your feedback. And honestly I expected some of the reactions here -- and I do understand where they're coming from.

I think what has contributed to my neuroticism is posts on SDN, especially "what are my chances threads" in the IM forum where people with scores 245+ are told they should apply broadly and they aren't very competitive for top IM programs. And I know people often retort with "well matching into a top program isn't the end all be all," but SDN is also the place where you see people constantly emphasize the importance of coming from a top medical school to provide a significant advantage for matching to competitive specialties.

I know I have a lot to be grateful for. I know I have a score a lot would kill for. And because of that I did count my blessings after getting my score. But if I'm just being 100% honest about my actual emotional reaction to my outcome, I was disappointed. And that's why I posted here. Maybe I do deserve the sarcastic and snappy reactions, but I've seen very similar posts over the past few years on here and just wanted some advice on where this leaves me.
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so please share: how did you prepare? If you feel more comfortable PMing me instead, feel free. I really want to know
 
Better get ready for Family medicine in North Dakota.

Its ok to be disappointed, but the score is what it is, process it , be grateful that every door is still open and move on.
 
M&L said:
so please share: how did you prepare? If you feel more comfortable PMing me instead, feel free. I really want to know
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Nothing out of the ordinary. Anki, UWORLD, Amboss, Rx, Sketchy -- the works. Finished over 6000 unique questions before test day. I scored 90% on the free 120 (actually found the real exam to be easier which is unusual). Honestly my assessment is I got unlucky on a few guesses and perhaps a higher % of my incorrect answers were not experimental questions.

And to answer your question if I've talked to Harvard and Hopkins residents -- I have not (I don't know any lol). I really wish there was a tool like the MSAR that gave you a mean Step 1 score per program, but I have not found one. When I looked into what scores are competitive for the top 10 IM programs, I was seeing 260+ from posts on SDN and reddit.
 
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According to Doximity Johns Hopkins is the number 1 IM program by reputation. I just checked JHU's website and it says that they don't have a minimum USMLE step 1 cutoff, but most people that do get an interview has a 220 or better. The second most reputable IM is Massachusetts General Hospital and their residents' USMLE step 1 scores range from a 236 to a 245 according to residency explorer. So you'd be better off worrying about other parts of your application and your attitude about this whole process. You're so much more than your board scores. Stop acting like a neurotic premed, you're gonna be a Doctor. See my attachments.


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According to Texas star, which compiles self-reported data from med students that match at different programs, the average step 1 for Johns Hopkins is 251 (n=19 for current PGY1 class). It’s not your Step 1 that’s gonna prevent you from matching at these types of places. But acting like an annoying neurotic humble braggy med student definitely could (sorry had to get a dig in couldnt help it 😀)
 
usmd2022 said:
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.
Click to expand...

You got to get some perspective in life. A 250 is a fantastic score. You may not get into a top 20 IM program but who cares. You will get into IM, pursue research, and you will be able to apply for a fellowship. There is no need to even have an ounce of regret given you put everything you had. It's better to learn now that life is unfair - you will do everything you can and still not reach some of your goals. Your score is not a weak point in your app. Move forward and keep your chin up. Do well during your clerkships.

Your board exams have no real value outside of your residency application and does not indicate self-worth and intelligence. Learn that now, preserve your mental health, and channel your energy into productive things like doing strong research and performing well on rotations.
 
You’re being ridiculous. You can still easily get into a top 20 program with that score, focus on other aspects of your application now, like research, AOA, getting honors. Your score won’t be the limiting factor.
 
ciestar said:
Once we learn to stop placing so much of our self worth on test scores, the better we’ll be.

OP, im sorry you’re disappointed, but things will work out for you.
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I appreciate the words of encouragement.
The thing is I'm not really tying my outcome to my self worth. It's just that this exam for better or worse has such a disproportionate impact on whether we can match to the residency programs we want to. The confidence interval on my score report is 242-258, but a 242 is treated very differently than a 258. So clearly this exam is being used to stratify applicants more than it's statistically able to. But of course, making that argument just makes it sound like you're bitter about not scoring higher, and obviously there's some element of truth to that.

Even in this thread it seems there's mixed messages. Someone said I may not match a top 20 program with this score, someone else said that all doors are open. Maybe if I was at a top 10 school I wouldn't really be disappointed, but the consensus seems to be applicants from non-elite schools need to not just crush Step but absolutely pulverize Step to be competitive for top programs.

And matching to a top program when I apply next year is important to me because it directly impacts my ability to attain competitive fellowships. If attending a top 10 med school can give you an advantage in the residency match, why is striving for a top residency so you have a competitive edge for fellowship viewed so negatively? It doesn't have anything to do with self worth but our career goals.
 
TAVR4life said:
You’re being ridiculous. You can still easily get into a top 20 program with that score, focus on other aspects of your application now, like research, AOA, getting honors. Your score won’t be the limiting factor.
Click to expand...
This is encouraging to hear. Thank you.
 
I'm gonna go against the grain (as per usual) and say OP isn't alone at all. I have a good buddy who was crushed to get a 259 because his dream he busted ass for was a 260. Another person got a 258, same dream, did >400,000 flashcards to just barely fall short.

I think it's the silver medal effect. Coming slightly shy of a major goal is upsetting even when you're objectively still the cream of the crop, because all you can think about is how close you were to much greater satisfaction.
 
efle said:
I'm gonna go against the grain (as per usual) and say OP isn't alone at all. I have a good buddy who was crushed to get a 259 because his dream he busted ass for was a 260. Another person got a 258, same dream, did >400,000 flashcards to just barely fall short.
Click to expand...

Well I'm aiming for a 3hunna and if I don't get it I'm gonna be blown into smithereens
 
efle said:
I'm gonna go against the grain (as per usual) and say OP isn't alone at all. I have a good buddy who was crushed to get a 259 because his dream he busted ass for was a 260. Another person got a 258, same dream, did >400,000 flashcards to just barely fall short.

I think it's the silver medal effect. Coming slightly shy of a major goal is upsetting even when you're objectively still the cream of the crop, because all you can think about is how close you were to much greater satisfaction.
Click to expand...
I don’t think that makes it any more logical, or even healthy, to fixate on such an arbitrary thing. In the grand scheme, it’s 2 points! No one gives a crap over two points. So unless you’re just looking to get a 260 to frame it... it’s getting riled up over what amounts to nothing. As with the OP: the score isn’t getting between them and their goals — other stuff will.

I’d also argue that the sense of accomplishment would probably be fleeting, as the next step (and Step) is right around the corner.
 
efle said:
I'm gonna go against the grain (as per usual) and say OP isn't alone at all. I have a good buddy who was crushed to get a 259 because his dream he busted ass for was a 260. Another person got a 258, same dream, did >400,000 flashcards to just barely fall short.
Click to expand...

Seems like your friend and OP have the same issue. Why are your dreams so set on the score you get? To the point that one or two points below a "magical" 260 means this much? Maybe it's because they've been too privileged from day 1 and don't really understand what it really means to fall flat on your face and not achieve something (get into college, get into med school, haven't worked a real job and been laid off, etc). Once you get to there, maybe you'll get some perspective on life. Then you won't spend that much time worrying about the score you get, the prestige of your institution, etc.


usmd2022 said:
And matching to a top program when I apply next year is important to me because it directly impacts my ability to attain competitive fellowships. If attending a top 10 med school can give you an advantage in the residency match, why is striving for a top residency so you have a competitive edge for fellowship viewed so negatively? It doesn't have anything to do with self worth but our career goals.
Click to expand...

OP, you have gone through undergrad and med school. How long is it going to take for someone to realize that the name brand institution you go to doesn't mean anything at the end? Just something that you can feel proud of and put on your CV. Is there something magical at a top 10 or 20 IM residency that you cannot find elsewhere? You did not mention a specific mentor that you want to work with or any type of cutting edge research. I can pull out a handful of current physicians who are GIs, EPs, etc. and they did not go to a "top" med school or "top" residency. Go to your institution and talk to IM -> fellowship trained physicians, and maybe they will give you some perspective. You can achieve your goals anywhere.
 
What I've learned in medical school is no matter what you do, a lot of people will be better than you. Especially here. In a place where you never see the middle. You only see the people who failed or received a 290.

You have 45 publications? Someone else has 50.

You have done extensive research you're proud of? Someone else did what you already did, and probably subjectively better too.

You just cured cancer in the break-room? That's cool, James just did that too, about 15 minutes ago in surgery. Crazy right?

If you are happy, awesome. Otherwise, you're going to judge yourself based on others. And this, again, is literally that: judging how you stand, based on those around you who are ungodly at everything they do.

Even if you're the bottom of the barrel in medical school. By getting to this point, you're already the 1% of the 1% (not saying be a bum and become complacent).

My question back to you is, can you talk to and comfort the patient? Can you be the best doctor in the eyes of that person sitting in front of you? Can you walk out of the room and say, "yes, that was my best work" or even, "you know, I can improve on [X]; let me do that."

You're more than a number; learn that. And if you can't learn that just a number doesn't care for people, you have no business caring for those who are vulnerable enough to trust you.
 
NonTrad16 said:
I don’t think that makes it any more logical, or even healthy, to fixate on such an arbitrary thing. In the grand scheme, it’s 2 points! No one gives a crap over two points. So unless you’re just looking to get a 260 to frame it... it’s getting riled up over what amounts to nothing. As with the OP: the score isn’t getting between them and their goals — other stuff will.

I’d also argue that the sense of accomplishment would probably be fleeting, as the next step (and Step) is right around the corner.
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yugimuto said:
Seems like your friend and OP have the same issue. Why are your dreams so set on the score you get? To the point that one or two points below a "magical" 260 means this much? Maybe it's because they've been too privileged from day 1 and don't really understand what it really means to fall flat on your face and not achieve something (get into college, get into med school, haven't worked a real job and been laid off, etc). Once you get to there, maybe you'll get some perspective on life. Then you won't spend that much time worrying about the score you get, the prestige of your institution, etc.
Click to expand...
Interestingly the guy with the 259 was also livid when the P/F decision came out. He tied up a lot of ego into Step 1, since it's functionally the closest thing to an intellectual yardstick for preclinicals. That's why he wanted to be in the 260+ bin so badly. Hearing from the creators of the test that Step isn't meant for that was not well received.

It's hard to place fault on his psyche, considering how much emphasis is placed on the test. I do agree that having to worry about bigger things like funding your own education as a teenager puts everything in a different perspective. I had the interesting experience of being a bottom 5% student by SES in my very wealthy, very premed-oriented undergrad, and seeing how much many people stressed about grades and scores was surprising to me. But not everyone has bigger fish to fry when they're young. If all you knew growing up under tiger parents was that academic excellence was the main measure of worth, you might feel like that too.
 
👎

Troll post. Surprised at how many of you are taking OP seriously.
 
yugimuto said:
Seems like your friend and OP have the same issue. Why are your dreams so set on the score you get? To the point that one or two points below a "magical" 260 means this much? Maybe it's because they've been too privileged from day 1 and don't really understand what it really means to fall flat on your face and not achieve something (get into college, get into med school, haven't worked a real job and been laid off, etc). Once you get to there, maybe you'll get some perspective on life. Then you won't spend that much time worrying about the score you get, the prestige of your institution, etc.




OP, you have gone through undergrad and med school. How long is it going to take for someone to realize that the name brand institution you go to doesn't mean anything at the end? Just something that you can feel proud of and put on your CV. Is there something magical at a top 10 or 20 IM residency that you cannot find elsewhere? You did not mention a specific mentor that you want to work with or any type of cutting edge research. I can pull out a handful of current physicians who are GIs, EPs, etc. and they did not go to a "top" med school or "top" residency. Go to your institution and talk to IM -> fellowship trained physicians, and maybe they will give you some perspective. You can achieve your goals anywhere.
Click to expand...
You know, I've thought a lot about this. I think on a logical level you are right, but on an emotional level, it's hard not to strive for the top.

I remember having this same conflict when deciding on which medical school to attend. At the end of the day, I chose to attend a cheaper (but reputable) school over a higher ranked school at full price (T10). It seemed the prevailing wisdom outside of SDN was to go with a cheaper school as long as the reputation isn't dramatically worse because you can crush boards and match at the same competitive programs.

But it just seems like that was a lie. I have seen so many disheartening posts about how students like me need to work harder than students from T10 schools to achieve the same outcome. I scored a 250 on step? A kid from a T10, all other things being equal, can probably achieve the same results with a 240. I need AOA whereas the T10 kid doesn't necessarily. And the list just goes on.

And you know what? I find that just a little exhausting. And so instead of being bitter about how the world works, may as well play the game by the rules that everyone recognizes. And for residency, I think for me that means striving for a top 10-20 IM program so I don't need to work 3x harder to achieve the same results. I don't mind working hard -- it's something I've had to do my entire life (I didn't get my Step or MCAT score from some natural talent, it was thousands of hours of work in total). But maybe it's ok to use some advantages along the way.
 
@Kardio : the types who make these kinds of posts are (often) the ones who don't think of them as "controversial"
 
Fair. There is a significant difference though between realizing others may think it's controversial, and oneself thinking it's actually controversial
 
I said it before, it is okay to be disappointed. That is fine. Again though, OP, you will match. You dont need T10 IM to get a fellowship, you just don’t.

I was CRUSHED after I got my step 1 score (hint: it was 39 points lower than your’s). I felt like a failure. My practice scores were higher. I felt like I was going nowhere and that I was doomed.

Here’s the thing: you‘re a very competitive applicant. A 250 sure isn’t closing doors for you. You can’t change it. You’ve just gotta work on what you can change. Get an equally impressive CK score. Get more research. Network. Nail your rotations.
 
usmd2022 said:
You know, I've thought a lot about this. I think on a logical level you are right, but on an emotional level, it's hard not to strive for the top.

I remember having this same conflict when deciding on which medical school to attend. At the end of the day, I chose to attend a cheaper (but reputable) school over a higher ranked school at full price (T10). It seemed the prevailing wisdom outside of SDN was to go with a cheaper school as long as the reputation isn't dramatically worse because you can crush boards and match at the same competitive programs.

But it just seems like that was a lie. I have seen so many disheartening posts about how students like me need to work harder than students from T10 schools to achieve the same outcome. I scored a 250 on step? A kid from a T10, all other things being equal, can probably achieve the same results with a 240. I need AOA whereas the T10 kid doesn't necessarily. And the list just goes on.

And you know what? I find that just a little exhausting. And so instead of being bitter about how the world works, may as well play the game by the rules that everyone recognizes. And for residency, I think for me that means striving for a top 10-20 IM program so I don't need to work 3x harder to achieve the same results. I don't mind working hard -- it's something I've had to do my entire life (I didn't get my Step or MCAT score from some natural talent, it was thousands of hours of work in total). But maybe it's ok to use some advantages along the way.
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I decided the other way and it's also been eye opening from the opposite side of the scholly vs brand name debate. At the most competitive institutions you're in a tiny minority for attending public schools or growing up in a family that ever faced unemployment or other financial stress. That's not by accident, wealth smooths the entire process in ways I never realized. For example, expensive and selective private high schools in New England that effortlessly place huge chunks of their class into Ivy Leagues via early decision every year. I never even realized these things existed until stepping foot into this bizarre alternate universe. You have to grind and perform your ass off to compete with those kinds of resources, and it only amplifies at every level from college admissions to medschool admissions to residency match.
 
usmd2022 said:
You know, I've thought a lot about this. I think on a logical level you are right, but on an emotional level, it's hard not to strive for the top.

I remember having this same conflict when deciding on which medical school to attend. At the end of the day, I chose to attend a cheaper (but reputable) school over a higher ranked school at full price (T10). It seemed the prevailing wisdom outside of SDN was to go with a cheaper school as long as the reputation isn't dramatically worse because you can crush boards and match at the same competitive programs.

But it just seems like that was a lie. I have seen so many disheartening posts about how students like me need to work harder than students from T10 schools to achieve the same outcome. I scored a 250 on step? A kid from a T10, all other things being equal, can probably achieve the same results with a 240. I need AOA whereas the T10 kid doesn't necessarily. And the list just goes on.

And you know what? I find that just a little exhausting. And so instead of being bitter about how the world works, may as well play the game by the rules that everyone recognizes. And for residency, I think for me that means striving for a top 10-20 IM program so I don't need to work 3x harder to achieve the same results. I don't mind working hard -- it's something I've had to do my entire life (I didn't get my Step or MCAT score from some natural talent, it was thousands of hours of work in total). But maybe it's ok to use some advantages along the way.
Click to expand...

Yeah man, if that's the game you want to play, one where you are concerned about reputation and the place you go to, then yeah. You should be prepared for moments like this where you feel like crap when you get only a 250. Striving for the top doesn't necessarily mean destroying a board exam. But you can pick your battles - just be prepared for the emotional toll and consequences.

You don't have to follow into the trap of medicine's classical method of stratifying applicants based on test scores. People repeatedly tell you that you can achieve your goals with your board exam score and attending a reputable IM program but it doesn't matter to you. You choose this life of suffering by making these posts. You've done that in college with your MCAT, and that is why you aren't actually thankful or take any pride in the fact that you got scholarship money from your "cheaper but reputable" school, something that the majority of med school students can't even get and are thus in enormous debt after their medical training. You're concerned about how your score can't get you into a top 10-20 residency. Again, you pick your battles.
 
Also @OP be thankful that you got a 250 and not a 249. Inconsequential difference obviously but I know some high-end programs (in certain specialties) will specifically screen at 250
 
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