DO Student. Failed USMLE Step 1, Low COMLEX I

[Candida]

Hi guys, this didn't get any responses on the Step I forum so I decided to post this here as well. Looking for advice ...

Long time lurker in dire need of advice. My spirits are really low at the moment as I do my third year rotations. I recently learned my scores for both of my exams. I was able to score a 437 on COMLEX I and unfortunately failed USMLE Step I.

I have average grades for my pre-clinical years and a 3 publications under my name.

I was wondering what I can do from this point on? Do I have a shot at fields like PM&R, Neuro, or Psych?
I don't think I'll have time to take Step I again. Does it at all make sense to take Step II at all with a failed Step I?
Should I forget the Allopathic match all together & just go with the AOA Match?
Is it safe to assume that if I apply for Allopathic programs, I'd automatically be out the moment they see my failed Step I, because you have to release your Step I score to Allopathic programs?
I know I screwed up immensely and have been very upset about it. Any advice would be appreciated!

Thank you so much

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[ShyRem]

the likelihood of garnering an interview in the allo match is slim without a passing score. And if you apply acgme match, you MUST report that you took the usmle (at which point they will ask for your score and you will be forced to tell them you failed the exam). If you apply osteo match, no one gives a rats behind about your usmle scores.

Now all that being said, it is my understanding that PM&R and psych are forgiving fields and not terribly competitive. If you want to go into that field, take your usmle exams again and pass them. I know people who didn't take the usmle at all but failed comlex 1 twice and yet still matched. But they did eventually pass their exams.

So here are your options:
1. retake the usmle and pass it and apply acgme and pray like crazy.
2. forget the usmle and only apply osteo match. You may be able to get into some dually accredited programs this way.

 

[Candida]

the likelihood of garnering an interview in the allo match is slim without a passing score. And if you apply acgme match, you MUST report that you took the usmle (at which point they will ask for your score and you will be forced to tell them you failed the exam). If you apply osteo match, no one gives a rats behind about your usmle scores.

Now all that being said, it is my understanding that PM&R and psych are forgiving fields and not terribly competitive. If you want to go into that field, take your usmle exams again and pass them. I know people who didn't take the usmle at all but failed comlex 1 twice and yet still matched. But they did eventually pass their exams.

So here are your options:
1. retake the usmle and pass it and apply acgme and pray like crazy.
2. forget the usmle and only apply osteo match. You may be able to get into some dually accredited programs this way.

Thank you so much! I really appreciate the advice!
Would I be right to assume that dually accredited programs will obviously be more competitive than their AOA counterparts? Also, would one be able to pursue an ACGME fellowship after a dually accredited program?
I don't know when I'll have time to take the USMLE again so at this point I'm really leaning towards just going the osteo match route.

 

[ShyRem]

I don't know but acgme fellowship may ask for your USMLE scores. This may be a problem, but I don't know the fellowship rules.

 

[Candida]

I don't know but acgme fellowship may ask for your USMLE scores. This may be a problem, but I don't know the fellowship rules.

Gotcha. Thank you so much ShyRem! I really appreciate it

Does anyone else know how this will affect applying to fellowships?

 

[Taus]

Gotcha. Thank you so much ShyRem! I really appreciate it

Does anyone else know how this will affect applying to fellowships?

probably depends on the fellowship..... but all the agcme pain management fellowships I applied to asked for usmle/comlex scores

 

[PalmDO]

I did a quick google search and see that it will affect ACGME fellowships since most use ERAS. I suppose they'll want your Step scores regardless.

 

[Bones DO]

On a semi related note, what if you got a 398 on comlex, retake and get a 600+... how does someone who got a 490 on the first attempt look compared to such a person for osteo residencies? Don't mean to steal the thread, just curious what people think/know about that? Im the guy w/490 hoping for Osteo EM. Thnx.

 

[Dissected]

On a semi related note, what if you got a 398 on comlex, retake and get a 600+... how does someone who got a 490 on the first attempt look compared to such a person for osteo residencies? Don't mean to steal the thread, just curious what people think/know about that? Im the guy w/490 hoping for Osteo EM. Thnx.

There are a lot of DO programs that put an infinite amount of weight in the audition and not much in your COMLEX score. Make sure to schedule auditions at places that are not going to count you out b/c of your score (which shouldn't be that many) and will appreciate you for your work ethic. The best people to ask about this (from my experience) are the residents currently at programs you are looking at. I would try and make a few visits this year and email a few residents to see what you can find out.

Good luck, I'm sure you'll find success.

PS, nice work on passing I've been following you on these boards for some time

 

[Makati2008]

On a semi related note, what if you got a 398 on comlex, retake and get a 600+... how does someone who got a 490 on the first attempt look compared to such a person for osteo residencies? Don't mean to steal the thread, just curious what people think/know about that? Im the guy w/490 hoping for Osteo EM. Thnx.

Hard question to answer. I would think you would have an upper hand vs that applicant due to some programs screening applicants out that failed step 1. Also I would be more concerned about the switch in schools, coming from a newer school and doing well on step 2.

 

[se20001984]

jus a question

how did u do in school??
were u struggling? or middle of the pack?

 

[ShyRem]

A board failure, no matter what the retake, is a red flag. Now if they were actively puking their brains out during the first attempt, their mother just died, they got divorced that week, etc. and just buffed that day, it might be a different story. But then it begs the question why didn't you reschedule. They will look very closely at their level 2 score, but still I know a bunch of programs that won't even look at you with a failed score no matter what the retake.

The above poster is correct... Your audition rotations will be very key for getting a good residency spot with a 490. I would plan on taking level 2 early in your fourth year, or the summer between third and fourth, as well as doing the pe exam. And dont fail either of them.

 

[group_theory]

Taking comlex level 2ce and pe early is to alleviate programs' fear that you may not graduate on time. Failure at level 2 will raise concerns about your ability to pass level 3 and more importantly the boards (from a program's perspective)

A failed Level 1 is a red flag. My old residency program is willing to interview someone who failed step 1 if he/she did extremely well on the retake and had impressive preclinical and clinical grades as well as LORs from academic faculty (and not some random community physician preceptor as some DO schools tend to use for their clinical education). However, come rank list time, they are usually low on the list and usually it takes an advocate like a faculty member or resident to speak up and advocate moving the applicant up on the list (and the committee always ask about the failed step score). I've seen applicants move up, some moved down after more concerns were found on closer scrutiny, and others staying at the same spot on the rank list.

Auditions can be helpful, because then the program will know you, instead of just knowing your file. However, since I have had years of experience working with med students, please note that it is hard to stand out as an excellent or super student. Most are your average student, smart, hardworking, but nothing special. I've worked with a few bad students. Only once have I recommended a failing grade, and it was after discussing with several attendings who have worked with that student during that rotation, and the student did not show improvement after several feedback sessions.

A failed step 1 or a low step 1 score doesn't mean the student will be a bad clinician or doctor. I know a couple excellent doctors who had low step 1 scores. However, when you are reviewing hundreds to thousands of applicants for limited residency spots, with a lot of the materials on the application being subjective and highly variable (especially 3rd and 4th years), steps and class rank are the only few objective standards that programs can use to compare applicants from different schools, in different parts of the country.



To the OP, wise decision not to retake usmle 1. With a failing usmle 1 score and low comlex 1 score, I fear you will not do well on the retake. Taking usmle 2 won't matter since you have already failed usmle 1, so programs will not be impressed, even if you score 240+. Focus your energy and time on doing well during your 3rd year, find a faculty mentor who will work with you on improving your clinical knowledge and skills, and will go to bat for you next year (ie making phone calls to ask programs to consider you). Take comlex 2 early so that you and the programs don't have to worry about them.

 

[Black Adder]

Didn't want to start a separate thread, so adding onto this one...
How much emphasis do ACGME residencies place on the COMLEX if an applicant has both a COMLEX and USMLE score? I did poorly on COMLEX I (474), but average on the USMLE (225). I'll be applying for acgme IM spots and skipping the osteo match. Thanks!

 

[Rollo]

Didn't want to start a separate thread, so adding onto this one...
How much emphasis do ACGME residencies place on the COMLEX if an applicant has both a COMLEX and USMLE score? I did poorly on COMLEX I (474), but average on the USMLE (225). I'll be applying for acgme IM spots and skipping the osteo match. Thanks!

I've talked to few ACGME residents/PDs and they said they don't really care about the COMLEX score so long as it isn't a failure. And honestly, it makes sense. If you're comfortable with USMLE score interpretation, you aren't really going to closely scrutinize COMLEX score if the applicant has a solid USMLE.

Everyone knows that COMLEX is a poorly written exam hence its reliability to predict students' future academic success as a resident is unreliable. It is no wonder ACGME residencies prefer USMLE scores over COMLEX if applicant has it.

 

[Black Adder]

I've talked to few ACGME residents/PDs and they said they don't really care about the COMLEX score so long as it isn't a failure. And honestly, it makes sense. If you're comfortable with USMLE score interpretation, you aren't really going to closely scrutinize COMLEX score if the applicant has a solid USMLE.

Everyone knows that COMLEX is a poorly written exam hence its reliability to predict students' future academic success as a resident is unreliable. It is no wonder ACGME residencies prefer USMLE scores over COMLEX if applicant has it.

I was assuming this was the case, just wanted to make sure. I guess I'll have to take USMLE step 2 as well, because I'm probably gonna tank the COMLEX step 2 as well.... OMM trivia just doesn't stick in my brain.

 

[supergumbo]

I was assuming this was the case, just wanted to make sure. I guess I'll have to take USMLE step 2 as well, because I'm probably gonna tank the COMLEX step 2 as well.... OMM trivia just doesn't stick in my brain.

Good thing about OMM is that you know it's gonna be high yield. Can't say much the same for the other stuff..

 

[Consigliere]

It's family practice for you, my man!

 

[JustPlainBill]

It's family practice for you, my man!

And what's so bad about about being a Family Practice Physician? You get to see your own patients, no one needs to sign off on your records, you can work in just about any field that you so desire and tailor your practice to your interests -- hospitalist, OB/Gyn, EM, ICU, outpatient clinic, acute care, geriatrics, nursing home, palliative care.....If you work it right, you're looking at $220K to start with and move up from there....

 

[ShyRem]

Most of those things you listed have fellowships under the internal medicine umbrella. If you are willing to work in a more rural, smaller community hospital they may consider a family practice doc. If, however you want to work in a larger center, a more urban environment or even small urban they may require internal medicine or pediatric hospitalists, emergency med residency, geriatrics fellowships (which there are both FM and IM programs), etc. critical care is either anesthesia, surgery, or internal medicine. according to Frieda, the only specialties you can get to from family practice are geriatrics or sports med.

But again, let me reiterate: if you want to live and work in a more rural environment, your options may expand. I know folks in programs where family practice physicians are basically all the medical care available and they do a great job both in and out of the hospital. Where I am, the family practice residency program does admit and round on their own patients for a month or two during their three years, but job opportunities for family med docs are strictly outpatient family practice clinics.

 

[Consigliere]

And what's so bad about about being a Family Practice Physician? You get to see your own patients, no one needs to sign off on your records, you can work in just about any field that you so desire and tailor your practice to your interests -- hospitalist, OB/Gyn, EM, ICU, outpatient clinic, acute care, geriatrics, nursing home, palliative care.....If you work it right, you're looking at $220K to start with and move up from there....

The bolded question you asked is answered within your post in bold.

 

[Candida]

Thanks for all the responses everyone ...

I guess the best bet for me at this point would be to pursue the AOA match. From what I understand, if I bring up my score on COMLEX II, to show an upward trend, I should be in an okay position to apply for AOA Psych programs.. Is that a fair assessment?

 

[Rollo]

Thanks for all the responses everyone ...

I guess the best bet for me at this point would be to pursue the AOA match. From what I understand, if I bring up my score on COMLEX II, to show an upward trend, I should be in an okay position to apply for AOA Psych programs.. Is that a fair assessment?

Yeah that's pretty fair. Just remember that AOA programs care more about "best fit" which means you need to rotate at couple of places...and if you really like one particular place, make sure they get to know you really well even before interviews are given out.