sweetlenovo88

7+ Year Member
Apr 30, 2009
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Attending Physician
Hello, I am a fourth year that did not match into EM. After the match, I found out I failed Comlex II Clinical Knowledge and PE. I took both one day after the other and was going through a divorce at the time and will document that as my reason.

I have retaken the Comlex, and am now thinking I should also take the USMLE (I never took step one USMLE) to help convince allopathic programs that the first failure was a fluke.

I plan on applying to every EM program in the country next year, DO and MD, all 160 of them.

I do not plan on doing an internship year as a I need a break from my hell of a life. I have good grades in EM clerkships, excellent EM letters, some limited research, good clerkship grades, good deans letter, loads of extracurricular and leadership activities in EM. I did not apply to enough programs in EM (geographic limitation),

Would you go with my plan of taking Step II USMLE? (I do not see what use Comlex 3 would be allo programs if I took that, plus it may be hard since I would not have the months of clinical internship experience)
 
Feb 2, 2010
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MD/PhD Student
Overall, I think you need to develop a more focused strategy.

First... you found out you failed AFTER the match? That means that when your programs made their rank list, they ALSO had no idea you had failed Step 2. This means that your failure to match was unrelated to your Step 2 performance. This means you need to evaluate the rest of your application thoroughly, perhaps using match statistics to help guide you. How many programs did you rank? General rule of thumb, you need 8 for IM, and about 3-5 more for every "weakness" - osteopathic, competitive specialty... now the board failures. Sit down with an impartial adviser with your entire application and pick it apart.

I think you also need to figure out what's most high-yield with your remaining time; your strategy reminds me of using a machine gun, when you may need to aim more like a rifle. Don't apply to all 160 programs. You won't match at HAEMR, Hopkins, UCSF, etc. and you knew this going into it. Look at your school's historic match lists and see where graduates have gone to evaluate your realistic chances. Evaluate the match lists from Caribbean and other osteopathic schools to look for trends / programs to target. You may need to convince the podunk program that you are really interested in them specifically- shooting emails around application time to PDs with some relevant benign question may convince them to look at your application closer.

You are likely to do better on Step 2CK than Step 1 simply bc that's more fresh. However, many programs use automatic USMLE step 1 cutoffs. If practice NBME tests can predict you'll do well, it might be good to retake it - if it predicts low scores, you are only dooming yourself further. If you take the USMLE, set a realistic time limit for how much you will devote to studying, or else this idea will balloon out of control and choke you. I think you need to do everything you can to get your feet in the door. Don't focus on your divorce or call attention to it- I'm not sure it will sway anyone's mind to invite you to interview even if they did know the reason for your failures. However, you will obviously be asked about this on interviews, and that's when it's time to tell them you've moved on.

Good luck. Have an open mind.
 

sweetlenovo88

7+ Year Member
Apr 30, 2009
333
295
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Attending Physician
Thanks for the suggestions. Yes, I was not planning on applying to Hopkins, etc. About the USMLE Step one 1 cutoff scores, how does that apply to me since I never took it? I just the Comlex Step one and got an average score there.


Overall, I think you need to develop a more focused strategy.

First... you found out you failed AFTER the match? That means that when your programs made their rank list, they ALSO had no idea you had failed Step 2. This means that your failure to match was unrelated to your Step 2 performance. This means you need to evaluate the rest of your application thoroughly, perhaps using match statistics to help guide you. How many programs did you rank? General rule of thumb, you need 8 for IM, and about 3-5 more for every "weakness" - osteopathic, competitive specialty... now the board failures. Sit down with an impartial adviser with your entire application and pick it apart.

I think you also need to figure out what's most high-yield with your remaining time; your strategy reminds me of using a machine gun, when you may need to aim more like a rifle. Don't apply to all 160 programs. You won't match at HAEMR, Hopkins, UCSF, etc. and you knew this going into it. Look at your school's historic match lists and see where graduates have gone to evaluate your realistic chances. Evaluate the match lists from Caribbean and other osteopathic schools to look for trends / programs to target. You may need to convince the podunk program that you are really interested in them specifically- shooting emails around application time to PDs with some relevant benign question may convince them to look at your application closer.

You are likely to do better on Step 2CK than Step 1 simply bc that's more fresh. However, many programs use automatic USMLE step 1 cutoffs. If practice NBME tests can predict you'll do well, it might be good to retake it - if it predicts low scores, you are only dooming yourself further. If you take the USMLE, set a realistic time limit for how much you will devote to studying, or else this idea will balloon out of control and choke you. I think you need to do everything you can to get your feet in the door. Don't focus on your divorce or call attention to it- I'm not sure it will sway anyone's mind to invite you to interview even if they did know the reason for your failures. However, you will obviously be asked about this on interviews, and that's when it's time to tell them you've moved on.

Good luck. Have an open mind.
 

dragonfly99

10+ Year Member
May 15, 2008
5,092
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261
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Attending Physician
I agree with spectulatrix.
If you are a DO your best chance would be at DO residencies or allopathic ones that have traditionally taken DO's. Failing a step is a big deal for a semicompetitive field like the one you picked. Not sure taking the USMLE will make up for that, and you're unlikely to kick its tail if you didn't do so hot on the COMLEX. Also you'd need to take steps 1 and 2 both, which seems to me would take a long time to study for. I think it would probably be better just to retake the COMLEX, if you haven't already. You should think about all aspects of your application and how you can improve it. Think about getting some ER research under your belt. Talk to the docs who wrote your LOR's , to get an honest assessment from them of your strengths/weaknesses. Nobody cares about your divorce or other problems in your personal life - I know it's harsh, but residencies just want someone who can suck it up and do his/her job, and that's about all they care about.
 

sweetlenovo88

7+ Year Member
Apr 30, 2009
333
295
181
Status
Attending Physician
I agree with spectulatrix.
If you are a DO your best chance would be at DO residencies or allopathic ones that have traditionally taken DO's. Failing a step is a big deal for a semicompetitive field like the one you picked. Not sure taking the USMLE will make up for that, and you're unlikely to kick its tail if you didn't do so hot on the COMLEX. Also you'd need to take steps 1 and 2 both, which seems to me would take a long time to study for. I think it would probably be better just to retake the COMLEX, if you haven't already. You should think about all aspects of your application and how you can improve it. Think about getting some ER research under your belt. Talk to the docs who wrote your LOR's , to get an honest assessment from them of your strengths/weaknesses. Nobody cares about your divorce or other problems in your personal life - I know it's harsh, but residencies just want someone who can suck it up and do his/her job, and that's about all they care about.
The reason I mention the divorce is that it serves to show a reason for my failures. Whether they care or not, I want them to see that reason and not assume it was because of lack of knowledge. I have already retaken the comlex and waiting for my score. Also, research is pretty close to the bottom of the list for ER and I think I would be wasting my time (and I hate research). There is no way I would take step one again, I would only take step 2 usmle. My reasoning for the retake would be to show that the first attempt was a fluke and justified by personal events. I am thinking that allopathic programs, whether DO friendly or not, will consider that failure less important if they see a passing if not excellent usmle score along with a new comlex score. I am thinkng that allopathic residencies trust the USMLE more than comlex, and if they see a decent score there it will minimize the damage. I agree that DO spots are my best chance, but to increase my chances with allopathic, I think I should take the USMLE step 2 based on my reasoning above. Do you agree?
 
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