Medical Failed IM shelf; What are my chances at certain IM programs?

[TheBoneDoctah]

Hey all! Long time lurker, first time poster.

Kind of in a frustrating position. I intend on pursuing IM, but during the shelf exam, anxiety really took the wheel. I completely accept the consequences and have taken steps to deal with this. The good news is that I can retake the exam; bad news is the highest grade I can get is a C despite A's on my clinical skills. I am looking for a little realistic perspective on my chances in IM at certain IM programs. Please be brutally honest! Here are the relevant CV details.

-MD student in the middle of the road southeast school
-either the 3rd/4th quintile of class
-Step 1 :230-235
-Shelves: A/B on all shelves, with fail in IM (will retake and obtain a C)
-Step 2: ?? (let's assume around 245-250)
-CV: hella posters & abstracts w/ some case reports

Schools of interest: Temple U, U of Houston, Miami, George Washington, GT, UI Chicago, Rush

I understand that all these are in cities (as that is where I am interested in going); if there are any other suggestions for academic IM programs in cities please let me know. I will also consider community programs in which I can obtain a fellowship!

Thank you

How are you graded for clinical rotations? For us, our shelf at the end was our entire grade, basically.

It's really impossible for us to tell you which schools will care and which won't. It is program/specialty dependent. Yes, it is better to get an A than a C, but how much it will affect you is program dependent.

FWIW, on my interviews, I was never asked about grades (ortho).

Regardless, what's done is done. Focus on improving other aspects your app moving forward to overshadow your C.

Even though the NBME is 20% of our grade, it sets a cap on the highest grade we can receive in the shelf.

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[GoSpursGo]

I think a lot depends on how this is annotated on your transcript. If it just appears as a C without any mention of re-taking the shelf. then getting a C in the specialty you're interested in is a red flag but not insurmountable except perhaps at the most prestigious programs. If there's an annotation that you had to re-take the shelf exam, I think that's much more problematic.

That said, what @TheBoneDoctah said is accurate--this is going to be program specific, and there's no way to know what they will do other than applying. Just do as well as you can on your remaining 3rd year rotations, try to do your sub-I early in 4th year if possible to get an A on your transcript, get strong letters to counterbalance that C, and maybe apply a little more broadly than you were originally planning to.

This is also a situation where a frank conversation with your home IM PD early in 4th year would be very helpful to steer you in terms of knowing which programs to target.