Failed Step 1. Need advice.

[deleted1176807]

Hi everyone. I failed step 1 last week and was heart broken. My scores were in the 60s/70s and I was performing well. I'm an MD PhD student at a T30 medical school and wanted to match into a surgical specialty (ENT, OB, general surgery) initially. I want to know if that's still possible with this setback so I can manage my expectations. If it's possible, what do I need to do to maximize my chances to match in the future, after I pass this exam. Thank you so much for your advice and insight.

---

Members don't see this ad.

 

[Tarsal-Tunnel]

Sorry to hear that OP. I think first step would be figuring out why you failed Step 1 especially if your practice scores were okay. What do you think happened?

 

[deleted1176807]

Sorry to hear that OP. I think first step would be figuring out why you failed Step 1 especially if your practice scores were okay. What do you think happened?

Honestly I’m not the best test taker so that could’ve contributed to it but other than that i’m still trying to figure it out as of now. I’m in my PhD so I’m not rushing to take it again unless I feel prepared. Do you think with the PhD, good scores on Step 2, and networking, any of those specialties are possible?

 

[EthylMethylMan]

Do you think with the PhD, good scores on Step 2, and networking, any of those specialties are possible?

I’d say they’re all pretty unlikely at this point. If you rock your rotations (like all honors kinda thing), do great on Step 2, and apply broadly, you could maybe swing it for gen surg. But generally speaking applicants to gen surg, Ob/Gyn, and especially ENT are quite competitive. You should reach out to your advisor and ideally someone at your school from each of those departments. They could give you a more holistic perspective based on all your academic details. They could also give you advice on how to salvage things if possible. You certainly can still match the less competitive specialties (EM, FM, peds, IM) if you keep your academics solid going forward.

 

[deleted1176807]

I’d say they’re all pretty unlikely at this point. If you rock your rotations (like all honors kinda thing), do great on Step 2, and apply broadly, you could maybe swing it for gen surg. But generally speaking applicants to gen surg, Ob/Gyn, and especially ENT are quite competitive. You should reach out to your advisor and ideally someone at your school from each of those departments. They could give you a more holistic perspective based on all your academic details. They could also give you advice on how to salvage things if possible. You certainly can still match the less competitive specialties (EM, FM, peds, IM) if you keep your academics solid going forward.

Yeah I talked to them and they told me with good rotations and Step 2 and applying broadly I could definitely do it for any of the 3 specialties I stated because of the PhD. However I’m always on the doubtful end.

 

[Billiam95]

Yeah I talked to them and they told me with good rotations and Step 2 and applying broadly I could definitely do it for any of the 3 specialties I stated because of the PhD. However I’m always on the doubtful end.

May still have an outside shot at OB/GS but I'd have my doubts about ENT, considering that match is such a crapshoot even without a S1 failure. Unless your school has some data suggesting otherwise, they seem to be giving you a too optimistic outlook IMO.

 

[deleted1176807]

May still have an outside shot at OB/GS but I'd have my doubts about ENT, considering that match is such a crapshoot even without a S1 failure. Unless your school has some data suggesting otherwise, they seem to be giving you a too optimistic outlook IMO.

That's exactly how I saw it too. I was confused when they told me I could still match ENT because of how competitive it is but I'm also not set on anything until I finish this exam

 

[Dral]

I suppose a competitive specialty is not out of the question totally. Possible? yes. Likely? I'd say no. Here is where the difficulty comes into play. Now that you know your chances are way lower, do you put all that effort into something that has a low chance of happening?

I can tell you this, I'm in a competitive specialty and on the residency application info website from where I trained, it says 'no failures' in the sentence talking about the Steps. So basically they say a fail is an auto screen out. Not everywhere will take that approach, but it certainly will happen at places. You might be able to overcome it if you totally knock step 2 out of the park. It might be worth it to just start cold emailing some programs and see how they would handle a step 1 fail.

Honestly, the 'applying broadly' part they mentioned means little to me. That's what people with stellar scores and apps do for the competitive specialties anyway.

 

[Just D.O. it]

with good rotations and Step 2 and applying broadly I could definitely do it for any of the 3 specialties I stated because of the PhD.

With all due respect to you personally and your PhD, your advisors don’t know what they are talking about unless your research was rockstar level ENT related stuff, you will not be matching ENT directly unless you build a 1 in a million relationship with your home PD or some other PD on an away, but trying for that is risky without having a back up speciality. I have seen people with red flags like yours take multiple research years to build connections to try and match a specific surgical sub. But then the question becomes how many extra years of your life as a low paid grunt would you endure to maybe have a shot.

OB is getting tough these days too I hear, but I don’t really know enough about the field to comment on it other than the fact that it is definitely no longer a “walk on” specialty, so the STEP failure will definitely hurt you.

Gen surg is the most feasible. I could see you having a good chance at low tier/ community programs with great clin grades/Evals + a home run of a step 2. The issue here is, even though I see this advice of telling people who fail step 1 to just “crush Step 2” almost every time the topic is discussed. I have actually never personally known, met, or even heard of (via in person means) a student who actually pulled off a high STEP 2 score after a failed Step 1. Maybe you will be one of the exceptions, but probably not.

It is always a hard pill to swallow, and I say this to be helpful and sincere even though I know it often seems cruel, but you need to do some serious reflecting on the doors that are open to you among the non-competitive specialties to see if you could be happy among them.

 

[operaman]

Agree with others you’ve got a tough road ahead.

ENT is very much a long shot at this point. Your best/only chance would be your home program and only if you are so beloved there that they will overlook this blip. Away rotations are too short for you to become so beloved they would overlook a step failure. But if your PhD is in ENT-related research and your mentor is a highly regarded ent in your department and you absolutely crush the rest of your app, you have a small small chance matching there. You might be able to get a few interviews by having well connected mentors make calls on your behalf but the yield from that may be slim.

In truth the phd only impresses the hardcore academics; the clinicians don’t give a flip. And sadly, no PD or asst PD will be a hardcore academic. The hardcore academics already have funded protected time and aren’t going to take on the burden of PD for an extra half day protected. It’s a busy and thankless job and only clinicians who love teaching will do it. And most of them won’t be impressed enough by research to outweigh a subpar academic performance. We would routinely ax MD/PhDs from T5 schools for a lot less than a step failure.

The reality is that nobody who fails S1 has the foundational knowledge to do well on shelves and impress on rotations. And it doesn’t bode well for a stellar S2 either. Passing medical school and graduating is going to be a challenge, much less matching one of the most competitive fields in the world. The issue becomes how do you craft a strong app to field you won’t match in AND craft a strong app to a more likely field at the same time? Not easy.

Your best bet of the ones you mentioned would be gen surgery but even that will be tough. The surgery shelf exam is a LOT harder than S1 and you’ll need to do well on all things surgery related to have a chance. Matching categorical would be tough, but matching prelim and then doing well and reapplying categorical and looking for open PGY2 spots might give you a shot assuming your app is otherwise unblemished.

Keep your eyes peeled for other fields that may fit you as you go through rotations. If you can be happy doing something less competitive, it will save you a lot of grief come match time.

 

[voxveritatisetlucis]

That's exactly how I saw it too. I was confused when they told me I could still match ENT because of how competitive it is but I'm also not set on anything until I finish this exam

They probably say it out of wanting to be nice.

I would say definitely not ENT. That’s a level up from the other two and most applicants will be near perfect.

Also it probably depends what you mean by T30. For example, Michigan is more respected and probably has more weight behind its name than say UVA or Rochester

 

[deleted1176807]

With all due respect to you personally and your PhD, your advisors don’t know what they are talking about unless your research was rockstar level ENT related stuff, you will not be matching ENT directly unless you build a 1 in a million relationship with your home PD or some other PD on an away, but trying for that is risky without having a back up speciality. I have seen people with red flags like yours take multiple research years to build connections to try and match a specific surgical sub. But then the question becomes how many extra years of your life as a low paid grunt would you endure to maybe have a shot.

OB is getting tough these days too I hear, but I don’t really know enough about the field to comment on it other than the fact that it is definitely no longer a “walk on” specialty, so the STEP failure will definitely hurt you.

Gen surg is the most feasible. I could see you having a good chance at low tier/ community programs with great clin grades/Evals + a home run of a step 2. The issue here is, even though I see this advice of telling people who fail step 1 to just “crush Step 2” almost every time the topic is discussed. I have actually never personally known, met, or even heard of (via in person means) a student who actually pulled off a high STEP 2 score after a failed Step 1. Maybe you will be one of the exceptions, but probably not.

It is always a hard pill to swallow, and I say this to be helpful and sincere even though I know it often seems cruel, but you need to do some serious reflecting on the doors that are open to you among the non-competitive specialties to see if you could be happy among them.

I do appreciate the honestly, and I know I could be happy becoming an allergist or pathologist too. I’m meeting with the residency director at my school to discuss my options next week as well, so hopefully that will give me some insight too. I was doing well in the preclinical curriculum, didn’t fail any exam and passed with good margins even with having a difficult second year due to health problems. I have issues with balance and vertigo that caused me to constantly lose balance both sitting down and standing. They still haven’t figured out what it is but that has been something i’ve been struggling to manage since they still dont know what’s wrong yet. But i’m extremely open to internal med and becoming an allergist if that’s possible

 

[eyeeye_captain]

I’m sorry you’re having to deal with all this. This is not at all to be mean, but persistent balance/vertigo issues concern me for pursuing procedural fields as much as the Step 1 failure. That could be very difficult to overcome if you haven’t been getting better. The stress of residency isn’t going to help. If you’re cool with doing allergy, that might be the right move anyway.

 

[mrbreakfast]

Agree with everyone else. The future can wait, for now focus on re-centering yourself, passing step 1, and starting clinicals on a good footing. Worrying about a long shot chance for ENT may distract you from the tasks in front of you now.

 

[solitarius]

Going Pass/Fail on Step 1 has become a dual-edged sword.

It was meant to reduce the pressure in medical school. The difference in questions wrong between a 235 and 260 is SMALL.

The bar to pass Step 1 was and probably still is HIGH, but I think pass-fail has lulled some students (not necessarily OP) into complacency.

 

[lacrossegirl420]

Gen surg and OB are still possible, but ENT is on a different playing field so I would say that’s realistically out of question. If it makes you feel better, I and most of my classmates switched our specialty preferences from end of M2 to end of M3, so it’s very possible you’ll find something less “competitive” you’ll like even more!