Failed Step 1 on first attempt...any chance at IM?

[bikedoc1021]

Hey guys and gals. I'm about half way through my 3rd year and I've decided I'm going to go the Internal Medicine route for residency and pursue a fellowship in GI. Unfortunately, I have a bit of a problem...I failed Step 1 on my first attemp (due to extraneous circumstances). I did well on my second attempt (206) and my 1st and 2nd year grades are all high pass/honors. My third year grades are solid as well, and I'm likely to honor my IM clerkship. My LOR should also speak very highly of my clinical abilities. Is anyone out there currently in the same boat, or have you dealt with this issue? Basically, are there certain programs that simply will eliminate me based on a failed step 1? Conversely, are there programs that do not have this restriction, and if so, which ones? I guess what I'm searching for are my chances at matching to IM and any advice that can be dished out my way. Thanks!

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[dragonfly99]

You can get into IM somewhere, no doubt.
I'm a bit confused about the incongruence between all your grades (preclinical and clinical) and your Step score. It's pretty unusual.
You should try for the best university IM program you can get, if you want to subspecialize in something like cards or GI or hem/onc, which are competitive.

You won't have a problem getting IM, but GI will be hard. GI is the hardest of all the medicine fellowships to get right now...one could argue it's allergy/immuno, but relatively few people pursue that so I'd say it's GI in terms of the sheer number of applicants and the acceptance rate. I think you should only do IM if you would be willing to consider fellowships other than GI. Pretty much nobody can assume they are definitely going to get GI or cards.

Some cardiology programs don't even ask for USMLE Scores to be sent, so I'm thinking there are likely GI programs like that, too. However, if the failed USMLE is listed on your med school transcript, the GI programs may find out about it anyway as many ask for your med school transcript.

You can't do anything about the failed step, and the low step score, now, so your best bet is to keep doing as well as you are in school, and to try to get higher scores on Step 2/3. Try for 220 or better if you can.

You could try google to look up different GI fellowship programs and what they require to apply...I'll bet some don't even require USMLE scores. Your biggest goal right now should be getting yourself into a good IM residency.

 

[dreamfox]

Hey guys and gals. I'm about half way through my 3rd year and I've decided I'm going to go the Internal Medicine route for residency and pursue a fellowship in GI. Unfortunately, I have a bit of a problem...I failed Step 1 on my first attemp (due to extraneous circumstances). I did well on my second attempt (206) and my 1st and 2nd year grades are all high pass/honors. My third year grades are solid as well, and I'm likely to honor my IM clerkship. My LOR should also speak very highly of my clinical abilities. Is anyone out there currently in the same boat, or have you dealt with this issue? Basically, are there certain programs that simply will eliminate me based on a failed step 1? Conversely, are there programs that do not have this restriction, and if so, which ones? I guess what I'm searching for are my chances at matching to IM and any advice that can be dished out my way. Thanks!

I think you will be just fine. Not everybody is a great standardized test taker. I'll be honest, if you're looking to go to MGH, UCSF, and places of that variety then you will most likely be screened because of your step 1 score. However, there are a ton of great IM programs across the country and since you are going to be an american medical grad (I'm assuming from your location) then you will definitely be able to match into IM.

Medicine tends to look at more of the whole picture when it comes to residency applications. It sounds like you're a good student and have done well on the wards, so don't think it's hopeless.

My best advice for when you apply is to apply broadly (it's around $10-$15/program after 20 if I remember correctly?) and see where the cards fall. Your best bet would be to talk to your IM advisor/chair and ask about which programs you would be competitive for. Good luck.

 

[VandyMed2009]

A limited number of schools (MGH, Hopkins, etc), have a Step 1 screen-point rumored to be 230. This is rarer for the less "top dog" programs, who tend to look at the applicant as a whole.

One piece of advice: if you are excellent clinically and the only bad thing on your file is the step 1 fail, you could consider doing an away elective at the school you really want to go to. That would give them an entire month to get to know you as a whole person and would definitely help them to look past the Step 1 fail.

Some GI programs do have a USLME cut off, like "Must get XXX on all 3 steps". But I think the majority care a lot more about your research and your LORs.

 

[bikedoc1021]

wow. it's been a while since I posted this thread. thanks for the advice from everyone above. here's an update...so I've earned Honors and High Pass in all my 3rd year clerkships, Honor in my IM AI, and Honors in my Nephrology elective. Oh, and rocked Step 2 CK with a 242! If anyone out there has any additional advice for me as far as programs/chances go, I'd appreciate it. I plan to submit my ERAS in the next 2 weeks, btw. Thanks!

 

[dragonfly99]

The 242 is a great improvement. Congrats! I think this will help you a lot, as now you can say that the Step 1 failure was just a screwup, and a blip on the screen. The only advice I have is not to make too many excuses about the Step 1...you say it was "extraneous circumstances" but that's what everyone says who failed or got a low score. Just tell them you screwed up, you feel like it was kind of a fluke, you've showed you can do better and would appreciate their consideration. I wouldn't even mention it in your personal statement...they can ask about it at the interview if they want to.

 

[dragonfly99]

Oh yeah, and definitely study hard for the Step 3 when you take it. Don't be in a rush to take it early if you don't end up in a program/state that requires that. Not everyone opts to or has to take it as an intern, and the longer you are a resident the more you learn.

 

[Frugal Traveler]

People fumble sometimes... failing Step 1 is disconcerting but you proved with your Step 2 score that you can pass these exams and do it well.

Applying does not cost much money until you hit a certain number (then it is $ 25)... so apply and let them do whatever screening they want. Applying does not hurt anyone... let them do the rejecting... don't reject yourself and not apply... you never know what programs are looking for.

 

[Charlesdotter17]

I have a friend who failed the step four times.. He has asked me for advice, anyone know of any programs that will even look at him. IM. I have little to tell him... Basically bottom tier programs, which ones are any good?? He has time to apply but wants to do away electives...

 

[boobelle]

I have a friend who failed the step four times.. He has asked me for advice, anyone know of any programs that will even look at him. IM. I have little to tell him... Basically bottom tier programs, which ones are any good?? He has time to apply but wants to do away electives...

I don't have advice for specific programs, but it's worth looking at the various licensing requirements for each state. Some states will not grant a medical license (including the limited/restricted license required for residency) if someone has failed a Step more than a certain number of times...and some states have a cut off of three failed attempts. So it's worth first looking for states that this person could theoretically be licensed in, and then look at programs within those states.

 

[NRAI2001]

wow. it's been a while since I posted this thread. thanks for the advice from everyone above. here's an update...so I've earned Honors and High Pass in all my 3rd year clerkships, Honor in my IM AI, and Honors in my Nephrology elective. Oh, and rocked Step 2 CK with a 242! If anyone out there has any additional advice for me as far as programs/chances go, I'd appreciate it. I plan to submit my ERAS in the next 2 weeks, btw. Thanks!

Wow good post... so any update to your story? Where did you end up matching? Still going for fellowships?