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I am a DO student and have failed Step 1. I plan on taking it again but I am wondering if I can match with a pass for the next attempt? I have no other red flags
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The short answer is yes you have a chance to match. Granted, my anecdotal experience is being a chief resident interviewing applicants and sitting on the rank meeting for 1 year. I interviewed a few applicants at an academic program that had failed with pass on 2nd attempt or low step 1. One thing we looked at was how did they do on step 2 and what other things do they bring to the table besides a step score?
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From what I understand, step is an optional exam for DOs. It might not be needed for residencies, but I may have to report the scores come time for licensure. It all just seems too risky for me so I would rather pass Step 1 if I can.
I do not plan on taking step 2 though. I just want to get over this failure, it has been eating me alive. In terms of extracurriculars, I really don't have much. I was not really active in research, nor did I do much volunteering. The only thing I have going for me is that I passed all my classes and COMAT (shelf) exams.
Step will not matter for licensure. You would have Comlex 1, 2 and 3 to satisfy the license. They wouldn't care about Step 1.
Just apply broadly and you should be fine. You might not get into competitive fields but family/internal med should be fine. If you get super nice Comlex 2 score, that would improve your chances immensely. I would put extra effort on Comlex 2.
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Do your best in COMLEX 2. Also see if you can jump on a project like a case report or something. Are you involved in any leadership stuff? What kind of things have you done that are relevant to psychiatry?
I bring that up because in all honesty I was confident about my match in 2018 and fell to my 11th ranked spot out of 12 even after my first choice guaranteed me a spot. Im a DO btw. After now interviewing, I see some of the issues that some applicants have. My app didn’t scream Psychiatry. My app was heavy on minority involvement but never towards a specialty. My board scores were meh but passing. I was an ok applicant and I think I interviewed well. I have a feeling I was probably ranked in the middle to middle low so when match happened the programs filled before they got to my spot. So I would tell you to do something interesting, get involved in psychiatry, do audition rotations to sell yourself. Make your application show you have passion for Psychiatry.
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My goal is only psychiatry, I am not interested in fm/IM. Are you sure step wouldn't matter for licensure when it is asked how many attempts you have had for both exams? States like Texas and Illinois do require listing both. I am trying to maximize my chance for psych right now and if that means taking step again then I will.
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A step failure will screen you out of the better programs (most of them at least), but there are many programs. Some just care that you’ve passed the first 2 exams.
DO’s already have some bias. Failing the only step taken doesn’t look good. Even if you don’t need to pass for licensure, Id probably retake step 1 and consider step 2 to show you aren’t an exam risk.
DO’s already have some bias. Failing the only step taken doesn’t look good. Even if you don’t need to pass for licensure, Id probably retake step 1 and consider step 2 to show you aren’t an exam risk.
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Very interesting and valid point. It may be able to be argued both ways. I did so terribly on my MCAT and debated over and over if I should retake it. Knowing I did bottom 5th percentile on the ACT, it was clear I'm terrible at standardized tests. I opted to not retake the MCAT (so emotionally draining too) and beefed up other parts of my med school application including lots of involvement with people more directly involved in the med schools I prioritized. Did the same thing for applying for residencies (audition rotations, then they can really get to know you). Fortunately, my Steps did pretty fine, which I attribute at least in part to the exemplary teaching at my med school (and an excellent support system they had in place for students). That approached worked for me, but I have no idea of knowing if retaking tests would have yielded a better result. I did retake the ACT and did just as bad LOL. My fear with retaking standardized tests again was if there was no improvement, the programs might me like "well damn, she really does suck." xD
Fast forward to residency, I did poorly 2/4 years on the PRITE. Also 2/4 times failed that supervised interview exam. So I was identified as an exam risk. But passed the boards the first try! Now at this point in the career I can embrace this crappy standardized test performance as a part of who I am <3. lol
Edit: in med school, the first semester I was getting D's and other terrible marks on the exams. It turned out I had test anxiety and getting that treated helped a ton. May not be a bad idea to potentially look into if you have a recurrent pattern of struggling with tests. Won't always explain it for everyone, but it helped me a ton.
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While you would think that faculty quickly adjust to changes in medical student lives, I often find they don’t, particularly at weaker programs.
I interviewed as a MS4. One of the questions I received was why I hadn’t passed step 3 yet. When I explained the process, the faculty elected to phone a friend mid-interview to confirm I was accurate. This was a deep safety for me, so I didn’t care at the time. To be fair, I think this program only had 1 active resident that hadn’t taken step 3 before their application cycle.
I’d be willing to bet that some interviewing faculty are unaware DO’s don’t need to pass step 1.
I’m a bit out of the academic game now, so I could be wrong about my advice. I think one of the ways programs filter candidates is by step/comlex failures. I don’t think there is a simple way that programs use to search for candidates that passed their required exams but ignores elective exams (like step in this situation). It would have been better to not take step 1 in retrospect. Again I could be outdated. Now with the red flag and interviews you’ll have a section in which there is only a fail. I think lesser psych program faculty would be distracted by this.
Some states do have licensure requirements with number of allowed failures on major exams. Some programs require passing of step/comlex 3 to promote at different levels. If you fail enough times to not be allowed full licensure in the state, your contract can be not-renewed. While rare, this is a fear of program directors. Losing an upcoming PGY ? due to exam failures can mean sitting with a dean to discuss where you went wrong in resident selection. Many programs over-correct and become afraid of anyone that increases their odds of looking bad.
The above is just my past experience. I still think you have fair odds of matching despite this issue.
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Extra curriculars are helpful, but unlikely to erase a step I failure. You need to retake this and I'm sorry your school has failed you. I'm aware that you have many classmates that have passed step I, but your school is to blame. They should have tested you enough and seen that you were close to the fence and instituted remediation and tutoring or decelerated you before you got in this situation. GME programs no longer get step I scores, but that makes a fail a louder red flag. The best damage control would be to pass it. The second to best would be to take step II and pass it. Both would be best.
Many GME programs want to see USMLE scores and not just COMLEX anyway so I would go for it. You want a good residency program with strong guardrails and structure. Work hard and get there and all will go well. It is true that you can license without USMLE, but residencies float more fluidly above the license black and white yes / no paradigm. This will become water under the bridge; dig in and kick tail. Letting this "eat you alive" isn't going to be productive. Not matching into a residency will be a crushing clear message you need to avoid with undergraduate medical education performance. You still have time. Don't waste it and get going. Depression and tears are not your friends.
Finishing with good follow through will be the best way out of this. Sorry about the single slap therapy discussion, but this is the truth and many students have made it out of dark times.
Many GME programs want to see USMLE scores and not just COMLEX anyway so I would go for it. You want a good residency program with strong guardrails and structure. Work hard and get there and all will go well. It is true that you can license without USMLE, but residencies float more fluidly above the license black and white yes / no paradigm. This will become water under the bridge; dig in and kick tail. Letting this "eat you alive" isn't going to be productive. Not matching into a residency will be a crushing clear message you need to avoid with undergraduate medical education performance. You still have time. Don't waste it and get going. Depression and tears are not your friends.
Finishing with good follow through will be the best way out of this. Sorry about the single slap therapy discussion, but this is the truth and many students have made it out of dark times.
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For a lot of programs you won't pass their filters. If you have a red flag like this they won't even consider interviewing you and it doesn't matter how good your application might be otherwise. Psych is getting so competitive that even programs that are not top in the nation are starting to apply these filters.
The tried and true recommendation from this forum and from experience is to apply broadly (>50 programs). Good luck!
The tried and true recommendation from this forum and from experience is to apply broadly (>50 programs). Good luck!
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Yes, really really good about applying super broadly. Be ready to apply for many less attractive programs. As a safety. Psychiatry was my second residency and I had a complicated past with my first residency. Story way too long, won't bore anyone with it. May I make a personal recommendation about the mid west programs. I've had very good experiences at sites throughout the midwest versus settings that can be more litigious or not the best work environments. The culture is much better, the facilities are nicer. At the same time, it does not seem that many people are competing to work in the midwest and when I applied, there were some very brand new programs excited to bring in residents period.
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I am literally applying all over the nation, +100 programs. But that isn't the concern. The concern I have is how do I go around this? Do I take the exam again, or do I just report a step 1 failure and hope I do alright with a decent level 2 score? I am not sure what to do and would really appreciate advice from other DOs. Preferably if they have been in this situation
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I thought if you take step 2 you have to report the fail. I don’t remember sending scores from each individual exam to eras—you just provide an NBME number and whatever scores they have for you populate. I may be incorrect tho, open to fact checking.
If I were you, I think I would retake step 1 for a P and then try for a strong performance on Step 2. Studying for step 1 again will only bolster your performance on Step 2. Then you can put forward a strong, honest application. It would give me anxiety to apply with comlex only and even more anxiety to apply with an unresolved failure. Psych is not ultra competitive by any means and, imo, quite forgiving of set backs in your journey. But that narrative becomes most compelling when you rise above the setback instead of shrink away from it.
If I were you, I think I would retake step 1 for a P and then try for a strong performance on Step 2. Studying for step 1 again will only bolster your performance on Step 2. Then you can put forward a strong, honest application. It would give me anxiety to apply with comlex only and even more anxiety to apply with an unresolved failure. Psych is not ultra competitive by any means and, imo, quite forgiving of set backs in your journey. But that narrative becomes most compelling when you rise above the setback instead of shrink away from it.
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What I meant was that what If I don't retake step, and just focus on level 2 COMLEX. I understand it would not be ideal to have a fail score on my transcript. I appreciate the words of encouragement. I will try to retake the exam
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Yeah, OP you’re a DO so you have to take COMLEX 1,2 and 3. For some states like Cali that have a DO state medical board, in order to get a license, you MUST take all COMLEX exams. They don’t care about Steps, since it’s not a requirement to graduate DO school or get a state license. So keep that in mind. In fact some people don’t take COMLEX 3 and take Step 3 (which is dumb), and then later can’t get a state license because, you need COMLEX 3 in most states, you can’t substitute it with Step 3.
Did you fail Step 1? Or COMLEX 1?
I would keep taking practice tests and see how you can do on Step 2. I think on ERAS you can still report Step 2 without Step 1 but not sure? Someone chime in please. But yeah you MUST take ALL the Comlex exams if you want to be able to practice in all 50 states.
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OP, read the following very carefully: Submit only your COMLEX score report when applying to residency. Do not retake USMLE Step 1. Do not take USMLE Step 2. Do not submit your USMLE score report to residency programs.
The Step 1 failure would be included in your USMLE exam score report even if you were to perform amazingly on Step 2; this board failure would be a red flag, and programs would be able to filter you out of the applicant pool in a matter of a couple of clicks. As a DO student, you have the option to not submit your Step scores. Please don't shoot yourself in the foot.
The Step 1 failure would be included in your USMLE exam score report even if you were to perform amazingly on Step 2; this board failure would be a red flag, and programs would be able to filter you out of the applicant pool in a matter of a couple of clicks. As a DO student, you have the option to not submit your Step scores. Please don't shoot yourself in the foot.
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Listen to @Osminog and @calvinhobbes
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I failed step 1. Passed comlex
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But what if I retook step 1 and passed it? Would that not help? Not reporting step is kind of dicey and tbh I have been feeling inadequate because of it. I don't feel like I should be in medical school because of it, I am a pseudodoc without it imo
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Agree with the above. Good luck OP! Focus on your clinical rotations and getting strong letters , and make sure your app is geared towards psych. Forget about the Steps. Many people match psych without it.
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The initial Step 1 failure would drastically outweigh your performance on any future Step exam. Program directors receive a huge number of applications, and they use filters to decrease the size of the applicant pool. One of the quickest ways for them to reduce the pool is to eliminate applicants with glaring red flags, e.g., board exam failures.
Choosing to not report Step exams is not "dicey." It's very commonly done, and there's virtually no chance that you'd be penalized for it.
Submitting only COMLEX scores will fortunately not prevent you from matching into psychiatry. See the table below, from 2022 Charting Outcomes (DO edition). 83% of DO applicants who didn't submit a Step 2 score ("Score unknown" category) were still able to match. I don't think these 166 applicants are "pseudo-docs"; they are gainfully employed resident physicians training in psychiatry.
If this is about personal fulfillment and wanting to feel adequate, then you can go ahead and retake Step 1 and take Step 2—but regardless of what score you receive on Step 2, I would strongly advise you to NOT submit your USMLE score report to residency programs. You don't want to include an unnecessary red flag that will sink your application.
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Can I retake step 1 and not report it if I pass? If I want to do just for personal reasons?
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And what about the licensing portion. After residency when applying for a license, would I input the step info as well or no?
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So I would just not report them at that point, correct?
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Not that I think it would ultimately affect licensure or credentialing but I'm trying to recall if there are any states (or healthcare orgs for credentialing) that ask if you ever failed any licensing exams where OP may be obligated to disclose the failure anyway. I don't think OP would want to do anything differently at this point even if that were the case.
I also doubt any non-malignant program would ask OP why he "didn't take" (report) the STEP exams but I'd imagine it is a potential question and probably better not to lie if asked.
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States like Texas and Illinois do ask for all attempts for comlex and step
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Back when I applied to psychiatry residency a few years ago, ERAS asked for all scores from all exams taken, STEP and COMLEX. The language used made it seem like the applicant would be lying if they omitted existing STEP scores. Although, I recall wondering how a residency program would even find out that STEP score(s) were omitted from the ERAS application. If there is no way for them to find out and the ERAS language is vague, I agree with the advice above.
Post-AOA-ACGME residency merger it may be difficult to pinpoint former AOA programs, but there seem to be former AOA programs that generally favor DO's and essentially all residents are DO's. These may be easier to get into for someone with only COMLEX scores.
I was accepted to an ACGME (pre-merger) academic program with mostly MD's (not a terribly competitive program though) with only COMLEX scores. I didn't bother taking STEP exams because they are technically unnecessary for DO's and they are extremely expensive. I'll admit I also didn't feel like studying extra biochem in order to take STEP.
You mentioned the failure is eating you alive; it's normal to feel sad and frustrated about failing a big exam, especially if you spent a ton of time studying and stressing, but the exam score doesn't reflect your worth. I hope you are finding fulfillment in other ways like family, friends, hobbies, etc. There is a whole world out there, please don't get too discouraged with this one exam.
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now theres basically a textbox where you can input your NBME id. The NBOME id is required the NBME is not. I have already contacted both ERAS and NRMP and was told it's optional to input NBME id. My main concern now is for licensure and whether I would have to report it or not. I appreciate your words though, thank you.
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So I am assuming no one knows what to do in this situation?
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Are you explicitly asking about the licensing piece or just ignoring the good advice you've received about ERAS?
There's not a right answer about either question, just reasonable next steps (which have already been reviewed ITT). You could retain an attorney familiar with IL and TX licensing if you'd like to get a professional opinion and I'd wager they'll also tell you that there's not a right answer. Alternatively, you could network with your med school faculty to see if they know anyone in practice in IL or TX who is on the medical board or familiar with these things.
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specifically licensure
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That’s great! I would agree with Osminog’s advice then
I went ahead and looked up my state’s physician license application and pasted relevant info here:
PLEASE INDICATE WHICH LICENSING EXAMINATION YOU HAVE TAKEN.
USMLE Yes No FLEX Yes No NBME Yes No NBOME/COMLEX-USA Yes No STATE BOARD EXAMINATION Yes No LMCC Yes No
If Yes, indicate the number of times you have taken each portion of the examination and the dates they were taken in the space below.
Part 1/Step 1/Level 1
Part 2/Step 2(CK)/Level 2(CE)
Part 2/Step 2(CS)/Level 2(PE)
Part 3/Step 3/Level 3
Component 1
Component 2
Section 334.040.2 requires each step of the examination to be taken and passed within three attempts, and steps one, two and three of the USMLE to be taken within a seven year period. If it took more than three attempts or more than seven years to pass the exam, please explain the circumstances
So it’s kind of vague, they lump part 1/step1/level 1 together and they only give one small box next to it.
As has been stated, DOs only need level 1,2,and 3 passed to be licensed. No steps required.
If you are really worried about some kind of ramifications of withholding information about a failed step on licensing app, you can look up the license application paperwork for states you are interested in practicing and see how they ask for the info. And if it’s vague you can call the licensing board in a given state and ask!
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thank you. I saw California does not even accept USMLE when you apply for licensure through the osteopathic board. Not sure about other states but I will look into it. If there has been anyone else in my shoes, please message me.
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So I think what you’re worried about is getting in trouble if you don’t report USMLE on ERAS, but then do report it on a state license application years later. The answer is: don’t worry. A state’s license application is completely different from ERAS. So, yes, you can omit USMLE from ERAS because you’re not forced to report it (and for you, you shouldn’t because you failed a test and it will make your residency interview season worse), but do NOT omit it from a state licensing application, because then by lying you screw yourself professionally forever — in that state, and other future states. Hope that helps! Plenty of people fail Steps or Comlex and retake one or both etc, and they are fine in getting a license (well, there is an exam limit, varies by state).
Again, a state license doesn’t care about ERAS and has no access to it. For all state medical boards, you have to send official exam score reports anyway from either NBME and/or NBOME, but never ERAS.
Good luck!
Again, a state license doesn’t care about ERAS and has no access to it. For all state medical boards, you have to send official exam score reports anyway from either NBME and/or NBOME, but never ERAS.
Good luck!
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Getting a license is a concrete relatively low bar, getting into the match and getting into where you want to go is an other story. You will be fine if you don't retake, but it will be a GME decision and not a worry about licensure.
