Failed Step but want to do General surgery, help with plan going forward.

[FormerNFLQB]

As the title says I found out I failed Step 1 today.

I am in shock because I passed 4 NBMEs with 68-69% and the free 120 with a 67%. I had less than a 5 % chance of failing but I managed to hit the failure jackpot.

I do not want to give up my dream of being a Surgeon so I was curious if anyone has any advice going forward? Should I retake Step 1 or focus on only doing well on Comlex level 2?

Are there Gen surg programs that will accept only Comlex level 1 and 2?

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[OffTheLand]

According to this graph adapted from the Journal of Osteopathic Medicine there appears to be some. I’m not sure on the necessity of reporting the step attempt though. I’m sure someone knowledgeable will chime in.

 

[Calizboosted76]

View attachment 374836
According to this graph interpreted from the Journal of Osteopathic Medicine there appears to be some. I’m not sure on the necessity of reporting the step attempt though. I’m sure someone knowledgeable will chime in.

There’s another post on here with a PD stating you don’t have to report the Step since you’re a DO. @NotAProgDirector I believe knows more.

 

[FormerNFLQB]

I am baffled as to what happened. A retake may be hard with starting rotations but if its what must be done its what Ill do.

 

[NotAProgDirector]

It used to be that DO's who took USMLE were "required" to disclose in ERAS, but they changed that rule (and it wasn't enforceable anyway). So it is your choice. Since you failed it, I'd recommend against it. Even retaking it, you'll have both the pass and fail show.

I'd probably focus your study work for L2 to try to do as well as possible and apply with COMLEX only. You'll be much more successful applying to prior "osteopathic" programs (everything is merged now).

 

[FormerNFLQB]

It used to be that DO's who took USMLE were "required" to disclose in ERAS, but they changed that rule (and it wasn't enforceable anyway). So it is your choice. Since you failed it, I'd recommend against it. Even retaking it, you'll have both the pass and fail show.

I'd probably focus your study work for L2 to try to do as well as possible and apply with COMLEX only. You'll be much more successful applying to prior "osteopathic" programs (everything is merged now).

So you would suggest just not retaking? I am just worried that I will be screened out and not have a chance at any surgical specialties without Step.

 

[kirtar]

View attachment 374836
According to this graph adapted from the Journal of Osteopathic Medicine there appears to be some. I’m not sure on the necessity of reporting the step attempt though. I’m sure someone knowledgeable will chime in.

FWIW when I tried to replicate the methods on the 2022 Charting the Outcomes data, the difference for Step 1 wasn't significant (lower bound of the OR 95% CI was ~0.75), although I seem to remember that <30 applicants didn't take step. Unfortunately, for some reason the spreadsheet didn't sync via Onedrive, so I can't play around with it until after this rotation.

E: Still have an image I sent on a group message so here's that. That should be the 10 that were in the paper + Neuro and PM&R due to personal interest. Only bothered showing the lower bound of the confidence interval because it's the one that matters for the purpose of deciding if it crosses 1.

 

[ToKingdomCome]

you still have a shot but everything needs to be perfect. Focus on former DO programs. Do 4 always, absolutely knock them out of the park and get LOR’s. That’s your only shot

 

[AlbinoHawk DO]

Nobody will want to tell the toughest thing which is that you need to apply with a backup specialty

Is surgery impossible? No. Is it unlikely? Yes. Retaking step 1 will have limited ROI. You need to focus on getting an incredibly high level 2 and wow people on away rotations

Now the question will be what you want to do as backup. Many people choose family medicine because it is the easiest for DO grads, but you could also see how you like procedural medicine subspecialties and go for pulm/cc, interventional cardio, or GI. Don't make the mistake of putting all your eggs in one basket. Take the backup seriously

 

[DOVinciRobot]

I’m going to be brutally honest. It’s time to do something else.

Board failures and surgery don’t mix, there are too many good applicants. Even the majority of former DO programs will ask you why you don’t have a Step (if you don’t report), and ALL programs will filter you out with a reported fail. No traditionally MD program will consider you without a Step so those are automatically off the table now.

No your chances aren’t completely zero, but they are closer to zero than they are any other number. You’re only chance lies with maybe the very few former DO programs that rank purely based off of the audition, and even then you’ll have faculty and PDs questioning why they should take the risk in you when they have a pile of applicants they also like who didn’t fail a major exam.

 

[FormerNFLQB]

Thank you all for the numerous responses.

@DOVinciRobot does publications, story, or anything play a role in bumping me up? I have roughly 10 publications prior to starting 3rd year and could really ramp up those numbers.

 

[voxveritatisetlucis]

Nobody will want to tell the toughest thing which is that you need to apply with a backup specialty

Is surgery impossible? No. Is it unlikely? Yes. Retaking step 1 will have limited ROI. You need to focus on getting an incredibly high level 2 and wow people on away rotations

Now the question will be what you want to do as backup. Many people choose family medicine because it is the easiest for DO grads, but you could also see how you like procedural medicine subspecialties and go for pulm/cc, interventional cardio, or GI. Don't make the mistake of putting all your eggs in one basket. Take the backup seriously

What are the chances of matching those sub specialties from a community IM program though? Especially GI and cardio

 

[AlbinoHawk DO]

What are the chances of matching those sub specialties from a community IM program though? Especially GI and cardio

Not impossible, but you might need to bridge with a hepatology year or a vascular year. The thing is, someone getting a 550 is probably enough to make it into UNLV or UNM or another low ranked university program, then stay in house for fellowship, whereas the same score won't get you into even a community surgery program

 

[DOVinciRobot]

Thank you all for the numerous responses.

@DOVinciRobot does publications, story, or anything play a role in bumping me up? I have roughly 10 publications prior to starting 3rd year and could really ramp up those numbers.

Unfortunately no. It would be better to bang out a 750 on Level 2 and only apply to DO programs and audition your butt off at places that wont ask about Step.

 

[FormerNFLQB]

Unfortunately no. It would be better to bang out a 750 on Level 2 and only apply to DO programs and audition your butt off at places that wont ask about Step.

Would retaking and passing open more doors? Or would that be pointless because the I would have to report the fail and I would still get filtered out?

 

[FormerNFLQB]

To give a little more context, I dont care where I do residency at. It could be in the middle of no where with one gas station for 500 miles.

 

[FormerNFLQB]

So from a cursory search at residency in the surgical fields it seems like General surgery is a lot less likely to accept someone with just COMLEX. However I have found multiple programs who state they will accept COMLEX only in the realm of Ortho. @TheBoneDoctah can you comment on this at all?

I know Ortho is super competitive I am just searching for a surgical specialty that I can only use my COMLEX scores.

 

[voxveritatisetlucis]

To give a little more context, I dont care where I do residency at. It could be in the middle of no where with one gas station for 500 miles.

Yes but this is most general surgery applicants. Plenty of people from my low tier MD school from big cities who wanted surgery had to go to community programs in rural areas after failing to get interviews in their preferred locations/academic programs

 

[NotAProgDirector]

I am afraid that your fail on S1, even followed by a pass and a pass on S2, will still lead to you being passed over by programs. Surgery is competitive, and (fair or not) more challenging for DO grads. I think you should invest your time in something other than USMLE. In addition, exam performance tends to predict exam performance. You failed S1, the chance of "killing S2" is just statistically unlikely. Exam performance just isn't your forte, that's the way it is.

Hence my advice above -- I'd focus your time on L2 and aways. And as mentioned above, you need a Plan B. Dual apply, or apply for prelims, or plan to SOAP for a prelim (not a fun process at all). Or apply to another field also.

Ortho is NOT a backup for Gen Surg. Perhaps it's more COMLEX friendly, but you need to be realistic. You'd need lots of ortho research - and if you do that, you HURT your chances of getting Gen Surg since they will see you as an Ortho applicant. Plus you'll need to focus on aways, and you cannot do both in ortho and Gen surg.

And here's the L2 data from Charting Outcomes for DO/Ortho:

Average L2 for matched applicants was 676, and for unmatched was 616. Just passing isn't going to do it.

 

[FormerNFLQB]

I am afraid that your fail on S1, even followed by a pass and a pass on S2, will still lead to you being passed over by programs. Surgery is competitive, and (fair or not) more challenging for DO grads. I think you should invest your time in something other than USMLE. In addition, exam performance tends to predict exam performance. You failed S1, the chance of "killing S2" is just statistically unlikely. Exam performance just isn't your forte, that's the way it is.

Hence my advice above -- I'd focus your time on L2 and aways. And as mentioned above, you need a Plan B. Dual apply, or apply for prelims, or plan to SOAP for a prelim (not a fun process at all). Or apply to another field also.

Ortho is NOT a backup for Gen Surg. Perhaps it's more COMLEX friendly, but you need to be realistic. You'd need lots of ortho research - and if you do that, you HURT your chances of getting Gen Surg since they will see you as an Ortho applicant. Plus you'll need to focus on aways, and you cannot do both in ortho and Gen surg.

And here's the L2 data from Charting Outcomes for DO/Ortho:

View attachment 374887

Average L2 for matched applicants was 676, and for unmatched was 616. Just passing isn't going to do it.

No I know that it isnt a back up. I didnt mean to come off that way.

So I am normally a very good test taker. I was scoring well above passing on all of my NBMEs leading up to the exam (my scores were like 220s-230s) and I got a 534, 550, 545 on my practice comlex exams (passed comlex first try)

I think what caused my fail for STEP is that I took comlex on the 12 and then STEP 2 days later (while taking STEP there was a gentleman taking a DUI, not sure what kind just overheard him when he was checking in, course of some kind next to me and he was coughing and clearing his throat for four hours and he kept making a huge scene at the testing center.).

I know that this may sound like an excuse but I am normally a very solid test taker.

My school advised me to retake since I was scoring well on the exams prior to my test day. They said that this is my only option in order to even have a chance for general surgery.

 

[FormerNFLQB]

I know this exam was a fluke. I just dont know what the ROI for retaking and passing and doing well on STEP 2 will net me. I am still set on surgery so I am stressing.

And yes I put in the survey of my exam about the gentleman coughing and causing a scene.

 

[kirtar]

I think the problem is that programs that are going to screen you for not reporting step 1/2 are also highly likely to screen you for failing step 1. Then on top of that, some programs that wouldn't screen for not reporting might screen you for failing step 1.

 

[FormerNFLQB]

I think the problem is that programs that are going to screen you for not reporting step 1/2 are also highly likely to screen you for failing step 1. Then on top of that, some programs that wouldn't screen for not reporting might screen you for failing step 1.

That makes sense. I am thinking I will just not report and dual apply to the few general surgery programs out there that will accept COMLEX only as well as a back up specialty.

My only issue with not reporting is what if they ask me in my interview why I didnt take STEP 1. I do not want to lie to them.

 

[DOVinciRobot]

Would retaking and passing open more doors? Or would that be pointless because the I would have to report the fail and I would still get filtered out?

No.

To give a little more context, I dont care where I do residency at. It could be in the middle of no where with one gas station for 500 miles.

Doesn’t matter.

My only issue with not reporting is what if they ask me in my interview why I didnt take STEP 1. I do not want to lie to them.

You tell them the truth. And then you accept the fact they aren’t going to rank you. If you lie to them and they find out that is grounds for dismissal from residency.

I’m really not trying to be negative. This is the brutal truth. You failed a board exam and general surgery has an over supply of very qualified candidates who not only didn’t fail anything but passed with above average colors. The fact ortho has even entered this thread shows you have some magical thinking going on. You are not a good test taker. Good test takers don’t have “flukes” and fail major exams because someone was coughing and “causing a scene at the testing center.” Trying to claim that is just more magical thinking.

I am still set on surgery so I am stressing.

My honest advice is that you need to become less set on surgery and need to realize the situation you are in. Your chances of matching general surgery are in the single digits, and that will require everything to fall perfectly into place.

 

[FormerNFLQB]

No.

Doesn’t matter.

You tell them the truth. And then you accept the fact they aren’t going to rank you. If you lie to them and they find out that is grounds for dismissal from residency.

I’m really not trying to be negative. This is the brutal truth. You failed a board exam and general surgery has an over supply of very qualified candidates who not only didn’t fail anything but passed with above average colors. The fact ortho has even entered this thread shows you have some magical thinking going on. You are not a good test taker. Good test takers don’t have “flukes” and fail major exams because someone was coughing and “causing a scene at the testing center.” Trying to claim that is just more magical thinking.


My honest advice is that you need to become less set on surgery and need to realize the situation you are in. Your chances of matching general surgery are in the single digits, and that will require everything to fall perfectly into place.

I appreciate the brutal honesty. Thank you

 

[FormerNFLQB]

No.

Doesn’t matter.

You tell them the truth. And then you accept the fact they aren’t going to rank you. If you lie to them and they find out that is grounds for dismissal from residency.

I’m really not trying to be negative. This is the brutal truth. You failed a board exam and general surgery has an over supply of very qualified candidates who not only didn’t fail anything but passed with above average colors. The fact ortho has even entered this thread shows you have some magical thinking going on. You are not a good test taker. Good test takers don’t have “flukes” and fail major exams because someone was coughing and “causing a scene at the testing center.” Trying to claim that is just more magical thinking.


My honest advice is that you need to become less set on surgery and need to realize the situation you are in. Your chances of matching general surgery are in the single digits, and that will require everything to fall perfectly into place.

I am going to dual apply. I am going to apply general surgery and whatever I end up liking as a second. I really appreciate it.

 

[Calizboosted76]

I am going to dual apply. I am going to apply general surgery and whatever I end up liking as a second. I really appreciate it.

For what its worth, I have a buddy in a similar situation and they have found multiple GS residencies that state they accept COMLEX in place of USMLE. Not sure that it will make much of a difference but just wanted to put my two cents in here.

Good luck!

 

[FormerNFLQB]

Thanks everyone. Going to try and do some self reflecting and decide.