Help for a friend please

[agranulocytosis]

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My friend just got her Step 1 score back this past week. 1st attempt resulted in a failure to pass, 2nd attempt she scored a 190. She's also a caribbean student.

She's always wanted to EM since before coming to this school. There's no other specialty she could consider. I've told her that come clinicals, her mind may change and she might fall in love with a specialty that she'd never imagine she would.

But let's say for argument's sake that she's dead set on EM. What can be done to salvage her potential carreer in EM? Will stellar clinical grades, an excellent Step 2, and a proven interest in EM by getting involved in major research in the field afford her improved chances to match? She's really down about this and really thinks she should give up now as she was hoping for >220 to make up for that poor 1st attempt, and I would like to hear your opinions on the possibility of her matching after making up for the Step 1.

 

[Rendar5]

My friend just got her Step 1 score back this past week. 1st attempt resulted in a failure to pass, 2nd attempt she scored a 190. She's also a caribbean student.

She's always wanted to EM since before coming to this school. There's no other specialty she could consider. I've told her that come clinicals, her mind may change and she might fall in love with a specialty that she'd never imagine she would.

But let's say for argument's sake that she's dead set on EM. What can be done to salvage her potential carreer in EM? Will stellar clinical grades, an excellent Step 2, and a proven interest in EM by getting involved in major research in the field afford her improved chances to match? She's really down about this and really thinks she should give up now as she was hoping for >220 to make up for that poor 1st attempt, and I would like to hear your opinions on the possibility of her matching after making up for the Step 1.

I'm not a prog dir so I don't trust my opinion on her possibility of matching other than that it would be tough (not saying anything new here). I'm just concerned that, if u're hoping for step 2 to save her, she'll have problems if she's already 30 points away from the hoped for score on step 1. Are there any standout reasons that she's had difficulty with her 2 board tests?

 

[Tiger26]

Also, not wanting to be mean, but from looking at the posts of people this match, it seemed like many seemingly overqualified IMGs failed to match EM even with stellar board scores (230s), great comments/LORs, and a proven record of academic/clinical success in 3rd year.

 

[Groove]

Chances are slim to none. Sorry to be the bearer of bad news. We had caribs with mid 90s, no fails, great applications, and plenty of interviews fall through the cracks this year.

Her best shot would be to ace step 2, LORs, clinical grades/evaluations, etc.. and do EM rotations at a program with a known track record of consistently taking graduates from her particular school. If they like her, then they might rank her high enough to match and be willing to overlook the step 1 fail and low score.

That being said, she would be very foolish not to apply for and rank a backup specialty and I would honestly consider her chances of successfully matching to be small but perhaps not impossible.

Head to NRMP's website and have her download Charting Outcomes for the Match 2007. It's fairly easy to extrapolate the numbers and get a feeling for how competitive the specialty is at the moment. Just to give you an idea... Out of 140 independent matched applicants, 11 had a step 1 score <= 190. Of the 54 that applied with a step 1 score between 181-190, only 10 matched.

Good luck.

 

[Speed Racer]

My friend just got her Step 1 score back this past week. 1st attempt resulted in a failure to pass, 2nd attempt she scored a 190. She's also a caribbean student.

She's always wanted to EM since before coming to this school. There's no other specialty she could consider. I've told her that come clinicals, her mind may change and she might fall in love with a specialty that she'd never imagine she would.

But let's say for argument's sake that she's dead set on EM. What can be done to salvage her potential carreer in EM? Will stellar clinical grades, an excellent Step 2, and a proven interest in EM by getting involved in major research in the field afford her improved chances to match? She's really down about this and really thinks she should give up now as she was hoping for >220 to make up for that poor 1st attempt, and I would like to hear your opinions on the possibility of her matching after making up for the Step 1.

Step 1: Study hard and do well on step 2. If she has text anxiety issues, find a way to deal with them. Don't shoot for the moon if its not realistic, just show that you have an average fund of knowledge. Step 2 is the more practical test anyway.

Step 2: Find a program that will let you rotate at their shop without asking for your scores etc. Do really well. Get a great letter and perhaps a job offer.

EM is more egalitarian that way. Given the choice between some prodigy that scores a 260 and spits on patients vs some one with an average-ish score who can hump it, who would you pick? Plus, everyone loves a come back kid. I know, I am one.......My strikes probably equaled hers, and now I'm at a top tier (whatever that means) shop.

Screw the research...no one cares. Its icing.

 

[EMIMG]

Here best bet may be to do really well on step II and then consider a transitional year before applying to EM. Do well in the transitional year and rotate at a place that has an EM residency

 

[howelljolly]

Its not going to be easy.

Rock Step2, which is easier said than done. Scores dont change very much. Her first and second attempts at the Step1 were likely close, and the Step 2 usually isnt far off. The failed attempt is also a bad thing.

Some of the more desirable 3rd and 4th year rotations will be closed for her, since they have minimum Step 1 score requirements for Carib students. So getting the EM electives, and getting the better cores which will get her into the EM electives may become an issue.

It also depends on what school she goes to. Somehow, SGU manages to send a lot of people into EM, whereas Ross sends a lot of people into Radiology. I dont know if its a matter of name recognition, or if programs really look at the track record of the school... maybe both.

 

[cinapism]

.

 

[cinapism]

I just heard from a Family Med resident who wanted to do EM and didnt get in. She is now doing a fellowship in EM through fam med. I dont know the details and if this allows you to be "board certified" but there may be other reasonable options.

either way, the plan should probably be the same. Study your ass off and work hard. Then see where you stand after step II and clinicals.

Anyone else know about this?

 

[SoCuteMD]

I just heard from a Family Med resident who wanted to do EM and didnt get in. She is now doing a fellowship in EM through fam med. I dont know the details and if this allows you to be "board certified" but there may be other reasonable options.

either way, the plan should probably be the same. Study your ass off and work hard. Then see where you stand after step II and clinicals.

Anyone else know about this?

It does not allow you to become board certified.

 

[howelljolly]

It does not allow you to become board certified.

And there are VERY limited seats. I heard that the last two established fellowships closed, but a new one opened in Tenn. That might be the only one now.

This scenario really is par for the course in the Caribbean. Whether its the Step1 score, or the availability of EM rotations, or just dumb luck, this happens all the time.

During clinicals, your friend might discover an interest in some other field, or at least come to terms with the realization that she wont be an emergency physician.

I know a Carib student who's a paramedic with an above average Step1 score, who isnt going to get to be an emergency physician. 🙁

 

[agranulocytosis]

Thanks for the responses and the honesty guys. I saw a few posts above this one and another separate thread where FM-trained physicians work as part of the ED. I think this may be her best option.

But clinicals and Step II are also quite a ways away, and miracles can and do happen, so let's just see how they go.

Question to Speed Racer: would you shoot for a pre-match offer or try your chances at the match?

 

[howelljolly]

Thanks for the responses and the honesty guys. I saw a few posts above this one and another separate thread where FM-trained physicians work as part of the ED. I think this may be her best option.

But clinicals and Step II are also quite a ways away, and miracles can and do happen, so let's just see how they go.

Question to Speed Racer: would you shoot for a pre-match offer or try your chances at the match?

Im not speedracer but....

you dont really 'shoot' for a prematch.

A hospital where you did really well might tell you during your rotation that they encourage you to apply for residency there, but that doesnt mean anything. You have to register for the Match, and be granted an interview. At the interview itself, a prematch might be offered to you. The decision of accepting that prematch, vs. taking your chances in the Match in the hopes of getting a program you like more... thats another story. So, anyway... this is really a moot point.

 

[Rendar5]

Thanks for the responses and the honesty guys. I saw a few posts above this one and another separate thread where FM-trained physicians work as part of the ED. I think this may be her best option.

But clinicals and Step II are also quite a ways away, and miracles can and do happen, so let's just see how they go.

Question to Speed Racer: would you shoot for a pre-match offer or try your chances at the match?

Miracles on board exams are unlikely. I think time is better spent learning to beat the exam and figuring out how the result is so far from expectation than to hope for a random miracle to occur. I mean there are a lot of reasons to not do so hot on the boards and there are a lot of answers and ways around it. if she doesn't figure it out, she's not gonna magically jump 30-40 points.

 

[NinerNiner999]

There are still jobs where one can practice EM as an internist or FP. Truthfully, your friend will likely need to consider this pathway.

 

[Speed Racer]

No your best chances are via the match. But if you target a program that has a hard time filling each year and can prove competence and commitment, I would think a handshake deal is not out of the question.

I like the idea of what OP's have mentioned in going somewhere that alumni have matched. Also, getting important connected people to vouch for her would be nice. I was friends with a lot of my senior med students and this helped immensely when I was hustling for interviews at places they had matched.

 

[peppy]

With the odds being against you in this situation, I definitely think you should take it if you get a prematch offer. The match is much riskier.
That said, if I were in this situation, I would apply to EM with FP as a backup (even if you run into problems getting to work in emergency as a FP at least you can still work in urgent care then).

 

[beriberi]

I had a similar score (189) five years ago BUT -- I went to a top 5 American med school, middle third of class, did not have a fail on Step 1 AND rocked Step 2 (220's). I applied to 15 programs, had 5 interviews (figured out I didn't apply to enough programs too late), ranked 4 -- and did not match. I was lucky enough to scramble into a great spot.

People say that "it is not all about the scores"--I think they mean, "it is not all about the scores as long as they are at least average." A crap score on Step 1 almost ruined my chances at EM, and I had a lot more going for me (on paper at least) than your friend. Not to be harsh, but it is time she try to figure out what she can love about another specialty.

 

[Drawing Dead]

You know, I just started looking into getting my unresticted licence yesterday (after finding out I passed step 3) and it occured to me that certain states (like the one I am applying to) only licence physicians from certain foreign medical schools. This one in particular only licences physicians from 4, Ross, St. George and the other 2 I cannot remember. This may factor into whether a program will take an IMG or not. For example, someone who got a 230+ on their boards but is attending a school that the state does not recognize, I can easily see the PD saying no, no matter what, because they would not be able to become licenced in that state. So, WHICH foreign med school you go to may be just as important as the rest of your app.

 

[howelljolly]

You know, I just started looking into getting my unresticted licence yesterday (after finding out I passed step 3) and it occured to me that certain states (like the one I am applying to) only licence physicians from certain foreign medical schools. This one in particular only licences physicians from 4, Ross, St. George and the other 2 I cannot remember. This may factor into whether a program will take an IMG or not. For example, someone who got a 230+ on their boards but is attending a school that the state does not recognize, I can easily see the PD saying no, no matter what, because they would not be able to become licenced in that state. So, WHICH foreign med school you go to may be just as important as the rest of your app.

If you dont mind me asking... are you in Illinios?.... or California?..... or where?

 

[Drawing Dead]

If you dont mind me asking... are you in Illinios?.... or California?..... or where?

Illinois, but you need 2 years post grad to apply for licensure, so I'm applying for Indiana.

 

[deleted109597]

Miracles on board exams are unlikely. I think time is better spent learning to beat the exam and figuring out how the result is so far from expectation than to hope for a random miracle to occur. I mean there are a lot of reasons to not do so hot on the boards and there are a lot of answers and ways around it. if she doesn't figure it out, she's not gonna magically jump 30-40 points.

I got national average on the 1st step and added 30 points to it for Step II. Studied probably 5x as much for Step I as well. Sometimes it has less to do with knowledge of minutiae and more about what to do clinically.

However, she has a bad track record so far, so I wouldn't hold my breath for a massive increase.

 

[FlaMedic]

Here is my n=1. Hilwa from SGU at ORMC

http://www.orlandohealth.com/pdf folder/Residency - ORMC ED/12-08/EmergencyMedicineClassof2009.pdf

 

[MrsK]

Hey! I'm not a PD, or an IMG, but of the advice I've seen, I second the thoughts of doing as well as possible on step 2, LORs, clinical grads/evals. I think it will be really important to find out which programs are IMG friendly, or have a tract record of picking up folks from her program, do well on clinical rotations at those places. Nothing is impossible- good luck!

Also, just throwing out another option- I know people who were IMGs, not initially picked up in the match, and scrambled into EM/IM. The EM/IM route may have a larger percentage of unfilled spots compared to EM- my friends who applied to EM/IM got their top spots, and mentioned they felt it was a smaller application pool. EM/IM is a long road, but may offer a few more options, especially if those programs have taken IMGs in the past.

Another option- consider a military scholarship, it will open options for civillian and military residencies (more programs to apply to). My husband is starting his EM residency in July with the military. His is a great training program, which works closely with my civilian program and other civilian hospitals. Your friend may have to go through a transition or prelim year (since some military programs are EM 2-4). Your friend may have to work as a general medical officer, for a year, or more. That work experience will make her a stronger applicant if she choses military or civilian residencies. The millitary can offer unique training experiences (hyperbarics, flight surgery, trauma, ect) if you are in it for the right reasons. Me? I hate ironing clothes, but I admire my husband for his ironing skills, and willingness to wear a uniform.

Don't give up, or let anyone tell her she can't do it!

 

[DrJosephKim]

Find a tutor. Nothing beats one-on-one tutoring to raise these types of scores.

 

[LadyGrey]

I know of a lot of DOs and Caribs who prematched in IM, peds, FM, but none who were even offered a prematch in EM. As with many things, YMMV, may depend on the region, etc., but I'd advise your friend that such an offer is unlikely in this field.

Honestly, I think she's unlikely to match at all in EM unless EM suddenly drops is popularity/competitiveness. She can do everything that people are suggesting, but I think she'd merely be improving her chances from awful to bad. Sorry, but I don't think false hope is going to help.

 

[Painter1]

Some people suggested doing rotations to see if that would overcome bad USMLE scores.

It's ok to give hope, however we need to be honest as well as this will allow the person to move-on.

For a residency like EM, being an FMG creates a very difficult barrier. Being FMG and having a very poor Step 1 score dwindles the chances to zero.