Help! I got a 205 on step 1

[optimisticpremed118]

I panicked on the day of my exam and scored 30 points lower than I was scoring on my last 2 practice tests. Before my score came out I was confident I wanted to go into ophthalmology and was heavily involved in research with 2 publications and 1 or 2 more that will most likely be published within the year (maybe 2021 with covid). Normally I would have thought i need to give up on pursuing any competitive specialty with my debilitating step score but with NBME announcing P/F for Step 1 im confused what to think at this point. I am in the class of 2022 but I am planning on taking a gap year for research so applying in the 2022-2023 cycle. I was hoping if anyone has any news on whether step 1 will retroactively be reported as P/F in 2022 for someone in my position and if not, how/if step 1 scores will still be important in the 2022-2023 cycle when there will be applicants with P/F vs applicants with an actual numerical score. Im ultimately trying to figure out whether or i still have a chance at ophthalmology with the current situation.

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[softball2344]

Do you go to a top tier school?

 

[optimisticpremed118]

I go to a T25 school

 

[Pinocytosis]

I am in the class of 2022 but I am planning on taking a gap year for research so applying in the 2022-2023 cycle. I was hoping if anyone has any news on whether step 1 will retroactively be reported as P/F in 2022 for someone in my position...

I would be very cautious with this thinking. If the CoV2 pandemic has taught us (and medical school administrators) anything, it's that the NBME is not exactly transparent with their future decisions/guidance. If you re-read their Step 1 P/F announcement, it says at the *earliest* Step 1 will be P/F in 2023. This may in fact be 2023, 2024, ..... Also we do not know whether the NBME will retroactively convert a scaled score over to a P or F is not known at this time. I personally do not feel they would do that, but who knows.

If you are still very serious about ophthalmology, ask on their specific SDN forum for guidance or, even better, discuss this with optho mentors. This is all secondhand, but from what I hear optho is a small field and "people know people". It will be an uphill battle no matter what, but I encourage you to continue following your desire. Either way, the grinding will help your application for whatever specialty you choose.

 

[drducky.]

An attending on the step thread said it’s borderline illegal to retroactively hide your score so I doubt it’ll happen but who knows

 

[piii]

two friends with 240s couldn’t even match ophtho, might be time to find a backup

 

[Splenda88]

NBME will not retroactive convert your score to P/F... Do not count on that. Your chances for ophtho is pretty slim. However, with a year of research and a robust step 2 (255+), I believe your chances might be average.

 

[efle]

I personally believe they WILL display everyone as Pass for the Sept 2022 ERAS, regardless of whether they initially received a Pass or a number. It would just be too unfair/lopsided to allow research year applicants to display a strong Step 1 score while their peers in direct competition for the same seats are restricted to only showing Pass. That sounds much more ripe for a lawsuit than does having you score shown as Pass after several years of notice.

OP if your heart is set on Ophtho or any other competitive surgical subspecialty, then yes taking a gap year and showing a Pass (hopefully) is your only real remaining option.

 

[deleted947265]

The bad news is yeah your odds are bad, far from nonzero though. It seems like you have a genuine interest in the specialty, and I'd hate to see someone give up something they're passionate about over some board examination Pajama Sam bs. As a general rule of playing to win, ignore things you can't control and keep playing until you lose. You can't retake it and nobody knows how it will be treated as far as reporting scores as far as pass/fail is concerned, probably nothing will change.

The best data that I could find was a study in the JAO that looked at 2013/2014/2015 match data, the odds of someone matching with Step 1 score less than 217 was 39%. Not great, but could be worse. The probability of an IMG matching with a step 1 score greater than 239 was 27%.

You shouldn't base your odds on those statistics, first of all it would be inaccurate to do it on a single metric. Second it doesn't matter if your chance is 9% or 90%; not matching is going to sting the same.

With the information in the thread and looking at the research, you have literally everything else going for you. You might find this article encouraging. A very good step 2 can only help. The average match step 2 was 246, average unmatched step 2 was 230. There's very little data published on step 2 scores and matching that I've come across but I didn't exactly dig deep. To briefly summarize it:

You got to a top 25 medical school which is associated with 1.4 times better odds of matching.

You presumably go to a top 40 NIH funded medical school which is associated with 2.25 better odds of matching.

You've done research in what I'm assuming is ophthalmology and thus have a program associated with your school which is associated with 1.4 higher odds of matching.

The data isn't clear on how much having publications helps but there's data showing that IMG's odds increased 3 fold if they had research published in a high impact journal.

As for what you should do? Get a good adviser that can help you navigate this. You'll probably want to mingle in the ophtho forums. I don't know if it's possible for you to get in the AOA despite your Step 1 score, but definitely gun for that if it's in the cards. I've never heard of the Gold Humanism Honor Society but the AAO mentions it, there's no data showing it'll help but take all the ground you can get. If you aren't in a student eye-balling interest group, join one. Talk to an adviser who is in the know.

 

[eyejust]

Someone at my school matched with a 199 in Ophtho a couple years back. Anything is possible!

 

[jazian]

Someone at my school matched with a 199 in Ophtho a couple years back. Anything is possible!

The odds are probably 1/3 that you match based on all the stats available. If Optho is the only thing in your career you see yourself doing, then its worth a shot, but its going to be a very uphill battle and 2/3 times you might have to reapply and switch fields in the end.

 

[therealfinale]

I panicked on the day of my exam and scored 30 points lower than I was scoring on my last 2 practice tests. Before my score came out I was confident I wanted to go into ophthalmology and was heavily involved in research with 2 publications and 1 or 2 more that will most likely be published within the year (maybe 2021 with covid). Normally I would have thought i need to give up on pursuing any competitive specialty with my debilitating step score but with NBME announcing P/F for Step 1 im confused what to think at this point. I am in the class of 2022 but I am planning on taking a gap year for research so applying in the 2022-2023 cycle. I was hoping if anyone has any news on whether step 1 will retroactively be reported as P/F in 2022 for someone in my position and if not, how/if step 1 scores will still be important in the 2022-2023 cycle when there will be applicants with P/F vs applicants with an actual numerical score. Im ultimately trying to figure out whether or i still have a chance at ophthalmology with the current situation.

I'd say go for optho, but know that there are no guarantees. Do well on Step 2. Just have a backup plan that you'd be able to see yourself doing, at least for a year.

 

[NotAProgDirector]

I'm all for people following their dreams, but this is a rocky road. I think your chances of getting Ophthal is much less than 1/3 - any of the stats from Charting outcomes only looks at people who actually get an interview, plenty in your situation will get no interviews at all. You could delay a year and hope that they will change to PF grading, but the timeline isn't certain and what they will do for people with scores is unclear. In my experience, the biggest predictor of S2 performance is S1 performance. And if you do a whole research year for ophthal, a backup plan becomes complicated. Apply for IM positions and few people will interview you -- your application will scream ophthal with a research year and multiple aways. You'd probably be stuck with a prelim GS year (or maybe prelim IM if you get lucky), and then have to plan a career around that -- not impossible, but not easy.

 

[zero0]

Listen to the program director and reevaluate your career path. Don't underestimate how brutal the match actually is.

 

[longhaul3]

I also think that, when Step 1 becomes p/f, all scores will be reported as p/f, so you may have a shot.

However, if this doesn't happen, you don't want to be the person who doesn't match in ophtho and then has to pivot. Plenty of people don't match in ortho or ENT or whatever with a 250, then easily pivot, or even SOAP, into GS or medicine or radiology or something. Your application with a 205 Step 1 score is not really a slam dunk to match even for what most people pivot into, so you could find yourself really up the creek if you don't match and then have no real fallback a year or more after graduation. If you score 260 on CK, I think this could be a totally different ballgame.

 

[Cawolf]

This will be a rough road due to your Step 1 score, although I can't comment on the P/F aspect. If you look at the available statistics (https://sfmatch.org/PDFFilesDisplay/Ophthalmology_Residency_Stats_2020.pdf) the matched mean goes up every year, to 245 this year. A 2018 paper which used data from 2013-2015, the mean Step 1 was 238 (SD = 16) which puts you below the 2nd percentile (I think, don't hold me to the stats part; PMID 30662977). If you are committed to the field, I would definitely dual apply to another field that is less competitive. Best of luck either way!

 

[Moose A Moose]

Rocky. You better plan on crushing Step 2, and inspiring everyone on your audition rotations. Application needs to be filled with specialty-specific research, glowing LORs, etc.

 

[Sed8&Intub8]

Go full force for ophthalmology but have a back up. You never know what will happen and should at least try. But also be realistic and know that it might not happen.

 

[Ho0v-man]

Doesn’t the optho match happen before the regular match? If so, might as well shoot your shot and apply to a backup in the regular match. You’ll likely end up not matching optho if going by the available data, but since it’s an earlier match there seems to be little reason why you shouldn’t try.