How important is step 1 score for MSTP residency applicants?

[narla_hotep]

My step score is average at best (around 230), which was disappointing given that I had a very good MCAT and was hoping to do well on Step 1. Plus I'm afraid that, since I've heard that average Step 1 scores are increasing every year, it will look even worse when applying for residency in 5-6 years. Is it true that board exam scores are weighted less heavily for MSTP applicants to residency? And also, do you guys agree w my fear that my score will look worse in 5 years as avg scores go up?

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[Fencer]

Manuscripts and Grant's are more important for PSTP residencies. Not a bad score just average.

 

[MSTPadvocate]

agree with Fencer. The score is fine. What will be differentiating are papers, grants, presentations, LORs, connections.

There's a mentally unhealthy emphasis on USMLE - this is a test to check competency and should be looked at like pass/fail.

 

[Neuronix]

Totally disagree with the advice given so far. Step 1 still matters a lot for MD/PhD applicants. How much it matters depends on your residency choice. For less competitive specialties 230 is fine, for more competitive specialties, 230 will be a problem. For things like IM/PSTP, 230 will be an issue for the more competitive programs, but you have a better shot for PSTP spots at less competitive programs with that score.

The idea of step 1 as a minimal competency exam is very outdated advice or applicable to a limited number of specialties AT BEST. This the attitude that leads to MD/PhDs failing to match. I have written extensively about this on my blog.

 

[narla_hotep]

I agree the emphasis on step is mentally unhealthy, and it SHOULD be pass/fail. But I'm afraid Neuronix might be right in that it's becoming more and more important these days... Got a link to that blog post, by chance? Not that I want to worry about my step score for the next 4 years, I should be focusing on my research. But I'm curious what I'll be in for eventually.

 

[JoaoMoutinho]

I agree the emphasis on step is mentally unhealthy, and it SHOULD be pass/fail. But I'm afraid Neuronix might be right in that it's becoming more and more important these days... Got a link to that blog post, by chance? Not that I want to worry about my step score for the next 4 years, I should be focusing on my research. But I'm curious what I'll be in for eventually.

MD/PhD: Longer, Harder, Faster

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www.neuronix.org

 

[Fencer]

The OP is asking for PSTP residencies. Last year, at our national retreat, we hosted 15 PSTP directors from top 20 schools. While for some high income specialties (such as Dermatology, Rad Onc, and others), the residency directors are still fixed with the Step I scores, SOM GPA, and AOA, that is NOT the case for PSTP residencies. I (and other MSTP directors) will disagree with Neuronix.

USMLE Step scores will become P/F licensing exams in the near future. Not this year; unlikely for next year, but very likely before 2025. More schools are becoming P/F in their SOM GPA.

 

[Neuronix]

Cool. Op, why don't you go ask the internal medicine forum or the PD of your internal medicine program? This discussion reminds me of when I was an mstp student and mstp directors used to say the same thing while our top tier pstp only ever matched pstps with super high step scores. There was a disconnect then, and I still see that disconnect between mstp faculty where I work now and the people actually making decisions about residency admissions.

 

[Fencer]

Perhaps the disconnect is somewhere else... High-income specialty residencies are competitive in Step 1 today. As I said previously, the national association of MD/PhD programs hosted a panel of top PSTP directors in IM, Peds, and institutional programs. A similar panel was at the National MD/PhD conference in Colorado earlier this year. In both cases, they were asked these particular questions. We also did an anonymous survey of PSTP directors asking them to rank factors important for interviews. Step 1 was in the lower third. Above Step 1 were Publications, Grants, Clerkship grades/evals, and LORs. That is what they answered. You might argue that they are telling us politically-correct answers in open forums, but would they also do that in an anonymous survey? I have seen a few graduates with painfully low step 1 scores getting into competitive PSTP spots. How? by strong pubs, grants, clerkship and LORs. My students fortunately are scoring a median of 245. A 230 will be ok... believe me... a 203 might be different but still hopeful.

 

[Neuronix]

Well I can agree that 230 isn't bad.

I hate to hear minimum competency and just need to pass. We had four MSTPs not match from where I trained in one year with that advice. Two were in "competitive" specialties.

And as for "high income specialties", everyone I know in PP IM subspecialties (med onc, pulm/crit care, etc) makes more than me in academic rad onc. I know several med oncs making double and triple what I make. High paying jobs in rad onc are not easy to find any more.

 

[JoaoMoutinho]

How important is clinical research vs the basic science research that would be the bulk of a PhD? I assume that it is expected to have at least some clinical research, but are PSTPs interested more one type of research than the other? My research interests (immunology) are fortunately applicable to just about any specialty, but I am curious to know how much clinical research would be good to have on my CV, or if it would even be worth my time at all to get involved with it right now in my pre-clinical years.

As far as step goes I will plan on shooting for the best score I can until I have confirmation that it is for sure going to be P/F, which will likely not happen before I take it anyway.

 

[MSTPadvocate]

Our experience is that for PSTPs in IM, Peds and Pathology, our MSTP graduates are highly competitive. We've done an analysis in those specialties and first author pubs (our graduates average 2.7), external presentations and grants are highly correlative with strength of PSTP they go to. USMLE not so much, but by the same token, a score of 203, while not disqualifying, will require explanation at the interview stage.

Not every specialty is physician-scientist friendly (and some shouldn't be), but for the ones that are most associated with physician scientists (IM, Peds, Path), our graduates are highly competitive regardless of USMLE Step 1 score.

 

[mstp4lyfe]

MSTP MS4 here. Grads from our program have been very competitive year-in-year-out across a number of different specialties regardless of their board scores. Of the MSTP MS4s who are applying now, I can tell you that all of us in my program have gotten plenty of invites from top places, and our scores run the gamut from below average to above.

At the end of the day, one or two solid publications can go a long way to prove your prospective worth to an institution when applying for PSTP-type residency. Those pubs will be in your tenure packet, on the university website, etc. for your entire career, while residency apps will literally be the last time anyone cares about your step 1 score. My advice would be to keep your head down and focus on doing good science during the PhD years, and be thankful that you don't have to hear the words "high-yield" or "sketchy" every other minute.

 

[ganglia777]

I've heard of many people getting into PSTP residencies in peds and path at places like UCSF, Wash U, and Stanford with scores between 200 and 210. It seems that in these instances, they all had something exceptional to make up for it (Nature publication, 50+ publications, multiple competitive grants). I have NOT heard of anyone getting into a lucrative specialty (anesthesia, ENT, ortho, derm, etc) , PSTP or otherwise, with a score in this range, regardless of how exceptional they are in other parts of their application. This could be due to the fact that less prestigious programs and community programs don't want to take the risk of training an MD/PhD who is probably going to be weaker clinically given their time spent doing research.

 

[ganglia777]

At the end of the day, one or two solid publications can go a long way to prove your prospective worth to an institution when applying for PSTP-type residency.

I think this really should be caveated. A barely passing step 1 score will keep someone out of a Stanford/UCSF/Harvard etc PSTP residency unless those one or two "solid" publications are in Nature or Cell..., and if the student's research output is overall in the top few % of all applicants (e.g., 50+ publications).

 

[narla_hotep]

How is it physically possible to produce 50+ publications? even if you're a minor author on a lot of them? :O Also this is actually kinda reassuring, since my step score falls above the 'barely passing' category you describe

 

[StIGMA]

Depends on the program. I have a hard time believing my friend at internal medicine/PSTP at MGH wasn't helped by his >260 score, but he did have the other factors in line as well.

 

[mstp4lyfe]

I think this really should be caveated. A barely passing step 1 score will keep someone out of a Stanford/UCSF/Harvard etc PSTP residency unless those one or two "solid" publications are in Nature or Cell..., and if the student's research output is overall in the top few % of all applicants (e.g., 50+ publications).

Not sure where the "barely passing" thing is coming from, as I was speaking to OP's experience and score. Obviously if you barely passed step 1, it would take something exemplary on your app to appeal to the Stanfords and UCSFs of the world. And even then it's a stretch. But for an MSTP with an average step score planning to apply to PSTPs in specialties that aren't derm/ortho/etc, a couple of first-author pubs in decent journals have typically been enough for applicants in our program to interview at top places and match very well. Also I should note that my program is at a state school and not like a top 10 place where everyone matches exceptionally well.

 

[phonyreal98]

One takeaway from this thread: it's very specialty dependent. My advice for the M1's/M2's in my program is to try their best, but after you get your score try not to worry too much about it because there's nothing you can do to change it.