How limiting is this?

Discussion in 'Medical Students - MD' started by ciestar, Jul 11, 2018.

  1. ciestar

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    I’m numb. I am upset and I feel like I just wasted the past two years of my life.

    Where does a 211 on Step 1 put a person? No, I was never boning for competitive specialties, but where do I go from here? I am devastated and at this point even be pleased I passed.
     
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  2. trobinsonmd

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    Not the end of the world -- there are certain things from hereon that are in your control, and other factors that are not in your control. Focus on the former. Try to get a few research experiences under your belt to bolster your residency application. Focus on killing your clerkships, and set realistic goals for yourself of what specialties you are eligible to apply to.
     
  3. ciestar

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    FM and that is it right? 211 just closes most doors.

    Idk how to get research as a third year lol idk how to time anything up.

    But now I am even more scared for the shelf exams and Step 2.

    I feel like quitting is the better option tbh
     
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  4. trobinsonmd

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    peds and MAYBE pathology if you can network well... quitting is really only an option if you have something else lined up. You can graduate with an MD and work as a consultant, work in biotech, teach maybe... you don't have to practice family medicine for the rest of your life if it makes you unhappy... shelf exams are more manageable in that the breath of knowledge is lesser than for step so they should be easier to study for... research is very advisable at this point, so sometime during early fourth year, i would take a research elective
     
  5. Goro

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    C'mon ciestar, you know better than that. You are NOT limited to the 7th Circle of Hell that ignorant pre-meds consider FM:

    http://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf

    Gas
    Child Neuro
    ER
    IM
    IM/Peds
    Rads
    Neuro
    OB/Gyn
    Path
    Peds
    PM&R
    Psych
    Rad Onc (maybe)
    Rads
    even Vascular Surgery!
     
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  6. irJanus

    irJanus Falling into a burning ring of fire
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    A few questions first....
    How were practice tests going? 240s? Same?
    How have you been as a student?

    I ask because a one off bad test day and a 250 step 2 won't fix it but will open doors. Not realistic to assume you can jump if all your practice stats read low, but hard work will absolutely help. Will NSGY or Ortho be an option? Not likely.... But a sharp rise in step 2, solid letters, excellent wards evals will open more doors than you think from here.
    The trick is to not wallow, pave a path forward, be realistic, and now to consider back up plans. A 211 isn't failing, and it's not sub 200. It's not as dismal as you think.
    Have a beer and relax tonight, get back on the horse tomorrow.
     
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  7. Lannister

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    I know that nothing I say is going to make you feel better, but just remember that a few years from now you're going to be an attending and you're going to look back and probably not even remember what you got on step 1.
     
  8. trobinsonmd

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    Whoops, I was looking at the wrong page of charting outcomes... Goro's list above is very accurate ^^
     
  9. AnatomyGrey12

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    Definitely not! Essentially everything is still on the table outside of the super competitive stuff. Even something like general surgery is possible if you build the rest of your app right. Hell, DO students with BELOW a 210 still had very high match rates into fields like IM, EM, and Gas. You're a USMD. Go control what you can control from here on out and I think you'll be very surprised with where you end up

    Edit: go make the new Charting Outcomes your favorite hobby. It might help you feel better.
     
  10. ciestar

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    It isn’t that I find it to be the 7th circle of hell. I am on FM now and I’d be lying if I said I wasn’t enjoying it for the most part. If i decided on FM i want it to be because I WANT to, not because I was FORCED to. If that makes sense?

    Yes, I spend enough time on SDN to know better but it is a lot different when it is your own reality.
     
  11. W19

    W19
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    The hyper competitiveness of med school can make people go nuts... If OP is a US student, he still has most specialties open to him or her. Derm, neurosurgery, ENT, Ophthal, Uro will be tough to get with 211, but OP still has a shot at gen surgery and even vascular surgery if cutting into people is his/her thing...
     
  12. ciestar

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    No my practice tests weren’t that high. Lowest one was a 198 on NBME 15 and that was before dedicated. I got a 230 on UWSA2 two days before so I was hopeful for at least a 220.

    Im good not doing any type of surgery ever. Lol
     
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  13. W19

    W19
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    You won't be forced to do FM with 211 if you are a US student.
     
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  14. ciestar

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    Yes, USMD
     
  15. W19

    W19
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    So relax... Do better in step 2 (240+) and most specialties are still open to you...
     
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  16. bananafish94

    bananafish94 SDN Gold Donor
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    Per Charting Outcomes, you would have over an 80% chance (based on Step 1 alone) in:
    Anesthesiology (>90%)
    Child Neurology (>90%)
    Diagnostic Radiology (~80%)
    Emergency Medicine
    Family Medicine (>90%)
    Internal Medicine (>90%)
    Med/Peds
    Neurology (>90%)
    OB
    Pathology
    Pediatrics
    PM&R (~80%)
    Psychiatry

    So you might not be a plastic surgeon. You're still going to be a wonderful doctor and have lots and lots of options in terms of what you want to do with your life. Godspeed.

    giphy.gif
     
  17. Oso

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    In addition to what others have posted above:

    DO NOT let this bring you down and affect your performance in your clerkships.

    For now, just try to forget step 1 was even a thing and go into M3 year with a positive attitude and the expectation of success.

    Also, I feel like step 2 is way better than step 1. It's all material from the clerkships, so studying for it feels a lot less like all cramming (step 1) and more like reviewing. I know of people who did significantly better on step 2.

    Good luck.
     
  18. Goro

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    That's what I've been trying to get into the OP. Hopefully s/he isn't one of those people who define themselves by their exam results and grades.
     
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  19. ciestar

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    I used to. Then i realized it wasn’t all that was important in the world. My preclinical grades also weren’t great, but it is what it is. Yeah, I am disappointed and would things be much easier if I scored higher? Absolutely.
     
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  20. atomi

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    You've taken yourself out of the running for the most competitive surgical subspecialties. Otherwise most fields are still open to you if the rest of your app is solid. My score was around 220 and I got into a field where the average was around 240. It'll be alright, just move on.
     
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  21. evilbooyaa

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    Agree with the laundry list of specialties you can still apply and have good success in as others have posted above. Keep your head up.
     
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  22. teeayejay

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    Throw yourself a small pity party and get back to it!

    You have another year to bust your ass and show you actually know how to think like a doctor instead of how well you did sitting in front of a computer, clicking the best answer choice to theoretical situations and esoteric diseases.
     
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  23. Crayola227

    Crayola227 The Oncoming Storm
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    I have quite a few friends that scored sub-220s and matched to great programs in quite a few fields

    that said, all USMD's from a highly respected school

    the other factors that like school, LORs, networking, clerkship performance, Step 2 CK, research, make more of a difference than SDN would have you believe, it seems

    yes, a sub-220s score will filter you out in ERAS as some places, but not all, and whoever offers you an interview with your score, will most definitely be looking at those things (and believe it or not... they are evaluating the 250+ people as closely, maybe for other reasons)

    I do highly advise a few things:
    -find good mentors and advisors at your school
    -get their help with networking, LORs, realistic expectations in matching (numbers ain't everything, each school has unique factors effecting the match pattern that they all have, leaders in your school's admin should be aware of these)
    -SDN can help, but school-specific advice from your school and even students ahead of you, is best
    -apply very broadly, include community programs, programs with DOs and IMGs, and programs in otherwise undesirable locations (that isn't to say include malignant programs, prestige/competitive and malignancy aren't totally connected)
    -go for what field you want, but if you're saavy you can set up your app to apply to all of IM, FM, and psych as backups, with not too much trouble, if you want to work peds in there you could, I have a post elsewhere on how to do this, this keeps a lot of options open by the time ERAS rolls around
    -saavy app building and application for matching is key and can definitely get you into something besides FM with your score, if you try hard

    Seriously, don't despair. This just means you need to focus more on the rest of your app, which is true for EVERYONE, even the 250+. It's like people think they'll wake up with that score and be a plastic surgeon. No.

    It is highly unlikely you'll end up head of neurosurgery at Hopkins. That doesn't mean you'll end up doing FM in Alaska. Don't catastrophize because you got a score that isn't worth tattooing to your forehead.
     
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  24. OrthoTraumaMD

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    I know this doesn’t sound like much coming from an orthopod, but believe me when I say that step 1 won’t have a lasting impact on what sort of doctor you will be to your patients. Yes, it is sad that it will be more difficult for you to match (or maybe not, depending on specialty, as people with more experience than I have said above). But at the end of the day, when you’re an attending and the patient shakes your hand and says, “thank you, doctor, for helping me,” (and they will!) your thoughts are so far away from any number. That is the only thing that matters, how good you are to your patients and how much of a difference you make in their lives. It’s corny but it’s true—it is the ONLY thing that matters, in the end.
    I thought I would dwell on my score forever. I have a much lower step 1 than anyone I know who went into my field. So low that I was told I wouldn’t match, and was laughed at when I applied. Yet out of the people who applied in my class, I’m the only one who matched. And now I am the chief of my subspecialty department. The point is, the door is still open for you...even a crack, but that’s all you need to walk in. What you do once you walk in is entirely up to you.


    Sent from my iPhone using SDN mobile
     
  25. atomi

    atomi Member
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    Yup,
    Like you, I went for the competitive specialty anyway. Couldn't accept not trying. The low step 1 made it a LOT harder for me to get in, but didn't outright prevent it.
    I didn't match the first go around. Got interviews but didn't work out. I found a spot later. Ended up scoring well in the top quartile on every inservice exam and always had stellar reviews. Using step 1 alone to predict resident success is stupid, and a lot of PDs know that. A 210-220 is still well above passing is a fine score, and by itself doesn't mean you're going to be worse than a 250 guy. When you get down in the 190s barely passing range, then sure, yeah there's a legitimate concern there about whether this guy is gonna be able to do well on ITEs and pass boards.
     
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  26. ciestar

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    Means more than you think. You took the time to respond and I thank you for that.

    I am unsure how to make everything else more competitive. It isn’t all board scores. But my school factors our shelf scores into our clerkship evals so you can’t get honors at all if you don’t score enough on the shelf. How do i shake the self doubt? First shelf is in FM and four weeks away. I hear it is hard so I am nervous. I have no research. My other ECs aren’t really remarkable, probably. I know this isn’t like applying to med school so idk what goes into a good app.
     
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  27. atomi

    atomi Member
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    Tell us what field you want to go into or at least your short list if you're unsure (before you knew your step score), and we can better advise you.
     
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  28. OrthoTraumaMD

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    There’s a actually a study (albeit a flawed one) that correlates step 1 score to board pass rates in ortho. The minimum is 227. So anyone who scores above that is fine to eventually pass Boards...yet because of the competition, step 1 rates just get higher, and you can’t really use the “step 1 predicts board pass rates” to choose your residents anymore.


    Sent from my iPhone using SDN mobile
     
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  29. OrthoTraumaMD

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    Put step 1 behind you, and move on to the next thing. There’s a reason it’s called “step 1” and not “endgame.” Focus all your efforts on the next step, whether it’s the shelf or doing well in the clerkship or anything else. Do not look back. Do not dwell. You will sabotage yourself doing so. It’s like carrying baggage from a past relationship. Your new one deserves your best efforts.
    And just keep your eye on the prize. I am writing this while standing on the balcony in a Caribbean country, overlooking the ocean, on day 1 of my 10-day vacation. I have my family, a drink in my hand, and a job that I love. it was hard for me to imagine this when I sat in my windowless cubicle at the school library. You will be here too, soon. Get after it.


    Sent from my iPhone using SDN mobile
     
  30. ciestar

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    Short list: peds, psych, EM (maybe)
    I actually kicked step’s butt in the psych section.
     
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  31. ciestar

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    Ahh so jealous!!! Beaches are my happy place.

    I get it. I am often my own worst enemy. I have trouble letting go or talking about what is botherig me. Can’t lie, family life has been really hard lately. I am really doing my best on my first clerkship. I just feel ill prepared for a shelf exam currently. I doubt that is an uncommon feeling, though.
     
  32. Crayola227

    Crayola227 The Oncoming Storm
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    This is where advice from SDN can be useful.
     
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  33. AnatomyGrey12

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    You're still in a good spot for all of those fields. Even in EM, which would traditionally be considered the more competitive of those 3, the match rate for USMDs between a 201-210 was 76% (111/146) and the match rate for 211-220 was 89% (203/229). Chin up, there's a lot of ball left to be played.
     
  34. raiderette

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    The day after one of my classmates got his score, he was lamenting that he was basically locked out if IR. Forget that he had never mentioned IR, that he would hate it, and that he had a score that was the mean for the specialty that he wanted since his first day med school. It is okay to freak out. Take a few days to be depressed. Then do your rotations, study for Step 2 and figure out what you like.
     
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  35. Crayola227

    Crayola227 The Oncoming Storm
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    oh jeez with your step that is all attainable

    EM is more of a stretch, but if you just do what steps anyone should do for peds and psych, and most important after realistic specialty choice, saavy match app choices, you will be fine

    this score in no way puts psych or peds or even EM off the table

    I get you're stressing because you just got this score, and just started MS3.

    I was totally freaking out about how short that year seemed for doing all that needed to be done for a successful specialty selection, ERAS, and match.

    You're facing a lot of uncertainties, so it's easy to mentally latch onto the one certainty, which is your score. To me, that score felt like one of the first and most important pieces of that app. It feels like a pigeonhole for most people, even those in the 220-230s range.

    It is the first step (pardon the pun) but it's far from the last. You have an overwhelming amount of ground to cover between now and ERAS. But you can do it.

    Longitudinal things to think about putting in motion:

    -Advising, advising, advising.

    -Research or case reports of some kind.
    If you are not going for something very narrow, like ENT or derm, and you have named fields that are in the more "generalist" or primary care boat here, then your research doesn't have to be terribly focused in one area of medicine.

    You could do something that was like, how to reduce COPD admissions to the hospital, and it's going to be a fine research topic for most apps even if not directly applicable. Part of a project's value is just what you learn about doing the research, not just the particular topic.

    Quite a few projects can be chart review that can be done at home after rotation days. SDN can give more info, and you can contact your school, advisors, and leaders of the departments of the specialties that interest you for more info on opportunities. The research is usually there if you look for it (school dependent, obvs).

    -Any sort of meaningful EC's you can manage.
    I think my prior posts list some of the "app-fillers" that were low time commitment, helped me AND were meaningful.

    I was involved in things related to the underserved, minorities, transgender, mental health, etc. You can see how those can be spun to support an interest in any of FM, IM, EM, peds, and psych, and be good interview fodder?

    -I signed up for various specialty groups and associations online.
    For example, EMRA, EMSA, ACP, etc. Most are free/cheap for students and gave useful resources. They are app filler in addition to being useful. Be broad with it, you only have to list the ones that go with the specialty you eventually choose.

    Short term and arguably most important, but not exclusionary to the above:

    -Think about how to do your best on your rotation day, today.
    -Think about how to improve for tomorrow.
    -That is part of your preparation for tomorrow, as is studying for tomorrow.

    -Know your patients. Studying what you need to for them, and keeping a list of anything that comes up that you need to look up, will help you do better for the subjective part of your rotation grade. It will help you with the shelf too.

    -Come up with a plan for the rotation-related non-eval didactic aspects of your grade. A plan to study for the shelf, any write-ups or such you must do, presentations, etc. For example, get some sort of multiple choice or review material, and calculate how much you need to average per day to get through it at least once if possible, be it qbank, anki, book, whatever.

    -I guess I split up my studying into two focuses each day: what I needed to for the rotation, ie things the attendings told me, pimp questions I failed, things I needed to delve into for my patients/those on the service, things I didn't know that came up that day that I wrote down (good habit is to keep such a list each day). Practical as it comes up stuff.

    -Then the more general things I needed to study for the field and for the shelf, that might not be directly related to what I was doing daily. Then obvs the other didactic stuff.

    -The short term study stuff, and the longitudinal study stuff above, describes basically what all docs do for all the rest of their careers daily.

    -Most of this was knowledge focused. Also plan for how you can help your team carry out patient care tasks - obtaining patient records, sending faxes, looking up phone numbers, calling pharmacy, getting telemetry results, etc etc.

    Basically practical skills that aren't really going to help with any test, but help the team, your subjective score, and honestly, helps you prepare for subI and intern year.

    -Think about how you can improve the more "people skills" type things.
    Bettering building rapport with patients, taking H&Ps, asking questions that show interest and not just ignorance, biting your tongue, being liked by your team, that sort of thing.

    It sounds like a lot, and it is, but the key thing is to just take it one step at a time, and triage each bullet point, and address it as best you can, and move on.

    It is true each day is a new day. Learn from the mistakes of yesterday, but don't dwell, just try to improve.
     
    #35 Crayola227, Jul 11, 2018
    Last edited: Jul 11, 2018
  36. Crayola227

    Crayola227 The Oncoming Storm
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    lol, that was basically my short map for "Step 1 to PGY1"
     
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  37. Lost in Translation

    Lost in Translation 単純な馬鹿でありたい。
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    Unfortunately many PDs will.
     
  38. Goro

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    PDs will use Boards as a cutoff, but as we have seen, the OPs score is still quite viable for many specialties. PDs don't care about grades. Class rank is a different story
     
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  39. mentirita

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    How refreshing to see on SDN someone familiar with Dante.

    8E92466B-DEF6-4226-A681-0E95B8E12694.jpeg
     
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  40. ciestar

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    Even my class rank isn’t great, unfortunately. Idk what that is exactly, as it is internal, but I can happily say I’ve never failed anything. I am doing my best to remediate things for third year.
     
  41. Goro

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    Two years from now you're going to match just fine, and we're going to say "we told you so!!"
     
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  42. ciestar

    5+ Year Member

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    I’m okay with this lol
     
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  43. Crayola227

    Crayola227 The Oncoming Storm
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    That's assuming he is clever about applying our advice and that of what he gets from his school admin and students.

    The main ways I see people bone themselves is when they don't do the simple things suggested about Match success on this site.

    Personally, I've always relied on heavily weighing different viewpoints on SDN and IRL experiences, when it has come to my career. I can say that this has worked very well for me.

    And no, SDN did not pay me to say this :p
     
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  44. Goro

    Faculty 7+ Year Member

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    As we have seen, there are too many people who define themselves by their exam scores. Not picking on OP, but for some people, you'd think their career in Medicine ends with Step I, and their entire goal in life was to get into med school, not be a doctor.
     
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  45. ciestar

    5+ Year Member

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    Wouldn’t say I necessarily define myself by scores, but, when you don’t do well and you’re really disappointed... it hurts. You start to question everything. I also have an extreme tendency to freak out and think worst case scenarios.
     
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  46. ciestar

    5+ Year Member

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    *She

    And I am doing my best. I know I limited myself and I am struggling to come to terms with this. I reached out to my school, no response yet, but we’ll see.
     
  47. AnatomyGrey12

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    Look at it this way, you successfully passed one of the hardest exams in the world against one of the smartest pool of test takers that exist.
     
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  48. Crayola227

    Crayola227 The Oncoming Storm
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    QFT.
     
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  49. pbrocks15

    pbrocks15 Romans 8:28
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  50. DubbiDoctor

    DubbiDoctor SDN Gold Donor
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    7/9 applicants with step 1 scores from 201-220 matched rad onc in 2018. She would likely need significant research and connections. I would not recommend that she appply to it, as the average step 1 score for rad onc is 247. And the job market is bad, so it's unusually important (based on what physicians on the rad onc forum say) to get into a well regarded residency.
     

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