Importance of Step 3 for IM fellowship match

[rox]

I have applied for IM and am considering taking Step 3 before my training starts for visa issues. Given that I heard it's not an easy exam, I was wondering if a low score will hurt me down the road in fellowship applications.

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[theunderdog]

I have applied for IM and am considering taking Step 3 before my training starts for visa issues. Given that I heard it's not an easy exam, I was wondering if a low score will hurt me down the road in fellowship applications.

Someone higher than me probably has a better answer, but from what I've seen, a lot of interns just try to pass step 3. They don't try to blow it out of the water like in steps 1 and 2.

For fellowship placement, I have to defer to somebody else on whether steps 1 or 2 scores factor in. However, I have heard from a resident that there isn't even a place to put your step 3 score on the fellowship app.

 

[VCMM414]

For fellowship placement, I have to defer to somebody else on whether steps 1 or 2 scores factor in. However, I have heard from a resident that there isn't even a place to put your step 3 score on the fellowship app.

For certain fields, fellowship application is done through ERAS, so you submit whatever scores you have. If you have taken Step 3, it will show up on your USMLE transcript that you send to fellowship programs. That said, not all programs ask for these scores.

 

[NotAProgDirector]

Although not perfect, this was study looking at what fellowship PD's were interested in. USMLE scores were in the middle. No discussion of Step 3 vs other steps. My guess is that a poor step 3 score will hurt your application, but may not be an application killer. But, if you need it for your visa, you really don't have any choice.

 

[CanIMakeIt]

I thought Chief Residency accounted for something substantial when applying for fellowship .. guess not. It makes sense why IMPDs would rank it that high but #13 on FPDs' list doesn't bode too well in terms of putting an extra year in that endeavor.

Any comment on that aProgDirector?

 

[Moonglow]

I thought Chief Residency accounted for something substantial when applying for fellowship .. guess not.

A Chief Residency year on your resume matters a lot if you want to work in General Internal Medicine at an academic program - but it's not needed to fellow into ID, GI, Heme/Onc. etc., or if you want to work in private practice primary care.

 

[NotAProgDirector]

A Chief Residency year on your resume matters a lot if you want to work in General Internal Medicine at an academic program - but it's not needed to fellow into ID, GI, Heme/Onc. etc., or if you want to work in private practice primary care.

Being a CMR is also highly correlated to how strong the IMPD letter would be. But I agree, I am surprised it was so low. I agree that it is much more important for Cards/GI, less so for HO, and even less for everything else.

 

[globallmedicine]

surprised at how important being at a university-based program was.
does being at a community program significantly hurt you for fellowship match at a university-based fellowship, regardless of the specialty?

 

[NightVision]

I just went through the fellowship match last year. I think step 3 does matter, but the value placed on it will depend on the program. At one interview, the guy was looking through my app in front of me and said "you didn't do too well on step 1 and 2 but picked it up on 3." My scores 200/198/228. So if you did well on the 1st 2, I would say take 3 later, but if you didn't do well, study hard for step 3. Also, I think step 3 is easier the futher you get in residency because it's medicine heavy. People say you forget peds/psych/obgyn if you wait too long but I forgot those topics 1 month after my 3rd year clerkships. I think the 2 elephants are the quality of your residency and your research and USMLE's are much less.

 

[gutonc]

surprised at how important being at a university-based program was.
does being at a community program significantly hurt you for fellowship match at a university-based fellowship, regardless of the specialty?

For the most part, yes, it is a problem. For the non-competitive specialties (Endo, ID, Renal), it will matter much less, but you still probably won't be matching at elite programs coming out of a community program. For Cards/GI you may still have a shot at a low-tier univ program but it will be much harder for you. In-house fellowships are the rule for a lot of community programs.

 

[ResidentMD]

For the most part, yes, it is a problem. For the non-competitive specialties (Endo, ID, Renal), it will matter much less, but you still probably won't be matching at elite programs coming out of a community program. For Cards/GI you may still have a shot at a low-tier univ program but it will be much harder for you. In-house fellowships are the rule for a lot of community programs.

How does the Mayo Clinic figure in this? Knowing it is essentially a community program (though it has a graduate school attached to it now), any opinions on how are the graduates from there looked at from other top tier academic places? I saw their list shows that they take a lot of their own, but was wondering if this was out of choice.

 

[Moonglow]

Make no mistake, a Chief Residency is a fellowship year for those staying in Internal Medicine, and is well valued for those who are being considered for division chiefs and department chairs.

 

[rox]

Is H1B visa really that bad for fellowship applications? "No H1-B visa" is ranked the 6th!

 

[rox]

I just went through the fellowship match last year. I think step 3 does matter, but the value placed on it will depend on the program. At one interview, the guy was looking through my app in front of me and said "you didn't do too well on step 1 and 2 but picked it up on 3." My scores 200/198/228. So if you did well on the 1st 2, I would say take 3 later, but if you didn't do well, study hard for step 3. Also, I think step 3 is easier the futher you get in residency because it's medicine heavy. People say you forget peds/psych/obgyn if you wait too long but I forgot those topics 1 month after my 3rd year clerkships. I think the 2 elephants are the quality of your residency and your research and USMLE's are much less.

I did well on Step 1 and 2, but I'm considering taking step 3 before residency in order to get an H1B visa. I heard previously that step 3 won't matter for fellowship, but apparently it does to a certain extent.

 

[Adcadet]

How does the Mayo Clinic figure in this? Knowing it is essentially a community program (though it has a graduate school attached to it now), any opinions on how are the graduates from there looked at from other top tier academic places? I saw their list shows that they take a lot of their own, but was wondering if this was out of choice.

Calling Mayo a community program is ridiculous and points out the problem with the University/community designation. Mayo was by far the most academically-oriented program I interviewed at back in the day. Mayo is perhaps the most notable quaternary care medical center in the US.

Mayo doesn't just have a graduate school - they had the first school of GME.

And yes, many, if not most, IM residents at Mayo very much want to stay at Mayo.

 

[gutonc]

Calling Mayo a community program is ridiculous and points out the problem with the University/community designation. Mayo was by far the most academically-oriented program I interviewed at back in the day. Mayo is perhaps the most notable quaternary care medical center in the US.

Mayo doesn't just have a graduate school - they had the first school of GME.

And yes, many, if not most, IM residents at Mayo very much want to stay at Mayo.

I thought this was pretty humorous as well. I think people at Mayo think far too highly of themselves but I doubt you can find a more academic medicine environment out there.

 

[ResidentMD]

I thought this was pretty humorous as well. I think people at Mayo think far too highly of themselves but I doubt you can find a more academic medicine environment out there.

Hey...I apologise as my post didnt come across correctly. What I meant was that though it is essentially a community hospital, it is probably one of the best places for internal medicine. I too dont consider it a community program at all, and hence, the question.

So let me reframe it - How is Mayo looked at by other "purist" academic institutions for fellowships. Giving an example, how likely is a place like BWH, MGH, UCSF, Stanford likely to take a Mayo graduate, as compared to say, one from UPenn (which again is a great program) or UCLA (relatively similar stats, same field of subspecialty)?

 

[Moonglow]

So let me reframe it - How is Mayo looked at by other "purist" academic institutions for fellowships. Giving an example, how likely is a place like BWH, MGH, UCSF, Stanford likely to take a Mayo graduate, as compared to say, one from UPenn (which again is a great program) or UCLA (relatively similar stats, same field of subspecialty)?

Mayo grads stay at Mayo for fellowships or they go to work in private practice firms styled like Mayo, mainly in the mid-west and Texas. Mayo people are rarely seen in northeastern academic programs. The Mayo "clinic" model of medical practice is very different than that of which came from Hopkins and Harvard.

 

[tacrum43]

Calling Mayo a community program is ridiculous and points out the problem with the University/community designation. Mayo was by far the most academically-oriented program I interviewed at back in the day. Mayo is perhaps the most notable quaternary care medical center in the US.

Obviously, the Mayo-Rochester program is fairly elite, but how about the two satellite campuses, Scottsdale and Jacksonville?

 

[gutonc]

Obviously, the Mayo-Rochester program is fairly elite, but how about the two satellite campuses, Scottsdale and Jacksonville?

They're warm.

 

[ResidentMD]

Out of genuine curiosity -

Mayo people are rarely seen in northeastern academic programs.

Why?

The Mayo "clinic" model of medical practice is very different than that of which came from Hopkins and Harvard.

How?

 

[dr.op]

Is H1B visa really that bad for fellowship applications? "No H1-B visa" is ranked the 6th!

Yup... Unfortunately! Actually, it didn't matter much for residency, but fellowship directors are really luke warm about visas in general, and H1B in particular. Having said that: Don't come to the US on a J1! It is definitely worth the extra 1-2 years of staying in your home country to avoid the J1 trap.
For residency, no one cares about your step 3 score. For fellowship, no one actually ever mentioned the score, they were more interested in my residency program and research.

 

[cbest]

Hey dr.op,

Forgive my ignorance, but why are fellowship directors that much more wary of an H1B status than residency directors? Is this sentiment more prevalent for longer fellowship programs (e.g. Cardiology) compared to shorter fellowships (e.g. Pain or Sports Medicine)? Thanks for your help!

 

[dragonfly99]

Chief residency certainly doesn't hurt a fellowship application for GI or cards, but someone mentioned above that they think it matters a lot, and I disagree. Most cards PD's don't care that much...it would be somewhat of a feather in your cap but I'd rather be an average resident at a good university program that is well known vs. a chief resident from a weaker university program or a community program.

Mayo Clinic is not a community program.
The Arizona and Florida programs are not as well thought of as the flagship campus, although I certainly wouldn't sneeze at a fellowship done there I wouldn't aim at those places for IM residency (? if they even have IM residencies).

The Step 3 score and the Step 1/2 scores are used by some fellowship programs in cardiology. Other programs did not even want the step scores to be sent, so obviously didn't care about them. If I were a foreign grad, I'd want to maximize everything good in my application, which would include high step scores. I think it would be easier to get a high Step 3 score after a year or two of residency...however, if you must take it earlier, then so be it. If you did well on Step 1/2 and usually do well on standardized tests, then you are unlikely to totally bomb it and probably unlikely it will hurt your fellowship applications a lot.

Needing a visa will be much more damaging to your fellowship application than an average Step 3 score would be, IMHO. Most cards and GI program directors don't want to deal with visas simply because they don't have to...they have a ton of qualified applicants, more than they need,who are already US citizens or permanent residents and don't need visas. Therefore, why should they (or their secretaries, their hospitals, departments, etc.) spend time and money helping coordinate a visa application when it's not necessary to do so. They have to want someone pretty bad, or not be able to find enough qualified people, to be willing to do that. That's why you'd probably find more takers among rheumatology program directors vs. GI, cards or hem/onc.

 

[rox]

Thanks dragon. It makes sense.

 

[ResidentMD]

Mayo people are rarely seen in northeastern academic programs. The Mayo "clinic" model of medical practice is very different than that of which came from Hopkins and Harvard.

Can someone please expand on this? Thanks.

 

[zeloc]

Maybe it's just personal preference and liking of the institution/area. I think this is why many Johns Hopkins people stay at Johns Hopkins.

 

[DrBacchi]

Yup... Unfortunately! Actually, it didn't matter much for residency, but fellowship directors are really luke warm about visas in general, and H1B in particular. Having said that: Don't come to the US on a J1! It is definitely worth the extra 1-2 years of staying in your home country to avoid the J1 trap.
For residency, no one cares about your step 3 score. For fellowship, no one actually ever mentioned the score, they were more interested in my residency program and research.

Doesn't the J1 mean you have to go to your home country for 2 years, and you could seek work again in the U.S. after that? Why is better to wait 2 years before residency than after? Since J1 seems to boost your chances in getting a fellowship so much.


J1 residency -> J1 fellowship -> 2 years home -> work in the U.S.
or J1 residency -> J1-waiver job -> work in the U.S.

vs.

H1b residency -> work in the U.S.

How easy is it to get a job in the U.S. after 2 years if you land a nice fellowship? I'm just wondering why everyone favors H1b, if the J1 gives so much better chances of getting that fellowship. Or is it just so hard to get back to U.S. eg. as a cardiologist after having been away for 2 years?

 

[dragonfly99]

I don't know the answer to your question for sure, but I can tell you that for medical licensing in the US, a lot of medical boards do not like it if you have ceased to practice in the US for more than 3-4 months, and I'm not sure how being gone for 2 years would affect your ability to get and keep a medical license (which you will absolutely have to get and keep to practice as an attending).