Improve application: do another observership or take Step3?

[Crazycatlady84]

Hi everyone,

I'm an IMG from Europe (permanent US resident) who graduated within the last 3 years. I passed Step 1 (214) and Step2CK (233) on first attempts and will take Step2CS in a month (I expect to pass because I'm fluent in English and the other parts shouldn't be an issue either).
I don't have any US electives as my plan to do my residency in the US didn't quite solidify during med school. In terms of research, I'm a second author for a published paper (hematology though)

I will do a 2month observership/clerkship with AmeriClerkship after 2CS, so I will get 1-2 LOR from there. I know observerships don't carry near as much weight as clerkships, but what are ya gonna do if that ship has sailed?

My question is: to make my application stronger, should I take Step3 or try to get another observership before I apply? Every website I've been on asks for 3 LORs so I'm behind on that! I don't think I can do both Step3+another observershipin time before applications are due, because I'm not sure how much time it will take to prep for Step3 . Also, I suppose volunteer work would be helpful too if I can squeeze that in?

HELP!!! (and thank you in advance for any helpful advice)

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[MacDonaldTriad]

Taking step 3 will help you to get your foot in all training doors. An observership will only influence that particular place. Of course, it only takes one place to want you and you’ll be on your way. The third letter may be easier to get from an observership. I say probably part 3, but it depends upon how interested you are in the place you would do the observership. I’m sure you will perform well, but sometimes familiarity doesn’t open doors.

 

[Doctor Bagel]

Admittedly, I don't know a ton about IMG matching, but I think an clinical experience in your case would trump Step 3. Your Step 1 and 2 scores are solid, and European medical schools are generally considered to be good (I think?), so I doubt you'll trigger that much in terms of anxiety about your academic potential. Instead, people would want to know that your clinical and language skills are solid, which would come from passing CS and getting more clinical experience, including solid letters.

 

[MacDonaldTriad]

I have heard two training directors say that it is their policy to only consider IMGs if they have all of their steps done. I don’t think they are a majority, but having step 3 eliminates any concern over training interruptions due to licensing.

 

[notdeadyet]

Ditto MacDonaldTriad's post. All steps wrapped up can be a big reassurance for some programs.

 

[Crazycatlady84]

Thank you so much for the replies so far, I really really appreciate it!!!
It's so hard to figure out which option program the majority of directors would favor more so it's great to hear some opinions.

Maybe I can do both a 4week observership and Step3 all in time before application. After reading that everybody wants 3 LORs, the possibility of me only having 2 makes me very nervous. But I'm also nervous to take Step3 before residency, but I'm sure others have done it before and all I need is a passing grade, right?

 

[Doctor Bagel]

Thank you so much for the replies so far, I really really appreciate it!!!
It's so hard to figure out which option program the majority of directors would favor more so it's great to hear some opinions.

Maybe I can do both a 4week observership and Step3 all in time before application. After reading that everybody wants 3 LORs, the possibility of me only having 2 makes me very nervous. But I'm also nervous to take Step3 before residency, but I'm sure others have done it before and all I need is a passing grade, right?

It's true that all you need to do is pass, and it's not a harder exam than the other Steps. However, you also really need 3 LORs -- I think that's a solid requirement for all applicants for pretty much every program. So I guess I disagree in that I'd still put clinical experience (and getting those needed LORs) over Step 3. Now, I don't think LORs have to all be from the US -- perhaps you have someone who can write you something from your medical school?

Probably most importantly, though, would be specifically contacting programs you're interested in and asking what they look for in IMG applications. I'm not sure there's a uniform answer.

Editing to add that it might also be useful to contact IMG posters here at good programs, including splik and shan. Maybe those guys have some thoughts.

 

[¯\_(ツ)_/¯]

forget about the step 3. when people say "all steps", they generally only mean all that are required for your certification (which doesn't require step 3). concentrate on getting some solid rotations and LORs in the bag. step 3 can be lower down in the priority and you can do it during or right after your interview season. step 3 isn't going to get you through the door if you haven't already at most programs i know. but they may boost your rank position

 

[rkaz]

You mentioned that you have not taken step 2 CS. I would focus on that first. Although the majority of people pass, there are many who think it is a blow off exam, and end up not passing. You still need to prepare for it. It helps the most if you take it after your outpatient/family medicine rotations, if possible. The passing score cutoffs have also gone up since you graduated, so I'd make sure you take the time to review for that (read the step 2 cs book, go through cases, etc). If you go to the step 2 forums, you can see in the last 4-5 months that people have posted being stunned at failing, as they never thought it could happen to them as they are Americans. Just knowing English isn't good enough. You need to be able to come up with good differential diagnoses, have good patient rapport etc. Excuse my soap box, but I felt like writing all of this because when you mentioned knowing English as qualifying you to pass CS, that set off red flags in my head, as it is certainly not the case. If you do well with patient exams in clinical settings, then at least give a solid week to reviewing cases and practicing them with another person from the step 2 cs book.

 

[¯\_(ツ)_/¯]

passing rates for US grads have traditionally been ~97-98%. so, even before the changes a whopping 2-3% still failed. whopping because that's about 500 grads each year. so preparing for the exam is a given no matter when it's taken. you don't want to be in the minority. not for this

 

[SmallBird]

Hi everyone,

I'm an IMG from Europe (permanent US resident) who graduated within the last 3 years. I passed Step 1 (214) and Step2CK (233) on first attempts and will take Step2CS in a month (I expect to pass because I'm fluent in English and the other parts shouldn't be an issue either).
I don't have any US electives as my plan to do my residency in the US didn't quite solidify during med school. In terms of research, I'm a second author for a published paper (hematology though)

I will do a 2month observership/clerkship with AmeriClerkship after 2CS, so I will get 1-2 LOR from there. I know observerships don't carry near as much weight as clerkships, but what are ya gonna do if that ship has sailed?

My question is: to make my application stronger, should I take Step3 or try to get another observership before I apply? Every website I've been on asks for 3 LORs so I'm behind on that! I don't think I can do both Step3+another observershipin time before applications are due, because I'm not sure how much time it will take to prep for Step3 . Also, I suppose volunteer work would be helpful too if I can squeeze that in?

HELP!!! (and thank you in advance for any helpful advice)

I think ur in pretty good shape, and that Step 3 may be more helpful unless an extra observership led to you getting an amazing letter or a unique clinical experience. I got great interviews without any US LOR's, so I think if you have two plus a good one from someone at your med school then Step 3 might be a better use of your time?

 

[PrideNeverDie]

forget about the step 3. when people say "all steps", they generally only mean all that are required for your certification (which doesn't require step 3). concentrate on getting some solid rotations and LORs in the bag. step 3 can be lower down in the priority and you can do it during or right after your interview season. step 3 isn't going to get you through the door if you haven't already at most programs i know. but they may boost your rank position

not always the case

my mom's program director only considers IMGs that have passed step 3

there are definitely some programs that take that into consideration

 

[shan564]

Observerships are useless unless you get actual hands-on clinical experience... and if you do get that, then it ceases to be an observership by definition.

Getting a third LOR from Europe would be good. Unless you went to an offshore school designed for Americans who couldn't get into American schools, it'll be good to shore that you were also good in your actual clinical rotations, not just in a formal observership program that's known for charging boatloads of money to give you mild clinical experience and a disproportionately glowing rec letter.

On the other hand, Step 3 is actually meaningful.

 

[MacDonaldTriad]

not always the case

my mom's program director only considers IMGs that have passed step 3

there are definitely some programs that take that into consideration

Again, this is true, and observerships are fairly worthless and don’t impress anyone unless you knock the socks off of someone of influence at the program where you are doing it.

 

[¯\_(ツ)_/¯]

an LOR from a US physician from that observership on the other hand...

 

[MacDonaldTriad]

I find letters of little use in discriminating candidates. They are bell curved with two standard deviations of similarity. 95% are fine and say nice things. Only about 2.5% are impressive and only 2.5% say anything that is a warning. Just so long as you have three that aren’t too thin or in any way disparaging, you will tend to be OK. They end up being more of a check box, “yep, they have three of them”. I don’t think I have ever been in a selection committee that came down to a comparison of whose letters are better than whose. The exception would be if the writer is known to the program, and it is always best if there is a letter from a chair, training director, or clerkship director (in that order). If the writer is known to the program, this can sometimes lead to a phone call that asks “come on now, tell me what you really think”. Many teachers will write nice things to be nice, but it is a new ball game when personal relations come into play. Bottom line, never ask anyone for a letter unless you are sure they honestly feel you performed well.

 

[¯\_(ツ)_/¯]

so if you're at a relatively small community program, you'll essentially pass on an international graduate who has glowing recommendation letters from a well-known medical school (say, an ivy league one) for someone who has the typical letters including a few from Europe that he could have written himself just because he's passed step 3 with a score of 190? i must say i would find that very hard to believe

 

[OldPsychDoc]

so if you're at a relatively small community program, you'll essentially pass on an international graduate who has glowing recommendation letters from a well-known medical school (say, an ivy league one) for someone who has the typical letters including a few from Europe that he could have written himself just because he's passed step 3 with a score of 190? i must say i would find that very hard to believe

We'll interview both, but expect that the latter, unless the former is strongly geographically/relationally tied to us, is more likely to appreciate what we have to offer.

But that's not the comparison in this case--it's more likely to be comparing 2 applicants with Step 2s of 200, lower quartiles of their class, less well-known schools--one with a passed Step 3, one not. In that case, passed Step 3 gives you the edge. No licensing and contract renewal drama.

 

[¯\_(ツ)_/¯]

the OP has mentioned a score of 233 on step 2 actually. while it would not be impossible for him/her to not pass step 3 after six months of off-service rotations experience added to that base knowledge, it would be quite hard to do so, isn't it?

 

[LisaLou]

I second (third? fourth?) MacDonaldTriad. For an applicant otherwise unknown to us, passing Step 3 would be preferable to an observship. However, if someone came and did an observership with our department it would hugely increase their rank with us (assuming we liked them when they were here for the observership).

 

[Crazycatlady84]

You mentioned that you have not taken step 2 CS. I would focus on that first. Although the majority of people pass, there are many who think it is a blow off exam, and end up not passing. You still need to prepare for it. It helps the most if you take it after your outpatient/family medicine rotations, if possible. The passing score cutoffs have also gone up since you graduated, so I'd make sure you take the time to review for that (read the step 2 cs book, go through cases, etc). If you go to the step 2 forums, you can see in the last 4-5 months that people have posted being stunned at failing, as they never thought it could happen to them as they are Americans. Just knowing English isn't good enough. You need to be able to come up with good differential diagnoses, have good patient rapport etc. Excuse my soap box, but I felt like writing all of this because when you mentioned knowing English as qualifying you to pass CS, that set off red flags in my head, as it is certainly not the case. If you do well with patient exams in clinical settings, then at least give a solid week to reviewing cases and practicing them with another person from the step 2 cs book.

Thank you for your post, I always appreciate honesty and yes Step2CS is most important right now! I have a bit longer than a month left to prepare. I'm not one to underestimate the difficulty of an exam, in fact I always overestimate it and get worried that I'll fail. I have the Step2CS case book and find that one very helpful! I just mentioned my English skills because that is one less thing to worry about as an IMG, I can focus all of my attention on making sure I get the physical and the differential diagnoses down.

 

[vistaril]

the OP has mentioned a score of 233 on step 2 actually. while it would not be impossible for him/her to not pass step 3 after six months of off-service rotations expereince added to that base knowledge, it would be quite hard to do so, isn't it?

yeah agreed. If someone scores 233 on step2, barring some miracle....they are going to pass step 3.

 

[Crazycatlady84]

I matched!!!!!!!

I wanted to update this thread because I've lurked on SDN for a while and got tons of valuable information, so I wanted to say thank you to everyone who takes the time to post!

Anyway, I ended up passing Step2CS and Step3 and did another externship. Honestly, I feel that my application was pretty average and probably comparable to a lot of other IMGs. I met quite a few IMGs during the interviews who had done Step 3 as well. A few interviewers complimented me on my personal statement, which surprised me cause I didn't think it was anything special. But I have a genuine passion for the field and I suppose that came across during interviews.

 

[MacDonaldTriad]

Congratulations Crazycatlady! I guess the conclusion about the externship vs part III is that both beat either one. Way to go.

 

[Crazycatlady84]

Congratulations Crazycatlady! I guess the conclusion about the externship vs part III is that both beat either one. Way to go.

Thank you!!!!
Yes I agree. I think for IMGs who aren't fresh graduates, Step 3 can be a huge plus. Almost all the IMGs I met during interviews had Step 3 done.

 

[kobebeefmd]

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[psychattending]

I would say taking Step 3 and continuing to work as a scribe in the clinic would go further towards helping you get into residency than not taking Step 3 and going to work in healthcare related company.

 

[kobebeefmd]

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