Just got step score. Advice for matching "top" IM?

[ehwatsupdoc]

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Hey everyone,

I figure I don't have enough information to make a WAMC thread yet but I do have a general question:

I just got my step 1 score: low 240s
note: I go to a "low tier" US MD school.

I have a strong interest in attending a top 20 academic IM program (particularly in the northeast) due to interests in a research/teaching/clinical career and likely pursuing a competitive fellowship. I also have family ties to the northeast.

I am just wondering if this step 1 score will significantly decrease chances of top IM programs? Does anyone have any advice on how to go forward?

Thanks in advance!

 

[DokterMom]

You were already starting one strike down because of your self-described "low tier" school. An 'only-slightly-above-average' STEP 1 score is strike two.

Unless your "family ties" are very influential, your odds of matching to a [highly desirable] Top 20 program in the [highly desirable] Northeast are vanishingly small. (The tippy top IM programs in desirable locations are every bit as competitive as the most competitive surgical sub-specialties.)

Fortunately, there are many 'really good' IM programs in the Northeast as well, so many to choose from where your 'US MD school' and STEP score will be plenty good enough to earn you consideration.

Bottom line, on paper, you're a "good" candidate from an "OK" school and you should have no trouble matching to a really good IM program. However, the Top 20 programs in the Northeast will have hundreds of applications from "excellent" candidates at "excellent" schools, and this is the applicant pool they'll go to first.


* edited to clarify

 

[MedScat]

Decrease? A 240 is great dude. According to the NRMP 2018 charting outcomes average step 1 of matched students in IM is 233 so i Think your 240+ score should be fine even for top programs. Remember, average is an AVERAGE - so even if you are below average for the program you want youll still have a good shot. Congrats on the awesome step score


Texas star date - not sure how accurate:

 

[ehwatsupdoc]

Thank you both for the advice! I agree it is a great score (though it was significantly lower than my practice scores, but that is a conversation for another day). Just feel like I have heard 245/250+ as the unofficial "cutoff" at these type programs.

Would be happy with any IM program in the northeast, but specifically wanted higher ranked programs for competitive fellowship/academic career reasons. @DokterMom do you think a higher step 2 CK and/or 3rd year grades can help in this situation? I figured a 240 step 1 wouldn't hurt me but certainly wouldn't "help" either. Maybe I'm being naïve.

 

[tantacles]

Thank you both for the advice! I agree it is a great score (though it was significantly lower than my practice scores, but that is a conversation for another day). Just feel like I have heard 245/250+ as the unofficial "cutoff" at these type programs.

Would be happy with any IM program in the northeast, but specifically wanted higher ranked programs for competitive fellowship/academic career reasons. @DokterMom do you think a higher step 2 CK and/or 3rd year grades can help in this situation? I figured a 240 step 1 wouldn't hurt me but certainly wouldn't "help" either. Maybe I'm being naïve.

There is only one thing you can do to improve your chances: Honor all of your rotations. Other than that, you have no control.

 

[Lawpy]

AOA is a major factor, even more important than Steps

 

[frenchyn]

The people who matched at these top programs at my school I know have 260+ step one, 270-280 step 2, And AOA.
If you really want to match there, I would say do a SubI...No experience with IM, but in more competitive specialty, subI become more and more important if you want to match at certain program.

 

[tantacles]

The people who matched at these top programs at my school I know have 260+ step one, 270-280 step 2, And AOA.
If you really want to match there, I would say do a SubI...No experience with IM, but in more competitive specialty, subI become more and more important if you want to match at certain program.

Not great advice for IM. IM tends not to care about away Sub-I's. They routinely do not interview applicants who have done sub-I's. It's not the same as surgical subspecialties.

 

[frenchyn]

Not great advice for IM. IM tends not to care about away Sub-I's. They routinely do not interview applicants who have done sub-I's. It's not the same as surgical subspecialties.

Oh really? That is interesting because people tend to interview/hire those who they know for sure can work and fit vs those who are strangers...

 

[tantacles]

Oh really? That is interesting because people tend to interview/hire those who they know for sure can work and fit vs those who are strangers...

With 40-50 residents per year, the aways are just not a good way to get to know someone. Residency is not a normal job.

 

[studentdocftw]

240 is fine, but as a low tier MD, you'll need to have some significant research/AOA to stand out more. If you are really set on "top 20" you'll need both, or you'll have to rock an away at a solid academic center. This forum generally looks down on aways, but I think they can be useful, particularly for low tier students who have their eyes set on the top. Best case, you rock it and get a great letter. Worst case, you cross a program off your list. Dont get me wrong, you'll still have to be a "fit" academically to have a reasonable chance to match, but getting a good evaluation at a big center, particularly if your hospital system is small or your med school is unknown, can be reassuring for PDs come rank. The Northeast programs are definitely more incestuous than other regions, so you may need to broaden your geographical area if you are prioritizing quality of training over area. Otherwise just apply broadly and you'll match somewhere up there.

 

[LunaOri]

Seriously, do away rotations at top programs. I know others on here would disagree, but a subI is like an audition--the program gets to see you in action, and it demonstrates that you are seriously interested in their program.

 

[AlteredScale]

Hey everyone,

I figure I don't have enough information to make a WAMC thread yet but I do have a general question:

I just got my step 1 score: low 240s
note: I go to a "low tier" US MD school.

I have a strong interest in attending a top 20 academic IM program (particularly in the northeast) due to interests in a research/teaching/clinical career and likely pursuing a competitive fellowship. I also have family ties to the northeast.

I am just wondering if this step 1 score will significantly decrease chances of top IM programs? Does anyone have any advice on how to go forward?

Thanks in advance!

Are you AOA? Does your school award AOA after 3rd year?

How much research output do you have?

Do you want a research career that you are trying to do the ABIM PSIP route, or just the classic 3+fellowship route?

Advice:

Honor at least your IM rotation. If you can, honor as many as possible.

Continue good research output. If pursuing research track need letter from your research mentor. Apply for extramural pre-doc grants if you are taking a research year.

Try and obtain AOA if possible.

Get the best score you can on step 2, preferably higher than step 1. If it's the same or lower, I would say that will lock you out of T10 spots.

For audition/sub-I, I would say if there is one or two places that you are interested as solid places you would be happy with and that aren't super reach and T10 then maybe do those.

From what I've seen around here form other applicants, most of the time auditions don't really do much at T10 places, they know they are getting the best applicants in essentially all areas (clinical, academic, research), so an audition can make or break your chances there. It's not worth that risk so as long as your application is solid overall which with a step 1 of 240, is already a good starting point. Of course based on the data of just step 1, you are lower than those who interview there, so you need to ensure that the rest of your app is as emaculate as possible.

 

[thumbz]

If you're going to do a subi make sure you know you're a solid student first - if you have a hard time putting together a presentation and critical thinking on the fly it'll do you more harm than good. As a subi you may be carrying 5-7 patients and if you can't do that and look like a rockstar it'll sink you at a program that may have considered you otherwise.

On the flipside - if you're a med student who has been consistently getting the feedback "you're functioning at the level of an intern" then a subi could be what moves you from the bottom half of the rank list into a rank to match position. I would much rather have a "lower" step score (a 240 as above is a good score) in a proven performer than an unproven 260+ who may not be able to evaluate a patient.

I've had subi's with fantastic scores who get moved into the bottom 1/4 of our rank list after I see how they perform clinically.

 

[ehwatsupdoc]

Are you AOA? Does your school award AOA after 3rd year?

How much research output do you have?

Do you want a research career that you are trying to do the ABIM PSIP route, or just the classic 3+fellowship route?

Advice:

Honor at least your IM rotation. If you can, honor as many as possible.

Continue good research output. If pursuing research track need letter from your research mentor. Apply for extramural pre-doc grants if you are taking a research year.

Try and obtain AOA if possible.

Get the best score you can on step 2, preferably higher than step 1. If it's the same or lower, I would say that will lock you out of T10 spots.

For audition/sub-I, I would say if there is one or two places that you are interested as solid places you would be happy with and that aren't super reach and T10 then maybe do those.

From what I've seen around here form other applicants, most of the time auditions don't really do much at T10 places, they know they are getting the best applicants in essentially all areas (clinical, academic, research), so an audition can make or break your chances there. It's not worth that risk so as long as your application is solid overall which with a step 1 of 240, is already a good starting point. Of course based on the data of just step 1, you are lower than those who interview there, so you need to ensure that the rest of your app is as emaculate as possible.

Thank you for all of the really helpful tips!
I believe my school does award AOA after third year. I am about to start third year now, so we'll see how it goes. My preclinical grades were definitely in the top 30-50% area, but I definitely did not get junior AOA and cannot say for sure where I currently stand (my school does internal ranking).

I never mentioned it but I do have a decent amount of research as of now (and plan to continue throughout third year). I have 4 publications (three are middle author, one as a co-first author) and one case report and these are all done at one of the "top" institutions in the northeast in a non-IM department. I believe I can get a very strong research letter from this attending, though he is not an internist.

I definitely have an interest in research in my career, but I'm not sure I can commit to an ABIM PSIP route as of now. I would likely do a standard categorical program with fellowship and see where my interests go.

 

[ehwatsupdoc]

Thanks everyone for the advice on away rotations!

I will see how my 3rd year goes and consider whether or not it is a good idea.

 

[blastokine]

You were already starting one strike down because of your self-described "low tier" school. An 'only-slightly-above-average' STEP 1 score is strike two.

Unless your "family ties" are very influential, your odds of matching to a [highly desirable] Top 20 program in the [highly desirable] Northeast are vanishingly small. (The tippy top IM programs in desirable locations are every bit as competitive as the most competitive surgical sub-specialties.)

Fortunately, there are many 'really good' IM programs in the Northeast as well, so many to choose from, where your 'US MD school' and STEP score will be just fine.

Bottom line, on paper, you're a "good" candidate from an "OK" school and you should have no trouble matching to a good program. However, the Top 20 programs in the Northeast will have hundreds of applications from "excellent" candidates at "excellent" schools, and this is the applicant pool they'll go to first.


* edited to clarify

So low 240s is considered "only slightly above average"?

 

[peachrings]

So low 240s is considered "only slightly above average"?

NMRP Charting outcomes for IM has matched MD applicants with mean Step 1 of 233. Assuming a SD of 20, a 243 is 70th percentile of IM matched applicants. ~600 of the matched MDs are 250+, so you can probably fill the top 10-15 programs using just 250+ MD applicants.

 

[Lawpy]

Thank you for all of the really helpful tips!
I believe my school does award AOA after third year. I am about to start third year now, so we'll see how it goes. My preclinical grades were definitely in the top 30-50% area, but I definitely did not get junior AOA and cannot say for sure where I currently stand (my school does internal ranking).

I never mentioned it but I do have a decent amount of research as of now (and plan to continue throughout third year). I have 4 publications (three are middle author, one as a co-first author) and one case report and these are all done at one of the "top" institutions in the northeast in a non-IM department. I believe I can get a very strong research letter from this attending, though he is not an internist.

I definitely have an interest in research in my career, but I'm not sure I can commit to an ABIM PSIP route as of now. I would likely do a standard categorical program with fellowship and see where my interests go.

Try to get AOA before ERAS is out

 

[Dwan]

Seriously, do away rotations at top programs. I know others on here would disagree, but a subI is like an audition--the program gets to see you in action, and it demonstrates that you are seriously interested in their program.

It seems logical, but I honored an away at a top program and got a really strong letter (I read it) from a high-ranked professor, and did not get an interview there. I've known several other top programs who have done the same to others. I did get interviews at other top 20's, and perhaps the letter helped for those. And there may be some top programs out there that do care about aways - just do the research before you spend money.

 

[DokterMom]

So low 240s is considered "only slightly above average"?

NMRP Charting outcomes for IM has matched MD applicants with mean Step 1 of 233. Assuming a SD of 20, a 243 is 70th percentile of IM matched applicants. ~600 of the matched MDs are 250+, so you can probably fill the top 10-15 programs using just 250+ MD applicants.

As @peachrings notes, low 240's is a solidly very good score. But the OP was talking about Top 20 academic IM programs. For them, it probably does fall into the "only slightly above average" (and that's not "slightly above their average") range.

Sure, it's OK to apply to those programs if you've got the money, and OK to do an away rotation if you turn out to be a rock star on the wards. But I'd suggest you focus your efforts on the next tier. The linked thread might answer your question --

School Pedigree and Top IM programs

 

[tantacles]

Thanks everyone for the advice on away rotations!

I will see how my 3rd year goes and consider whether or not it is a good idea.

For IM, it is not a good idea regardless of how you do.

 

[LunaOri]

NMRP Charting outcomes for IM has matched MD applicants with mean Step 1 of 233. Assuming a SD of 20, a 243 is 70th percentile of IM matched applicants. ~600 of the matched MDs are 250+, so you can probably fill the top 10-15 programs using just 250+ MD applicants.

The Step website shows exactly what percentile that score will be in, and also shows the Step 1 and Step 2 score distribution of applicants who matched in each specialty. Does not, of course, differentiate between top tier programs and lower tier programs.

 

[Oso]

@ehwatsupdoc I don't have any additional advice, just commenting to say I like your username and photo

Best of luck to you

 

[CanIBeAnonymous]

View attachment 311110

Top 25 internal medicine residencies, ranked by physicians

Johns Hopkins University in Baltimore offers the best clinical training in internal medicine, according to Doximity's 2018-2019 Residency Navigator.

www.beckershospitalreview.com

Is that really what's considered the "Top 25" - this whole thread makes it seem almost 'impossible' to get into those from a low-ranked med school, but schools like Drexel match what I'd consider a decent chunk of students into those IM programs, unless I'm reading their match list incorrectly.

 

[Lawpy]

How is Pennsylvania Hospital on there? Isn't it a community hospital for IMGs and DOs

probably cause its part of penn

Is that really what's considered the "Top 25" - this whole thread makes it seem almost 'impossible' to get into those from a low-ranked med school, but schools like Drexel match what I'd consider a decent chunk of students into those IM programs, unless I'm reading their match list incorrectly.

what fraction of them got AOA

 

[CanIBeAnonymous]

probably cause its part of penn



what fraction of them got AOA

I'm sure most, but still was a decent percentage of their IM applicants as far as I'm concerned. Just my point is it being a low tier school doesnt seem to matter right?

The people who get into T20s are usually top students to begin with, so them matching at the top makes sense. And those who get into low tier schools for whatever reason but are students of the same caliber as T20 students also match at the top. Just seems it's more dependent on the individual than the school itself.

Not saying it has zero impact of course, the connections and prestige of T20 still play a role, just it's still 90-95% based off the applicant themselves and their abilities.

 

[Lawpy]

I'm sure most, but still was a decent percentage of their IM applicants as far as I'm concerned. Just my point is it being a low tier school doesnt seem to matter right?

The people who get into T20s are usually top students to begin with, so them matching at the top makes sense. And those who get into low tier schools for whatever reason but are students of the same caliber as T20 students also match at the top. Just seems it's more dependent on the individual than the school itself.

Not saying it has zero impact of course, the connections and prestige of T20 still play a role, just it's still 90-95% based off the applicant themselves and their abilities.

Thing is AOA replaces the school name factor for low and mid tiers and that can be a problem since AOA can itself be overly political, biased etc.

 

[LetsDoThisThrowaway]

Thing is AOA replaces the school name factor for low and mid tiers and that can be a problem since AOA can itself be overly political, biased etc.

Are schools typically transparent about the AOA process, or do they mostly have it as "need x grades to qualify, and selection is based on a number of vague criteria not excluding popularity" haha.

 

[Lawpy]

Are schools typically transparent about the AOA process, or do they mostly have it as "need x grades to qualify, and selection is based on a number of vague criteria not excluding popularity" haha.

Idk it depends on the school and what you learn from upperclassmen

 

[Mochi2020]

Are schools typically transparent about the AOA process, or do they mostly have it as "need x grades to qualify, and selection is based on a number of vague criteria not excluding popularity" haha.

It depends on school...my school is top 10 for junior AOA and the next 10 for senior AOA

 

[Lawpy]

I also feel like I underperformed on step 1 but have similar aspirations of going to top 20 IM. I know I'll need to honor as many 3rd year rotations as possible and hopefully perform 20+ better points on step 2 vs step 1.

I go to a "top 15" school (according to USNWR), step 1 was 243, and have a pretty strong research profile (think JAMA, not first authors though). My school doesn't offer AOA

You'll be okay.

 

[ehwatsupdoc]

^^^ and this is why the MCAT is indirectly more important than step 1 is. Never realized how much medical school name matters until now.

 

[AnonymousDoctorGuyPerson]

^^^ and this is why the MCAT is indirectly more important than step 1 is. Never realized how much medical school name matters until now.

Tbf I'm attending a low-tier MD school with a 99th percentile MCAT

But I do agree, the earlier you land a "prestigious" position the easier the future becomes for sure.

 

[ehwatsupdoc]

Tbf I'm attending a low-tier MD school with a 99th percentile MCAT

hahaha ok fair enough

 

[Lawpy]

^^^ and this is why the MCAT is indirectly more important than step 1 is. Never realized how much medical school name matters until now.

Top IM is prestige heavy and apparently even more so than surgical subs. That's the unfortunate nature of the game.

 

[Deecee2DO]

Decrease? A 240 is great dude. According to the NRMP 2018 charting outcomes average step 1 of matched students in IM is 233 so i Think your 240+ score should be fine even for top programs. Remember, average is an AVERAGE - so even if you are below average for the program you want youll still have a good shot. Congrats on the awesome step score


Texas star date - not sure how accurate:

Sorry to dig up an old post but where can I get this app^

 

[MedScat]

Sorry to dig up an old post but where can I get this app^

It's the Texas star, some schools give you access to it. My school does not so I got that screenshot from this page, some kind person posted a lot of specialty pages here.

.

.

forums.studentdoctor.net

I think Residency explorer tool is good too Residency Explorer™ Tool: Home

 

[Redpancreas]

It's the Texas star, some schools give you access to it. My school does not so I got that screenshot from this page, some kind person posted a lot of specialty pages here.

.

.

forums.studentdoctor.net

I think Residency explorer tool is good too Residency Explorer™ Tool: Home

Are any of these really up to date? The ones I have see (Residency Explorer, AAMC) are outdated. I remember MSAR was there for medical schools and even that had plenty of errors. I don't think there's any perfect resource out there because this stuff is in constant flux and no one entity has committed to following every little detail of every residency program. If someone decided to do that, it would have to be individualized to one specialty because there's no way to keep track of them all.

 

[MedScat]

Are any of these really up to date? The ones I have see (Residency Explorer, AAMC) are outdated. I remember MSAR was there for medical schools and even that had plenty of errors. I don't think there's any perfect resource out there because this stuff is in constant flux and no one entity has committed to following every little detail of every residency program. If someone decided to do that, it would have to be individualized to one specialty because there's no way to keep track of them all.

Yeah i mean it's not a perfect resource but its definitely better than nothing. Outdated and response rate are two of the big issues so its like not representative of the whole sample but, a sought guide

 

[Redpancreas]

Yeah i mean it's not a perfect resource but its definitely better than nothing. Outdated and response rate are two of the big issues so its like not representative of the whole sample but, a sought guide

It's good to have something, but that something is often not much more than what people already know intuitively. Then when people want nitty gritty details, these sites aren't super reliable and it's better to look at the program's website or wait until the interview day. On Doximity Residency Navigator (example), they have a feeder school section. The schools listed make sense to an observer, but I can tell for the programs that the information's either blatantly false or outdated to the extent that it is no longer relevant. Board Pass Rates are also discordant. I remember an 84% being reported and then during the presentation the PD presented a 100% board pass rate for the last 3 years which is when I stopped trusting Doximity.