Need some honest advice about chances.

[ordersol6]

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Hello.
I am a 3rd year medical student who has decided on EM looking for some honest input on my chances of matching.

AMG at mid tier MD school
My step 1 was a 209.
I am taking Step 2 in late July to show improvement. FWIW I took a practice step 2 back in April and scored in the mid 220s on it.
My clinical grades have been all passes. School is H/HP/P/F and the clerkships are curved so that 60% of a given group gets pass, next 20 gets HP, then next gets H.
Currently in surgery trying my best to honor or at least HP. On a service known for being fairly generous with evals so I'm hopeful.
No failures or red flags.

Home EM clerkship is in August with an Away set up in September.

I feel what's been holding me back clinically are my performances on the exams, which are usually just average to below average and end up pushing me into the pass range. My evals have mostly been good-great and virtually all have comments to the effect of "hard worker, excellent presentations and notes, good team player".


No EM research but I did take a Peds EM elective in 3rd year that was P/F. And got in touch with the EM faculty at my school. They told me they thought I performed very well from what they saw of me and gave me advice for when I have my real EM clerkship. Also attended ICEP.

Ideally would like to stay in the midwest but beyond that I am not too picky.

 

[BoardingDoc]

My .02? Your chances aren't great, but as long as your letters and evals are great I'd guess you will match provided you apply very broadly. As in, 60+ places broadly.

Also, keep working on upping that step 2. 220s is well below average, so that's not going to show improvement so much as reinforce a below average M.O.

 

[ordersol6]

.

 

[ordersol6]

Thanks. What Step 2 should I shoot for? I'm taking the month of July off to study so I'm fairly confident I could improve from where I am.

 

[link2swim06]

It's all come down to your step 2 and your EM rotation grades/SLOE.

You need >245 on step 2 and very good EM SLOEs.

I had a much lower step 1 (<200) than you and matched at my number 2 this last cycle. Although I busted my ass on step 2 (>250) and my EM rotations. I applied to 70 programs and got about 25 interviews.

So the take home message is....if you do VERY well on step 2 and your rotations you will have no problem matching. If you don't do well on those...then you are going to have some problems and need a backup plan.

 

[ordersol6]

That answered my question. thank you.

 

[Modafinil]

It's all come down to your step 2 and your EM rotation grades/SLOE.

You need >245 on step 2 and very good EM SLOEs.

I had a much lower step 1 (<200) than you and matched at my number 2 this last cycle. Although I busted my ass on step 2 (>250) and my EM rotations. I applied to 70 programs and got about 25 interviews.

So the take home message is....if you do VERY well on step 2 and your rotations you will have no problem matching. If you don't do well on those...then you are going to have some problems and need a backup plan.

I came in here to tell your tale

 

[EsTxDr]

My .02? Your chances aren't great, but as long as your letters and evals are great I'd guess you will match provided you apply very broadly. As in, 60+ places broadly.

Also, keep working on upping that step 2. 220s is well below average, so that's not going to show improvement so much as reinforce a below average M.O.

It's all come down to your step 2 and your EM rotation grades/SLOE.

You need >245 on step 2 and very good EM SLOEs.

I had a much lower step 1 (<200) than you and matched at my number 2 this last cycle. Although I busted my ass on step 2 (>250) and my EM rotations. I applied to 70 programs and got about 25 interviews.

So the take home message is....if you do VERY well on step 2 and your rotations you will have no problem matching. If you don't do well on those...then you are going to have some problems and need a backup plan.

I disagree with both of these. I think they are both a little too severe. We all have our anecdotes but I had a 213-215 step one (can't remember off hand) and 235 step 2, mostly passes (couple HPs thrown in) did two aways early in 4th year, applied to 40 programs (probably a little too many actually) and ranked less than 10 programs (after declining interviews). Now anecdotes are what they are and I dont suggest my path to every med student but your chances are not as bleak as they are making them seem. I think a lot of times SDN goes to the extreme to try and drive a point home (in this case being you need to work hard which I assume is understood already).

I think your strengths are your clinical evals, if they are as strong as you say and crushing step 2 as well as your personal statement and ability to interview well. You need to apply broadly (not 70 programs) but even more importantly you need to study the programs and learn them well. You need to apply to programs purposefully and choose the programs you would fit well and would fit you well. If you understand this aspect of the application season you can be very successful with your current grades/situation.

 

[gman33]

You can match if you apply broadly.
In my mind, applying broadly isn't about number of programs.
It is about applying to a bunch of programs in less desireable georgaphic locations (outside of major cities, not on the coasts).

Continue trying your best.
If test taking is an issue, try changing your study habits.
Spend most of your time doing practice questions.

 

[alpinism]

You can match if you apply broadly.
In my mind, applying broadly isn't about number of programs.
It is about applying to a bunch of programs in less desireable georgaphic locations (outside of major cities, not on the coasts).

Continue trying your best.
If test taking is an issue, try changing your study habits.
Spend most of your time doing practice questions.

Exactly.

OP you should have a good shot at matching as long as you bust your ass on your EM rotations and do better on step 2.

Be aware that, however, your chances at competitive programs on the coasts or in big cities will be much less.

Your best shot will be at newer programs and at programs located in less desirable locations in the midwest.

 

[EsTxDr]

Exactly.
Be aware that, however, your chances at competitive programs on the coasts or in big cities will be much less.

Your best shot will be at newer programs and at programs located in less desirable locations in the midwest.

Yeah I agree with this except the specific geographic locations part. This is what I was touching on by saying apply with purpose. Its not only new programs or those in the midwest that you have better chances with. Look for programs that have connections with areas of medicine you are interested in (programs with heavy pre-hospital/EMS connections and curricula if thats your interest) assuming your application (either volunteer, leadership, or personal statement) tells the same story. You will be looked at more favorably in smaller more community programs but there are plenty of them both on the coast (depending on what coast you are talking about lol) and outside the midwest. New programs can be tricky, for instance the new program in Austin TX had more applicants than lots of well established programs. They highly valued step scores and you wouldn't have been very competitive there even though its a new program.

So the real bottom line is these hard rules really fail to tell the whole story. Its more about finding programs that you fit, and making sure that matches the story your application tells. Dont place your trust and energy on specific rules, but rather work hard, take a look at yourself and really determine what you want and put all your energy in that direction. Be honest with yourself about why you haven't done better on step and grades and be ready to address it if asked (you probably wont be, but be ready).

I would agree though, step 2 is probably going to give you the most benefit at this point. So do questions, get study partners, use DIT or some other study program. Whatever it takes. Then once that has passed turn to your personal statement and program selection.

 

[link2swim06]

Just to add one more thing.

There are definitely strong programs in crappy locations. I'll avoid naming particular states/cities so I don't offend people about their home state(s) but you can figure it out pretty quickly browsing through all the programs ERAS.

If you are willing to go anywhere for EM this will be an advantage.

 

[alpinism]

Cough, Indiana, cough.

 

[ordersol6]

Thanks everyone for all your advice.
I really appreciate you guys taking the time to give me tips on how to succeed.
It's definitely been a humbling experience for me coming from undergrad where I could kill tests without too much effort to med school where I find myself struggling to beat the mean.
I do think I'm improving my test taking skills. I actually did very well on the Medicine Shelf (got an 82 scaled). Unfortunately at my school we have 2 exams, a shelf and a departmental exam (I don't get it either) and I didn't do so well on the latter. And that clerkship has a rule that you need to meet cutoffs on BOTH tests to qualify for a certain grade.
Anyway, really appreciate the help.

 

[BoardingDoc]

Unfortunately at my school we have 2 exams, a shelf and a departmental exam (I don't get it either) and I didn't do so well on the latter.

This is likely in place because your preceptors threw a hissy fit when they were told that your curriculum was being changed to teach to the boards so that more students would do well and subsequently match well.

Prof: "But the boards don't teach you how to be a doctor! My research into the rate of change in bloodflow in your calf while on the stairmaster vs at rest is what's really important!"

School: "Ok, ok, we'll test both."

 

[RustedFox]

This is likely in place because your preceptors threw a hissy fit when they were told that your curriculum was being changed to teach to the boards so that more students would do well and subsequently match well.

Prof: "But the boards don't teach you how to be a doctor! My research into the rate of change in bloodflow in your calf while on the stairmaster vs at rest is what's really important!"

School: "Ok, ok, we'll test both."

Hahahaha... This in academia.... all day long.

 

[ordersol6]

Hello.

I am writing again for more advice.
By now I'm finishing up my away and have done very well on both my ER rotations.
My first EM grade was a HP with excellent comments per my home advisor.
And the grade for my away was honors.
Unfortunately, I did very poorly on Step 2. Got a 209.
I honestly have no idea what happened. I averaged 74% on uworld on first pass, scoring in the 240s-250s range on the NBMEs and in the 240s on UWSA. I felt comfortable going in and left feeling unsure about some questions but overall felt I did ok.
I am pretty devastated. I honestly almost wished I had failed because at least then I could retake with a better score.
Can I get advice as to what I should do? Should I even release my step 2? How should I address on interviews or in my PS? Any advice you can give me would be great.

 

[winkleweizen]

Hello.

I am writing again for more advice.
By now I'm finishing up my away and have done very well on both my ER rotations.
My first EM grade was a HP with excellent comments per my home advisor.
And the grade for my away was honors.
Unfortunately, I did very poorly on Step 2. Got a 209.
I honestly have no idea what happened. I averaged 74% on uworld on first pass, scoring in the 240s-250s range on the NBMEs and in the 240s on UWSA. I felt comfortable going in and left feeling unsure about some questions but overall felt I did ok.
I am pretty devastated. I honestly almost wished I had failed because at least then I could retake with a better score.
Can I get advice as to what I should do? Should I even release my step 2? How should I address on interviews or in my PS? Any advice you can give me would be great.

Failing is much worse then barely passing. If they bring it up, just tell them you're a better clinician then test taker. Don't make up any half ass excuses about how your practice tests were better or whatnot just be honest

 

[ordersol6]

Hi everyone,
I appreciate you all taking the time to advise me, and would like your advice again.

At this point in the cycle I have exactly 1 interview invite, to OSF Peoria where I rotated, and 1 waitlist at University of Iowa, and then 13 rejections.

I applied to 70 EM programs, almost all in the midwest or south, and a few on the east coast, mainly out of fear. There's still 55 programs that haven't given me an answer.

At this point, should I give up and start applying to prelim medicine as back-up? I'm really devastated by all this because I really can't picture myself as happy doing anything other than EM, and i'll most likely just try to apply again next year.

I've read over my MSPE and there's nothing negative on there (beyond one comment of "encouraged to read more" from OB), and my letters shouldn't have anything bad on them given what my evals were like.

I guess I should point out too that there was an error with my ERAS application that might have led to me being marked incomplete until the end of October. My photo wasn't uploaded properly and student affairs at my school contacted me about and the problem was fixed on 10/27 if I remember right.

 

[pandahunter]

your chances are not good at this point. A faculty member could better answer your question but FWIW, if i were you, I would apply to some prelim spots and hope for some chance to get into EM next year. However, that strategy isn't good either as EM is going getting more competitive and your chances of matching out of prelim are slim to none. I would seriously consider applying to some less competitive specialties in less competitive geographic areas.

 

[pkwraith]

I'm not sure your late photo has anything to do with it. I think in the long scheme of things, I'm sure it's probably low on the list of filters PDs use. If it's true, it's certainly a tragedy. Did you get your 1 interview before or after 10/27?

To be honest, based on your step I score, you should have more than 1 interview at this time. Step 2 is certainly hurting you, but not destroying you to 1/70 interview level if you have an appropriate application list. My concern is probably in the actual application list. For example, someone upstream suggested Indiana (wtf?) for this applicant. If his list looked like that, he is in for a very, very bad time.

I guess some questions.
1. Did you review your 70 application list with your adviser, and what did they say?
2. What happened with your home program? Waiting or rejected?

At the minimum right now, you should be contacting Iowa to express your undying adoration and hope to get off the waitlist.

 

[ordersol6]

My advisor went over my list with me. He mostly instructed me to delete programs that might screen me out due to my step scores. I've added 4 programs since then. And my school doesn't have a home ER program, just a home clerkship.
I could also point out that I didn't have 3 letters uploaded until 10/22 since I was waiting on a 2nd SLOE, and that the interview for OSF is automatic for people that rotate there so I got it before the 27th.

 

[Psai]

It's all come down to your step 2 and your EM rotation grades/SLOE.

You need >245 on step 2 and very good EM SLOEs.

I had a much lower step 1 (<200) than you and matched at my number 2 this last cycle. Although I busted my ass on step 2 (>250) and my EM rotations. I applied to 70 programs and got about 25 interviews.

So the take home message is....if you do VERY well on step 2 and your rotations you will have no problem matching. If you don't do well on those...then you are going to have some problems and need a backup plan.

what does it mean to bust your ass on rotations
i just go in and people say do this so i do it and try to do it well