Ortho Residents; scored >220<225 on S1. Please advise on reality and/or experience with matching

[laterratherthan]

Hi everyone, My SO is about to start 4th year and has been pursuing Orthopedics since his 1st year. He is terrified he won't match to a decent residency or match at all because is got a 224 on Step 1. He's ranked in the top half of his class, but not top quartile. He has done 3 Ortho research studies, presented 1 in Argentina at the Global Spine Conference. He has gotten high pass on 2 of his core rotations so far, clinical honors but not overall honors on those two because he struggles with test taking. (i.e. The 224 on Step 1).

For those of you who scored lower than a 225 on Step 1, did you match or not match? Did you get interviews at the places you wanted or AIs? If you did match, was it in your top 5? If you didn't match but did a Pre-lim year in Gen Surg, did you get a preferable Ortho spot after?

His top picks are UAB, Colorado, Ole Miss, Jacksonville FL, Gainesville FL, Columbia SC, Vanderbilt, and South Alabama.

He's too busy to post these questions so I'm doing it for him.

Thanks in advance!

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[deleted480308]

It puts them bottom 10% of acceptees if they make it so odds aren't good

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

 

[laterratherthan]

It puts them bottom 10% of acceptees if they make it so odds aren't good

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

Hello again. We've looked at charting outcomes but have also heard conflicting stories to the results.
What about Pre-lim year in Gen Surg?
He's not really wanting to budge on this... That's why I'm hoping hearing from other people may help him see things realistically.

 

[pd1112]

Based on CTO from 2 years ago, you might have a 50% chance of matching at all with that step 1. Although there hasn't been published data to back it up, talk from many people in the field is that the step 1 averages have gone up from the 245 quoted in that CTO from 2014, which is supported by the increase in step 1 average across the board.

Without being in the top quartile for your class, you won't be eligible for AOA.

The number of people who are able to get an ortho spot after not matching & completing a pre-lim gen surg year is exceedingly low, such that it's fairly likely there aren't any active SDN members who have done it.

All things considered, your chances of matching at all are slim, but it's not impossible. If you're dead set on the field, you're going to need to do everything you can to honor every rotation from here on out & annihilate step 2. It might be a good idea to do a research fellowship for a year before M4 if you can find one that you know will be productive. If it's only going to result in 3 publications, the difference between having 3 total & 6 total is likely not going to increase your odds of matching much. You probably need to stop concentrating on matching at a specific program & instead concentrate on simply matching anywhere. Meeting with your home ortho chair and/or PD will maybe give you a better idea.

I would never encourage anyone to give up a dream & there are always a few people every year that match after failing once or multiple times, completing research year(s), or just defying the odds. Make sure if you're absolutely set on applying this year, you have a backup plan, whether it's research year, prelim year, or dual applying to another field.

FWIW I was dead set on ortho for the first 2 years, scored 230s on step 1, wavered for a little while because of the score & the current competitiveness of the field, decided to stick with it, gunned hard for the past 6 months honoring every clerkship & spent time every day looking into away rotations/match histories/step 1 cutoffs etc etc & finally just burned out on it. I started having a more open mind about other fields & found one that I love that I never thought I would. Words can't describe the amount of relief I had after getting out of this game. I still love the field, but the process was turning me into someone I'm not. Point is, ortho is the most competitive field right now & it's probably not very close. As a below average applicant (like I was), you can put the blinders on & go all out for it, stress yourself out to the max trying to impress everyone & honor every rotation, do everything you can to make up for 1 test score & you still might not match. Or you can take an objective look in the mirror, realize the odds are against you & start looking at other fields.

 

[Duotone]

Hi everyone, My SO is about to start 4th year and has been pursuing Orthopedics since his 1st year. He is terrified he won't match to a decent residency or match at all because is got a 224 on Step 1. He's ranked in the top half of his class, but not top quartile. He has done 3 Ortho research studies, presented 1 in Argentina at the Global Spine Conference. He has gotten high pass on 2 of his core rotations so far, clinical honors but not overall honors on those two because he struggles with test taking. (i.e. The 224 on Step 1).

For those of you who scored lower than a 225 on Step 1, did you match or not match? Did you get interviews at the places you wanted or AIs? If you did match, was it in your top 5? If you didn't match but did a Pre-lim year in Gen Surg, did you get a preferable Ortho spot after?

His top picks are UAB, Colorado, Ole Miss, Jacksonville FL, Gainesville FL, Columbia SC, Vanderbilt, and South Alabama.

He's too busy to post these questions so I'm doing it for him.

Thanks in advance!

An ortho match with step-1 of 224 is challenging but not insurmountable. However, the Step-1 score is inversely proportional to his ability to make choices of where to apply. Hence, with 224 he loses the power to cherry-pick where or where not to apply. There are always outliers with the NRMP data. He may be the next outlier-in-wait. To optimize his chances of matching, I would advise him to:

1. Aim for a >240 in Step-2 to help convince the programs that he can improve on his test performance as well as pass the OITE.
2. Obtain 3 strong and personalized recommendation letters from attendings that know him very well and can attest to his work ethics and commitment to ortho (which should be nothing short of outstanding). Waiving his right to read the letters make them more "authentic" (if you like).
3. Be open to apply to any program in the country (100% geographically mobile)
4. Schedule his audition rotations tactfully (avoid programs that emphasize stats)
5. Honor as many of his MS3 rotations as possible (may be too late since he is about to start MS4)

This year, like every other year, there will be many "high-stats" candidates that will not match, and some "low-stats" candidates that will match.
I would also advise that he nurses a viable fall-back option should his ortho plans fail to materialize.

 

[MedAppRx]

I matched to a top 10 Ortho residency with a 227. One of my interns scored even lower than that. As has been mentioned, the Ortho path is tough and unforgiving. However, your SO has the right attitude (being unrepentant about wanting this field and no other). Some advice I would give (and happy to discuss further on PM). You just have to think like a program director a bit to understand how to do well.

1. Unfortunately, being "bad at tests" is a really bad thing to admit during an interview. I was terrible at exams when I started med school because I was a humanities major + masters in college (the downside of a BA/MD program is you don't have the incentive to become a great test taker then). After royally bombing my first semester (I mean total flame-out) and following through with a questionable Step 1, I forced myself to learn to take a test. This has to be a talking point of your SO, because most program directors really worry about if you can take an exam (such as your specialty boards) and pass it. That's it. I've never used Step 1 content as a resident here - most of my skills are experiential. But I swear by the test-taking strategies I taught myself during med school.

2. Do a research year. With a low Step 1, you need to do something to make your application stand out. Your SO already has some research, but we need for him to be in the top 5% of research volumes when he applies to residency. It doesn't have to be in ortho. It just has to be work that he thought out and completed - that's key. That research year is also a time for him to go out and experience medicine. Go on a medical mission (HIGHLY recommend it. It will change your life and you'll never forget it). Join some of the orthopods in your hospital in the OR regularly. I did my research year in plastic surgery, and ended up working in the OR so often that I was doing semi-solo breast reconstructions by the end of the year.

3. Have a story. So many top candidates forget that they have to be human AND high caliber to be in ortho. After interviewing for my program it was so frustrating to see 260+ candidates who just assumed they would match, didn't talk through the interview, and basically looked like they were waiting to be given something. In contrast, we LOVED a guy with a 220-something who looked like he lived his life. Make sure your SO loosens up, gets a good story together, and has fun.

4. Finally, Step 2 CK is your guy's time to shine. This test matters. Even at top 5 programs (who still offered me interviews with my test scores. Funny enough, a lot of PDs don't really know what a good Step 1 is so if there are thresholds, many aren't that high. Even with 900+ apps, many really, really good programs don't have cutoffs. On the other hand, some do - keep that in mind and apply widely), a solid Step 2 CK completely silences any mention of my Step 1 score. That's going to redeem you.

Lots to think about, but hopefully this can help you and him think. Thanks for being such a supportive SO to him. He'll need you throughout the Match process, just like I needed my fiance through mine.

 

[massmocha]

This is not to be pessimistic, but PLEASE be mindful that there is a good chance your SO will not match in ortho. 2 med school classmates of mine had similar Step 1 scores, did research years in ortho, published, and went on not to match. This is anecdotal, but also the reality based on the numbers. Take the time to sit down and weigh the "passion" vs the reality of an extra year with the more-than-likely chances that he will not match.

I only post this because a year of life is a valuable thing.

 

[spartywrx]

I'd say chances are small. I would encourage him to check out orthogate.org as sometimes unfilled spots are posted there or if someone quits or gets fired. That may be where he can score a spot. I would not count on it though. I would recommend everything MedAppRx said. I personally would do a research year and try again, surgery prelim years can be brutal and you would have no time to improve your application.

 

[genswim24]

A general surgery prelim will not help him at all with matching orthopedics. Spots opening up are very rare so few people end up matching into Orthopedic residents as PGY-2's. In addition, intern year for orthopedics has 6 months of orthopedic rotations and not many surgery prelim residencies allow you to do that much ortho during the year.

Like others have said it is going to be very difficult to match, scores and grades are below average for ortho. Two of the three programs in the city i live in would never see his application because his score wouldn't meet the cutoff. It's an uphill battle and he better be prepared to pick another field. It's not impossible, but a long shot.

 

[massmocha]

As an update: we matched a gen surg prelim to our program this year... anything is possible if you make a good impression

 

[netminder]

As an update: we matched a gen surg prelim to our program this year... anything is possible if you make a good impression

What the person a gen surg prelim this past year in your institution, or from elsewhere?

Thanks.

 

[massmocha]

What the person a gen surg prelim this past year in your institution, or from elsewhere?

Thanks.

Prelim here, and rotated on our service as one of his electives

 

[4thQTHailMary]

Prelim here, and rotated on our service as one of his electives

Just curious, how does that work as a prelim? You get a certain amount of time to do an Ortho elective and then just hang around the program in your spare time? Props for making it work. Can't imagine how difficult is must have been.

 

[massmocha]

As a prelim there are certain rotations, one of their options is to do ortho trauma. When they rotate with us, if they work hard and everyone likes them we tell the program directors... voila!