Passed COMLEX step 1 third attempt. Need advise.

[munster05]

I've read many of the forums regarding this topic, but would like some input on my specific situation. I attempted COMLEX step 1 three times; two fails and one pass (grades below). I'm concerned about possibilities for matching into FM/IM or if I should cut my losses and move on.

COMLEX scores:
Attempt 1 - 334 (August 2017)
Attempt 2 - 362 (December 2017)
Attempt 3 - Passed 473 (March 2018)

COMSAES
E - 423 (June 2017)
D - 445 (August 2017)
C - 430 (September 2017)
B - 470 (November 2017)
A - 501 (December 2017)

Uworld scores
Average - 65
Form A - 215 (March 2018)

If anyone is wondering on the time gaps most were due to family emergencies (father diagnosed with MM with multiple post-treatment hospitalizations (May 2017-August 2017), Grandmother had multiple hospitalizations along with suspected elder abuse by caretakers (september 2017-late november 2017), Brother in-law hit by a car morning of my step 1 (December 2017) persistent vegatative state since. While I've been told it is a lot to happen all at once I do not want to use them as excuses for my failures.

I've been told to look into taking USMLE step 1 (if I can score above 240 on practice exams) and to aim high for step 2, but I'm still skeptical about this information since it came from my university's advisors (best for business is usually whats on their mind). Any advise would be appreciated.

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[trs88]

As someone who failed comlex once, I am only saying this because I feel it's in your best interest. Do not take usmle step 1.

The advice you are getting from the advisors is not specific for you. It's a general suggestion. I am concerned that even with studying that usmle step 1 will not be passable for you.

I would start researching some FM residency programs now to see how many will take multiple board failures. The most I have found is 2 failures in any board category. Meaning, you cannot risk another failure. Also, some state licencing programs will not license you if you have over a set amount of board failures.

 

[Goro]

I've read many of the forums regarding this topic, but would like some input on my specific situation. I attempted COMLEX step 1 three times; two fails and one pass (grades below). I'm concerned about possibilities for matching into FM/IM or if I should cut my losses and move on.

COMLEX scores:
Attempt 1 - 334 (August 2017)
Attempt 2 - 362 (December 2017)
Attempt 3 - Passed 473 (March 2018)

COMSAES
E - 423 (June 2017)
D - 445 (August 2017)
C - 430 (September 2017)
B - 470 (November 2017)
A - 501 (December 2017)

Uworld scores
Average - 65
Form A - 215 (March 2018)

If anyone is wondering on the time gaps most were due to family emergencies (father diagnosed with MM with multiple post-treatment hospitalizations (May 2017-August 2017), Grandmother had multiple hospitalizations along with suspected elder abuse by caretakers (september 2017-late november 2017), Brother in-law hit by a car morning of my step 1 (December 2017) persistent vegatative state since. While I've been told it is a lot to happen all at once I do not want to use them as excuses for my failures.

I've been told to look into taking USMLE step 1 (if I can score above 240 on practice exams) and to aim high for step 2, but I'm still skeptical about this information since it came from my university's advisors (best for business is usually whats on their mind). Any advise would be appreciated.

Do you realistically believe that you can perform well on USMLE?

 

[munster05]

Do you realistically believe that you can perform well on USMLE?

One hand I feel like I might pass the exam, but on the other I'm not sure if my two COMLEX fails were due to something else or just issues with knowledge; anxiety as a possibility. I've developed a few nervous tendencies during the last few months that i never had, but I am getting help for them. I didn't do amazingly well on my uworld questions nor on the uworld form A (not sure how accurate this score is), so I am a bit cautious of putting myself in an even worse state with a possible fail on USMLE step 1.

 

[W19]

Your residency choices are limited to path, FM and maybe IM... and passing USMLE step 1 will not change that... OTOH, failing USMLE will probably close the FM/IM doors, so why would you take such a risk?

I am going to be honest here: If you are intelligent enough to get into med school, you should be able to make these simple analyses. I frankly sometimes don't get medical students.

 

[mk04447]

Your residency choices are limited to path, FM and maybe IM... and passing USMLE step 1 will not change that... OTOH, failing USMLE will probably close the FM/IM doors, so why would you take such a risk?

I am going to be honest here: If you are intelligent enough to get into med school, you should be able to make these simple analyses. I frankly sometimes don't get medical students.

Because they've never failed at anything before, they were always given a trophy or a certificate, and a 240 is their ticket back. The same thing Tara Reid thought when she signed on for the Sharknado series.

 

[Goro]

One hand I feel like I might pass the exam, but on the other I'm not sure if my two COMLEX fails were due to something else or just issues with knowledge; anxiety as a possibility. I've developed a few nervous tendencies during the last few months that i never had, but I am getting help for them. I didn't do amazingly well on my uworld questions nor on the uworld form A (not sure how accurate this score is), so I am a bit cautious of putting myself in an even worse state with a possible fail on USMLE step 1.

I can't recommend taking USMLE

 

[mk04447]

I can't recommend taking USMLE

Funny, but the vague simplicity of your post sounds a lot like the administrators at my school. Personally, I think this response, not you, not here obviously, but this response in general, when it comes from school officials, has more to do with some perceived threat to the AOA and NBOME than it does with student beneficence.

 

[You shall know the Truth]

I can't recommend taking USMLE

You changed your picture. I like the cat.

 

[JamesPotterMS-3]

Have you heard about the massive score inflation that happened to the Level 1 scores this year? Do you realize that you probably also failed your 3rd attempt but the score inflation bumped you high enough to pass? This is going to sound rough but taking Step 1 is out of the question. Just focus on honoring as many 3rd year rotations as possible.

 

[Promethean]

Funny, but the vague simplicity of your post sounds a lot like the administrators at my school. Personally, I think this response, not you, not here obviously, but this response in general, when it comes from school officials, has more to do with some perceived threat to the AOA and NBOME than it does with student beneficence.

What?

Dude. Goro is just being gentle.

I see you put a lot of qualifiers on your reply, to indicate that you understand that Goro isn't who you are talking about... but I would challenge you to extend that same benefit of the doubt to anyone who gives this advice. Sometimes, it isn't a conspiracy. Sometimes vague simplicity is just the most tactful way to give hard advice.

Have you heard about the massive score inflation that happened to the Level 1 scores this year? Do you realize that you probably also failed your 3rd attempt but the score inflation bumped you high enough to pass? This is going to sound rough but taking Step 1 is out of the question. Just focus on honoring as many 3rd year rotations as possible.

Score inflation was in full effect in May 2017, as well.

OP should not have taken the exam with so much going on in life just then. Certainly, not that second try.

What matters is that OP passed. And yes, FM and IM are both still on the table, but do REALLY well on Level 2 and shine like a diamond in your rotations. Be sure you rotate at places you want to apply. People who know you as a student who works hard will give you more of a chance despite an early stumble than will people who only know you from your application.

 

[mk04447]

What?

Dude. Goro is just being gentle.

I see you put a lot of qualifiers on your reply, to indicate that you understand that Goro isn't who you are talking about... but I would challenge you to extend that same benefit of the doubt to anyone who gives this advice. Sometimes, it isn't a conspiracy. Sometimes vague simplicity is just the most tactful way to give hard advice.



Score inflation was in full effect in May 2017, as well.

OP should not have taken the exam with so much going on in life just then. Certainly, not that second try.

What matters is that OP passed. And yes, FM and IM are both still on the table, but do REALLY well on Level 2 and shine like a diamond in your rotations. Be sure you rotate at places you want to apply. People who know you as a student who works hard will give you more of a chance despite an early stumble than will people who only know you from your application.

Possibly, and schools may be different, but I hear this answer in ironclad succession at my institution. Maybe it's just my spider sense, but they feel like they're changing the subject too, in a slimy way. I've never heard anyone suggest, yes, under any circumstances. Just my n=1.

 

[Promethean]

Possibly, and schools may be different, but I hear this answer in ironclad succession at my institution. Maybe it's just my spider sense, but they feel like they're changing the subject too, in a slimy way. I've never heard anyone suggest, yes, under any circumstances. Just my n=1.

Weird.

Our school is about 80% - You should take USMLE if you can do well on it. And 20% - if you want FM so bad, why pay for the extra test?

And some of the people saying the former are definitely deeply invested in AOA / NBOME.

 

[W19]

What matters is that OP passed. And yes, FM and IM are both still on the table, but do REALLY well on Level 2 and shine like a diamond in your rotations. Be sure you rotate at places you want to apply. People who know you as a student who works hard will give you more of a chance despite an early stumble than will people who only know you from your application.

slim chances at ACGME IM, but ok chances at FM...

 

[Goro]

Funny, but the vague simplicity of your post sounds a lot like the administrators at my school. Personally, I think this response, not you, not here obviously, but this response in general, when it comes from school officials, has more to do with some perceived threat to the AOA and NBOME than it does with student beneficence.

What do you want? A full-blown essay explaining my rationale?. It's obvious that the OP is at risk of doing poorly on Step I.

We should not engage in Magic thinking.

This has nothing to do with school results, or the AOA or the n b o m e, this is about the OP.

 

[Goro]

Possibly, and schools may be different, but I hear this answer in ironclad succession at my institution. Maybe it's just my spider sense, but they feel like they're changing the subject too, in a slimy way. I've never heard anyone suggest, yes, under any circumstances. Just my n=1.

Maybe your faculty know their students?

 

[IsWhat]

A 240 on step 1 is, what, like 80th percentile? Don’t let SDN fool you, that’s a tough score for just about everyone.

 

[Lawpy]

I've been told to look into taking USMLE step 1 (if I can score above 240 on practice exams) and to aim high for step 2

I'll be surprised if you actually scored 240+ on the Steps given your COMLEX record. I haven't seen any cases of a low COMLEX/high Step combination.

 

[Dr.Jekyll75]

Give nbmes a shot if you really believe you can do it but Goro is right. Also this score inflation of level 1 i have not heard about. this is news to me.

 

[AlbinoHawk DO]

If you're not forced to release the scores for USMLE step 1, I say go ahead and take it. If you are forced to release it, don't take the chance and just do your best to tailor all your time into matching FM. This means attending conferences, doing some research, multiple rotations and auditions for it.

 

[Stagg737]

As was mentioned earlier, the risk/reward of taking Step 1 just isn't worth it. If you pass Step 1 with a low score, it's likely going to get overshadowed by 2 previous failures and if you fail Step 1 you're screwed. The only shot is if you managed to score average or better on Step 1, which is unlikely given your previous performance. Even then, everyone is still going to have those two failures sitting in the back of their minds.

Best thing to do at this point if you want to continue down the medical path is to focus on clinical rotations, start looking into which FM and IM programs like applicants from your school or take very weak applicants (which you should consider yourself even if the rest of your app is decent), and get in as many audition rotations as possible. At some places even the most egregious red flags can get overlooked if the PD, faculty, and residents at an audition love you. So just move on and bust your butt from here on out.

A 240 on step 1 is, what, like 80th percentile? Don’t let SDN fool you, that’s a tough score for just about everyone.

240 is around the 67th percentile. 80th percentile is around a 250. Even so, it's unlikely OP would hit either of those marks or even average given their previous performance.

I'll be surprised if you actually scored 240+ on the Steps given your COMLEX record. I haven't seen any cases of a low COMLEX/high Step combination.

I know one or two people who had lowish Level 1's (upper 400's) and had solid USMLE scores (upper 230s/lower 240s). They basically focused only on USMLE and did zero prep for COMLEX and said they weren't accustomed to the timing (less time for COMLEX) or phrasing of the questions (some are pretty poorly worded and require "magical thinking"). Those people are certainly the exception though.

 

[Lawpy]

I know one or two people who had lowish Level 1's (upper 400's) and had solid USMLE scores (upper 230s/lower 240s). They basically focused only on USMLE and did zero prep for COMLEX and said they weren't accustomed to the timing (less time for COMLEX) or phrasing of the questions (some are pretty poorly worded and require "magical thinking"). Those people are certainly the exception though.

Was this in the pre-COMLEX inflation days? How did they fare in the match (mainly in regards to ACGME vs AOA)?

 

[W19]

240 is around the 67th percentile. 80th percentile is around a 250. Even so, it's unlikely OP would hit either of those marks or even average given their previous performance.

I know one or two people who had lowish Level 1's (upper 400's) and had solid USMLE scores (upper 230s/lower 240s). They basically focused only on USMLE and did zero prep for COMLEX and said they weren't accustomed to the timing (less time for COMLEX) or phrasing of the questions (some are pretty poorly worded and require "magical thinking"). Those people are certainly the exception though.

Was ~ 73 percentile in 2016... with 228 average and 20 standard deviation.

 

[Goro]

You changed your picture. I like the cat.

My daughter felt the old one was on for too long

 

[ortnakas]

I know a few people with proportionally higher USMLE scores, like @Stagg737 usually due to focusing on UWorld and running into trouble because COMLEX is longer and has a different question style (not especially in a good way, but that’s a debate for another thread). The discrepancy is far smaller than what OP is picturing, though— I’m talking in the ballpark of 510s COMLEX and 220s/230 USMLE, which is far different than failing/sub500 COMLEX and 240s USMLE.

OP, I don’t think Step 1 is a safe option for you, especially if you’re talking about studying for it while on rotations. However, it sounds like your failures were at least partly due to some tragic problems that are now in the past, so if third year rotations and shelf exams go well, you could definitely consider taking Step 2 in addition to Level 2 to strengthen your application.

 

[mk04447]

What do you want? A full-blown essay explaining my rationale?. It's obvious that the OP is at risk of doing poorly on Step I.

We should not engage in Magic thinking.

This has nothing to do with school results, or the AOA or the n b o m e, this is about the OP.

Sure, send that in triplicate to my secretary. Oh, and I still expect you to finish those TPS reports.

 

[mk04447]

What do you want? A full-blown essay explaining my rationale?. It's obvious that the OP is at risk of doing poorly on Step I.

We should not engage in Magic thinking.

This has nothing to do with school results, or the AOA or the n b o m e, this is about the OP.

Well I've eliminated one school west of St. Louie.

 

[Stagg737]

Was this in the pre-COMLEX inflation days? How did they fare in the match (mainly in regards to ACGME vs AOA)?

I'm not really sure what the "pre-inflation" days were as the average is generally consistently between 510 and 520. When it does jump up in a year, the scoring is adjusted to bring the average back close to 500. The most recent data is for tests taken between May 2016-April 2017 and the mean was 519.52, as far as I've seen there is no data for this past year yet as the cycle isn't complete for the test dates.

The ones I know all matched ACGME, which was their goal and the reason they completely ignored studying for Level 1 and focused only on Step 1. Worked for them, but I believe they were also generally solid students who weren't concerned about failing COMLEX, which allows for a completely different mindset when studying.

 

[Promethean]

Well I've eliminated one school west of St. Louie.

🙄

 

[TeddyBoomBoom]

The COMLEX is *much* easier than the USMLE.

If you struggled so much for Level 1, for whatever reason, I wouldn’t even consider the Steps.

 

[DocWinter]

If your best comlex was below 500 on attempt #3, run, don't walk away from USMLE.

Do not buy into the "well it's a different exam"... doors remain open for you, but this is not one of them.

 

[Stagg737]

If your best comlex was below 500 on attempt #3, run, don't walk away from USMLE.

Do not buy into the "well it's a different exam"... doors remain open for you, but this is not one of them.

I mean, it is a different exam with a completely different set of challenges (OMM questions, very poorly worded questions/questions that require "magical thinking", several questions about seemingly random topics like latin legal terms or bioterrorism, etc). While USMLE may be tougher to do well on because of the quality of the pool of test-takers, I don't think it's more difficult (or only slightly more difficult) in terms of content than COMLEX as a whole. Either way, I still wouldn't advise someone who failed Level 1 twice to take Step 1, even if there were extenuating circumstances for those failures.

 

[Dr.Jekyll75]

I mean, it is a different exam with a completely different set of challenges (OMM questions, very poorly worded questions/questions that require "magical thinking", several questions about seemingly random topics like latin legal terms or bioterrorism, etc). While USMLE may be tougher to do well on because of the quality of the pool of test-takers, I don't think it's more difficult (or only slightly more difficult) in terms of content than COMLEX as a whole. Either way, I still wouldn't advise someone who failed Level 1 twice to take Step 1, even if there were extenuating circumstances for those failures.

I’d rather have them do a trial of nbmes . A fail is going to sink them more


Sent from my iPhone using SDN mobile

 

[BorntobeDO?]

I’d rather have them do a trial of nbmes . A fail is going to sink them more


Sent from my iPhone using SDN mobile

In most situations I would say I support the NBME (x3) trial as well. If he can score 230+ on 3 different forms, then I think its likely he will at least pass (it doesn't seem like people have greater than 20 point swings in general). But in this situation, I don't think it will help unless he withholds his Comlex and does Acgme only. I saw someone claiming to do this, so I guess its possible, but still, seems shaky to me.

Honestly Step 1 seems like a zero sum game at this point in most scenarios. But I am not the one taking the risks.

 

[Giovanotto]

If you take the COMLEX and USMLE, and you're applying AOA, can you choose not to release your USMLE score? if so, OP doesn't have much to lose, right?

 

[Dr.Jekyll75]

If you take the COMLEX and USMLE, and you're applying AOA, can you choose not to release your USMLE score? if so, OP doesn't have much to lose, right?

hes got time, and money to lose. some pds will straight up ask you why you didnt take the step, and then you have to lie and say you didnt for x reason

 

[ortnakas]

If you take the COMLEX and USMLE, and you're applying AOA, can you choose not to release your USMLE score? if so, OP doesn't have much to lose, right?

You don’t even have the option of giving your USMLE scores to AOA programs. However, by the time OP is applying, there will be very few if any programs left still in the AOA Match, so OP could sink their app with a failing/bad USMLE score on top of their existing COMLEX track record.

Most people should probably take USMLE to open doors, but it’s a bad idea for OP.

 

[niko327]

On the surface of your post, I'd say no way to Step 1. But there's a psychologic component here isn't there. You feel that extenuating circumstances are the reason for all the trouble on comlex (Sorry to hear about all that terrible stuff BTW). That may or may not be true. So put in a little work and take 3 or 4 NBME exams to answer your own question. If you find you didn't consistently score in the 240's (because you need to WOW them) it's a definite no go. But at least you'll have the peace of mind of knowing that you didn't just walk away from an opportunity. With all that being said, if I were you, I'd work my butt off on clinical rotations and focus entirely on level 2 at this point.

 

[DocWinter]

I really don't get why people are encouraging him to take NBOMEs and see how close to a 230/240 he can get. Maybe you haven't gone through this step process yet, but this is not a circumstantial issue or hard work issue. This should not be attempted by this particular student.

A student who fails comlex twice and cannot break 480 on round three will not get close to the mean on USMLE. The student would be fortunate to pass or hit a 210 at the highest with additional study short of many months off rotations or a remedial year of M1/2 material. NBMEs can serve as an expensive way to confirm this.

I'm probably too strong on this but the lack of realistic advice is irksome

 

[AlbinoHawk DO]

I mean, it is a different exam with a completely different set of challenges (OMM questions, very poorly worded questions/questions that require "magical thinking", several questions about seemingly random topics like latin legal terms or bioterrorism, etc). While USMLE may be tougher to do well on because of the quality of the pool of test-takers, I don't think it's more difficult (or only slightly more difficult) in terms of content than COMLEX as a whole. Either way, I still wouldn't advise someone who failed Level 1 twice to take Step 1, even if there were extenuating circumstances for those failures.

I did significantly better (percentile wise) on my USMLE compared to COMLEX. If your weakness is OMM (like it was for me), it pays off to take USMLE

 

[Stagg737]

I did significantly better (percentile wise) on my USMLE compared to COMLEX. If your weakness is OMM (like it was for me), it pays off to take USMLE

Right, but OP's situation isn't that cut and dry. If OP passed COMLEX first time with a 450 and was doing well in UWorld, I'd say do some NBMEs and definitely take Step 1 if the scores looked good.

OP failed Level 1 twice though and then got a mediocre score on the third try. On top of that, OP was scoring 100 points higher on their COMSAEs than they did on their first 2 attempts of the real thing. That is not promising for future exams. Let's say that trend continued with Step 1, then that 100 point drop on Level 1 would be like an 18 point drop on Step 1. So unless they're scoring in the 230's on their NBME's, there's no way I'd recommend they take Step 1, even if OMM was their weakness. They're likely to end up with a failure or really weak Step 1, which only confirms the thought in PD's minds that they're not a strong candidate (at least in terms of board scores). So why risk it when the reward is so low?

 

[AlbinoHawk DO]

Right, but OP's situation isn't that cut and dry. If OP passed COMLEX first time with a 450 and was doing well in UWorld, I'd say do some NBMEs and definitely take Step 1 if the scores looked good.

OP failed Level 1 twice though and then got a mediocre score on the third try. On top of that, OP was scoring 100 points higher on their COMSAEs than they did on their first 2 attempts of the real thing. That is not promising for future exams. Let's say that trend continued with Step 1, then that 100 point drop on Level 1 would be like an 18 point drop on Step 1. So unless they're scoring in the 230's on their NBME's, there's no way I'd recommend they take Step 1, even if OMM was their weakness. They're likely to end up with a failure or really weak Step 1, which only confirms the thought in PD's minds that they're not a strong candidate (at least in terms of board scores). So why risk it when the reward is so low?

My argument would be to take it if you can hide it if it's a failure. I know at one point this could be done. I would have more confidence on someone passing USMLE with a 200 after 2 board failures than no USMLE with 2 failures. Maybe those of you in FM know better than me in terms of how PDs would perceive a simple pass on the USMLE.

 

[samac]

My argument would be to take it if you can hide it if it's a failure. I know at one point this could be done. I would have more confidence on someone passing USMLE with a 200 after 2 board failures than no USMLE with 2 failures. Maybe those of you in FM know better than me in terms of how PDs would perceive a simple pass on the USMLE.

Being able to hide things is going to go away with th merger.

 

[AlbinoHawk DO]

Being able to hide things is going to go away with th merger.

Then never mind. Too much of a gamble.