Program Requirements and Not Passing Step 1

[astro-pilot]

So, I didn't pass step 1 the first time (blew it off, bad move). Anyway, what IM residencies require that you pass step 1 and 2 the first time?

Thanks.

---

Members don't see this ad.

 

[Clay]

Dartmouth requires a first time pass for Step 1 -- stated on their web page. I would bet that most competitive programs do as well. However, you still should be able to get a good residency. Good luck!

 

[doc05]

So, I didn't pass step 1 the first time (blew it off, bad move). Anyway, what IM residencies require that you pass step 1 and 2 the first time?

Thanks.

the good ones.

don't worry though, that still leaves you with a ton of potential IM programs.

 

[irlandesa]

"competitive" and "really good" are tossed around very carelessly on this board. The only program where I have seen it in writing that an initial Step 1 failure is not acceptable is Dartmouth, and I've heard this is mandated by the state of NH and applies to ALL of DHMC's residency programs. Check individual program websites to clarify.

 

[doc05]

"competitive" and "really good" are tossed around very carelessly on this board. The only program where I have seen it in writing that an initial Step 1 failure is not acceptable is Dartmouth, and I've heard this is mandated by the state of NH and applies to ALL of DHMC's residency programs. Check individual program websites to clarify.

maybe so, but even if it is not available in writing, think about it: would mass general take someone who'd failed their boards on the 1st try? of course not, regardless of what their written policy says. same goes for any other competitive program: there are just too many applicants without this blemish.

 

[bof]

failing step 1 is one of those red flags. i doubt that the top programs will interview you because of that flag. even if you get an interview, you will probably be ranked low on most residency rank list because you'll be labled a "boards risk" (ie you might fail your IM boards). that is a risk that most good programs don't have to take. i hate to sound harsh but i would apply broadly, and make sure that you rank every program that you would be willing to do your residency at (don't be suprised if you go to 8-12 on your rank list).

maybe so, but even if it is not available in writing, think about it: would mass general take someone who'd failed their boards on the 1st try? of course not, regardless of what their written policy says. same goes for any other competitive program: there are just too many applicants without this blemish.

 

[rhoboat]

Perhaps I'm overly optimistic, but i think that if you retake step 1 and score really well and then take step 2 early and also score well, the initial fail could be overlooked. Also, I would address the issue in your residency applications, you can always spin it into a humbling learning experience or something.

 

[Furrball]

I agree, if you fail Step 1, then take Step II early and do well. Maryland's PD said on interview day that if someone scores higher than 220 on Step 1m, then she has no concerns about their passing the ABIM exam.

 

[LaBelle]

I can speak from experience. I did not pass Step 1 during my first try but passed it on the second attempt. I took Step 2 in the early part of my 4th year and redeemed myself. Not sure why I didn't pass the first time around, but it certainly was not for lack of motivation or studying. To be honest, the subject rarely came up during my interviews.

Contrary to what most medical students or residents believe, life goes on even after failing the boards. It's a test --- that's all it is. It's not a particularly good indicator of intelligence nor does it reflect one's ability to become an outstanding physician. I applied to programs regardless of this so-called "blemish," and guess what? I got interviews at very respectable, competitive programs. My advice ... Apply all over --- Don't second-guess whether you're good enough for a given program; let the programs evaluate you as a whole and decide for themselves whether they should invite you to interview.

This is just an aside ... I've been reading this forum on and off since last November, and I'm curious .... where did all the egos come from? Why all the self-aggrandizement? There needs to be a reality check for most of you.

 

[Pili]

So, I didn't pass step 1 the first time (blew it off, bad move). Anyway, what IM residencies require that you pass step 1 and 2 the first time?

Thanks.

Realistically, you won't be able to get interviews at top notch programs. You might still be able to match at mid tier academic programs if you do very well on your second attempt AND really well on step 2 AND have a good academic record. I somehow suspect that your pre-clinical grades are less than stellar, it is not easy to honor pre-clinicals and then fail step 1. Work your butt off third year. Make sure to apply to lesser academic programs and a bunch of community programs. Your hunch is correct, failing step 1 is a bad move and a huge red flag for programs.

 

[rht]

LaBelle, you're money. I agree that everyone on this website is boarding on a significant axis 2 diagnosis starting with an n. I personally failed step one on two separate occasions, reflected on it, and turned it into a strength. Apparently, Beth Isreal and Stanford didn't have a problem. Anyway, any program that has such a cursory investigation into their applications is hardly what I would consider "competitive."

 

[Pili]

LaBelle, you're money. I agree that everyone on this website is boarding on a significant axis 2 diagnosis starting with an n. I personally failed step one on two separate occasions, reflected on it, and turned it into a strength. Apparently, Beth Isreal and Stanford didn't have a problem. Anyway, any program that has such a cursory investigation into their applications is hardly what I would consider "competitive."

Hard to believe it, dude. Unless you have a Nobel prize to compensate for it...or daddy in the admon committee. Anyway, peace.

 

[Proverbs31Chick]

Definitely don't let failing step I the first time keep you from applying to top IM programs. I spoke with 2 PD directors from two different top 5 IM programs and they both told me that they have had interns/residents in their programs who have failed the boards. I know, I was shocked to hear this too.

Just goes to show that it's all about the total package...Like everyone has been saying study hard and try to do well when you re-take step 1 and then step 2. Obviously, you want to make sure that the other aspects of your application are strong too (grades, letters, research if applicable, personality, etc).

Stay encouraged!

 

[rht]

Congrats on a great first post Proverbs31Chick... that's exactly what I found out in my own interview process. I, contrary to popular opinion, do not, in fact, have a daddy on any acceptance committee and am hardly close to being awarded the nobel prize... I highly doubt anyone with such intelligence would dare venture into medicine in this era. But what I do have is a well-rounded application with glowing letters, a well-written statement, excellent grades... which also contrary to popular opinion can occur in the context of poor step 1 performance. For you new applicants be aware that during the interview season I saw many overly confident applicants with big board scores get dissed by residents when they weren't looking and many humble applicants embraced by those same residents. Afterall, programs are looking for colleagues and co-workers, not egos. Sincerely, dude.

 

[Pili]

Congrats on a great first post Proverbs31Chick... that's exactly what I found out in my own interview process. I, contrary to popular opinion, do not, in fact, have a daddy on any acceptance committee and am hardly close to being awarded the nobel prize... I highly doubt anyone with such intelligence would dare venture into medicine in this era. But what I do have is a well-rounded application with glowing letters, a well-written statement, excellent grades... which also contrary to popular opinion can occur in the context of poor step 1 performance. For you new applicants be aware that during the interview season I saw many overly confident applicants with big board scores get dissed by residents when they weren't looking and many humble applicants embraced by those same residents. Afterall, programs are looking for colleagues and co-workers, not egos. Sincerely, dude.

Doing poorly on step 1 and having a good application otherwise does not pose the same challenges as FAILING step 1. I too have talked with many PDs and all said that to them, it is a huge red flag. This is true even for low tier academic programs. PDs think that the best predictor of how you will do on your ABIM exam is the USMLE. I think it is not fair to allow our poster to be overly optimistic. He can still match at a very good program, but it will be extremely difficult for him to land a top spot.

 

[Dazed]

LaBelle, you're money. I agree that everyone on this website is boarding on a significant axis 2 diagnosis starting with an n. I personally failed step one on two separate occasions, reflected on it, and turned it into a strength. Apparently, Beth Isreal and Stanford didn't have a problem. Anyway, any program that has such a cursory investigation into their applications is hardly what I would consider "competitive."

I don't believe it - there are lots of other applicants with very well-rounded applications that did very well on Step I. From their perspective, why would a program take someone who failed step I when they have their pick of the litter.

 

[Furrball]

LaBelle, you're money. I agree that everyone on this website is boarding on a significant axis 2 diagnosis starting with an n. I personally failed step one on two separate occasions, reflected on it, and turned it into a strength. Apparently, Beth Isreal and Stanford didn't have a problem. Anyway, any program that has such a cursory investigation into their applications is hardly what I would consider "competitive."

I think you're optimistic. I think their are some more like axis II cluster A, with a Dx that starts with an A.

 

[buz]

I think you're optimistic. I think their are some more like axis II cluster A, with a Dx that starts with an A.

rht,

I couldn't agree more with your post. I think that unless you have professional work experience prior to med school, it's easy to overlook the importance of the personality fit. Working with people you can't stand doesn't just make work miserable, but your life.

While I doubt it makes much difference in gaining an interview offer, I believe personality becomes critical in the program's final ROL.

 

[LaBelle]

Doing poorly on step 1 and having a good application otherwise does not pose the same challenges as FAILING step 1. I too have talked with many PDs and all said that to them, it is a huge red flag. This is true even for low tier academic programs. PDs think that the best predictor of how you will do on your ABIM exam is the USMLE. I think it is not fair to allow our poster to be overly optimistic. He can still match at a very good program, but it will be extremely difficult for him to land a top spot.

Pili, why do you speak as if you are the ultimate authority on the residency selection process? Do you have a crystal ball in front of you? You make it seem like those of us who have FAILED Step 1 will be branded for life ... that somehow we're inadequate, not worthy or capable of being at a top program, etc ... How ridiculous! The real measure of our success will ultimately come from patient gratitude, not our board scores! Truth is, you've got a much more serious "red flag" on your hands --- it's called being a pompous ass.

 

[scootad.]

haha! you tell 'em girl!

 

[CCMD2005]

Pili, why do you speak as if you are the ultimate authority on the residency selection process? Do you have a crystal ball in front of you? You make it seem like those of us who have FAILED Step 1 will be branded for life ... that somehow we're inadequate, not worthy or capable of being at a top program, etc ... How ridiculous! The real measure of our success will ultimately come from patient gratitude, not our board scores! Truth is, you've got a much more serious "red flag" on your hands --- it's called being a pompous ass.

Pili, are you going to take this??? FIGHT FIGHT FIGHT!!!! You need to Give this person a TEXAS STYLE TAKEDOWN

 

[Pili]

Pili, are you going to take this??? FIGHT FIGHT FIGHT!!!! You need to Give this person a TEXAS STYLE TAKEDOWN

I am aware that failing step 1 is a huge letdown, and what we are witnessing is the Kubler Ross stage of denial. I myself did not do so hot in step 1. If those who fail step 1 prefer to believe that MGH will be pouring interviews on them, that's their choice. I for one would recommend maximizing the strengths in the rest of the application, and be fully prepared to not land a top spot. And this is the last I am going to say on this thread.

 

[fantasty]

I have to agree with irlandesa and LaBelle on here (at least, the first post - not trying to be antagonistic).

I know I'm obsessed with the numbers game, but this board seems to think that there are only 5 or 6 IM programs worthy of consideration ("top tier"). There are 4500+ IM spots in 380+ programs. <60% of spots are filled by U.S. grads. And, when people on here are posting "mid tier" when it seems like they are talking about programs in the range of 10-25.

I'd be interested in see where the unfilled spots go and where people pick up spots in the scramble. But, for those "perfect" applicants without a blemish on their record (probalby 1% of the applicant pool), I imagine they could all get their #1 choice and there would still be a lot of primo spots left.

I'm not saying failing Step 1 is a minor problem, as > 90% don't fail. But, someone could still make up for that with outstanding other factors, and they might stand as good of a chance (if not better) than someone was fairly "typical" in their factors.

Even looking at the "where did everyone interview" thread - there are obviously a lot of factors that go into the selection process for the programs, so I doubt any of us can say with certainity what the OP's chances are at "top programs". So, just keep working hard and apply where you want to go (and rank them based on your preferences, not based on your assessment of the likelihood they were rank you).

 

[rht]

I leave for a couple of days and look what happens... but as much as I agree with Labelle on the assessment of Pili, I have to say Pili is correct in one regard... this is about providing the best information for the upcoming applicants. There are two groups of people writing in on this thread: Those who have been down the road of stuggling with the USMLE, interviewed at some great and highly competitive programs, and come out of it with some perspective, humility, and my guess is a pleasant surprise on Thursday.... and those who didn't stuggle with the boards but feel they can somehow contribute to this thread in an informed way. Pili, I highly doubt you talked with "many" program directors over what would have happened if, hypothetically, you hadn't passed step 1 just like I didn't talk with them about what would have happened if I had, hypothetically, rocked the test.

Certainly, whether holding a marginal pass or a 270 you should neither overestimate your credentials nor sell yourself short. The people who get burned are the ones who are arrogant, apply only to the best, piss off programs with their egos, and aren't left with a chair when the music stops or, conversely, the ones who avoid their dream schools because the don't think they can get in when they, in fact, had a reasonable shot. If you follow the advice from those on this thread who have experience with this situation, then it is clear that you should be careful to apply to good safety schools but also take your dream shots. You might just be surprised at who invites you for an interview. But be warned that pompous asses are a dime a dozen in medicine, they gravitate towards these "highly competitive" programs, and they're not fun to work with. Best of luck to all.

 

[scutmunky]

Stumbled across this thread. For the record, I am a non-IM resident, graduated from a so-called top 15 med school. In the interest of helping the initial poster and others in the future, here is the general rule of thumb:

USMLE scores (step 1 more than step 2) matters MOST to highly competitive programs. For example, ortho, rads, derm at traditionally prestigious programs. For the most part--just like college--how well you do academically (including board scores and SAT scores) are the easiest ways to directly compare candidates. 1500 on the SAT or 270 on the USMLE demonstrates that the candidate is at least somewhat intelligent (or a good test taker). Regardless, it is the easiest way for committees/PDs to compare applicants. GPA or grades at different schools are all relative and hard to compare between programs and schools/colleges.

That being said, obviously board scores arent everything. Good extracurriculars, evals, LORs, Deans letter, etc. will balance out an applicant. Most IM programs take/interview a mix of candidates who look great on paper, and those who have a more "well rounded" application. For instance, I know several ortho residents who got "average" on the USMLE (~220) but still matched at VERY competitive programs due to strong Sub-Is and cool personalities. On average, the most competitive programs will decide not to interview based on board scores (many rads or ortho programs are rumored to have a 220 + cutoff). In order to get interviews, usually the lower scoring applicants do a sub-I and shine.

FAILING the boards is DEFINITELY a red flag--to any tier program in any field (ortho or FP). It is definitely not the end of the world, but it makes life a lot harder and unless one does a sub-I or phenomenal research, most likely will not get any interviews from so-called top tier programs. Not never, but usually not. That being said, the great thing about IM is the # of spots and programs. THere are tons of great programs. Think of rad-onc or ENT or urology. A failing score is almost the kiss of death.

Bottom line, dont lose hope--period. If you shine on rotations, and impress the powers that be, you will get a spot no matter what specialty or USMLE score.

 

[Easydoesit]

FAILING the boards is DEFINITELY a red flag--to any tier program in any field (ortho or FP). It is definitely not the end of the world, but it makes life a lot harder and unless one does a sub-I or phenomenal research, most likely will not get any interviews from so-called top tier programs. Not never, but usually not. That being said, the great thing about IM is the # of spots and programs. THere are tons of great programs. Think of rad-onc or ENT or urology. A failing score is almost the kiss of death.

Very well put!

SO do everything you can to do well on the USMLEs!

 

[pedronavaja2005]

Hmm

My classmate and friend matched at Yale for IM after failing STEP 1. That person got interviews at top places like Cornell as well.