Question regarding low USMLE

[bluezeno]

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If I have a bad day and receive a USMLE score, say around 220, would it be possible to eventually match into derm if shown the effort (fellowship, reapplying for the 3rd time) or will a low USMLE score just automatically always disqualify you? Basically, what I'm asking is will a USMLE score of ~220 pretty much guarantee that you'll never be able to match into derm even with great letters and descent school grades? Also, with a score of 220, most advisors will advise against applying to derm. If the only thing I want to do is derm, then should I ignore them and still apply even though I know it's going to be a lost cause?

Thank you.

 

[2012mdc]

This is just hearsay but there are people who have matched into Derm without a good Step 1 score. I don't know if they had great connections, great LOR's, a million pubs or whatever but it does happen.

Go for what you want and apply very broadly and be optimistic 😎

 

[dermalot]

you would have to have amazing connections, amazing letters, amazing pubs and amazing grades-- all of them, not just one or two!! if derm is your ONLY interest, consider trying to back door your way into MD/PhD. MD/PhDs always match, regardless of step scores (i have no basis for this statement, but i think most people will agree)... at my school, a lot of people dropped out and they were willing to add people on even in the 3rd year. or, if you can do a fellowship at a place that has a VERY STRONG track record of taking their fellows. people do match with 220 or lower, but it is exceedingly difficult

 

[starbuckscoffee]

I agree with dermalot.

With that low of a step score, you're unlikely to match unless there's something else amazing in your application. Programs that screen using USMLE often set 240 or 245 as a minimum just to look at your app.

 

[FixItUp Chappie]

Do 3 away rotations (at say one reach program and 2 moderate/low tier programs), and be the best medical student and best person that they have ever seen. Come a little early, stay a little late, answer questions appropriately when asked, don't ask to many questions yourself, don't show off, be polite and friendly with everyone, seek out opportunities to do some scut work on a current research project, etc...

If you can make a program love you early on, then they won't care as much about your 222.

I have heard rumors of a high 180's (yes 180's) getting into a top program a few years back, because they rotated there. Make sure the 220 is the only thing holding you back.

 

[werd]

it's difficult but possible. what you need is a program (esp. your home program) to love you enough to rank you very high anyway. i think there are at least several cases where this happens each year.

the reason it's so tough to break though a low score are that 1) there's so many other good applicants with high scores and 2) the derm boards are tough and many very smart people fail each year; programs worry about training someone that will fail their boards at the end of training.

 

[DermToBe83]

Hi Bluezeno,

If derm is the only thing you can see yourself doing, then go for it! Each program is different. I've personally encountered programs that use USMLE scores to screen before accepting a student for an away rotation (240) and others that use USMLE scores to screen before inviting a student to interview (250). However, I've also spoken to a PD who told me the cut-off at their institution to interview a student was 200. As you can see, it depends! Plus, if you look at the mean score for those who matched into derm, it's obvious that not everyone scored 260+.

There are things on your application that you won't be able to change (e.g. scores) and things that you will be able to change (e.g. publications, research, etc.), so focus on the latter. Also, don't underestimate the importance of enthusiasm and personality!

And yes, aways are good, especially at small programs that care more about how you integrate with the group as opposed to how good your scores are.

Good luck!

 

[Nellyakgo]

... at my school, a lot of people dropped out and they were willing to add people on even in the 3rd year. or, if you can do a fellowship at a place that has a VERY STRONG track record of taking their fellows. people do match with 220 or lower, but it is exceedingly difficult

This is probably going to seem as a very dumb question, so apologies in advance. I'm not from the US system, new to the environment and learning my way around. What is a fellowship and how does it work? I mean, is it something one does after graduation? Is it for only a couple of months? Is it a paid/non paid position? Does one have to be from a US medical school to do it? How does the duties/tasks/hours differ from that of a residency?

And also a second question please: You wrote people drop out of dermatology programs. And they're willing to add people even in 3rd year. Can you please elaborate? Someone drops out at their 3rd year of the derm res and then they add someone as a new 1st year derm res or do you mean they will add someone who's already been a non-derm resident somewhere else for at least 2 years and they do a "lateral transfer" as a 3rd year res into this derm program? If the latter, which types of residency programs are they more willing to "laterally transfer in" candidates from?

Thanks

 

[HoganHulk]

There are many types of fellowships. They are usually 1 year or 2. Usually they are paid but you have to find them and apply. Many require a medical license so you would need to do your internship first. Others are more basic science so you wouldn't need a medical license. They are probably the single best thing to do to improve your application.

There are others that are 1 year and are done between years of medical school.

I dont think he meant people drop out of derm residency.. what he meant was that people drop out of MD/PHD programs so you can fill those spots as a medical student.

 

[Nellyakgo]

What's the difference between an internship and a residency? And if I need to be licensed to do certain types of fellowships that means I've already done a residency, right? In that case why would I want a fellowship?
Sorry for the barrage of Qs. Is there somewhere I can read up on fellowships do get a broader understanding?

 

[asmallchild]

it's difficult but possible. what you need is a program (esp. your home program) to love you enough to rank you very high anyway. i think there are at least several cases where this happens each year.

the reason it's so tough to break though a low score are that 1) there's so many other good applicants with high scores and 2) the derm boards are tough and many very smart people fail each year; programs worry about training someone that will fail their boards at the end of training.

Point 1 is certainly valid

I've heard Point 2 repeatedly on the interview trail too. I wonder if there's a proven correlation between Step 1 performance and the ability to pass the derm boards?

 

[mohderm]

If I have a bad day and receive a USMLE score, say around 220, would it be possible to eventually match into derm if shown the effort (fellowship, reapplying for the 3rd time) or will a low USMLE score just automatically always disqualify you? Basically, what I'm asking is will a USMLE score of ~220 pretty much guarantee that you'll never be able to match into derm even with great letters and descent school grades? Also, with a score of 220, most advisors will advise against applying to derm. If the only thing I want to do is derm, then should I ignore them and still apply even though I know it's going to be a lost cause?

Thank you.

I may be reading this incorrectly, but have you taken Step1 yet?

If not then why are you wasting your time with a hypothetical situation? Get off of SDN and log into USMLEWorld so that hopefully you won't have to worry about a score of 220.

 

[werd]

Point 1 is certainly valid

I've heard Point 2 repeatedly on the interview trail too. I wonder if there's a proven correlation between Step 1 performance and the ability to pass the derm boards?

whether or not the correlation is proven (it's probably not), i can verify it's what some programs discuss when they sit down together.

 

[Nellyakgo]

What's the difference between an internship and a residency? And if I need to be licensed to do certain types of fellowships that means I've already done a residency, right? In that case why would I want a fellowship?
Sorry for the barrage of Qs. Is there somewhere I can read up on fellowships do get a broader understanding?

 

[werd]

What's the difference between an internship and a residency? And if I need to be licensed to do certain types of fellowships that means I've already done a residency, right? In that case why would I want a fellowship?
Sorry for the barrage of Qs. Is there somewhere I can read up on fellowships do get a broader understanding?

internship is the first year of residency. fellowships are done after residency for ppl who want to further specialize within a field.

 

[Dral]

What's the difference between an internship and a residency? And if I need to be licensed to do certain types of fellowships that means I've already done a residency, right? In that case why would I want a fellowship?
Sorry for the barrage of Qs. Is there somewhere I can read up on fellowships do get a broader understanding?

Think of residency training in terms of PGY's (Post graduate years).

For Dermatology in the US:
Internship (still part of residency) = 1st year of residency (PGY-1)

Residency (Advanced years) = 2nd, 3rd, 4th years of residency (PGY-2, PGY-3, PGY-4)

Fellowship = follows residency: Training in dermpath, surgical/procedural/Mohs, Immunology, Pediatrics, etc.




However, there are two types of 'fellowships' in dermatology: Ones that someone participates in after they have completed all their residency, or ones that people are referring to in this thread, which is a fellowship before you would start PGY-2.

This type of fellowship is usually a 'research fellowship'. Since it often involves clinical aspects, they often require you to finish an intern year (and Step III if I'm not mistaken) before you are eligible for the fellowship.

It's fairly different from the typical fellowship done after completion of all of residency, but is still called a 'fellowship'.

I believe there are some 'research' fellowships that focus on basic science and may not require completion of an intern year prior to participating in the fellowship.

I hope that helps.

 

[asmallchild]

What's the difference between an internship and a residency? And if I need to be licensed to do certain types of fellowships that means I've already done a residency, right? In that case why would I want a fellowship?
Sorry for the barrage of Qs. Is there somewhere I can read up on fellowships do get a broader understanding?

An internship is typically one year in medicine, surgery, pediatrics, or a transitional year.

A residency (which can encompass an internship year, to make things more confusing) is variable in length depending on what you choose to do.

In this forum, an internship is one year typically in medicine/surgery/transitional. And then the derm residency is 3 years afterwards.

You will need to complete a derm residency to be eligible for certain fellowships which come after residency training. You may want to pursue certain fellowships because derm residency (while it will give you plenty exposure to these different areas) may not be enough to fully prepare you: MOHS surgery, dermatopathology, pediatric dermatology are some of the fellowships I've heard of.

 

[Nellyakgo]

Thank you very much asmallchild, drall and werd (written in alphabetical order 🙂)

 

[MsMacey]

i would be as prepared as i possibly could for not matching into derm, like applying to other specialties.. if you dont match and reapply your odds of matching are even lower

 

[Nellyakgo]

i would be as prepared as i possibly could for not matching into derm, like applying to other specialties.. if you dont match and reapply your odds of matching are even lower

Is there data that shows second time applicants' match rates are lower? Is this across all specialties or specifically for derm?

 

[pupster]

If I have a bad day and receive a USMLE score, say around 220, would it be possible to eventually match into derm if shown the effort (fellowship, reapplying for the 3rd time) or will a low USMLE score just automatically always disqualify you? Basically, what I'm asking is will a USMLE score of ~220 pretty much guarantee that you'll never be able to match into derm even with great letters and descent school grades? Also, with a score of 220, most advisors will advise against applying to derm. If the only thing I want to do is derm, then should I ignore them and still apply even though I know it's going to be a lost cause?

Thank you.

People I know have matched into derm. w/ a Step 2 in the 180s and a Step 1 that wasn't much better. They had great letters and awesome research.

 

[pupster]

Is there data that shows second time applicants' match rates are lower? Is this across all specialties or specifically for derm?

http://archderm.ama-assn.org/cgi/content/abstract/archdermatol.2010.303v1

http://www.ncbi.nlm.nih.gov/pubmed/18694691

 

[scumbagderm]

I personally know of sub-220, even sub 210 matchers. Usually it is due to research experience/completion of research fellowship, having a PhD, and/or having special connections.

 

[pupster]

I personally know of sub-220, even sub 210 matchers. Usually it is due to research experience/completion of research fellowship, having a PhD, and/or having special connections.

Yeah...I should have added that the people that I know that got in had PhDs AND had completed research fellowships and demonstrated that they could bring in grants. Plus, they had developed connections through their work.