MD Residency application with a low Step1 score

[mangobrz]

Hi everyone!

I am a medical student attending a state medical school in the US. I got an unexpectedly low Step1 score (208) and I am distraught about it. I am interested in Cardiology right now so planning to apply to IM residencies (haven't completely ruled out surgery though). I am currently doing a research year between my M2 and M3 years and will probably have 2 papers out of this period. I still have all of my rotations/clerkships and Step2 left.

I am looking for advice about the following:
- how to counteract my Step1 score
- how to do well on rotations/clerkships to get "honors" in them
- my chances at a top IM program, especially in NYC or Boston (I was really hoping to apply to top programs but now it seems that my chances are very slim of getting an interview)
- any other residency specialties I should consider due to my low score

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[Redpancreas]

Hi everyone!

I am a medical student attending a state medical school in the US. I got an unexpectedly low Step1 score (208) and I am distraught about it. I am interested in Cardiology right now so planning to apply to IM residencies (haven't completely ruled out surgery though). I am currently doing a research year between my M2 and M3 years and will probably have 2 papers out of this period. I still have all of my rotations/clerkships and Step2 left.

I am looking for advice about the following:
- how to counteract my Step1 score
- how to do well on rotations/clerkships to get "honors" in them
- my chances at a top IM program, especially in NYC or Boston (I was really hoping to apply to top programs but now it seems that my chances are very slim of getting an interview)
- any other residency specialties I should consider due to my low score

You’re not getting anywhere close to any of those programs, but you’ll probably match IM somewhere as long as you don’t have multiple other red flags. It’s not only getting the interview but Step 1/2 are considered for ranking as well. Your ceiling at this point is a low/mid tier academic IM program. Whether you end up there or a community IM will depend on Clinical grades and Step 2. Just improve by 30-40+ points on CK. Buy UWorld soon and start doing it alongside clerkships. You’re probably good with IM/Surgery as you likely won’t be getting surgical subspecialties. There’s tons of threads on how to honor third year on the Clinical subforum. Good luck.

Regarding surgery, doing poorly on Step 1 does put you at a high risk of not matching but it’s not impossible to match especially with honors in surgery among other things, but don’t go insane trying to achieve these things.

Edit: The research gap year helps and you’re likely going to end up at an academic place somewhere, but probably nothing in the top 30-40 I’d say. Even most mid tier places screen at >220, but I suppose the research gap year shows commitment to academia and programs may be willing to overlook your Step 1 for that reason. Also, matching Cardiology from IM may be difficult but not out of the question.

 

[Oso]

my chances at a top IM program, especially in NYC or Boston (I was really hoping to apply to top programs but now it seems that my chances are very slim of getting an interview)

Very unlikely this will happen.


Forget about applying to residency right now/ what “tier” you should apply to/ where you will get interviews. That will come much later.

Here’s what you need to think about right now (aside from your research):
- how to excel in clerkships - grades are very important. Look through the forums for all kinds of advice on how to excel on the different clerkships.
- doing well on clerkships —> good LOR’s + good step 2

You need to destroy step 2 and excel in clerkships to demonstrate that the step 1 was a fluke.

If you do well on that stuff you can match IM and probably have a shot at some academic places, though likely not “top” programs. Is cardiology still in the cards? Yeah. Surgery will be more difficult but still possible. Again, we don’t have enough information to tell you anything other than you probably won’t go into ortho/derm/optho/etc or top IM/surgery programs.

Come back after you finish third year and we can talk about what kind of programs to apply to.

Best of luck.

 

[mangobrz]

Edit: The research gap year helps and you’re likely going to end up at an academic place somewhere, but probably nothing in the top 30-40 I’d say. Even most mid tier places screen at >220, but I suppose the research gap year shows commitment to academia and programs may be willing to overlook your Step 1 for that reason. Also, matching Cardiology from IM may be difficult but not out of the question.

Thank you for your feedback Syncrohnize. Why would matching Cardiology from IM be difficult? Will my Step1 score be considered during fellowship applications as well or is it because I won't be at a top-tier IM residency?

Also which other residency specialties should I consider with my score besides IM - Neuro? Peds? Ob/Gyn?

 

[mangobrz]

Very unlikely this will happen.


Forget about applying to residency right now/ what “tier” you should apply to/ where you will get interviews. That will come much later.

Here’s what you need to think about right now (aside from your research):
- how to excel in clerkships - grades are very important. Look through the forums for all kinds of advice on how to excel on the different clerkships.
- doing well on clerkships —> good LOR’s + good step 2

You need to destroy step 2 and excel in clerkships to demonstrate that the step 1 was a fluke.

If you do well on that stuff you can match IM and probably have a shot at some academic places, though likely not “top” programs. Is cardiology still in the cards? Yeah. Surgery will be more difficult but still possible. Again, we don’t have enough information to tell you anything other than you probably won’t go into ortho/derm/optho/etc or top IM/surgery programs.

Come back after you finish third year and we can talk about what kind of programs to apply to.

Best of luck.

Thank you Oso! I believe Step1 was a fluke (unfortunately) so will do my best on clerkships and Step2.

Who should I be aiming to get LOR's from during clerkships? Do you recommend one per clerkship and then choose the three strongest at the end?

Will a non-clinical LOR from my research mentor for this year help as well?

 

[Redpancreas]

Thank you for your feedback Syncrohnize. Why would matching Cardiology from IM be difficult? Will my Step1 score be considered during fellowship applications as well or is it because I won't be at a top-tier IM residency?

Also which other residency specialties should I consider with my score besides IM - Neuro? Peds? Ob/Gyn?

Um...because last time I checked Cardiology was a very competitive fellowship...and because you’re a below average applicant. Many programs will atleast screen at >220 for Step 1/CK. Some even supposedly screen at 80th percentile according to things I’ve read.

That said, if you apply broadly and work hard in residency, you may still have a decent shot so if your heart is set on Cardiology, I encourage you to pursue it. Even if you don’t match initially, I’d rather lose 300K doing a chief year/reapplying than doing Neurology or OB/GYN.

Do some more SDN reading. All your questions are constantly being answered on here and a book could be written in response to each. Given your Step 1 score, the best thing you can do for yourself is find a way to take Step 2CK early and score 250+ on it so start looking at UW and OME.

 

[mvenus929]

Thank you for your feedback Syncrohnize. Why would matching Cardiology from IM be difficult? Will my Step1 score be considered during fellowship applications as well or is it because I won't be at a top-tier IM residency?

Also which other residency specialties should I consider with my score besides IM - Neuro? Peds? Ob/Gyn?

If you're gunning for IM/Cards, I don't want you in peds. But, your score will not preclude you from a good peds residency.

Really, you should focus on doing well and finding out what your interests truly are in third year. A LOT of people change their mind, and you may too. You may be okay with general IM. You may want surgery or OB. You may decide you want a little of everything and do FM. Your step 1 score will be something to overcome, but if you do well on your clerkships and do much better on step 2, you can still match at a decent program in most specialties. Not Derm or the Surgical Subspecialties, but most others.

 

[W19]

I wonder what % percentage of US students got <210 in step1 and ended up crushing step2 (255+)...

What was your practice score average? If it was 225+, your 208 is probably a fluke... Your best shot right now might be low tier academic IM and community programs. Even low tier academic programs might screen for > 210+... I might be wrong here, but I don't think many mid tier would take a bite if other parts of your application are not outstanding (e.g.., step2...240+, research, good clinical grades and LORs)

 

[Med Ed]

Hi everyone!

I am a medical student attending a state medical school in the US. I got an unexpectedly low Step1 score (208) and I am distraught about it. I am interested in Cardiology right now so planning to apply to IM residencies (haven't completely ruled out surgery though). I am currently doing a research year between my M2 and M3 years and will probably have 2 papers out of this period. I still have all of my rotations/clerkships and Step2 left.

I am looking for advice about the following:
- how to counteract my Step1 score
- how to do well on rotations/clerkships to get "honors" in them
- my chances at a top IM program, especially in NYC or Boston (I was really hoping to apply to top programs but now it seems that my chances are very slim of getting an interview)
- any other residency specialties I should consider due to my low score

This is the story of one of my classmates, only she got lower than a 208. Here is how she won in the end:

1. Rotations: first one in, last one out. Team player, improved every week, showed great interest and tried to learn from every experience.
2. Spent all available free time in M3 reading about her patients or Step 2 CK review books.
3. Killed Step 2 CK (see #2).
4. Applied broadly. There are a lot of very high quality programs, particularly in the upper midwest, that get overlooked.

She matched well and then did fellowship a rung further up the ladder.

 

[Lexdiamondz]

You absolutely can match IM and end up in a Cardiology fellowship, it's just gonna be somewhat harder.

You probably aren't going to snag a top-tier IM residency in NYC or Boston though (you do realise that effectively limits you to Harvard, Columbia, Cornell and NYU right?) - a 208 from a state school isn't going to get you in the door in any of those places. Your best bet is to focus on being productive on your research year (get at least 2-3 papers out of it) as well as destroying your clerkship year and Step 2 - you want to tee yourself up for a strong mid-tier program with good fellowship prospects in house (ie: Tufts, BU/BMC, Montefiore, Northwell, etc)

 

[tulsi3patel]

Hi everyone!

I am a medical student attending a state medical school in the US. I got an unexpectedly low Step1 score (208) and I am distraught about it. I am interested in Cardiology right now so planning to apply to IM residencies (haven't completely ruled out surgery though). I am currently doing a research year between my M2 and M3 years and will probably have 2 papers out of this period. I still have all of my rotations/clerkships and Step2 left.

I am looking for advice about the following:
- how to counteract my Step1 score
- how to do well on rotations/clerkships to get "honors" in them
- my chances at a top IM program, especially in NYC or Boston (I was really hoping to apply to top programs but now it seems that my chances are very slim of getting an interview)
- any other residency specialties I should consider due to my low score

I am looking for advise on what are the chances on step1 score of 218 for Internal at Mid tier program.