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Lemon Doctor

Lemon Doctor

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DO student. Above avg COMLEX 1. Several months later, it was suggested to me to take USMLE to be more competitive for ACGME programs. Was busy on rotations and hadn't studied Step 1 material in a while, but took a couple of NBME's and did well, so went ahead and took USMLE 1. Got a 186, FAIL. 😱 Was expecting more like a 220.

So it looks like I took an otherwise competitive application, and pretty much trashed it. Question is: What's the best course of action now?

If I retake USMLE 1 and pass, the failed attempt will still show. So would it be worth it? Will I be screened out anyway? Or should I forget about USMLE 1 and crank out a killer USMLE/COMLEX 2 since that is what I should be studying now? Or will the failed USMLE 1 attempt still knock me out of contention?

I guess I'm wondering what the best bang for my buck (time, energy) is at this point? What's the best "fix" I can put on this bad situation?

I could just apply to AOA programs, but I didn't want to limit myself and the ACGME places are more desirable to me.

Any advice is appreciated.
 
I don't know that this is the best forum for this question (especially since the match is over now and likely won't see a ton of viewers) but I'll try to answer....What specialty are you applying to? I would think that if you are still planning on applying to ACGME residency programs that you will probably want to retake USMLE Step 1 and pass it. I am saying this because at least they will have (hopefully) a passing score to look at, rather than to see a failing score with no passing score after it. If you studied a ton and worked your butt off during the first attempt, then maybe that wouldn't be the best but by your own admission, it sounds like you didn't take studying for USMLE Step 1 very serious. If you have the time to buckle down and seriously study for USMLE Step 1, then do it. I guess the other concern is that the farther you get away from your first 2 years of medical school, the faster you forget that information. You risk failing it twice, which would be pretty devastating for your ACGME application. This is a tough situation. Either way, you need to do well on Step 2. Good luck!
 
I don't think you have any choice but to retake USMLE Step 1 if you are applying to ACGME programs.

There are some programs that will take your COMLEX and don't require USMLE; perhaps you can concentrate on those. However, since you've take it and failed, frankly to not retake the exam looks a little lame.

In general, Step 2 will not "replace" Step 1 especially if the latter is a fail and hasn't been retaken. Programs that use Step 1 as a filter will likely not even see your Step 2 score.
 
Lemon Doctor said:
DO student. Above avg COMLEX 1. Several months later, it was suggested to me to take USMLE to be more competitive for ACGME programs. Was busy on rotations and hadn't studied Step 1 material in a while, but took a couple of NBME's and did well, so went ahead and took USMLE 1. Got a 186, FAIL. 😱 Was expecting more like a 220.

So it looks like I took an otherwise competitive application, and pretty much trashed it. Question is: What's the best course of action now?

If I retake USMLE 1 and pass, the failed attempt will still show. So would it be worth it? Will I be screened out anyway? Or should I forget about USMLE 1 and crank out a killer USMLE/COMLEX 2 since that is what I should be studying now? Or will the failed USMLE 1 attempt still knock me out of contention?

I guess I'm wondering what the best bang for my buck (time, energy) is at this point? What's the best "fix" I can put on this bad situation?

I could just apply to AOA programs, but I didn't want to limit myself and the ACGME places are more desirable to me.

Any advice is appreciated.
Click to expand...
The most important question. What field are you applying?
 
If you were thinking about a competitive MD residency, you are in a bind. I applied to a mid competitive MD residency this year and experienced first hand how important it is for a DO student to have a great USMLE step 1 score. in a specialty of my choice first attempt USMLE step 1 <220 for a DO was considered a pretty mediocre score. My guess is that a failed first attempt for a DO student would simply = no interview.

Maybe consider a DO residency? Of course a lot depends on the specialty you are applying for
 
Sorry to hear this happened to you. If you're sure you wouldn't be satisfied with a DO residency and you are going into a specialty where the ACGME programs are relatively DO-friendly (if you're aiming for a specialty that doesn't take a lot of DOs like say derm I would say it might not be worth your trouble to retake it and just to try to focus on finding the best DO programs), I agree that taking Step 1 again is the way to go.
Good luck to you!
 
Thanks for the replies. I guess the question was somewhat rhetorical and I just wanted to hear someone else say the answer instead of saying it myself.

If I want to apply just to AOA programs, I could forget about this whole mess and just move on. If I want to apply to ACGME programs, I would have been better off never having taken the USMLE, but since I did, I need a passing score, since I've got to report it on ERAS and it seems unlikely any program is going to be too excited about one attempt and fail. A lot of programs may screen me out for this alone, but there may be some that don't, as long as there is a passing score on the second attempt. Clearly a good score would be better yet.

I'm not sure what I'll apply for... FM, EM, PM&R? I need to do a couple more rotations to narrow it down. There are obviously some good AOA programs, I just haven't enjoyed the AOA politics - and their locations are limited. But I'll make due with whatever I need to.
 
Just a suggestion, but there is also the option (that no one really talks about) of just not reporting your USMLE scores when applying for residency. If you don't provide your USMLE# to ERAS then there should be no way for residency programs to which you've applied to get your USMLE scores. The key words here are "should be no way", though, and this could be a risky strategy because the ERAS rules state that you must report both scores if you have them. My personal opinion is that this is an unenforceable rule on their part, but understand that you would do this at your own risk. There are people on SDN who mention that they or people they know have gone this route successfully.
 
It's perfectly legal for the ERAS application to ask whether you've taken the USMLE or not. Legally, I doubt they can force you to release it (although that's their policy). Simply not reporting it at all is clearly application fraud. If it's discovered at any time, your entire career is at risk. It's unlikely that anyone would notice, though.
 
wanna_be_do said:
Just a suggestion, but there is also the option (that no one really talks about) of just not reporting your USMLE scores when applying for residency. If you don't provide your USMLE# to ERAS then there should be no way for residency programs to which you've applied to get your USMLE scores. The key words here are "should be no way", though, and this could be a risky strategy because the ERAS rules state that you must report both scores if you have them. My personal opinion is that this is an unenforceable rule on their part, but understand that you would do this at your own risk. There are people on SDN who mention that they or people they know have gone this route successfully.
Click to expand...

As of 2008 DOs MUST report any and all USMLEs taken....As stated by "wanna-be-do", probably not enforceable but more likely NOT worth the risk of getting caught in a lie....even if you have an acceptance, it could be withdrawn if they found out.
Also.........TAKE USMLE Step 1 again
Also.....please try to tell the classes coming up behind you how important it is to take the USMLE.
 
Interesting stuff.

I don't agree with the policy - seems odd they can make you report whether you've taken the exam or not. But it is what it is. Personally, I don't think risking your career is worth it. Even though - like you guys said - chance of anyone finding out is probably nil (as long as MSPE doesn't include it). Still, it's possible. And the consequences could be devastating.

Some programs may screen me out, but those that don't may appreciate that I overcame the adversity.

I will say that if the policy was different, I would just forget about retaking it and focus on COMLEX 2, which is of course what I should be working on right now.

BTW- I only took USMLE b/c I did well on COMLEX 1 and scored >200 on 2 consecutive NBME's. I figured I had nothing to lose and would only be boosting my competitiveness by adding this. Boy was I wrong! It just happened to be a tough week, tough day, tough test, tough everything; and obviously I needed to be more prepared.

If I decide to just apply to AOA programs, I could forget about this mess and focus on COMLEX 2, which is tempting. But I was pretty disappointed with the failure and am leaning towards taking and passing this thing.
 
FutureInternist said:

Also.....please try to tell the classes coming up behind you how important it is to take the USMLE.
Click to expand...

I'm not sure how important it really is. Hindsight 20/20, I wish I hadn't taken it. I would be a MUCH more competitive candidate than I now am. Not to mention the $ I'm sinking into this process.

Want to go to a highly competitive place? Sure, you probably need it. Most other places, probably not. But what happens if [surprise!!] you drop 25+ points below your NBME's and fail?😕

It's a question I wish I didn't know the answer to. I got a 186/74 BTW.
 
Lemon Doctor said:
I'm not sure how important it really is. Hindsight 20/20, I wish I hadn't taken it. I would be a MUCH more competitive candidate than I now am. Not to mention the $ I'm sinking into this process.

Want to go to a highly competitive place? Sure, you probably need it. Most other places, probably not. But what happens if [surprise!!] you drop 25+ points below your NBME's and fail?😕

It's a question I wish I didn't know the answer to. I got a 186/74 BTW.
Click to expand...

Hindsight is 20/20, but I would hope that you learned that taking a major exam with little preparation was your mistake not taking the USMLE Step 1, especially since you're unsure of your desired specialty. Unless you're sold on doing a DO residency (and that's hard to decide your 2nd year of med school), I also recommend taking Step 1 with major preparation. I just matched this recent match as a DO student into a competitive allopathic residency and I feel my USMLE scores helped along with strong sub-i performances at allopathic residency programs. The match is getting more difficult with each passing year and IMGs and FMGs are going to feel most of the squeeze, but DO & allopathic seniors are certainly not exempt. I would do whatever I could to maximize your odds of matching into the program of your choice, or at least of your desired specialty. Good luck!
 
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Lemon Doctor said:
I'm not sure how important it really is. Hindsight 20/20, I wish I hadn't taken it. I would be a MUCH more competitive candidate than I now am. Not to mention the $ I'm sinking into this process.

Want to go to a highly competitive place? Sure, you probably need it. Most other places, probably not. But what happens if [surprise!!] you drop 25+ points below your NBME's and fail?😕

It's a question I wish I didn't know the answer to. I got a 186/74 BTW.
Click to expand...

UT Houston, UTMB - Galveston ....Not that competitive, but require USMLE step 1 (for IM atleast)
UT San Antonio - Will not interview unless you have passed BOTH USMLE step 1 & 2

How much greater than 200 were your 2 scores ?? If close to 200 then not a surprise since test day anxiety, timing issues, noisy neighbours etc do play a part..... but if you are getting 230s etc then you are most likely a minority in that you dropped 50 points
 
I re-studied (for real this time - not nights and weekends while on a busy rotation) and re-took USMLE 1 and got a 220. Score converters had me thinking ~230 was more likely, but I'm not complaining. (Based on my last experience, I didn't really believe it anyway.)

So, it looks like I have to list both my 1st attempt (fail) and this attempt on ERAS. I am not applying to any "highly competitive" specialties but would still like to go somewhere good. Is this one of those scenarios where I should apply to 40+ programs? How likely am I to get screened out with this history?

A few other questions:

  1. Any suggestion on how to minimize the stigma of that failed 1st attempt?
  2. Is there a particular order I should list the attempts in? Does that matter?
  3. Is this a scenario where it would benefit to wait for step 2 scores before applying or should I just update ERAS when they come in (October)?
  4. Should I discuss this somewhere, like in my personal statement? (I'd rather not - because it will be tangential. But I wouldn't want to get denied just because I didn't. I'd obviously be prepared to talk about it in an interview if I get to that point.)
Any advice/insight is appreciated. Thanks!
 
Glad to hear things turned out better for you the next time. What specialty do you have in mind? That would make it easier to give advice about application strategies.

In any case, I would definitely apply far and wide. It's easy to cancel interviews if you get too many invites, but it is a lot harder to get more invites late in the season if you realize in November that you aren't getting as many invites as you'd like.
 
Sorry, don't want to hijack the thread but I have a similar problem. I failed the step 1 too but subsequently got a good score 250+. I am applying for IM and every program wants Ist attempts on the test. I passed cs and ck both on Ist attempts, with a 260+ score on ck.
I would like somebody's opinion on this, are these criteria enforced strictly? I mailed quite a lot of the programs, some didn't bother replying, some replied with a generic email not addressing the issue at all. This looks like a catastrophe, I can't even apply to programs which want a minimum score of 200 on the steps. Only programs that don't mention this criteria are big shot academic programs where I don't stand a chance. I am an IMG by the way.
 
Lemon Doctor said:
So, it looks like I have to list both my 1st attempt (fail) and this attempt on ERAS. I am not applying to any "highly competitive" specialties but would still like to go somewhere good. Is this one of those scenarios where I should apply to 40+ programs? How likely am I to get screened out with this history?

A few other questions:

  1. Any suggestion on how to minimize the stigma of that failed 1st attempt?
  2. Is there a particular order I should list the attempts in? Does that matter?
  3. Is this a scenario where it would benefit to wait for step 2 scores before applying or should I just update ERAS when they come in (October)?
  4. Should I discuss this somewhere, like in my personal statement? (I'd rather not - because it will be tangential. But I wouldn't want to get denied just because I didn't. I'd obviously be prepared to talk about it in an interview if I get to that point.)
Click to expand...
Peppy, I PM'd you w/ more details.

Anyone else have advice/suggestions on the above questions?
 
Rep said:
Sorry, don't want to hijack the thread but I have a similar problem. I failed the step 1 too but subsequently got a good score 250+. I am applying for IM and every program wants Ist attempts on the test. I passed cs and ck both on Ist attempts, with a 260+ score on ck.
I would like somebody's opinion on this, are these criteria enforced strictly? I mailed quite a lot of the programs, some didn't bother replying, some replied with a generic email not addressing the issue at all. This looks like a catastrophe, I can't even apply to programs which want a minimum score of 200 on the steps. Only programs that don't mention this criteria are big shot academic programs where I don't stand a chance. I am an IMG by the way.
Click to expand...

You;re likely to be fine. First, the "electronic filtering" system will only filter based upon your last USMLE score. So, your app will be filtered into the 250+ pile. Then, I'll look at your transcript and see the Step 1 fail followed by outstanding scores on step 1 and 2. Most likely, PD's will see your fail as a fluke and continue processing your app. Some may dump your app in the garbage. When you get a rejection, you'll never know if it was the score or something else. But I expect you'll get interviews. I would tend to apply to programs that require a first time pass. My program has such a rule, and I'd certainly look at the rest of your app and consider you. The fact is that most people who fail the first time then get a low passing score the next. Your app will stand out, in a good way.

Lemon Doctor said:
I re-studied (for real this time - not nights and weekends while on a busy rotation) and re-took USMLE 1 and got a 220. Score converters had me thinking ~230 was more likely, but I'm not complaining. (Based on my last experience, I didn't really believe it anyway.)

So, it looks like I have to list both my 1st attempt (fail) and this attempt on ERAS. I am not applying to any "highly competitive" specialties but would still like to go somewhere good. Is this one of those scenarios where I should apply to 40+ programs? How likely am I to get screened out with this history?
Click to expand...

Yes, you need to list the failed attempt. Even if you don't, PD's will see it on your transcript. Yes, you should apply to 40+ programs if you can afford it. Alternatively you could apply to 20 programs early, with a plan to add another 20 by mid Oct if you don't have a decent number of interviews (10+)

A few other questions:

Any suggestion on how to minimize the stigma of that failed 1st attempt?
Click to expand...
Do better on step 2 on your first try
Is there a particular order I should list the attempts in? Does that matter?
Click to expand...
No, it does not matter. I believe ERAS will sort them by date and by step, no matter what you do. Even if it doesn't, the order doesn't matter.
Is this a scenario where it would benefit to wait for step 2 scores before applying or should I just update ERAS when they come in (October)?
Click to expand...
I've addressed this issue on similar threads. There is no easy answer. A good score on STep 2 will clearly help your app. A poor score would be bad. Mid Oct is still plenty early for US grads, perhaps late-ish for IMG's
Should I discuss this somewhere, like in my personal statement? (I'd rather not - because it will be tangential. But I wouldn't want to get denied just because I didn't. I'd obviously be prepared to talk about it in an interview if I get to that point.)
Click to expand...
No simple answer, but you do not necessarily need to discuss it in your PS. You failed, studied, and passed. The best thing you can do is pass Step 2.
 
aProgDirector said:
You;re likely to be fine. First, the "electronic filtering" system will only filter based upon your last USMLE score. So, your app will be filtered into the 250+ pile. Then, I'll look at your transcript and see the Step 1 fail followed by outstanding scores on step 1 and 2. Most likely, PD's will see your fail as a fluke and continue processing your app. Some may dump your app in the garbage. When you get a rejection, you'll never know if it was the score or something else. But I expect you'll get interviews. I would tend to apply to programs that require a first time pass. My program has such a rule, and I'd certainly look at the rest of your app and consider you. The fact is that most people who fail the first time then get a low passing score the next. Your app will stand out, in a good way.
Click to expand...
Thanks for the reply. I am going to go ahead and apply.
Should I discuss the reason for the failure in my personal statement and how detailed do I need to be?
 
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Something is wrong with the ERAS rules/system when it comes to mandating USMLE reporting as a DO. When I failed the test by 1 point, the advice I got above was either:

  1. don't re-take it and just don't list that you ever took it, and no one is ever likely to find out. Or,
  2. you have to list it so re-take it and do better.
I did what I thought was the right thing to do: retook it and did much better. The result in terms of interview offers so far has not been great. I believe this is the only thing on my application to explain that. On the other hand, I know people who took the other (easier and less expensive) route. They just didn't list it and went with COMLEX scores only, and they have plenty of interviews.

I'm responsible for putting myself in this position, but when the system punishes someone who is honest and genuinely tries to improve, and rewards the alternate approach, there's something wrong.
 
If you're going into IM, you probably didn't need to list your USMLE score. I wouldnt retake nor present to them your only weakness. They won't know if you took it or not. If they asked, I'd still deny.

I'm taking Step 2 in a week. If I do well, I'm reporting. If I don't, I'm not gonna.

Everything's so GD competitive apparently. Programs set cut-offs that are so bogus ... just say you want 2 digit score of 90+ and not 80.

Lemon Doctor said:
Something is wrong with the ERAS rules/system when it comes to mandating USMLE reporting as a DO. When I failed the test by 1 point, the advice I got above was either:

  1. don't re-take it and just don't list that you ever took it, and no one is ever likely to find out. Or,
  2. you have to list it so re-take it and do better.
I did what I thought was the right thing to do: retook it and did much better. The result in terms of interview offers so far has not been great. I believe this is the only thing on my application to explain that. On the other hand, I know people who took the other (easier and less expensive) route. They just didn't list it and went with COMLEX scores only, and they have plenty of interviews.

I'm responsible for putting myself in this position, but when the system punishes someone who is honest and genuinely tries to improve, and rewards the alternate approach, there's something wrong.
Click to expand...
 
aProgDirector said:
I believe this statement describes life in general.
Click to expand...

Yes of course, but ERAS needn't be that way. It's an application service, not the Dalai Lama. If it can't enforce reporting, then why require it? Since it cannot enforce the edict, it invites the applicant to make an ethical decision fraught with consequences. If students see that PD's punish you for taking the more arduous route, and (unknowingly, of course) reward you for the lie of omission, then more will choose to simply pretend it never happened.

On the other hand, if PD's recognize that overcoming such an obstacle is a character building event, they might consider not weighting it so heavily against candidates. Maybe some don't. I don't actually have a solution, but am just reflecting on my experience so far.
 
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