STEP 1 score?

[m4kim]

---

Members don't see this ad.

What is considered a competitive step 1 score for EM residency?

 

[doc05]

240

 

[Sessamoid]

Originally posted by doc05
240

Dude, you're evil. 🙂

 

[Apollyon]

Hell, I barely got 240 on Step I AND II put together. And yet, twice today, patients told me I was a good doc. Go figure.

(One had been poisoned with arsenic - no, really - and the other had a K+ of 6.6 from his necrotic foot.)

 

[Idiopathic]

Originally posted by Apollyon
6.6

Yowza...you are a good doctor😉

 

[Apollyon]

Peaked T's, flattened P's, neb, calcium gluconate, bicarb, insulin and glucose, Kayexalate which he puked up - and he was willing to take the Kayexalate PR after I convinced him. Reglan and more PO instead.

 

[Sessamoid]

Speaking of high potassiums, I had a great one last month. K of 8.7. Normal renal function. Na of 123. CC: general weakness.

 

[Sessamoid]

Originally posted by Apollyon
Hell, I barely got 240 on Step I AND II put together. And yet, twice today, patients told me I was a good doc. Go figure.

Exaggerating a little? Passing score for the Steps is around 176, isn't it?

 

[Idiopathic]

Originally posted by Sessamoid
Speaking of high potassiums, I had a great one last month. K of 8.7. Normal renal function. Na of 123. CC: general weakness.

That is absurd. OD of a K+-sparing diuretic?😉

Our Path professor told us that serum Na+ < 120 is pathognomonic for siADH. Any thoughts?

 

[Apollyon]

Originally posted by Sessamoid
Exaggerating a little? Passing score for the Steps is around 176, isn't it?

Yes. Just a little hyperbole.

 

[Apollyon]

Originally posted by Idiopathic
Our Path professor told us that serum Na+ < 120 is pathognomonic for siADH. Any thoughts?

Methinks he is wrong. Extreme psychogenic polydipsia. When I was a student, the chair of IM (who was our service attending that block) told us of a patient some 30 years before, who was schizophrenic, and locked himself in a bathroom, and just kept drinking water. His serum Na was 97 before he died.

 

[Idiopathic]

I would like to see the write up. We have been explicitly told that no acute syndrome (polydipsia) can bring Na+ down that low...it has to be chronic.

 

[Sessamoid]

Originally posted by Apollyon
Methinks he is wrong. Extreme psychogenic polydipsia.

No, not polydipsia. Polydipsia causes hyponatremia, but doesn't explain the hyperkalemia. Don't feel bad it you don't get it in a flash. I had to put the chart down, deal with the potassium, then come back to it before it hit me.

BTW, the rest of the routine bloodwork was normal (including bun and creatinine), the EKG had t waves that looked a bit peaked (in retrospect). Urine analysis was also normal, much to my surprise, as I expected an elderly patient with generalized weakness to have a UTI. I'll reserve the rest of the results until somebody comes up with the answer.

Exam was unremarkable except for generalized weakness evident on strength testing, and just appearing very tired.

 

[Sessamoid]

Hold on, I still have the chart. Lemme correct a few numbers.

Na 124
K 8.4
Cl 98
CO2 20.5
Glu 113
Bun 29
Cr 1.7
Ca 10.5

WBC 4.4
Hgb 11.7
Hct 34.5
Plt 200

LFTs normal
Head ct normal

PMH: htn, angina
psh: hst, orif knee

ROS: positive only for tongue and lip numbness, dizziness

 

[The White Coat Investor]

A competitive score is 230+. A good enough score to do EM is 200+. Cross your fingers if you're below that. (Especially if you're around 120 like Apollyon. J/J)

 

[mikecwru]

Originally posted by Sessamoid
No, not polydipsia. Polydipsia causes hyponatremia, but doesn't explain the hyperkalemia. Don't feel bad it you don't get it in a flash. I had to put the chart down, deal with the potassium, then come back to it before it hit me.

BTW, the rest of the routine bloodwork was normal (including bun and creatinine), the EKG had t waves that looked a bit peaked (in retrospect). Urine analysis was also normal, much to my surprise, as I expected an elderly patient with generalized weakness to have a UTI. I'll reserve the rest of the results until somebody comes up with the answer.

Exam was unremarkable except for generalized weakness evident on strength testing, and just appearing very tired.

Adrenal insufficiency? Go off their steroids?

mike

 

[Apollyon]

Originally posted by Sessamoid
No, not polydipsia. Polydipsia causes hyponatremia, but doesn't explain the hyperkalemia. Don't feel bad it you don't get it in a flash. I had to put the chart down, deal with the potassium, then come back to it before it hit me.

I was strictly referring to the Na <120 as being pathognomonic for SIADH - not for your case in specific. Sorry for any confusion.

 

[sweetfynesse]

Originally posted by Sessamoid
Speaking of high potassiums, I had a great one last month. K of 8.7. Normal renal function. Na of 123. CC: general weakness.

did you repeat the labs? or check to see if it was hemolyzed? just a thought

 

[12R34Y]

are the step I scores people are posting......right?

230-240 to be competitive?

better start studying harder.

later

 

[gimmedog]

I think it only stands out if you did very very well or very badly.
I was told <200 may be a red flag, but your performance in EM and your letters count A LOT more than step 1.

 

[Sessamoid]

Originally posted by mikecwru
Adrenal insufficiency? Go off their steroids?

mike

Yes, adrenal insufficiency. No, this was not a known problem. It was a new diagnosis. How often does that happen in the ER?

did you repeat the labs? or check to see if it was hemolyzed? just a thought

Good thought. After kayexalate, insulin, glucose, and a neb treatment, it was the first thing I thought of too. The redraw was the same.

The one thing I didn't mention I omitted partly because it was ironically the last thing done. X-ray was busy with traumas for a long time, and my chest xray took ages. When they finally did the xray, it showed a large right hilar mass.

After her first dose of IV steroids, she perked right up and asked if she could go home now. Unfortunately, I had to tell her she couldn't. 🙁

 

[Idiopathic]

Is this individual in early renal failure? BUN of 29 and creatinine of 1.7 are both elevated right? Or is that just decreased CO, due to early CHF? Just asking cause we covered azotemias last week.

 

[Sessamoid]

Originally posted by Idiopathic
Is this individual in early renal failure? BUN of 29 and creatinine of 1.7 are both elevated right? Or is that just decreased CO, due to early CHF? Just asking cause we covered azotemias last week.

Probably early renal failure was my guess. She was not clinically in CHF.

Anyway, with her lung mass, my presumptive diagnosis was Addison's Disease secondary to paraneoplastic syndrome.

 

[DrQuinn]

Originally posted by Sessamoid
Probably early renal failure was my guess. She was not clinically in CHF.

Anyway, with her lung mass, my presumptive diagnosis was Addison's Disease secondary to paraneoplastic syndrome.

Strong work, very nice!

I scored a 93%ile on Step 1 (COMLEX) and 99% on Step 2... but I do not think it is necessary to get those sort of scores to get into EM. If you only scored a 40%, woudl that stop you from applying? Would you give up on what you think would be the "best residency" just because you heard you have to have a 20X on Step 1? Do your best, apply, and see what you get. That's all anyone can ask, and often the best advice I can give.


Q, DO

 

[16846]

What would be considered a competitive Step 1 score for a US-IMG that wants an EM residency? Any info is appreciated.

-Mike

 

[16846]

No one knows that answer to the previous question? There has to be at least one US-IMG that got into an EM residency recently that reads these boards!

 

[The White Coat Investor]

A US-IMG needs at least a 182 to get into residency. If he has a 262, he might have a better chance.

 

[Sessamoid]

Perhaps those of us who are/have been there could at least chime in with what the range of Step I scores were in our respective classes?

My residency was probably second-tier in competitiveness. A solid program, but in a generally undesirable location for most people. My class of 8 residents were all US grads. I doubt any of us had a Step I score below 210, definitely none below 200. My 233 (or was it 234? I don't remember) was probably the second highest in my class. I don't know if that helps you.

 

[m4kim]

sessamoid,

where are you doing your residency?

 

[Sessamoid]

Originally posted by m4kim
sessamoid,

where are you doing your residency?

Heh, I did my residency at Texas Tech in El Paso. Good program, but El Paso ain't the Jewel of the Desert that Phoenix or Las Vegas is.

 

[anonymousEM]

It's been said before, you never can tell exactly what will pique the interest of the interview invites. Some places have scores that are minimums to get you looked at, but with similar grades and boards within 3 points of each other, my classmate and I got an entirely different set of invites. And I got invited to one that a classmate with board scores 40 points higher than mine didn't. It's really hard to say. You should apply where you want to go but if you're in the 200 or lower range you should apply to at least 25 programs, maybe more. I had a 207 applied to 31 got 17, went on 12 matched at my #2. Another classmate failed step 1 the first time and only got a couple of interviews but is still currently an EM resident.

 

[Dr. Zorders]

204 step 1
214 step 2

49 programs (perhaps too many)
so far 12 interviews

penis length average
penis girth adequate

(the last was a stolen quote)

 

[limabean]

My advice is study as hard as you can but don't give up if you don't get a 260.

I got a 195 on Step 1 and 227 on Step II.
I was a little discouraged because of my Step 1 score but so far have gotten 17 interview offers ( including NYU, UCSF-Fresno, Vanderbelt, Jacobi, Drexel, Northwestern, Duke....)

In retrospect I realized that I am a much more competitive applicant than I originally thought and that if you have other things to offer a program you can make up for not being a good test taker.

Although USMLE scores are important(especially at a few schools that may have cutoffs, although I don't know which ones those are) many schools weigh other things very heavily i.e excellent recommendations, sincere personal statement, kicking ass in your EM away rotations especially when taking shifts with the PD***, talking to current EM second years at your programs of choice and getting them to put in a good word, rubbing elbows at the ACEP/SAEM conference, getting your application in early(first week of Oct.),etc. I think are just as, if not more important, then your score (as long as you pass..)

Having said all that, study as hard as you can and just do your best. Good luck and thanks to everyone on this forum who offered words of encouragement to me dispite my membership in the <200 club.

 

[frog4brooke]

The mean on USMLE Step 1 was a 216-So getting above this will help you to become more competitive. I reccomend finding a quite place to study away from high stress classmates and put in some hours. Also, everyone walks out feeling like they did crappy.

I was in the 220s and was told that this was a "competive" score for step 1 by our EM residency director.

As for step 2, IF you study most people can bring thier scores up and this tends to mean more for residency applications.

limabean's advice was great, because all the exam score help you to do is get your foot in the door.

Good luck-

Brooke

 

[jashanley]

Originally posted by Sessamoid
Hold on, I still have the chart. Lemme correct a few numbers.

Na 124
K 8.4
Cl 98
CO2 20.5
Glu 113
Bun 29
Cr 1.7
Ca 10.5

Were they orthostatic?
Did they end up checking an AM cortisol or did they do a corticotropin stim test?
Did she get an ABG?
Urine pH? and urine lytes for Urine AG.
The IM side of me wants to know if she had a Type 4 RTA (hypoaldosterone associated non-gap acidosis)

Sorry, I forget this is an EM forum.
Glad to hear EM docs thinking and waxing poetic about medicine. It makes me proud.

 

[Dr. Cowboy]

Step 1 - 200
Step 2 - 215

Applied to 26 programs
8 interviews & 1 rejection thus far

 

[iwakuni_doc]

Step 1 - 241
Step 2 - 202
Step 3 - 220

11 Invites for interviews (8 accepted, 3 declined)
7 Pending

 

[DrQuinn]

Step 1 (COMLEX) 93%ile
Step 2 (COMLEX) 99%ile

42 (roughly) applied
22 (roughly) interview offers
10 (roughly) interviewed
5 (post-interview GENUINE positive feedback from PD)
Matched #1

Q, DO

 

[Sessamoid]

Originally posted by jashanley
Were they orthostatic?
Did they end up checking an AM cortisol or did they do a corticotropin stim test?
Did she get an ABG?
Urine pH? and urine lytes for Urine AG.
The IM side of me wants to know if she had a Type 4 RTA (hypoaldosterone associated non-gap acidosis)

Heh, hell if I know what happened after she got to the floor. This IS an EM forum after all! 🙂 I hope she did well, but her chest x-ray really didn't speak of a very good prognosis. I assume I screwed up their ACTH stim test by using hydrocortisone instead of dexamethasone, but given the likelihood of malignancy as a primary cause, I doubt it made much difference.

 

[Lumberg]

Step 1....sucked
Step 2....sucked worse
Applied to 34 programs
11 invitations so far, 1 rejection.

Rest of application is pretty solid...EM research, honors in EM, strong letters, all honors 3rd year, top 1/4 of class. So far no one has mentioned my pathetic Board scores, but will it hurt me in March? I guess I'll let you all know. Thanks to the members of this forum for all of the encouragement and terrific advice.

'Berg