Step 2 and getting interviews?

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siimpleton

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For most competitive EM programs would it be prohibitive to getting an interview if you delay taking step II, assuming your step I score is 230ish and you don't expect to do much better on step II. (and the rest of you application is consistent with a 230)

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For most competitive EM programs would it be prohibitive to getting an interview if you delay taking step II, assuming your step I score is 230ish and you don't expect to do much better on step II. (and the rest of you application is consistent with a 230)

I also debated this and ended up taking step 2 in december-just before hitting the interview trail. This way i was able to say "i'm awaiting scores" at the interview, and i knew it would be back before programs have to rank you (some programs REQUIRE your step 2 before they are willing to rank you now). Another good thing was that at the season was winding down, i was able to contact PDs at places i was interested in and "update" them with my scores--and mention how much I love program, etc. With a 230ish step 1 i bet you improve on that with minimal effort!
good luck!!
streetdoc
 
For most competitive EM programs would it be prohibitive to getting an interview if you delay taking step II, assuming your step I score is 230ish and you don't expect to do much better on step II. (and the rest of you application is consistent with a 230)

I didn't take my step 2 until February and had no problem getting interviews. Some programs asked my step 2 score during my interview and I told them I'm not taking it until February. They all took it well and I ultimately ended up with my #1. I chose to take it late simply because there is no time in my fall schedule to study and I know I won't do well if I take it early. If you can do well on Step 2, it can definitely help you boost your app. But if not, as long as you have a strong step 1 score, strong letters, good grades, etc., you should be good to go.
 
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Sort of related...

I had one PD talk about step 2 scores during my interview. He told me that there have been some studies done recently (in EM, I presume?) about what factors in an application are most predicitive of success as an intern/resident. He said that Step 2 scores correllated well... PD's said that their best residents had the best Step 2 scores. Step 1, grades, and LORs did not correllate as well.

Now I have no idea which study he was quoting or where to find it, I just thought I'd throw this out there as an interesting discussion point.
 
Another question for those who have already matched. I know it's debatable whether or not to take Step II early, but what if you're pretty sure you can't do any better? My study habits are terrible this year and I just can't see myself doing better on Step II. My Step I score (>240) is competitive, but I don't want to not get interviews just because I haven't taken Step II. Any ideas? Also, which programs in particular want your Step II scores early?
Thanks!
 
Another question for those who have already matched. I know it's debatable whether or not to take Step II early, but what if you're pretty sure you can't do any better? My study habits are terrible this year and I just can't see myself doing better on Step II. My Step I score (>240) is competitive, but I don't want to not get interviews just because I haven't taken Step II. Any ideas? Also, which programs in particular want your Step II scores early?
Thanks!

If your Step I score was >240, don't worry about it.

Personally, I took Step II in July and did very well and I think it helped me get the 27 interview offers I got. But each applicant is unique and whether to take it early or not is going to be different for everyone. I personally wanted to get that crap out of the way in July and I still did well on it.
 
Another question for those who have already matched. I know it's debatable whether or not to take Step II early, but what if you're pretty sure you can't do any better? My study habits are terrible this year and I just can't see myself doing better on Step II. My Step I score (>240) is competitive, but I don't want to not get interviews just because I haven't taken Step II. Any ideas? Also, which programs in particular want your Step II scores early?
Thanks!

With a step 1 >240 not having a step 2 score probably won't keep you from getting INTERVIEWS...
I was worried about doing better than step 1 (>240) since they say it's not good to go down on step 2, but if I were a program, i would want to see step 2 before i RANK someone. It is VERY unlikely with a 240 you would fail step 2, but it's just one more hurdle cleared.
Step 2 is very different than step 1, your study time is review for the most part and a lot less intense-even with 4th year study habits. Emergency medicine rotations are a good time to read Crush/Secrets/etc and good prep too.
As far as which programs requir step 2 to rank you...i think WVU, Michigan, and one other (can't remember now-Carolinas maybe?) specifically contacted me to make sure results were in by early february.
Hope this helps
streetdoc
 
Another question for those who have already matched. I know it's debatable whether or not to take Step II early, but what if you're pretty sure you can't do any better? My study habits are terrible this year and I just can't see myself doing better on Step II. My Step I score (>240) is competitive, but I don't want to not get interviews just because I haven't taken Step II. Any ideas? Also, which programs in particular want your Step II scores early?
Thanks!

DON'T take Step 2 early. If your Step 1 is that high, then you've already proven you can do very well on standardized tests and you have really very little to gain from taking Step 2 early.

As a general rule I've heard if your Step 1 score is above 220 or 230, then think about delaying Step 2 because a good score won't help you much more. If you just want to take it to get it over with, that's another story.
 
Another question for those who have already matched. I know it's debatable whether or not to take Step II early, but what if you're pretty sure you can't do any better? My study habits are terrible this year and I just can't see myself doing better on Step II. My Step I score (>240) is competitive, but I don't want to not get interviews just because I haven't taken Step II. Any ideas? Also, which programs in particular want your Step II scores early?
Thanks!
here's from SAEM's site:

"The final consideration on when to schedule USMLE Step II is whether you would desire for USMLE II to be a consideration in the residency application process (take early) or not (take late). To explain the thinking here, use the analogy of the "NFL Draft". At the scouting events, top draft prospects will often skip these sessions, while weaker prospects want to attend to show scouts what they can do, and enhance their chances of getting drafted. Why? The top prospects have nothing to gain by a good workout, but have a lot to lose with a sub-par workout performance, including draft position and money. The weaker prospects have little to lose from a poor workout, but have much to gain from a strong one. The analogy carries over with Step II timing from a residency application viewpoint. If you achieved a Step I score of 240, you have little competitiveness to gain in taking Step II early, but much to lose with a sub-par performance. From a competitiveness standpoint alone, you might consider deferring the exam (although if it is better to take it early for other timing reasons, then do so). Conversely, if you achieved a Step I score that is marginally competitive in your intended specialty, then take Step II early. You have little to lose from a poor score (correlates with the lower score for Step I anyway, doesn't change programs thinking about your candidacy), but everything to gain in raising your competitiveness with a good score. This is a golden opportunity to improve your application if you can prepare well and perform superbly."
 
With a step 1 >240 not having a step 2 score probably won't keep you from getting INTERVIEWS...
I was worried about doing better than step 1 (>240) since they say it's not good to go down on step 2, but if I were a program, i would want to see step 2 before i RANK someone. It is VERY unlikely with a 240 you would fail step 2, but it's just one more hurdle cleared.
Step 2 is very different than step 1, your study time is review for the most part and a lot less intense-even with 4th year study habits. Emergency medicine rotations are a good time to read Crush/Secrets/etc and good prep too.
As far as which programs requir step 2 to rank you...i think WVU, Michigan, and one other (can't remember now-Carolinas maybe?) specifically contacted me to make sure results were in by early february.
Hope this helps
streetdoc
i think it's silly that any program would require step 2, especially from an applicant that scored >240 on step 1. if you can score that highly on step 1 which is hands down the more difficult of the two steps, it is very unlikley that you'll score low/not pass step 2; this is especially true since the curve is easier on step 2, being that people don't tend to study as intensely.

unless i hear some striking evidence to the contrary, i'm personally not going to take step 2 as per the advice from SAEM's website.
 
i think it's silly that any program would require step 2, especially from an applicant that scored >240 on step 1. if you can score that highly on step 1 which is hands down the more difficult of the two steps, it is very unlikley that you'll score low/not pass step 2; this is especially true since the curve is easier on step 2, being that people don't tend to study as intensely.

unless i hear some striking evidence to the contrary, i'm personally not going to take step 2 as per the advice from SAEM's website.

Not true at all. I know plenty of people who scored 240 and 250+ that had major drops in there step 2 scores. There's no guarantee that you will score just as well or even pass. That being said, the programs will likely rank someone higher who has everything taking care of since they no longer have to worry about these requirements being fulfilled.
 
I'll add one more thing. Nobody I know got a lower score on step 2 than they did on step 1. The average score increases by 10 points on step 2 from step 1.

Besides, people who are afraid of step 2 are just silly. :p
 
I'm not afraid of Step II itself, I'm simply afraid of ruining three years of hard work by doing poorly on one test. At this point, everyone on here (and the artice from SAEM) is telling me that Step II has diminishing returns. In other words, if you do very well on Step I, Step II can't do much to help you but can definitely hurt you. My only concern at this point is not getting interviews or not getting ranked by a program simply because I'm taking Step II in late January/early February.
 
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i have no idea what the PD perspective on the issue is, but i'll tell you about me so that you won't be mortified that a drop in score dooms you

i took step 2 CS and CK late july becasue i didn't want to spend the next 4 months with that monkey on my back. i have read tons of people saying delay delay delay, but i just wanted it over and done with and it fit best into my 4th yr schedule at the time. i thought i'd study more than i ended up doing during july, so my score dropped. i had a brief puckering moment, then figured its too late and the rest of my app and the next few months of my away rotations at strong programs would make up for it.

so, step 1=217/89 step 2=207. neither of those are the magic 230+ number everyone seems to have, so if you are in my boat dont freak out. i got 15 interview offers, and matched at Christiana which i think is one of the best programs out there, and has nearly unmatched ultrasound training IMO. so at least in my case taking step 2 early, WITH a lower score, AND a score below even the averages turned out not to be a death sentence
 
I think that if you have 230+ and you don't want to take it, you would possibly have problems at only a few places (if that). So don't bother if it doesn't fit in your schedule or just don't want to. If 240+, even more so. This is all if your app is otherwise pretty good. If you have some problems with the rest of your app, probably good to take. If you think you will bomb based timing, then just don't take it yet.
 
I'll add one more thing. Nobody I know got a lower score on step 2 than they did on step 1. The average score increases by 10 points on step 2 from step 1.

However, I know about 3 that did drop. One by 10, one by 25, and the other wouldn't say. I'm not one of them, though. I went up by 30. Didn't help :(
 
I'm not afraid of Step II itself, I'm simply afraid of ruining three years of hard work by doing poorly on one test. At this point, everyone on here (and the artice from SAEM) is telling me that Step II has diminishing returns. In other words, if you do very well on Step I, Step II can't do much to help you but can definitely hurt you. My only concern at this point is not getting interviews or not getting ranked by a program simply because I'm taking Step II in late January/early February.

That's my worry as well. I know that both myself and breaker are probably overthinking the hell out of this...

As opposed to say, Plastics, where nearly every serious applicant is going to have a basically flawless app the EM world seems full of more normal people. Judging by the chatter on this forum it seems that there are alot of applicants with mediocre Step1s who take Step2 early, thereby apparently proving some sort of increased clinical acumen.

I sometimes wonder if those of us with high Step1s will be looked at askance by some programs as "overly academic." I think we are all aware of the phenomemnon in medical school whereby students who perform less well on exams tend to think of themselves as clinically superior to those who get awesome scores...

Let me repeat: I know that I am overthinking this, but it's 5:30am and there's nothing good on TV.
 
I agree that if Step I is good, the Step II score is unlikely to get you more interviews. On the other hand, a good Step II score can help you if you didn't "ace" Step I.

Many schools require CK and CS to be successfully completed before graduation.

Many programs will not rank an applicant without seeing a passing Step II score, as they do not want to match someone who may not be eligible to graduate (and therefore start their residency program in July).

My $0.02 ;)
 
(Disclaimer: my bias is to take both by rank list time. Why not show you can score well on a clinical-oriented test?)

Beyond just getting the interviews, consider how a stronger score might improve your ranking. Many applicants will have taken step 2 CK, and if the program requires it before ranklists are made (mid-Feb), you might as well do as well as you can.

I know plenty of people who scored in the 220s-230s who studied 2 weeks and significantly improved their scores--it actually came up during one of my interviews. If you scored >240, you'll probably still do very well if you study.

Keep in mind that Step II takes less time to study and is very closely related to what you've been working hard at learning the last year.
 
I agree that if Step I is good, the Step II score is unlikely to get you more interviews. On the other hand, a good Step II score can help you if you didn't "ace" Step I.

Many schools require CK and CS to be successfully completed before graduation.

Many programs will not rank an applicant without seeing a passing Step II score, as they do not want to match someone who may not be eligible to graduate (and therefore start their residency program in July).

My $0.02 ;)


Do you have any written evidence for this statement (that a program will not rank you without seeing your Step II)? If not, then that's a pretty brash statement.
 
It is brash to assume this will be written everywhere. Some programs list their requirements on their website, some do not. Some will tell you they need your step II score, some won't. Every program has their own application requirements. I agree with most of the statements above...
 
Most programs don't list anything on their website, but every program has some rationale for ranking, as well as for interviewing.
I can tell you right now that there is no program out there for EM that I looked at that says they have a cutoff Step I score on their site, but in actuality they do (one even told me what it was during my interview). This whole match process is so lacking in transparency that the FUD concept wholeheartedly applies.
 
just out of curiousity, are there programs out there which accept "lower" step 1 (or step 2) cutoff scores? Or are they generally equal?
 
EM_Rebuilder... for how long did you study?
 
EM residency programs receive anywhere from 400 to 900 applications and can only interview a fraction of these applicants. So you need a screening process using criteria that allow you to fairly compare the largest number of applicants. To be useful the criteria need to be unbiased, easily obtainable, and hopefully predictive of future performance as a resident and hopefully as an emergency medicine specialist.

Anyone who claims that a multiple choice score is predictive of anything other than taking a multiple choice test is engaging in a favorite academic hobby known as inventing literature. A fairly sizeable number of studies (including one I presented at the AAMC years ago) have shown exactly the opposite. If we were truly rationale, we wouldn’t even look at Part I. However, *everyone* takes Part I so it is attractive because it is general to all applicants and unbiased. Furthermore, it does predict strong scores on the resident inservice exam, something that is a future ego boost for the program and program director.

Everyone sets their own screening rules (ranking lists fluctuate wildly between programs) and some programs may well use poor selection criteria such as NBE II. I personally advocate the Steve Cantrill method of throwing all the applications down the stairs and taking those on the seventh step. It is much less work and far more entertaining. Most of the program directors and chairmen out there are pretty good at this and I'd be surprised if they used NBE 2 to screen applicants. In the three programs I have been associated with, we did not.
 
EM residency programs receive anywhere from 400 to 900 applications and can only interview a fraction of these applicants. So you need a screening process using criteria that allow you to fairly compare the largest number of applicants. To be useful the criteria need to be unbiased, easily obtainable, and hopefully predictive of future performance as a resident and hopefully as an emergency medicine specialist.[/COLOR]

This is all completely true, and it is why Step 1 will always have more weight. Everyone takes it and everyone studies for it. It lets the program know you can take standardized tests. Not everyone studies for Step 2. If you did well on Step 1 don't be in a hurry to take Step 2. I took Step 2 at the end of February. I only applied in the Southeast, but I can tell you that not having a Step 2 score didn't matter to any of those programs.
 
Dr.McNinja...did your friends that did poorly take off a month to study? ...or how did they prepare?
 
I am writing a small book for the people in my school below us that will be applying to Emergency Medicine. Here is the section that I came up with about this topic:

EDIT: Just some background that you do not get by reading everything... I compare program tiers as having electricity, gas lighting, or candles (corny I know, but I am trying to make it easy to compare to something real world... and I explained that most competitiveness in EM is based on location so the places off the beaten path are the candles...) and the gods are of course PDs, Charimen, etc.

So if you're a stud and scored a 230+, you can probably skip this section. One big question a new fourth year medical student has is, "Should I take Step II at the beginning of fourth year or later?" The answer to this is very individualistic. Since the stud isn't reading anymore, we will not let him know that he probably should delay in taking Step II (bet he can't wait to tell his friends at lunch that he skipped that one section about the Steps). We all know he studied night and day for months to obtain that 260, and what does he have to prove on Step II…simply that chances are he would end up doing worse on it (which never looks good). So the normal folks in the 200-225 range need to consider a few options. One, your score is decent enough that you will probably be able to match at places that use gas lighting (instead of candles)…but if you are after that electricity…well then you have a chance to prove yourself again on Step II. Traditionally (but NOT always) a student with an average or below average Step I score will do better on Step II by about 10 points. But remember, it is a gamble in the end. That 220 will not look so great if you happen to grab a 185 on Step II….you might bat yourself back to candles. Now for those who this paragraph is really about: the sub 200ers and the test retakers. You have NOTHING to lose by taking Step II early in the fourth year and only EVERYTHING to gain. Remember, we usually increase our score (but again, NOT always) on Step II. Luckily, most gods will essentially overlook that 195 on Step I when you get the 220 on Step II. On the flip side, if your 195 went to a 185 on Step II….they can say, "Hey at least he passed and he is safe as far as those two boards go." So take a month off, study hard and do very well.
 
Dr.McNinja...did your friends that did poorly take off a month to study? ...or how did they prepare?

One took a couple weeks, score dropped 10 points (222 to 212). One I have no idea, but their score dropped from the 240s into the 210s. They were fairly upset, but still matched into gas.
 
To understand the effect of national boards II or any other ranking criteria, it helps to understand how applicants are ranked. I humbly apologize if my post simply repeats much better information contained elsewhere, but here goes.

At the risk of not keeping very loose trade secrets, here would be my advice to a young program director about to set up the process to match his/her first class. This is how the other side thinks.

HOW TO RANK APPLICANTS

Weight each criteria you are going to use to rank an applicant with a maximum score for that criteria. If [Honors on an ED] rotation is twice as important to you as NBE I, then the maximum score for [Honors on an ED rotation] is twice the value for honors on ED rotation than NBE-I. How you weight these criteria is capricious as the only real predictive criteria are signs of past negative performance. This has been shown to repeat itself in residency. Requirement: Everyone must have all the criteria so the scores are truly equal. One could use best score of NBE-I vs. NBE-II but they really are different exams.

Step 1: the paper application when you have all the initial stuff :
NBE I score: 1 to NBE Max
Dean's letter: 1 to DL max
Letters of Rec: 1 to LOR max
and so on with whatever criteria the program sees as of value:
research, charitable work, beauty of the personal photo, 1/(typos), personal statement analyzed using DSM-IV, number of Olympic gold medals, etc...
Add them all up and you have the paper score.

Step 2: invite top applicants using the paper score to fill all interview spots.
Conclusion: NBE-II won't often be used to sort out who is invited.

Step 3: Decide how you will calculate the interview score and how you will weigh it. Generally this is the average of all the interview scores and ranges from 50% to 100% of the paper score. Most programs will allow anyone to veto an applicant. Negatives are golden, positives are not.

NBE-II can play a role at the interview to diffuse a poor NBE-I score by showing that exam taking skills and fund of knowledge are fine. The effect however is small. The effect of crashing and burning on NBE-II can cause considerable damage at the interview if NBE-I is okay.

 
Heamr Head, you are awesome! Where were you last year when some of us could have used more advice from a PD? :) And you're becoming a dedicated poster coming on here at 5am!

By the way, would you have given me an interview at whichever HAEMR program you are at if I mentioned I was on SDN? ;) You guys were the only ones to let me down. Just kidding. :D
 
Heamr Head, you are awesome! Where were you last year when some of us could have used more advice from a PD? :) And you're becoming a dedicated poster coming on here at 5am!

By the way, would you have given me an interview at whichever HAEMR program you are at if I mentioned I was on SDN? ;) You guys were the only ones to let me down. Just kidding. :D

Sleep is overrated. And posting is pretty good entertainement so far. I assume I'll get myself kicked off sooner or later when I start sundowning in one of my posts.

I turfed the responsibility of selecting applicants and removed myself from the ranking process years ago. It's much more fun to advise students and torment the PD with irrational demands. It really isn't much fun to block some young kid who's app looks a hell of a lot like mine when I applied. And when someone doesn't get an interview I can say "Not my fault!" and "The process is idiotic!". However, I guess I am still up at night so maybe some of the guilt remains.

I'll yell at the PD and get him to add 5 points for every SDN post. I would bet it would be a better predicitor than NBE I.
 
I didn't take my step 2 until February and had no problem getting interviews. Some programs asked my step 2 score during my interview and I told them I'm not taking it until February. They all took it well and I ultimately ended up with my #1. I chose to take it late simply because there is no time in my fall schedule to study and I know I won't do well if I take it early. If you can do well on Step 2, it can definitely help you boost your app. But if not, as long as you have a strong step 1 score, strong letters, good grades, etc., you should be good to go.

MightyShorty, do you mind revealing what your step I score was? You say..as long as you have a "strong" score you should be ok...is 230 strong?

Also, does anyone know which programs require step II. If some do, there is no way to send your score to just that one program right? ...and if you take Step II and don't release it..schools can see that you didn't release it, which looks bad, correct?
 
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