MD Surgical Sub + High Step 1, Risk Step 2 Score Drop or Delay?

[Welshman]

Hi everyone, I got some really great advice on away rotations a few weeks ago and wanted to hear some more opinions on my latest conundrum. Unfortunately, my school doesn't have any faculty from competitive specialties so their advice tends to be very superficial; I kid you not after presenting this same situation to a dean, their only response was that scoring well will help me. Anyway, without further ado...

Background: My school takes step 1 after third year, step 2 is usually scheduled shortly after that, and I'm applying to a surgical subspecialty this cycle. I recently received my Step 1 score and was ecstatic to get 260-265. I'm currently scheduled to take step 2 in 4 days. Right now, my practice exams average ~250 with ~6 point range; based on Reddit data, these are typically under-predictive by about 10 points, and score predictors I've used so far are projecting a 260. I'd be more than happy with this score, but I'm doubtful I can attain it. I poured a lot of my soul out for step 1 and was so burnt out trying to transition straight into Step2 studying that I haven't put nearly as much into it as I should have; ie I won't complete a full first pass of UW before testing even after carrying over >50% during rotations, my peers are ~50% through a second pass of all the Qs. I find Step 2 questions pretty difficult and frequently find myself going with my 'gut' rather than explicitly knowing the info cold. To an extent this is the nature of step 2 questions, however, I'm concerned about ending up on the wrong side of a lot of my 50:50s and underperforming my practice tests. A lot of my performance feels like luck.

My question is, given the increasing importance of Step 2 and coming from a no-name school, after scoring 260-265 on Step 1 would it be advisable to take Step 2 at all before ERAS is sent out? This would give me the option to not send the score until after receiving interview invites if needed. Or would it be better to take it, likely perform worse percentile-wise but maybe the same numerical score, to get it out of the way so my full application is complete for ERAS and I don't have to worry about it while on aways?

For what it's worth, I would really like to take it and never think about it again, coming off step 1 and dedicated I'm likely the most "in the mind" of the NBME than I'll ever be but probably a bit underprepared step2 content-wise. I just don't want to make a rash decision and spoil my previous hard work. As an added note, if I delayed, I wouldn't take it next until at least mid/late-October. Thanks for all your help guys!

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[efle]

Id push step 2 until slightly past ERAS submission. If you do well, release the score and you might improve your odds at places which are trying to switch away from Step 1 already this cycle. Dont do well, and you can hold your score until past your interviews so it doesnt cost you any youd otherwise receive. Take it now and you lose the power to control it like that.

 

[operaman]

Yeah I think delaying is almost certainly the smart move unless you find that programs in your area are requiring it before offering interviews. I was in a very similar situation to yours and I delayed until well after ERAS. Ended up doing just fine on Step 2 as well and with minimal preparation other than shelf study throughout third year. I also got Interview invites from 90% of the programs I applied to, and I didn't apply that broadly.

I would also point out that the Step 1 and Step 2 scoring scales are completely unrelated and comparing them directly makes as much sense as comparing Step 1's 3-digit score and the LSAT's 3-digit score. The actual percentile breakdown is different such that a 265 on Step one is probably more in line with a 275 on step 2. A 260 on step 2 is probably closer to a 245 on Step 1, so the fact your practice tests are predicting this fits rather well with a very strong student who hasn't put in the same level of soul-killing study that they did for the last exam. If you're especially nerdy like me, you can pull up the percentile charts on the USMLE's website.

Even so, I think you lose nothing by delaying. No program is going to see a 265 on Step 1 and worry that you're going to do poorly on Step 2 and let that be the reason they don't interview you.

 

[Lem0nz]

I don’t know. Your step one is fantastic and your step 2 seems highly unlikely to be below 240 from what you’ve described. If the rest of your application is even remotely comparable to your are 1 score I can’t see it mattering that much. You haven’t said what you’re applying for or what the rest of your app looks like which are necessary to give additional guidance.

Personally I would be way happier and less burnt out having the exams done and behind me.

 

[Welshman]

Id push step 2 until slightly past ERAS submission. If you do well, release the score and you might improve your odds at places which are trying to switch away from Step 1 already this cycle. Dont do well, and you can hold your score until past your interviews so it doesnt cost you any youd otherwise receive. Take it now and you lose the power to control it like that.

I agree taking it right before the deadline would be ideal. However, I will be doing away rotations from August to the beginning of October. If I factor in a two week dedicated right after that I earliest I could take it would be after October 18th, adding in 2-3 weeks to get my score back puts it around the first week or two of November which is the exact time interviews were released last year and in past years it was a bit earlier than that. So there the potential that programs that do want it won't have it. That being said in this field I haven't seen any programs that require it by rule but am unsure about how they view it in practice, especially with the move to P/F

 

[efle]

I agree taking it right before the deadline would be ideal. However, I will be doing away rotations from August to the beginning of October. If I factor in a two week dedicated right after that I earliest I could take it would be after October 18th, adding in 2-3 weeks to get my score back puts it around the first week or two of November which is the exact time interviews were released last year and in past years it was a bit earlier than that. So there the potential that programs that do want it won't have it. That being said in this field I haven't seen any programs that require it by rule but am unsure about how they view it in practice, especially with the move to P/F

I think October would be fine, your step 1 is strong enough that I really doubt it will make or break any interviews. The risk of doing worse is much more substantial than the marginal benefit of a second strong score.

 

[Welshman]

Yeah I think delaying is almost certainly the smart move unless you find that programs in your area are requiring it before offering interviews. I was in a very similar situation to yours and I delayed until well after ERAS. Ended up doing just fine on Step 2 as well and with minimal preparation other than shelf study throughout third year. I also got Interview invites from 90% of the programs I applied to, and I didn't apply that broadly.

I would also point out that the Step 1 and Step 2 scoring scales are completely unrelated and comparing them directly makes as much sense as comparing Step 1's 3-digit score and the LSAT's 3-digit score. The actual percentile breakdown is different such that a 265 on Step one is probably more in line with a 275 on step 2. A 260 on step 2 is probably closer to a 245 on Step 1, so the fact your practice tests are predicting this fits rather well with a very strong student who hasn't put in the same level of soul-killing study that they did for the last exam. If you're especially nerdy like me, you can pull up the percentile charts on the USMLE's website.

Even so, I think you lose nothing by delaying. No program is going to see a 265 on Step 1 and worry that you're going to do poorly on Step 2 and let that be the reason they don't interview you.

I have indeed poured over the percentile breakdowns, nerd recognizes nerd lol. Part of me is hoping that these are overlooked by PDs because pulling up with a 97th percentile step 1 feels much different than 70-80% even though the scores are too far off. Regarding my test prep that is exactly my thinking exactly. Throughout the year I played a soul-destroying game keeping up with the 25k step 1 Anki cards while trying to score >75th percentile on shelves (which dictates honors at my school) in rotations cut in half d/t covid. So my overall step2 prep suffered.
It's reassuring to hear this perspective.

I don’t know. Your step one is fantastic and your step 2 seems highly unlikely to be below 240 from what you’ve described. If the rest of your application is even remotely comparable to your are 1 score I can’t see it mattering that much. You haven’t said what you’re applying for or what the rest of your app looks like which are necessary to give additional guidance.

Personally I would be way happier and less burnt out having the exams done and behind me.

I've vacillated a lot between this perspective and Operaman's. Logic and strategy tells me to delay but my heart says to get it out of the way and if Step2 is really not important enough to be needed for an interview invite PDs won't care about a 250 score even if it is 60th percentile vs 97th....

I was trying to be a bit more covert about my details as to not be doxxed but I suppose the puzzle pieces are already out there. The field is ENT. I'll be top half of my class, clinically my evals are really good but I only netted a few Hs and the rest near honors (honors entirely depended on >75th percentile on the shelf and I was anchored by the godforsaken step1 cards and actually trying to learn on the floor). Research, and now step1, is the real money maker for my app, by October I'll have around 15 papers and book chapters and similar numbers of posters (no advanced degree or time off). Not all are strictly ENT but I think can paint that in a positive light

 

[Lawpy]

I don’t know. Your step one is fantastic and your step 2 seems highly unlikely to be below 240 from what you’ve described. If the rest of your application is even remotely comparable to your are 1 score I can’t see it mattering that much. You haven’t said what you’re applying for or what the rest of your app looks like which are necessary to give additional guidance.

Personally I would be way happier and less burnt out having the exams done and behind me.

Do PDs view a 260 Step 1 --> 250 Step 2 to be a red flag? I mean that'd be completely idiotic if they do but the risk of being in that scenario is significant enough to delay

 

[efle]

Personally would not risk a 40 percentile drop if you have an unlucky form for your step 2. You sound like you have a killer app, the relief of being done with USMLEs isnt worth the risk of shooting yourself in the foot at the final stretch

 

[Welshman]

Do PDs view a 260 Step 1 --> 250 Step 2 to be a red flag? I mean that'd be completely idiotic if they do but the risk of being in that scenario is significant enough to delay

Thats the biggest thing on my mind. It seems silly when looking at the score and especially considering the SEM of the Step exams is +-6 points, but when I start to look at the percentiles it paints a different picture

 

[Chromium Surfer]

Thats the biggest thing on my mind. It seems silly when looking at the score and especially considering the SEM of the Step exams is +-6 points, but when I start to look at the percentiles it paints a different picture

This is an unrelated question, but what was your rationale for keeping up with the step 1 cards? I feel like I have heard from other people that once they got to third year they only kept up with step 2 deck cards.

 

[Welshman]

This is an unrelated question, but what was your rationale for keeping up with the step 1 cards? I feel like I have heard from other people that once they got to third year they only kept up with step 2 deck cards.

I would have but we don't take step 1 until the end of third year so to keep up with that knowledge I had to keep up with all the cards

 

[GoSpursGo]

Honestly I'm with @Lem0nz . I think you would really need a major drop to raise a red flag, and while sure in theory it makes sense to delay and maximize your step 2 score, in this case there is a real opportunity cost where you would be dividing your attention between your away rotation and step 2 studying. Clearly you really want to be as impressive as possible on your away, and ideally that hour+ you would be spending each night to prep for step 2 would go towards knowing your patients inside and out. And it's not like you're going to magically be less burnt out after your away rotation than you are now.

You've already spent a lot of time prepping for the exam. Even if you don't "feel" as ready, your practice scores indicate you will probably do more than well enough. I don't feel like you're going to gain enough marginal benefit here by delaying.

 

[Lem0nz]

Honestly I'm with @Lem0nz . I think you would really need a major drop to raise a red flag, and while sure in theory it makes sense to delay and maximize your step 2 score, in this case there is a real opportunity cost where you would be dividing your attention between your away rotation and step 2 studying. Clearly you really want to be as impressive as possible on your away, and ideally that hour+ you would be spending each night to prep for step 2 would go towards knowing your patients inside and out. And it's not like you're going to magically be less burnt out after your away rotation than you are now.

You've already spent a lot of time prepping for the exam. Even if you don't "feel" as ready, your practice scores indicate you will probably do more than well enough. I don't feel like you're going to gain enough marginal benefit here by delaying.

Yea, knowing the rest of your application you would have to be next level socially inept not to match at a place more or less of your choosing. You might struggle with like… Mayo, I guess. But having interviewed kids coming from places like that you will be a better surgeon if you are looking at places that will teach you to operate AND open fellowship doors which tends to not be ‘the worlds best’ but one step down, and you’re extremely qualified for those programs.

 

[efle]

Honestly I'm with @Lem0nz . I think you would really need a major drop to raise a red flag, and while sure in theory it makes sense to delay and maximize your step 2 score, in this case there is a real opportunity cost where you would be dividing your attention between your away rotation and step 2 studying. Clearly you really want to be as impressive as possible on your away, and ideally that hour+ you would be spending each night to prep for step 2 would go towards knowing your patients inside and out. And it's not like you're going to magically be less burnt out after your away rotation than you are now.

You've already spent a lot of time prepping for the exam. Even if you don't "feel" as ready, your practice scores indicate you will probably do more than well enough. I don't feel like you're going to gain enough marginal benefit here by delaying.

Or focus on aways and just take CK late (like jan-feb). That would've been the smart move in previous years. Maybe different now if ENT programs are trying to switch over to CK early

 

[Lawpy]

I feel it's a bit premature for programs to start weighing Step 2 heavily when a lot of schools don't have the time to change their curricula and new MS4s are getting whacked by a still scored Step 1 after clinicals.

 

[Lawpy]

If Step 2 is in fact going to be even more valued by ENT, OP ends up in a difficult spot of having to decide between Step 2 and aways. It's rough and bizarrely a strange situation where scoring too high on Step 1 ends up being problematic.

 

[DTX_1212]

Was in a similar dilemma with 250+ step1 also applying to surgical sub specialty. Decided to take step2 early and get it out of the way. no regrets and it’s nice to not have to worry about studying or keeping up with anything for board exams for the rest of med school. Trust your practice test scores and know that if you scored highly on step1 chances are you will do well on step2. (Ended up with 260+
with minimal dedicated study time). From taking to those ahead of me the numerical score is looked at more that the percentile and with your step score it’s mainly just for confirmation that you’ve got your stuff together.

 

[Cath Up]

Was in a similar dilemma with 250+ step1 also applying to surgical sub specialty. Decided to take step2 early and get it out of the way. no regrets and it’s nice to not have to worry about studying or keeping up with anything for board exams for the rest of med school. Trust your practice test scores and know that if you scored highly on step1 chances are you will do well on step2. (Ended up with 260+
with minimal dedicated study time). From taking to those ahead of me the numerical score is looked at more that the percentile and with your step score it’s mainly just for confirmation that you’ve got your stuff together.

Did you mean more than the percentile?

 

[aaronrodgers]

Take Step 2 now and get it out of your head. You have already been preparing well. I think the mental health benefit of not having to put Step 2 in the equation anymore for the rest of 4th year is astronomically better than delaying!

 

[efle]

Idk why people think it's a mental health benefit to take it with a lot riding on the score. I took it after interviews and it was zero stress extremely chill that way

 

[Chelsea FC]

Idk why people think it's a mental health benefit to take it with a lot riding on the score. I took it after interviews and it was zero stress extremely chill that way

Think mostly people who didn’t do hot on step 1 put a lot of worry into step 2

 

[Cath Up]

Idk why people think it's a mental health benefit to take it with a lot riding on the score. I took it after interviews and it was zero stress extremely chill that way

You think it's still a smart strategy this cycle for those potentially facing a percentile drop for step 2?

 

[7331poas]

step 2 is crazy vague and poorly written. I would not risk it.

just my 2c

 

[The wise one]

step 2 is crazy vague and poorly written. I would not risk it.

just my 2c

Lol at poorly written. Your anki premade decks are poorly written. Step 2 Ck is probably the most medically relevant exam ever.

 

[7331poas]

Lol at poorly written. Your anki premade decks are poorly written. Step 2 Ck is probably the most medically relevant exam ever.

Yes yes. Where else can i be pimped on the correct antivenom to use for a snakebite in Arkansas. Or the guidelines for what position a mother should be in for childbirth. Definitely gonna need that to enter radiology.

 

[efle]

Lol at poorly written. Your anki premade decks are poorly written. Step 2 Ck is probably the most medically relevant exam ever.

Dude the exam has a 66% interval of like 16 points. So, for example, having a slightly lucky vs unlucky form is the difference between average and 260. Hard to call that a fantastic yardstick. These tests arent designed for how they're used in practice

 

[aaronrodgers]

Idk why people think it's a mental health benefit to take it with a lot riding on the score. I took it after interviews and it was zero stress extremely chill that way

Like another poster stated, it’s nice to not split up your attention between aways, interviews, and step 2. More than likely for someone with a 265, they will do well. OP’s exam is 3 days away and he/she is at the best point in their preparation to get it done. To each their own! I was glad to have had mine done and wouldn’t have it any other way

 

[operaman]

If you do delay, definitely don’t waste any time on aways studying. The whole point of delaying is not to maximize your score, but to make your score a non issue and give you control over when programs get to see it.

The only ding I see on your app will be your clinical grades and even that is fairly minor, especially if your honored surgery and Medicine. Your research sounds good. That usually means you will have some strong letters as well. It’s always hard to predict how someone will do based on limited info but an app like yours should fare rather well.

I still think that your step 2 at this point can only hurt you. A strong performance will simply keep the status quo of an already strong application. A bad day could add a ding to good app which is why I chose to delay.

I will say that approximately 0% of the PDs I’ve spoken to know or care about the percentile differences between step exams. So long as the numbers are close I don’t think anyone will notice or give a crap.

 

[slowthai]

Dude the exam has a 66% interval of like 16 points. So, for example, having a slightly lucky vs unlucky form is the difference between average and 260. Hard to call that a fantastic yardstick. These tests arent designed for how they're used in practice

Sorry, can you go into more detail about this please? How does this work?

 

[efle]

Sorry, can you go into more detail about this please? How does this work?

If someone is a true 252, the exam will place them 66% of the time in the range of 244 to 260.

So reasonable good or bad luck - hitting the upper end of that 66% interval vs the lower - is literally the difference between average and 260.

If you expand to 95% interval and ask what the most and least lucky people out of every couple dozen tend to look like? Now you're talking separation by 32 points.

Just one of several reasons it never made sense to use step exams like we do.

 

[Welshman]

I appreciate all of the feedback, I was definitely leaning towards taking it at first but I've decided to postpone. If anyone cares I'll walk you through my thought process, maybe it'll help future applicants and its definitely therapeutic for me haha

At first, I told myself that I would keep grinding, take the last practice exam tomorrow, and if I broke 260 keep my test date but I don't think it makes sense anymore. There is definitely something to be said about getting it out of the way and never thinking about it again but with how step 2 is right now I think to agree it's far more of a risk than a reward.

What @efle mentioned has been my main concern. From taking them and talking to people, the current NBME practice exams are relatively easy content-wise but their curve is extremely harsh (eg one question = 2 points for your score on NMBE 6, the others are a bit better but not by much). When 5 questions out of 200 can change your practice score +-10 points it makes it very hard to identify where you truly stand which is really important since the SEM and SEE are +-6-8 points 66% of the time.If my practice test average was higher, which it probably would be if they weren't so harshly curved, to where I could absorb the lower end of the SEM I'd definitely take it. But as Operaman and others are pointing out, that's a roll of the dice and just simply not worth the risk.

From what I've seen of the NBMEs data only about 20% of people underperform their practice test and 80% score above it, of which 50% are score over 10 points higher. I think we all agree that the odds are pretty good that I would be fine, probably do way better than expected and never worry about it again. But the 20% chance of underperforming, especially when knowing my "true score" is so tricky given the current practice tests, its a risk with no reward. I could score well to keep the status quo with my app or raise a lot more questions underperforming. Even if that didn't stop me from getting an interview, I really would not want to answer, "So what happened on Step 2?" "Why did you take such an important exam if you didn't feel ready?" "You just wanted to get it out of the way?" "Seems like poor planning to me."

I think the worst-case scenario is if in August or September I find out that PDs really want both scores and most applicants are applying with both so not having it would be a red flag somehow. In that case, I could keep up with my Step 2 anki so the content is still fresh in my mind and then hammer out a 2-week dedicated period right after aways to hopefully submit a score before interviews go out. Since I've done a lot of the leg work with anki already keeping up with my deck is about ~200 cards a night which is 30-45 minutes. Three new practice exams are also being released at the end of the month so hopefully those are more consistent and predictive. My knowledge will probably atrophy in 3 months but given that its been 6-9 months since I last did IM and surgery too I think the anki will pull through again.

That worst case scenario seems a lot more palatable right now than a 20% chance of getting 245-250.


(I realize all of the time spent overanalyzing this situation could probably have allowed me to take Step 2 and destroy it but alas)

 

[Welshman]

If you do delay, definitely don’t waste any time on aways studying. The whole point of delaying is not to maximize your score, but to make your score a non issue and give you control over when programs get to see it.

The only ding I see on your app will be your clinical grades and even that is fairly minor, especially if your honored surgery and Medicine. Your research sounds good. That usually means you will have some strong letters as well. It’s always hard to predict how someone will do based on limited info but an app like yours should fare rather well.

I still think that your step 2 at this point can only hurt you. A strong performance will simply keep the status quo of an already strong application. A bad day could add a ding to good app which is why I chose to delay.

I will say that approximately 0% of the PDs I’ve spoken to know or care about the percentile differences between step exams. So long as the numbers are close I don’t think anyone will notice or give a crap.

Word has just got out that ENT is moving to a single interview invite day, potentially on November 5th. More details are being released in August, but could you see this affecting anything? Any extra need to have a score waiting in the wings by then?

 

[GoSpursGo]

I appreciate all of the feedback, I was definitely leaning towards taking it at first but I've decided to postpone. If anyone cares I'll walk you through my thought process, maybe it'll help future applicants and its definitely therapeutic for me haha

At first, I told myself that I would keep grinding, take the last practice exam tomorrow, and if I broke 260 keep my test date but I don't think it makes sense anymore. There is definitely something to be said about getting it out of the way and never thinking about it again but with how step 2 is right now I think to agree it's far more of a risk than a reward.

What @efle mentioned has been my main concern. From taking them and talking to people, the current NBME practice exams are relatively easy content-wise but their curve is extremely harsh (eg one question = 2 points for your score on NMBE 6, the others are a bit better but not by much). When 5 questions out of 200 can change your practice score +-10 points it makes it very hard to identify where you truly stand which is really important since the SEM and SEE are +-6-8 points 66% of the time.If my practice test average was higher, which it probably would be if they weren't so harshly curved, to where I could absorb the lower end of the SEM I'd definitely take it. But as Operaman and others are pointing out, that's a roll of the dice and just simply not worth the risk.

From what I've seen of the NBMEs data only about 20% of people underperform their practice test and 80% score above it, of which 50% are score over 10 points higher. I think we all agree that the odds are pretty good that I would be fine, probably do way better than expected and never worry about it again. But the 20% chance of underperforming, especially when knowing my "true score" is so tricky given the current practice tests, its a risk with no reward. I could score well to keep the status quo with my app or raise a lot more questions underperforming. Even if that didn't stop me from getting an interview, I really would not want to answer, "So what happened on Step 2?" "Why did you take such an important exam if you didn't feel ready?" "You just wanted to get it out of the way?" "Seems like poor planning to me."

I think the worst-case scenario is if in August or September I find out that PDs really want both scores and most applicants are applying with both so not having it would be a red flag somehow. In that case, I could keep up with my Step 2 anki so the content is still fresh in my mind and then hammer out a 2-week dedicated period right after aways to hopefully submit a score before interviews go out. Since I've done a lot of the leg work with anki already keeping up with my deck is about ~200 cards a night which is 30-45 minutes. Three new practice exams are also being released at the end of the month so hopefully those are more consistent and predictive. My knowledge will probably atrophy in 3 months but given that its been 6-9 months since I last did IM and surgery too I think the anki will pull through again.

That worst case scenario seems a lot more palatable right now than a 20% chance of getting 245-250.


(I realize all of the time spent overanalyzing this situation could probably have allowed me to take Step 2 and destroy it but alas)

Honestly I don’t think a 245–250 would hurt you, and again you’re very focused on step scores when I think LORs are probably more important once you have you’re S1 score.

but to each their own. Good luck.

 

[Lawpy]

Honestly I don’t think a 245–250 would hurt you, and again you’re very focused on step scores when I think LORs are probably more important once you have you’re S1 score.

but to each their own. Good luck.

I mean we're talking ENT. I def would not gamble on a potentially lower Step 2

 

[operaman]

Word has just got out that ENT is moving to a single interview invite day, potentially on November 5th. More details are being released in August, but could you see this affecting anything? Any extra need to have a score waiting in the wings by then?

Dang that would have been nice! I don’t see how it would change your decision though. If you delay, the only date that matters is the cutoff for your score to be automatically reported.

 

[GoSpursGo]

I mean we're talking ENT. I def would not gamble on a potentially lower Step 2

He had a 260 something. It is statistically likely that he will have a lower step 2 score.

When you are that high, the goal isn’t to raise your step 2 score, it’s just to make sure you don’t crater.

 

[FindersFee5]

I didn't take any practice NBME's for step 2 and only used a 2 week dedicated after 2 months of grueling sub-is. Still outscored my step 1. The minutiae you grinded for step 1 will definitely be helpful on step 2 as well, as long as you understand the sick/not sick and stable/unstable aspect of step 2 questions.

 

[Lawpy]

He had a 260 something. It is statistically likely that he will have a lower step 2 score.

When you are that high, the goal isn’t to raise your step 2 score, it’s just to make sure you don’t crater.

A drop to a 245 is enough to be viewed as cratering for competitive surgical subs like ENT. A 250 probably less so but i really don't suggest gambling on this unless OP feels he can score in upper 250s/low 260s.

 

[GoSpursGo]

A drop to a 245 is enough to be viewed as cratering for competitive surgical subs like ENT. A 250 probably less so but i really don't suggest gambling on this unless OP feels he can score in upper 250s/low 260s.

At this point it doesn't matter because the OP made their decision. But you wouldn't say that someone who had a score breakdown of 250/245 "cratered." It's silly to say that someone who had a score breakdown of 26x/245 is worse because they had a more substantial drop; clearly the 26x/245 applicant is better than the 250/245. And again, we're not talking about things in a vacuum. There are plenty of things I could imagine the OP could do that would enhance their application more than maybe moving their step 2 score from 245 to 255.

Maybe the story will be different in the coming years when applicants no longer have a step 1 score. But right now I just don't believe that step 2 score is really that important unless you're trying to make up for a sub-par step 1 score.

 

[efle]

At this point it doesn't matter because the OP made their decision. But you wouldn't say that someone who had a score breakdown of 250/245 "cratered." It's silly to say that someone who had a score breakdown of 26x/245 is worse because they had a more substantial drop; clearly the 26x/245 applicant is better than the 250/245. And again, we're not talking about things in a vacuum. There are plenty of things I could imagine the OP could do that would enhance their application more than maybe moving their step 2 score from 245 to 255.

Maybe the story will be different in the coming years when applicants no longer have a step 1 score. But right now I just don't believe that step 2 score is really that important unless you're trying to make up for a sub-par step 1 score.

Agree I think he will pass all the score filtering by step 1 alone. Its next year that CK takes the throne

 

[Lawpy]

At this point it doesn't matter because the OP made their decision. But you wouldn't say that someone who had a score breakdown of 250/245 "cratered." It's silly to say that someone who had a score breakdown of 26x/245 is worse because they had a more substantial drop; clearly the 26x/245 applicant is better than the 250/245. And again, we're not talking about things in a vacuum. There are plenty of things I could imagine the OP could do that would enhance their application more than maybe moving their step 2 score from 245 to 255.

Maybe the story will be different in the coming years when applicants no longer have a step 1 score. But right now I just don't believe that step 2 score is really that important unless you're trying to make up for a sub-par step 1 score.

I mean i agree but ENT is a field where being competitive in everything matters. PDs are looking at numbers and not really paying attention to standard deviations, so a 260 to a 245 drop can look significant even if it statistically is the same thing.

It's not worth the risk to take it now, especially if some programs are already now placing more weight on step 2

 

[GoSpursGo]

I mean i agree but ENT is a field where being competitive in everything matters. PDs are looking at numbers and not really paying attention to standard deviations, so a 260 to a 245 drop can look significant even if it statistically is the same thing.

It's not worth the risk to take it now, especially if some programs are already now placing more weight on step 2

Again. I never said it didn't matter. But there is an opportunity cost. Once you have checked off the strong step 1 score, I suspect that having your attention undivided during your aways may be worth more than some percentage chance at raising your step 2 score a few points.

Yes, it is abundantly obvious that stats are important in matching to a competitive specialty. But there is a tipping point where those intangible pieces on an app/CV may matter more--you wouldn't trade 3 points on step 2 for 3 publications, for example. That's an absurd example, but just to show that the other pieces really do matter when you're applying to these competitive specialties. And I think it's telling that the only attending surgeon in this thread, @Lem0nz , agreed that it probably wasn't worth the tradeoff.

 

[Lawpy]

Again. I never said it didn't matter. But there is an opportunity cost. Once you have checked off the strong step 1 score, I suspect that having your attention undivided during your aways may be worth more than some percentage chance at raising your step 2 score a few points.

Yes, it is abundantly obvious that stats are important in matching to a competitive specialty. But there is a tipping point where those intangible pieces on an app/CV may matter more--you wouldn't trade 3 points on step 2 for 3 publications, for example. That's an absurd example, but just to show that the other pieces really do matter when you're applying to these competitive specialties. And I think it's telling that the only attending surgeon in this thread, @Lem0nz , agreed that it probably wasn't worth the tradeoff.

Isn't step 2 only needed before rank lists are out? Why not take step 2 in like january after finishing aways?

 

[Lawpy]

Also @operaman suggested to delay and he's in the field OP's trying to match to so tbh his advice should be the top priority

 

[Lawpy]

I appreciate all of the feedback, I was definitely leaning towards taking it at first but I've decided to postpone. If anyone cares I'll walk you through my thought process, maybe it'll help future applicants and its definitely therapeutic for me haha

At first, I told myself that I would keep grinding, take the last practice exam tomorrow, and if I broke 260 keep my test date but I don't think it makes sense anymore. There is definitely something to be said about getting it out of the way and never thinking about it again but with how step 2 is right now I think to agree it's far more of a risk than a reward.

What @efle mentioned has been my main concern. From taking them and talking to people, the current NBME practice exams are relatively easy content-wise but their curve is extremely harsh (eg one question = 2 points for your score on NMBE 6, the others are a bit better but not by much). When 5 questions out of 200 can change your practice score +-10 points it makes it very hard to identify where you truly stand which is really important since the SEM and SEE are +-6-8 points 66% of the time.If my practice test average was higher, which it probably would be if they weren't so harshly curved, to where I could absorb the lower end of the SEM I'd definitely take it. But as Operaman and others are pointing out, that's a roll of the dice and just simply not worth the risk.

From what I've seen of the NBMEs data only about 20% of people underperform their practice test and 80% score above it, of which 50% are score over 10 points higher. I think we all agree that the odds are pretty good that I would be fine, probably do way better than expected and never worry about it again. But the 20% chance of underperforming, especially when knowing my "true score" is so tricky given the current practice tests, its a risk with no reward. I could score well to keep the status quo with my app or raise a lot more questions underperforming. Even if that didn't stop me from getting an interview, I really would not want to answer, "So what happened on Step 2?" "Why did you take such an important exam if you didn't feel ready?" "You just wanted to get it out of the way?" "Seems like poor planning to me."

I think the worst-case scenario is if in August or September I find out that PDs really want both scores and most applicants are applying with both so not having it would be a red flag somehow. In that case, I could keep up with my Step 2 anki so the content is still fresh in my mind and then hammer out a 2-week dedicated period right after aways to hopefully submit a score before interviews go out. Since I've done a lot of the leg work with anki already keeping up with my deck is about ~200 cards a night which is 30-45 minutes. Three new practice exams are also being released at the end of the month so hopefully those are more consistent and predictive. My knowledge will probably atrophy in 3 months but given that its been 6-9 months since I last did IM and surgery too I think the anki will pull through again.

That worst case scenario seems a lot more palatable right now than a 20% chance of getting 245-250.


(I realize all of the time spent overanalyzing this situation could probably have allowed me to take Step 2 and destroy it but alas)

I was under the impression Step 2 was not required for interviews and you only needed it before rank lists are out, but tbh i think your plan is reasonable.

 

[Lawpy]

My rationale is PDs will see you took Step 1 after 3rd year so taking Step 2 right after might be risky, so deferring that to like January after aways would be reasonable. It's not like you took Step 1 after MS2 and ghosted Step 2, which would be different

I know OP made his decision but the situation is worth considering. I def think aways and letters are far more important which is why i thought postponing Step 2 to Jan would make sense

 

[GoSpursGo]

Isn't step 2 only needed before rank lists are out? Why not take step 2 in like january after finishing aways?

I'm going to be out on this after this response, because it's a personal decision without a right or wrong answer. But while in principle taking it in January would make sense, I don't think it makes sense once one has already sunk a few weeks of dedicated studying time into taking it now. Especially when 245 seems like a "worst case scenario" and there was still a solid chance of having something in the 250-265 range.

 

[Lawpy]

I'm going to be out on this after this response, because it's a personal decision without a right or wrong answer. But while in principle taking it in January would make sense, I don't think it makes sense once one has already sunk a few weeks of dedicated studying time into taking it now. Especially when 245 seems like a "worst case scenario" and there was still a solid chance of having something in the 250-265 range.

Ok agreed, this makes sense

 

[Lem0nz]

I'm going to be out on this after this response, because it's a personal decision without a right or wrong answer. But while in principle taking it in January would make sense, I don't think it makes sense once one has already sunk a few weeks of dedicated studying time into taking it now. Especially when 245 seems like a "worst case scenario" and there was still a solid chance of having something in the 250-265 range.

I feel like he already won the lottery. If he delays the exam he’s going to have to ‘start over’ with studying. I know that isn’t entirely true, but literally everyone in this thread also knows what I mean when I say he will have to start over with his studying and preparing for step 2 and that’s an awful feeling. I think OP is in such a strong position that he really can’t hurt himself that much even with a lukewarm step 2. I also would not be particularly interested in a program that needs to distinguish between applicants by ten points on their step 2.

My point is that he already passed all the barriers to get interview invites literally everywhere. The interviews are what matter now, his step 2 is quite frankly not going to be relevant whether he does amazing and gets 275 or does so so and gets 245.

That’s why I feel he will not hurt himself by getting it over with, and it will make him happier to do so. But if he decides to delay, it is certainly not wrong. Not at all. That level of OCD is kind of par for the course tbh. My emphasis remains though that the sort of programs I personally would recommend ANY surgical applicant seek out are the ones where you meet the bar to get an interview (he does) and then they decide to rank you based on how much they liked you on the interview. Not by counting your pubs and adding your steps together.

That’s just me. Opera isn’t wrong. I’m not wrong either. OP will be fine whatever he does and will probably get a freaking 280 anyway and this is all irrelevant.