USMLE Taking it scored vs P/F (Sorry long post ahead)

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Feb 10, 2015
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Hey everyone, I’m an international student (i.e. need a J-1 or H-1B visa sponsorship for residency) at a US DO school. As a second year, I have the option of taking the USMLE step 1 for a P/F score in January 2022. This is assuming the timeline, for P/F implementation, doesn’t change much. Even then, I could potentially take it as P/F if it got delayed a little further.
Unfortunately, I had to repeat my first year of medical school for academic reasons secondary to personal/family matters. I realise this would be a major red flag for residency applications, but I take full responsibility for this and have tried to take the right steps to ensure that my academic performance is not affected in the future. For what it's worth, my specialty interest is internal medicine. I might also be interested in one of the competitive internal medicine sub-specialities like cardiology and gastroenterology (I know lol! 🙃). Additionally, I don’t have any geographic restrictions when it comes to residency programs. Community, academic, urban, rural, I’ll go pretty much anywhere that accepts me lol!
My question is that should/can I take USMLE step 1 as P/F in January 2022 (as a 3rd year student) if I feel like my performance could potentially be poor if I took it scored? This is especially given my academic history with having to repeating first year of medical school.

TL;DR International student at US DO school. Had to repeat 1st year. Need visa sponsorship for residency. Interested in internal medicine (maybe cardiology or gastroenterology). No geographic restrictions. Potential for poor performance on USMLE step 1, so should/can I take it as P/F in 2022 as a 3rd year?

TIA to everyone! This sub has always been a source of great information and guidance. Stay safe out there 🙂

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My school will not let you start clinicals without passing step 1. You will have to check with your school, but I would assume you do not have a choice in the matter - either take a leave of absence just to get a P/F step 1 (a LOA does NOT look good on your residency applications. And you do also do not want any more red flags, already requiring a visa, being a DO, and repeating a year), or continue on as normal and risk a poor step score. If you are just applying to IM, then it really does not make a huge deal what your score is, unless you actually fail. You likely already will not be competitive for top-tier programs, so you will have to work extremely hard through the rest of med school AND as a resident to consider a competitive fellowship.
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Thank you so much for your response! So, for our school we need to take/pass COMLEX level 1 to advance onto 3rd year. There’s no requirement for step 1. I was thinking of taking step 1 as P/F during my second semester of 3rd year (i.e. January 2022). I won’t have to take a LOA for that I believe. I hope I’m making sense.
Yes, as far as residency programs are concerned, I don’t even intend to apply to top tier internal medicine places (veryyy small chance that I might be interested in neurology as well). Community, low low tier academic, the like. Beggars can’t be choosers. If the place just happens to have some of the in-house internal medicine fellowships that I’m interested in, I’d be a happy camper.
Please feel free to give any additional feedback that you might have. Thank you once again!
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If you do have poor grades in basic sciences then that will translate to a poor step score. I would shoot for p/f if I were you.
Not that I think it will actually help too much if you have to report comlex too? I really don't know anything about that exam, but isn't it in some way comparable to the step exams? Like programs will be able to estimate your grade on step 1 anyway?

Regarless, still go for step 1 p/f
So, when I repeated 1st year my grades were in the B-B+ range (More Bs than B+s). The trend has continued up till now in 2nd year. You make an interesting point, and honestly I’m not sure. I have heard though that PDs don’t put a lot of stock into COMLEX 1, particularly because it’s relatively hard to decipher the meaning of the score (apparently the percentiles of the scores vary significantly from year to year to). In other words, PDs mainly are looking for a passing score on COMLEX level 1 mostly. Again, that’s just what I’ve heard.
I cannot comment any further on comlex, but my other thought it that it will also be pretty obvious that you delayed taking step 1 just to get the p/f, and that may reflect poorly as well. I know many PDs are not necessarily happy about the change to p/f, so they may be looking into things like this more carefully. This really runs the limit on the advice I am qualified to give though.