Hi - I am third year medical student at a top 40 medical school and I am not doing well this year grade-wise. I've gotten high pass in medicine then pass in psych and ob-gyn and I feel so burn out I don't see myself doing much better going forward. As far getting into IM residency - what's the outlook for someone like me? My Step 1 is 223 and I plan to maybe take Step 2 before I apply for residency and also complete an MPH degree at an IV school between third and fourth year. Has anyone had stats like this? Please help! Thanks so much.
Third year of medical school and not doing well
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I think your best bet for a position at a good program is at your home institution. If that would be okay with you, just start letting people in the department know that you're interested in staying.
There are not too many im programs at which an MPH would make you much more competitive. Maybe programs with a strong international health program, you can try to sell them on that using your MPH. But you'd have to get an interview there first.Some sort of small research project without delaying graduation would probably help more than MPH, imho. Perhaps others can weigh in on this. Only do the MPH if you're really interested in doing one.
By the way, why do you feel you aren't doing as you hope to in the clerkships? Is it exam scores or ward performance? Sometimes you have to be selfish and not allow yourself to be dragged into spending too much time on the wards, because you do need to study. I always had this problem; I was fortunate to barely make a lot of the cutoffs I needed, but if I had to do it over again, I wouldn't have spent the extra hours wearing myself out on the wards, giving myself only 1-2 days to study for the shelf, usually the weekend before.
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You shouldn't have any problem getting interviews at most university programs (middle to lower tier). Step 1 is the most important. Good step 1 score. You'll be fine. A's and B's on rotations are perfectly fine. Getting that honor in medicine helps. Medicine isn't competitive unless you're aiming for top programs (e.g., Hopkins, Mayo, CCF, etc). I disagree with the above poster.
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FYI, CCF is not that competitive for IM with those kind of stats. You should get an interview there if you apply with these stats (as an AMG from a top 40 med school). I think you will have an issue getting a call from the Harvard programs, Hopkins and UCSF, Maybe Penn, Columbia, etc. but as the poster above mentioned, most mid tier programs would be happy to have you, if you do well from here on (and get good letters, the works).
I am interested in knowing how much the actual letter grade vs. comments matters for a top tier institution. Obviously in the medicine clerkship it is a big deal, but in something like OB or psych, if one gets great comments but didn't do well on a shelf for one reason or another, is that going to hurt them??
Unfortunately the letter grade is what matters the most. This is especially true for your medicine grade in which many top tier programs will, supposedly, filter out your application if you don't get honors. However, your OB and psych grades mean less and matter more in the sense of what your class rank will be.
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CCF, yes the OP should have a decent chance of getting an interview from. As far as maybe Columbia or Penn, I would say very, very doubtful Columbia or Penn. (Just being realistic, 223 is an average step 1 score for IM, meaning 1400+ people applying to im have step 1's that high.) Without honors in medicine, and that step score, the only way you would get interviews at places like Columbia is if you had an incredible research CV or something, several first author papers, etc.
People underestimate the competitiveness of medicine at good programs. Anyone who gets into programs like Penn, Columbia, the Harvards, etc., would have the stats and grades to land a residency position in any other field. Maybe not at a very good program, but yes, even derm or orthopedic surgery. Sometimes people are under the wrong assumption that since they don't have the stats to make it into neurosurgery, they can just go ahead and do IM at Hopkins. IM isn't family medicine. It is still medium competitiveness, with more competitive stats (step scores, AOA) than fields like anesthesia, obgyn, neuro, peds, pathology, psych etc.
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I meant maybe Penn, Columbia meaning...there is a high probability that he/she may NOT get into Penn or Columbia. I wonder even if places like UCLA, Vandy and Mayo may also be out, but I am not sure about those. Jefferson, Temple...you should be able to make it there comfortably.
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Based on what I have heard, you still need 230s and honors in medicine to get interviews from places like Mayo and UCLA, and it is not like everyone with 230s will get an interview from them. Now if the OP is at a borderline top 10 kind of school, then I would say places like Mayo and Vandy are still on the table. Otherwise, odds are against him/her. That is why I would STRESS, start talking to people at your home program now. An HP at your home program can definitely still get you a spot there. People take pride in their own med students. If your home PD writers an LOR for you, then by all means set up a meeting with them and explain how much you love the program and feel like you would a strong fit there.
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I would bet that places like those upper tier programs like penn, mgh, ucsf etc probably have statistics that rival derm and plastics...
for the op, i think some things to consider when you are applying to make yourself the most competitive applicant especially if you want to try for top tier programs is doing well on a subI with a letter from a subI attending and improving significantly on step 2 with your score in when you apply for residency
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No question, the average step 1 score at most top tier programs will be around 250 or higher. (It could be higher if step 1 is all they looked at, but they also want people with honors in medicine and research and good letters and good ECs. Generally speaking, there is a lot of crossover in the people who have all of these things. But there are people with step 1 260s who are lacking in other areas who won't even get an interview from some top im programs.) But an average step 1 of 250 is higher than the average for any other specialty...So there is little doubt than anyone who gets into the big 4 or even a top 10 im program, probably could have made it to any other field they wanted...perhaps only in a community program or whatever, but they would match in any case.
THANK YOU!!! Cosign completely. I'm sorry but derm folks at my home institution really annoy me for that reason..."oh, maybe I won't match in Derm, so I'll go ahead and apply to match at MGH just in case." Seriously?
To the OP, you have to nail Step 2, and as recommended by other posters, you MUST set aside time to study no matter how intense your clerkship is. If you have to drink Red Bull to get through Pre-test, then do it. Don't be so down on yourself. Also, you need to really work hard on your IM "acting internship" to get a strong letter. Many programs value a stellar AI letter over a basic clerkship grade of HP.
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A few things to the OP -
What is written on this board may freak you out even more. Dont let it.
I think we are missing an imp point here, that the OP is also feeling burned out. I think you need to talk to your advisor and find a way to deal with that. It may make life easier. Sometimes you need to press on the brakes, rather than on the accelerator. You have basically got the advice reg a top IM program, but there are still MANY programs out there that will interview you if you do well from here on. Maybe just taking a step back, and then going ahead after gathering your breath will help.
With 223 , you now know that maybe BWH and Hopkins are out. But dont screw yourself over and screw your chances at 50 other IM programs that are also very good for training an internist and sending you to a decent fellowship (often of your choice of subspecialty, maybe even Cards). I know a few people who felt they were getting burned out and just pushed themselves over into "schizophrenia" zone. So know that all is not over - you are still a decent candidate, and just get your act together and move ahead. If you do reasonably well, you WILL find yourself a decent IM spot.
Lastly, I am honestly tired of this harping on SDN that you need 250 to get into UCSF, BWH and Hopkins. You guys are just freaking everyone else out. Is there someone on this forum who had calls from these top programs, had scores > 230 (but not necessarily > 260), had a well-rounded CV, (I do believe AOA is important to these programs), and was not from a top 5 med school, that was interviewed at these programs? Something tells me that 250 is just not mandatory, even if you are coming from a borderline top 10-20 school. >235-340: agreed. A well-rounded CV with honors in Medicine: agreed. AOA: Agreed.
I really want to see some scores so that we stop freaking out MS-2/3s who believe theyve just lost everything because they scored a 232 on step 1.
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AOA is probably more important than board score. But just remember the corollary, for every person below a 250 who gets interviewed at the top programs, there are others with above 260 who don't. No way to know until you apply. If board score is all you have going for you though, it better be like 265. There was a poster on here last year or the year before...I think he had a 266 or so on step 1...went to HOPKINS. But only got a pass in medicine because he got into a bit of a confrontation with a chief resident iirc. He got an interview from Hopkins, but none of the other top programs, and he did not match at Hopkins. I think he wound up at UM or something.
But by all means, you can get into IM and get into any fellowship you want with a board score of 235-240. There are plenty of people at IM programs that aren't even top 50, maybe not top 100, who still match into cards or GI. In house fellowship spots are available at almost every university IM program. Just work hard and you'll get the spot. SDN is biased towards people who want to be involved in cutting edge medicine and research, myself included. That is why we obsess over prestige of programs. But if your goal is to a practicing clinician (and you will likely make more money than the vast majority of us involved in academics), you really don't have to worry as much about prestige. We talk a lot about fellowship matches at the top programs, but don't let that confuse anyone into think you need to be at a strong im program to get into competitive subspecialties. If you have good clinical reasoning, you will impress people wherever you go and get in house fellowship spots. The only difference is they won't be at cutting edge research centers.
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There are a few PSTPers on this forum that have ranked programs like WashU over Hopkins. People also choose to go to UTSW. My rank 1 is a program that isnt in the top 20 of any of the million lists published on SDN, but it produces arguably the most number of papers in the subspecialty of my interest. So good research comes from anywhere. The 2005 (or 6?) Nobel Prize went to Craig Mello, who has a lab at UMass (though he spent time in Stanford). Imatinib mesylate was discovered at OHSU. But basic point, good research happens anywhere. Its just you have more opportunities when you go to "top 5 centers", but by no means can you make a blanket statement that there wont be cutting edge research at other places...its just the number of opportunities are lesser. They still exist.
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Welcome to SDN. Please ignore the above quarrels about getting into MGH.
Psych and OBGYN can be hard clerkships. Psych people can be weird and odd. OBGYN clerkship is notorious for nailing people with bad grades. I can totally understand your frustrations with these two groups of people.
I would continue working hard during your MS3 year. All is not lost. Keep working hard and try to be a pleasant on the wards (I feel much of MS3 is acting and pleasing people... it is like a personality contest). Third year is a rough one because many aspects are undefined.
You still have the potential to rock Step 2CK. I have seen people that were persistent in increasing their score by 20-30 points.
An MPH degree will add to your application, but I am not sure how much. You pursue this degree if your desire is genuine. Otherwise, pursuing some sort of research experience like Doris Duke, etc. may be an option.
Bottom line here is:
1. Continue to work hard and study during your MS3... rack up as many Hs as possible.
2. Try to rock Step 2CK
3. Try to get an Acting Internship or Critical Care Acting Internship at the beginning of MS4 with a good attending that will write you a supportive letter.
While we can't predict your chances at specific programs, you have a good chance of matching at an average to above average program. Apply broadly and hope for the best.
Best wishes
Psych and OBGYN can be hard clerkships. Psych people can be weird and odd. OBGYN clerkship is notorious for nailing people with bad grades. I can totally understand your frustrations with these two groups of people.
I would continue working hard during your MS3 year. All is not lost. Keep working hard and try to be a pleasant on the wards (I feel much of MS3 is acting and pleasing people... it is like a personality contest). Third year is a rough one because many aspects are undefined.
You still have the potential to rock Step 2CK. I have seen people that were persistent in increasing their score by 20-30 points.
An MPH degree will add to your application, but I am not sure how much. You pursue this degree if your desire is genuine. Otherwise, pursuing some sort of research experience like Doris Duke, etc. may be an option.
Bottom line here is:
1. Continue to work hard and study during your MS3... rack up as many Hs as possible.
2. Try to rock Step 2CK
3. Try to get an Acting Internship or Critical Care Acting Internship at the beginning of MS4 with a good attending that will write you a supportive letter.
While we can't predict your chances at specific programs, you have a good chance of matching at an average to above average program. Apply broadly and hope for the best.
Best wishes
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No, I didn't mean there was little research at non top 5 places. I meant there was little research at non top 50 or non top 100 programs.
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-I agree with the above poster who said you may be spending too much time on the wards and not enough studying. I would also say probably not enough time kissing up. If you want the grades, then kissing up to the attending and fellow(s) and/or chief resident (if it's OB or surgical rotation) and spending a lot of time perfecting your oral presentations is what will get you the grade. It's not how hard you work or how well you take care of your patients. I'm not telling you how to become a great doctor - I'm telling you how to get good grades in 3rd year.
-If your shelf scores are the reason you've been missing the cut for HP and Honors on your rotations, then you need to find out what books people are studying from and study a lot. Even if it cuts down on your time with patients. I know it sucks, but med school grading is what it is. You'll learn to take care of patients during all of 4th year and residency, so don't sweat that. I am giving you advice I didn't take.
-Sometimes it is not working harder - it is working smarter. Find out what the attending wants and give it to him. If he's the world expert on drug eluting stents, then bring in the latest paper from NEJM on drug eluting stents. If he's Mr. "industry is bad" then don't be seen with any drug eluting stents and don't use any brand names when giving your patient's medication list. You get what I'm saying.
-Make sure to get some sleep. Working overly hard and staying up later doesn't necessarily make you look smarter on rounds if you're too tired to pay attention or you look bored because you're about to fall asleep.
-Try to get a 240 or so on Step II. You should be able to swing it if you got 224 on Step 1 and you study a lot. You don't need to study for it now...wait until 4th year and then study hard for a couple of months and take it.
-You need to get Honors on your AI next year. You need to work hard on your AI, and also find out from current 4th years which is the best hospital or ward and/or attendings to do your AI with. You want a good learning experience but also someone who is hopefully willing to give you Honors if your work for it.
-Try to forget your prior grades, and try to get all high pass and Honors for the rest of 3rd year. Don't discuss your grades with classmates or interns or residents - just act like you want honors and tell the attending that you want honors. Then you put them in the position that they know you want to do well, and psychologically it often works on them; at least it puts them in the position that perhaps they are in your corner as they see you as a "go-getter".
-If you still have surgey clerkship left to do, just know that it will be a lot of work. Get there early, try to be helpful on prerounds - i.e. carry around scissors and bandages to help the intern (at least if your surgical clerkship is anything like mine),smile a lot at the attending, and don't announce the fact that you want to do IM. They may not want to "waste" a high grade on someone they don't think is interested. If you are going to scrub into OR cases, try to find out what the case is the night before, so you can read up on the anatomy b/c they may pimp you.
- I think AOA is seen as probably more important than USMLE score, but you are likely not going to get AOA now. However, some PD's know that getting into AOA at a more high tier school is harder by virtue of the competition.
-I agree that staying at your home program may be your best bet...at least you want to keep that door open so try to get to know some people in the IM department if you can.
-If your shelf scores are the reason you've been missing the cut for HP and Honors on your rotations, then you need to find out what books people are studying from and study a lot. Even if it cuts down on your time with patients. I know it sucks, but med school grading is what it is. You'll learn to take care of patients during all of 4th year and residency, so don't sweat that. I am giving you advice I didn't take.
-Sometimes it is not working harder - it is working smarter. Find out what the attending wants and give it to him. If he's the world expert on drug eluting stents, then bring in the latest paper from NEJM on drug eluting stents. If he's Mr. "industry is bad" then don't be seen with any drug eluting stents and don't use any brand names when giving your patient's medication list. You get what I'm saying.
-Make sure to get some sleep. Working overly hard and staying up later doesn't necessarily make you look smarter on rounds if you're too tired to pay attention or you look bored because you're about to fall asleep.
-Try to get a 240 or so on Step II. You should be able to swing it if you got 224 on Step 1 and you study a lot. You don't need to study for it now...wait until 4th year and then study hard for a couple of months and take it.
-You need to get Honors on your AI next year. You need to work hard on your AI, and also find out from current 4th years which is the best hospital or ward and/or attendings to do your AI with. You want a good learning experience but also someone who is hopefully willing to give you Honors if your work for it.
-Try to forget your prior grades, and try to get all high pass and Honors for the rest of 3rd year. Don't discuss your grades with classmates or interns or residents - just act like you want honors and tell the attending that you want honors. Then you put them in the position that they know you want to do well, and psychologically it often works on them; at least it puts them in the position that perhaps they are in your corner as they see you as a "go-getter".
-If you still have surgey clerkship left to do, just know that it will be a lot of work. Get there early, try to be helpful on prerounds - i.e. carry around scissors and bandages to help the intern (at least if your surgical clerkship is anything like mine),smile a lot at the attending, and don't announce the fact that you want to do IM. They may not want to "waste" a high grade on someone they don't think is interested. If you are going to scrub into OR cases, try to find out what the case is the night before, so you can read up on the anatomy b/c they may pimp you.
- I think AOA is seen as probably more important than USMLE score, but you are likely not going to get AOA now. However, some PD's know that getting into AOA at a more high tier school is harder by virtue of the competition.
-I agree that staying at your home program may be your best bet...at least you want to keep that door open so try to get to know some people in the IM department if you can.
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1. Agree with everything dragonfly said. There definitely is a game to be played third year. (And some people are just naturally better at it.)
2. Yes, that is who I was thinking of joyful. That was one person who apparently made a bad move in the game and got blacklisted?, and it is unfortunate. In any case, I'm sure he is brilliant and UM has more than enough resources to do anything you want. If not for location, I thought that program was superior to the UPenn/Columbia/Duke/UW/Stanford/BIDMC type programs.
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I forgot to mention avoid confrontations with any authority figures...this includes residents, chief residents, ALL attendings, and in your care probably interns. It may be best to avoid interns as much as possible, since they tend to be cranky and may try to scut you out. However, this may differ on surgical rotations, where the attending and upper levels may like it if you help the intern do scut. Generally, it's better to finagle more face time with the attending, versus helping interns do their work.
Also, don't complain about the work or how unfair the grading is (even if it is, and/or seems so). I mean don't complain about it at work. You can phone your mom, your sister, boyfriend, whatever and complain about it to them. But at school you need to act like you are enjoying yourself even if some of it is like walking over hot coals.
And be sure to get some sleep.
Also, don't complain about the work or how unfair the grading is (even if it is, and/or seems so). I mean don't complain about it at work. You can phone your mom, your sister, boyfriend, whatever and complain about it to them. But at school you need to act like you are enjoying yourself even if some of it is like walking over hot coals.
And be sure to get some sleep.
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Having interviewed at JHU, this comment seems even more ballsy. One takeaway lesson for 3rd yr: Don't piss anybody off.
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It seems like some on this board feel like if you dont go to a top 5 medical school you have to be perfect to even be considered by the top 10 programs. They say you must be AOA, have >260 on the boards, have tons of research, honors in medicine and letters from the leaders in the field.
I can tell you it is malarkey. I come from an unranked school with a step 1 score below 250, I was not AOA, and had only a few minor pubs in obscure journals. I got interviews at all the top places I applied including MGH, Hopkins, Penn etc (except BWH). I also got a good indication from the program director at one of those highly coveted top 4 that I would match if I ranked them highly.
I don't fit that stereotype that SDN people say you need to meet to get interviews. I dont go to a top 5 school or *Gasp* even a top 60 med school. Oh, and I'm really not all that interesting, so it's not my sparkling personality or crazy ECs that sparked interest.
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Knowing the people who will be doing the evaluating beforehand always helps. This unfortunately isn't always possible, but usually you can get a sense for it for each rotation from people who have already completed that rotation. If you know, then you know who you want to try to impress, who you want to get face time with, and whose lectures/other activities you don't want to be late for. Interns, from my experience at least, never have any input to your evaluations, with the surgery rotations as a caveat. Surgery is very hierarchy driven; if your chief hears from an intern that you weren't around when the intern could have used a hand, you will be in trouble. That is not to say you shouldn't always be a team player and help people out as much as you are capable of, just don't do it at the expense of your evaluation.
And sometimes it is unavoidable that someone random will evaluate you. During my cardiology elective, I had one attending the entire month, but had 3 different fellows over the course of the month. (It was a consult elective.) Guess who evaluated me? The fellow who I was with for the first 3 days of the elective only.
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First of all, a few pubs in minor publications, is STILL a big deal. Most people do not have publications at all.
Second of all, you might have something else going for you, to be blunt. Do you have an LOR from someone really famous? Were you a former division 1A football player? Do you have some incredible extracurricular activity? Are you an under-represented minority? No one is saying it is impossible with lower stats, just that it is a 1 in a 100 person with those lower stats who gets the invites. And then teh selection bias of said person advertising it on SDN. You must definitely have something else going for you to get the invites you did. It might just be the research alone which you are understating.
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I was not a college athlete, have relatively unimpressive activities, am not a URM, and my LORs while strong were from relatively unknown people. My grades for third year were strong (not AOA) but still, you make it seem like you have to be at harvard or perfect. My experience has not bore that out. Who knows though, maybe I will end up at #10 on my ROL (still above 20 on your top 30 IM programs list).
Compared to the MD/PhDs I felt like were everywhere, I felt my research was relatively weak.
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Your research is probably stronger than you think. And I just searched your prior posts. So your step 1 was high 240s, and you have mostly clinical honors. Not sure why that wouldn't get you AOA, but you are certainly in that ballpark. I imagine you honored medicine? So really your application was borderline to a lot of stats we're talking about, and then your research publicationS (there was an S at the end of that) pushed you over the top. You're not really an exception in that case. Hopkins gives some geographic preference. MGH interviews more candidates than the other top programs. The numbers don't surprise me in that case.
I totally agree with both of these points, MPH might only help to get into med school. Also, try really hard to get to know the attendings at your home program. Do a sub-i in medicine at your home program, stay late, work your butt off, get the residents to put in a good word for you and you'll be all set.
Hope this helps.
I come from a middle/lower tier program. AOA, step 1-230, step 2-240
1 publication. Honors in all of my clinical rotations except OBGYN (high pass).
I received interviews from MGH, BWH, PENN, HOPKINS, etc...
Don't need 250+ just need to be a well rounded candidate. I truly think that the step scores are WAAAAAY over emphasized on this forum.
1 publication. Honors in all of my clinical rotations except OBGYN (high pass).
I received interviews from MGH, BWH, PENN, HOPKINS, etc...
Don't need 250+ just need to be a well rounded candidate. I truly think that the step scores are WAAAAAY over emphasized on this forum.
Similar stats, but not AOA, also got interviews at places people said I'll need 250s to get my foot in the door.
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I think that rather than focusing on which programs will give out interviews, the focus should be on the fact that you feel burnt out and like you won't do well going forward. Take a vacation and figure out where your weak spots are - most people not doing well in rotations because of the shelf. If that's the case, you need to think about why that is and change something. The fact is that your step 1 is fine and will get you lots of interviews, but you shouldn't be burnt out and getting passes in rotations and not planning to do better. If you're taking a year off, I would suggest using that time and studying right after rotations for step 2 while everything is fresh and you have extra time. Although the focus is on step 1, you want a good step 2 score that shows improvement. Good luck!
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Hey,
I am at a top 20 school and was in the same situation during 3rd year, always on the wards trying to be helpful, and it really screwed me over when it came to shelf exams. I would often stay in the hospital until 7-8pm, and when I got home, I only had 2 hours to study, and often I was too tired to really be effective. I also found it very difficult to study on the wards, b/c I always wanted to be doing something rather than reading. Anyway, I realized that I had to get a stellar score on the Step II (my Step I was 220), and I gave myself a whole month to study during the beginning of 4th year (starts in May for my school). I ended up getting a 257, which was beyond anything I ever hoped for. Still, I was advised by many faculty at my school that I would not be competitive for top tier programs, so I didn't apply to any of the Harvard programs, Hopkins, Penn, Columbia WashU or UCSF. I did, however, get interviews everywhere I applied--including Duke, Michigan, and Stanford, which I think are pretty great programs.
I actually regret not applying to the top programs, because I would have liked to see them for the purpose of comparison, even though realistically, I may not have matched there. I'm still a little angry at myself for underestimating myself and not applying to all the great programs. I don't know where I'll match yet, but my point is, there is still time to improve, and don't ever lower your expectations because you didn't have an ideal 3rd year. I don't have any publications, but I did make sure my rec letters were stellar, and it helped that I had consistently superb evals from 3rd and 4th year. I did have to address my shelf exam grades during several interviews, so be prepared for that. Good luck!
I am at a top 20 school and was in the same situation during 3rd year, always on the wards trying to be helpful, and it really screwed me over when it came to shelf exams. I would often stay in the hospital until 7-8pm, and when I got home, I only had 2 hours to study, and often I was too tired to really be effective. I also found it very difficult to study on the wards, b/c I always wanted to be doing something rather than reading. Anyway, I realized that I had to get a stellar score on the Step II (my Step I was 220), and I gave myself a whole month to study during the beginning of 4th year (starts in May for my school). I ended up getting a 257, which was beyond anything I ever hoped for. Still, I was advised by many faculty at my school that I would not be competitive for top tier programs, so I didn't apply to any of the Harvard programs, Hopkins, Penn, Columbia WashU or UCSF. I did, however, get interviews everywhere I applied--including Duke, Michigan, and Stanford, which I think are pretty great programs.
I actually regret not applying to the top programs, because I would have liked to see them for the purpose of comparison, even though realistically, I may not have matched there. I'm still a little angry at myself for underestimating myself and not applying to all the great programs. I don't know where I'll match yet, but my point is, there is still time to improve, and don't ever lower your expectations because you didn't have an ideal 3rd year. I don't have any publications, but I did make sure my rec letters were stellar, and it helped that I had consistently superb evals from 3rd and 4th year. I did have to address my shelf exam grades during several interviews, so be prepared for that. Good luck!
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I will never understand the advice to not even apply to reach programs. Applying is dirt cheap. You have nothing but $10-25 and a little self esteem to lose. And based on the IVs you did get, I think it's safe to say that you would have gotten them from most (if not all) of the programs you were told not to apply to. Bad advising at your school. That sucks for you, sorry to hear it.
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Did you have good clerkship grades despite the shelf scores? I don't think shelf grades matter if you do well in the clerkship regardless. Most people would just view that as you're not a good test taker, but you're really solid on the wards. Doing well in clerkships and getting strong LORs, if you're at a top med school, usually gets you quite far in applying to IM programs. Clerkship grades are definitely more important than step 1 scores, and particularly more important if you're at a strong med school.
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i think one thing to keep in mind that carries more weight than I thought is the reputation and regionality of your medical school... i got rejections from places like upenn, MGH, northwestern but my statistics were what I consider competitive (250s on steps with AOA and honors in most of my clerkships including medicine and medicine subI) but because I came from a lower tier school in texas not UTSouthwestern or Baylor, that hurt me in terms of getting my foot in the northeast area
