Thoughts on Delaying Step 1

[navy kenzo]

I suspect that a lot of 2nd year MD/PhD students are currently deciding between taking Step 1 now for a score or delaying until it's pass-fail (post PhD after clinicals along with Step 2). I would love to hear the community's thoughts on pros vs cons. Also, given that many of us are several years off from deciding on a specialty and training path I would like to hear how this might change if we choose to apply to PSTPs or to competitive specialties vs not-as-competitive ones in the future.

---

Members don't see this ad.

 

[ValentinNarcisse]

I suspect that a lot of 2nd year MD/PhD students are currently deciding between taking Step 1 now for a score or delaying until it's pass-fail (post PhD after clinicals along with Step 2). I would love to hear the community's thoughts on pros vs cons. Also, given that many of us are several years off from deciding on a specialty and training path I would like to hear how this might change if we choose to apply to PSTPs or to competitive specialties vs not-as-competitive ones in the future.

If you are at a top-tier school, I wouldn’t risk anything by taking the exam for a score. If at a lower ranked program and you are a great test taker, scoring a 260+ will help distinguish you from others.

 

[Serac]

I'd largely agree, except I'll add that I think scoring a 250+ will help distinguish you from others...

 

[Lucca]

There’s too much time between preclin and clin for us for me to be comfortable postponing step 1. Additionally Step 1 review is the last thing I want to worry about during the last year of my PhD when I should be focused on publishing , writing, and graduating.

I don’t think the exam will continue to be anywhere near as important as it is now in 5-7 years.

 

[SurfingDoctor]

I suspect that a lot of 2nd year MD/PhD students are currently deciding between taking Step 1 now for a score or delaying until it's pass-fail (post PhD after clinicals along with Step 2). I would love to hear the community's thoughts on pros vs cons. Also, given that many of us are several years off from deciding on a specialty and training path I would like to hear how this might change if we choose to apply to PSTPs or to competitive specialties vs not-as-competitive ones in the future.

If I saw a high score versus a pass score... I'd favor the high score.

 

[MSTPadvocate]

We have clear data that students in our program who delay taking step 1, even by a few months, do much worse than those who take it earlier. We are encouraging our students to take the test and move on with their lives.

 

[Alyssum]

We have clear data that students in our program who delay taking step 1, even by a few months, do much worse than those who take it earlier. We are encouraging our students to take the test and move on with their lives.

That's likely due to correlation rather than causation. Your data, I'd assume, is mostly from pre-covid and pre-P/F step days. The students in your program who delayed taking step 1, went against the norm, and studied for more than 8-10 weeks probably had issues (family, health, events, etc) that prevented them from preparing for boards in a timely manner. They might have struggled to academically keep pace with their peers. While at some point, more studying does lead to diminished returns, those students could have done even worse had they not delayed their test.

 

[Serac]

There is published data out there suggesting students do better if they take step 1 after 3rd year if I recall correctly. I think you can take it when you want but if you can get a 240+ I would just get it over and done with, it doesn't deserve to hang over your head any longer than it already has.

 

[inode]

I would like to hear the community's thoughts on the following two things:
Scoring a sub-220 score on step 1 now versus taking it pass/fail later: Will it really make that much of a difference?
Will studying for step 1 (pass/fail) and step 2 simultaneously (for an extended dedicated period) after clerkships benefit one's step 2 score?

 

[ValentinNarcisse]

I would like to hear the community's thoughts on the following two things:
Scoring a sub-220 score on step 1 now versus taking it pass/fail later: Will it really make that much of a difference?
Will studying for step 1 (pass/fail) and step 2 simultaneously (for an extended dedicated period) after clerkships benefit one's step 2 score?

Yes it will make that much of a difference. Even a Nature paper in grad school will not save you from a Sub-220 step score when you apply to residency. That used to be the case years ago, but now is definitely not the case particularly for competitive sub specialties. Don’t close doors for yourself unless you are 100% confident that you do not want to enter a competitive field or if you prefer to be a full time scientist.

 

[Fencer]

Yes it will make that much of a difference. Even a Nature paper in grad school will not save you from a Sub-220 step score when you apply to residency. That used to be the case years ago, but now is definitely not the case particularly for competitive sub specialties. Don’t close doors for yourself unless you are 100% confident that you do not want to enter a competitive field or if you prefer to be a full time scientist.

I am sorry, but not true in all instances. I actually have seen "SEVERAL" sub-210 step 1 match on top 10 research intensive residencies for their specialty (Pediatrics, IM, Neuro).

 

[ValentinNarcisse]

I am sorry, but not true in all instances. I actually have seen "SEVERAL" sub-210 step 1 match on top 10 research intensive residencies for their specialty (Pediatrics, IM, Neuro).

I would argue that these fields are not particularly competitive. Ortho, neurosurgery, ENT, plastics, derm, etc will not care. I only make this point because when I was fortunate enough to be an MSTP student at a top program, our director did not particularly emphasize performance on the exam. Fortunately, I had mentors that told me otherwise. Over the years I have seen many students have their specialty choice, location, and tier of program limited by this metric. Now as I review residency applications, those applications below a cut-off USMLE score are simply not even opened on ERAS for review. Even in this context, residents and faculty at my program are highly successful obtaining NIH funding and go on to be successful physician scientists, so its not an either/or scenario with regard to board scores. In addition, there sometimes can be a culture within MSTP programs that students are special and revered, but the reality is that there are plenty of highly successful MD-only students who in 4 or 5 years have more/higher impact publications than many MD/PhD students. I think junior MSTP students might get enamored by an M4 matching at a top name brand residency program, but always keep in mind the competitiveness of the specialty. It is a very different game if you go into Pathology or Pediatrics than going into Dermatology or competitive surgical subspecialty. As a M1 or M2, I would advise keeping all options open since you do not want to be in a scenario where you are uncompetitive for your dream program or specialty no matter how successful you are in grad school.

 

[MSTPadvocate]

Our students with sub-220s match very, very well. If a single score on a single exam is the determining factor for residency admissions, perhaps that program isn't the best for an otherwise highly accomplished physician scientist.

 

[Neuronix]

I saw 4 MSTPs at a top tier program all not match in one year and step scores were a huge factor. It was a wake up call for them, and it should be for you.

Strong academic residencies are highly competitive, get tons of applications, and often use score cutoffs to filter applicants. A bad score can absolutely hurt you in many programs in many specialties. If you're not prepared to get at least the average score for specialties you may be interested in, don't take the test.

 

[biobukowski]

MD/PhD grad here.
With Step 1 being pass/fail, you have two options.
1. Take it now, you’ll pass and just dive in to research.
2. Take it before returning to clinic, which will force you to review concepts and when you get to clinic you rock your evaluations.

However, these scenarios have potential downsides:
1. you will struggle if you start back with internal medicine, or another inpatient-heavy (or pimping-heavy) specialty.
2. You will struggle with re-memorizing two years of jam packed knowledge to pass the test.

There IS an Option Number 3. I think I would have taken it had I been given that chance: Dive into your PhD, and aim to barely pass Step 1, then trust that knowledge base will build back up. Truth be told, even aiming to pass will give you a good review and place you in a competitive place with your MD-only peers.

 

[inode]

MD/PhD grad here.
With Step 1 being pass/fail, you have two options.
1. Take it now, you’ll pass and just dive in to research.
2. Take it before returning to clinic, which will force you to review concepts and when you get to clinic you rock your evaluations.

However, these scenarios have potential downsides:
1. you will struggle if you start back with internal medicine, or another inpatient-heavy (or pimping-heavy) specialty.
2. You will struggle with re-memorizing two years of jam packed knowledge to pass the test.

There IS an Option Number 3. I think I would have taken it had I been given that chance: Dive into your PhD, and aim to barely pass Step 1, then trust that knowledge base will build back up. Truth be told, even aiming to pass will give you a good review and place you in a competitive place with your MD-only peers.

What about taking it after 3rd year rotations?

 

[biobukowski]

What about taking it after 3rd year rotations?

clinical rotations should prepare you for step 2, but step 1 is best as a tool to assess pre-clinical knowledge (and help you synthesize some of that knowledge before you apply it)

 

[Serac]

There is a little data out there showing an improved step 1 score in students who took it after 3rd year, but it deserves the usual skepticism one would expect. These were straight MDs but I think doing this way is increasingly common and given you only need to pass if you wait, I think it is an attractive option.

 

[smithers12]

I saw 4 MSTPs at a top tier program all not match in one year and step scores were a huge factor. It was a wake up call for them, and it should be for you.

Strong academic residencies are highly competitive, get tons of applications, and often use score cutoffs to filter applicants. A bad score can absolutely hurt you in many programs in many specialties. If you're not prepared to get at least the average score for specialties you may be interested in, don't take the test.

I remember coming to this board as an M1 and heeding @Neuronix 's advice about the importance of step scores. I am now an M4, and I can say without reservation that, almost a decade later, his advice still holds true. Your board scores matter. Period. Anyone who tells you otherwise is lying to you.

 

[Lucca]

I remember coming to this board as an M1 and heeding @Neuronix 's advice about the importance of step scores. I am now an M4, and I can say without reservation that, almost a decade later, his advice still holds true. Your board scores matter. Period. Anyone who tells you otherwise is lying to you.

but will step 1 cutoffs for app filtering exist in 6 years, when this becomes relevant for OP? obviously, no

 

[Neuronix]

If you can get a high step score now I think it can only help you down the road. The problem is they will probably compare you to the MDs taking the exam now (as it always has been, and this has always been an issue with score creep). So if you feel confident in a high score go ahead and take. If you don't want to risk it, I would wait and just plan to pass.

 

[ClimbsRox]

Curious if anyone has any credible info on residencies blinding themselves to step one scores after the P/F transition? Unconfirmed rumor has it some EM residencies plan to do this, as my friend who is an M3 was advised by EM faculty not to take a research year because he absolutely nailed step and wants it to count. I'm curious if this is going to be a trend. I'm taking it in May because I don't want to have to worry about it during grad school, but I might go surfing and climbing a bit more during dedicated if that's the case.

 

[inode]

Here's a related reddit thread:



I'm mainly deciding between taking it this coming year or taking it during MS3 year.

 

[Alyssum]

Curious if anyone has any credible info on residencies blinding themselves to step one scores after the P/F transition? Unconfirmed rumor has it some EM residencies plan to do this, as my friend who is an M3 was advised by EM faculty not to take a research year because he absolutely nailed step and wants it to count. I'm curious if this is going to be a trend. I'm taking it in May because I don't want to have to worry about it during grad school, but I might go surfing and climbing a bit more during dedicated if that's the case.

UChicago Internal-Med/Peds residency program is blinding both Step 1 and 2 scores even for this application cycle, but they do require passing scores on both Step1 and Step 2 CK before entry. Also, I remember a while ago attending info sessions by IM PSTP residency directors and those from very desirable academic programs on the coasts all said that Step 1 scores have always mattered little, if at all, during their research track residency evaluations.

However, I think if you take it now with a score, you should still take it seriously and aim to do well, in case you become interested later in a speciality that has traditionally relied greatly on step scores for interview invites. There are certainly specialities where your PhD will help you less.