Transitioning from another residency

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There is no advantage to doing internal medicine, either for 1 or 3 years. It won't negate a poor step 1 score and it doesn't do anything to make you more competitive for the ophtho match. It may even be construed as a lack of interest in ophtho on your part. Your time would be better spent doing research for a year or doing a pre-residency fellowship in ophthalmology. These things will improve your chances of getting in.
 
Agreed with the above. Your actions from here on out should show that you couldn't live without doing ophthalmology and that you are brilliant both clinically and in the research realm. Running off to start another career doesn't fit the bill. If your Step 1 was truly an outlier and your Step 2 proves it, then you will have a shot. Be cautiously optimistic because to residency programs, a botched Step 1 represents a significant risk, one that is unnecessary in an endless pool of qualified applicants. The only way to counter it is with top notch research and prominent people in the field that will personally vouch for you.
 
I mostly agree with the above. The only advantage with completing a year of IM or a transition year right out of medical school (if you do not match) is that such action would allow you to jump right into an open PGY2 position (first year ophthalmology) at any point. These open from time to time. Having the intern year out of the way would give you more options along these lines.

However, the above is a separate issue from step 1 score, research, letters, performance in medical school. I don't think there is a perfect answer for all. You are already sensing the uncertainty, but If you give your all in all academic activities over the next couple of years, I believe it will work out.
 
It sounds like you are a good applicant. The problem is STEP 1 is huge. Almost every program uses it as some type of screen. I attend a solid, but by no means top tier medical school, and the cutoff is 215 for STEP 1. Programs just get too many applications (500+ at the top programs) to review each individually. I don't think having completed an IM residency would change the screening process. Its not hopeless, but you would have to apply very very widely and have some personal references/connections to specific programs to have people overlook a sub 200 STEP 1. This sounds harsh, but being on the interview trail and having interviewed at 10+ programs this year, its hard to ignore how the process really works
 
Without the sugarcoating, the plain truth is you are out of Ophthalmology match probably for ever, except if your uncle is a PD in a program. I know how it works; I've many friends at different levels of the residency tier all over the country. It is highly unfair and sucks badly; but that is the plain reality. Whatever you do from now on pursuing the goal of Ophthalmology residency will be a waste of time because research/pubs are counted at a much later stage in this screwed up process. It is the step scores and medschool that gets you the interviews.If you have none, research/pubs are meaningless. Did you want the truth or just some comforting words? If the former, screwed up step scores particularly step-1 causes irreversible damage. Sorry, but you are out of the game! If you are looking for some comforting words, yes it can be done, why not, so many have done it before, try to win a Nobel etc, meaningless blah blah blah.....................once again, sorry for being blunt!
 
It may be worth talking to the PD at your home institution and getting his/her perspective on it. While I strongly agree that recovering from a low Step 1 score is difficult, you never know what a phone call from a well connected person can do. If ophtho is what you seriously want to do, you should pursue a research fellowship and see if it helps... Personally, I would find it easier to reconcile to a career other than ophtho only after I had given it my best shot. Good luck!
 
Without the sugarcoating, the plain truth is you are out of Ophthalmology match probably for ever, except if your uncle is a PD in a program. I know how it works; I've many friends at different levels of the residency tier all over the country. It is highly unfair and sucks badly; but that is the plain reality. Whatever you do from now on pursuing the goal of Ophthalmology residency will be a waste of time because research/pubs are counted at a much later stage in this screwed up process. It is the step scores and medschool that gets you the interviews.If you have none, research/pubs are meaningless. Did you want the truth or just some comforting words? If the former, screwed up step scores particularly step-1 causes irreversible damage. Sorry, but you are out of the game! If you are looking for some comforting words, yes it can be done, why not, so many have done it before, try to win a Nobel etc, meaningless blah blah blah.....................once again, sorry for being blunt!

I don't think the situation is that hopeless, especially if the OP can attain an elite Step 2 score. Plenty of people apply and obtain their interviews entirely by brute force of phone calls and letter writing. Sure, if you do nothing you will get completely screened out, but if you have the right people in your corner, you can get the interviews by other means.

Almost every year (except this year), there are a certain number of spots that go to foreign grads who probably don't have the same access to research opportunities. If the OP can put together good pubs and destroy Step 2, they would be a bargain deal to take one of these spots.
 
while the cards are stacked against you it will not be impossible to match. I would not start IM but rather take a year to do research or the like. Perhaps a good research fellowship would help. Or apply now. The low board score could be offset by good step 2, research/pubs, and great letters of rec. If you think you have all of the other aspects of your application wrapped up, then go ahead and apply. Otherwise, work on those weaknesses to make yourself a more competitive applicant.

You are not out of an ophthalmology residency by any stretch, don't listen to those trying to convince you otherwise. I've seen some (but not a lot) low step scores as I have reviewed applicants that end up matching. Are you a shoe in at a top 10 program? Probably not. Do you have a chance at a middle/lower tier program...sure.
 
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