Unsure about taking USMLE Step 1

[TheoryOfEverything]

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I'm in the situation where I'm unsure if I should take Step 1. I'm scheduled to take it in about 1 week, I could probably move it back about 2 more weeks though if absolutely necessary. I already took COMLEX and am predicting a fairly average score, but who knows.

My first NBME (13) was a 170ish back at the end of March. Since then I've taken 15, 16, 17, and 18 over the past 6 weeks (18 being a few days ago, I have consistently scored around 200 +/- a couple points on all of them. So I basically haven't improved at all which has been very frustrating. I also took UWSA 1 about 3 weeks ago and got a 213.

So obviously I don't want to take Step 1 if it looks like I'm going to get around a 200 or risk failing. I would take it if I felt comfortable getting around a 210 or above. My plan is to take UWSA2 in the next few days and if I get above a 220 then I'll probably take Step. I know it's supposed to be the most predictive/slight over prediction.

I'm wondering if this seems like a reasonable cut off point. I'm extremely burnout at this point and don't think I'll be very productive if I were to push it back further. I'm mainly interested in FM/IM/Neuro, I know they aren't considered competitive but everything I read seems to imply that no Step is a serious hindrance so I'm not really sure what my plan should be.

 

[Rekt]

I'm in the situation where I'm unsure if I should take Step 1. I'm scheduled to take it in about 1 week, I could probably move it back about 2 more weeks though if absolutely necessary. I already took COMLEX and am predicting a fairly average score, but who knows.

My first NBME (13) was a 170ish back at the end of March. Since then I've taken 15, 16, 17, and 18 over the past 6 weeks (18 being a few days ago, I have consistently scored around 200 +/- a couple points on all of them. So I basically haven't improved at all which has been very frustrating. I also took UWSA 1 about 3 weeks ago and got a 213.

So obviously I don't want to take Step 1 if it looks like I'm going to get around a 200 or risk failing. I would take it if I felt comfortable getting around a 210 or above. My plan is to take UWSA2 in the next few days and if I get above a 220 then I'll probably take Step. I know it's supposed to be the most predictive/slight over prediction.

I'm wondering if this seems like a reasonable cut off point. I'm extremely burnout at this point and don't think I'll be very productive if I were to push it back further. I'm mainly interested in FM/IM/Neuro, I know they aren't considered competitive but everything I read seems to imply that no Step is a serious hindrance so I'm not really sure what my plan should be.

I would not take it.

 

[Drrrrrr. Celty]

With a UWSA1 of 213 and an average of 200ish on your nbmes I wouldn't take step 1. I would try to figure out what's the limiting factor on why you weren't hitting your target though for step 2/level 2 time however.

 

[Giovanotto]

I'm somewhat similar to you, except I didn't take as many practice exams, but scored 204 on NBME18, and 215 and 226 on UWSA1 and 2, respectively. I'm going for it in 4 days! It depends on what your goals are too, I'm not trying to rock the damn thing, just trying to get a passing score that starts with a 21....

From what I gather reading online, most people score pretty similar to their NBME18 or UWSA2 test scores.

 

[Giovanotto]

With a UWSA1 of 213 and an average of 200ish on your nbmes I wouldn't take step 1. I would try to figure out what's the limiting factor on why you weren't hitting your target though for step 2/level 2 time however.

You can take Step 2 without taking Step 1? Furthermore, is that a thing people do?

 

[pedspedspeds18]

A good COMLEX without a STEP is better than a good COMLEX with a poor STEP at the moment. Unfortunately, no one can speak to what will change with the "merger". I would say work hard at raising your STEP but if you cannot, I don't think I would take it because you listed non-competitive specialties as your interests. You are not wrong in saying that not taking STEP may limit your options. However, any program that won't interview without a STEP score is also unlikely to interview you with a poor STEP score so taking it an doing poorly doesn't open any doors in my opinion.

 

[AlbinoHawk DO]

A good COMLEX without a STEP is better than a good COMLEX with a poor STEP at the moment. Unfortunately, no one can speak to what will change with the "merger". I would say work hard at raising your STEP but if you cannot, I don't think I would take it because you listed non-competitive specialties as your interests. You are not wrong in saying that not taking STEP may limit your options. However, any program that won't interview without a STEP score is also unlikely to interview you with a poor STEP score so taking it an doing poorly doesn't open any doors in my opinion.

Absolutely not true. Everything is moving into the ACGME. Not taking the step sends the signal that you are a weaker student than the MDs and didn't take the test for risk of failing it. As long as your step 1 is >200, you sit in a better place than just a good comlex.

That said, OP is in danger of failing step. I would not take it.

 

[Giovanotto]

Absolutely not true. Not taking the step sends the signal that you are a weaker student than the MDs and didn't take the test for risk of failing it. As long as your step 1 is >200, you sit in a better place than just a good comlex.

That said, OP is in danger of failing step. I would not take it.

That's what I thought, thank you for chiming in.

 

[pedspedspeds18]

Absolutely not true. Not taking the step sends the signal that you are a weaker student than the MDs and didn't take the test for risk of failing it. As long as your step 1 is >200, you sit in a better place than just a good comlex.

That said, OP is in danger of failing step. I would not take it.

That's what more of I meant. A STEP score out of proportion to your COMLEX score reflects poorly. A 700+ COMLEX score with a 210 STEP is worse than a 600 COMLEX score with no STEP in my opinion. But anyone taking the NBMEs and coming close to failing should definitely not take the STEPs.

There's a COMLEX to STEP conversion floating around these forums and from my personal experience it tends to underestimate a significant portion of DO students STEP scores by about 10 points. I have always told people that if you are scoring within or above the range that corresponds to your COMLEX score, then absolutely take STEP. If not, I'm more hesitant to encourage it. But, I by no means prescribe to the AOA propaganda that is the #PerfectMatch BS.

 

[pedspedspeds18]

Absolutely not true. Everything is moving into the ACGME. Not taking the step sends the signal that you are a weaker student than the MDs and didn't take the test for risk of failing it. As long as your step 1 is >200, you sit in a better place than just a good comlex.

That said, OP is in danger of failing step. I would not take it.

But I do agree. If a student is doing well, they should take it to prove that the can without failing. I just worry about the discrepancy some may find between the two exams.

 

[Giovanotto]

But I do agree. If a student is doing well, they should take it to prove that the can without failing. I just worry about the discrepancy some may find between the two exams.

They don't seem to be alike at all. Despite my lackluster practice scores for the USMLE, I'm more concerned about the COMLEX.

 

[pedspedspeds18]

They don't seem to be alike at all. Despite my lackluster practice scores for the USMLE, I'm more concerned about the COMLEX.

I'm not sure what to tell you, I only gave my opinion. I did not ask any program directors about the influence that my STEP vs my COMLEX score had on their program interviewing me. I do know that I interviewed at more academic programs than a friend with similar COMLEX scores did who didn't take STEP. But, these forums are all anecdotal. I would recommend reaching out to alumni from your medical school who are in programs similar to your interest and ask what their personal experience was.

 

[radkat101]

You can always just plan to push step into 3rd year. Being able to take step 1 whenever you want is one of the few advantages of being a DO student. I honestly have no idea why more people don't take advantage of this, and I wonder how many who recommend against it truly attempted it. I did it this way and my actual score ended up about 30 points higher than my NBME were predicting during dedicated. I actually found that 3rd year rotations helped solidify some of the material, and I otherwise just kept running through u-world sets to keep the details fresh in my mind. Takes some dedication but it really wasn't a big deal. Balancing rotations with step 1 review was much less stressful than the dedicated period for me.

 

[AlbinoHawk DO]

That's what more of I meant. A STEP score out of proportion to your COMLEX score reflects poorly. A 700+ COMLEX score with a 210 STEP is worse than a 600 COMLEX score with no STEP in my opinion. But anyone taking the NBMEs and coming close to failing should definitely not take the STEPs.

There's a COMLEX to STEP conversion floating around these forums and from my personal experience it tends to underestimate a significant portion of DO students STEP scores by about 10 points. I have always told people that if you are scoring within or above the range that corresponds to your COMLEX score, then absolutely take STEP. If not, I'm more hesitant to encourage it. But, I by no means prescribe to the AOA propaganda that is the #PerfectMatch BS.

The thing is that the COMLEX is already seen as a dubious test to begin with. I've heard stories of people being asked out of how many points the COMLEX is or what the score means. This year's AOA match barely exists, but for those in 2020 and beyond it won't exist at all. Programs that were former AOA are already happily opening their doors to MDs. A COMLEX alone is simply bad even if you have a 700. Anecdotally, I know someone that got rejected almost everywhere in neurology by VSAS with a 700 but people with 200+ were getting at least some of the bottom tier programs. The only time to avoid USMLE is when you know that you'll fail it. This is not the world where you can ask even a 2016 grad what it's like to go COMLEX only.

You can always just plan to push step into 3rd year. Being able to take step 1 whenever you want is one of the few advantages of being a DO student. I honestly have no idea why more people don't take advantage of this, and I wonder how many who recommend against it truly attempted it. I did it this way and my actual score ended up about 30 points higher than my NBME were predicting during dedicated. I actually found that 3rd year rotations helped solidify some of the material, and I otherwise just kept running through u-world sets to keep the details fresh in my mind. Takes some dedication but it really wasn't a big deal. Balancing rotations with step 1 review was much less stressful than the dedicated period for me.

This is all dependent on what your schedule is like. I think many students don't have the time to be juggling every COMAT, keeping up with step 1 and then be fully prepared for Level 2 and Step 2. Certainly it's very unlikely for the type of student that is in the Step 1 failing range during 2nd year dedicated to accomplish this.

 

[dabears405]

Hi, I took the school nbme about a month ago and scored 167. I took another NBME and got a 180 after a month of dedicated study. I have 5 more weeks until step 1, am I screwed? I only increased my score in 13 points after a month of studying, should I focus more on COMLEX? A 210+ would be great but at this point i dont know anymore.

 

[Giovanotto]

Hi, I took the school nbme about a month ago and scored 167. I took another NBME and got a 180 after a month of dedicated study. I have 5 more weeks until step 1, am I screwed? I only increased my score in 13 points after a month of studying, should I focus more on COMLEX? A 210+ would be great but at this point i dont know anymore.

5 weeks is a very long time, I would buckle down and keep trying. See where you're at 2 weeks from the exam and go from there.

 

[radkat101]

This is all dependent on what your schedule is like. I think many students don't have the time to be juggling every COMAT, keeping up with step 1 and then be fully prepared for Level 2 and Step 2. Certainly it's very unlikely for the type of student that is in the Step 1 failing range during 2nd year dedicated to accomplish this.

Yeah, I can agree with this. I'll admit that my COMAT scores were probably a little lower because of it. But despite taking it in Feb. 3rd year, I didn't feel like it negatively affected step 2 prep, and it actually might have helped a little because (at least on my exam) I found some of the material overlaps between the 2 steps.

 

[Drrrrrr. Celty]

Absolutely not true. Everything is moving into the ACGME. Not taking the step sends the signal that you are a weaker student than the MDs and didn't take the test for risk of failing it. As long as your step 1 is >200, you sit in a better place than just a good comlex.

That said, OP is in danger of failing step. I would not take it.

honestly I dont believe that. I dont think a 10th or under percentile leaves anyone with an advantage of any sort and the risk of failure is frankly too unacceptably high.

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[DocWinter]

honestly I dont believe that. I dont think a 10th or under percentile leaves anyone with an advantage of any sort and the risk of failure is frankly too unacceptably high.

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The benefit is checking the box "USLME" which is for many programs out there, a must. If you have a passing USMLE you'll get more interviews than if you do not have one. Obviously the risk of failing must be contended with, but that's the logic for you.

To the OP, I think a week of rest would do you far better than another week or 2 of study. Most people end up getting within a couple points of their averaged NBMEs, so 198-202 or so is probably a realistic landing spot for you. 195-205 maybe in your range also. Not a good score, but a passing score, and it will invariably give you more interviews than no USMLE, but you'll get fewer with a failure.

 

[Drrrrrr. Celty]

The benefit is checking the box "USLME" which is for many programs out there, a must. If you have a passing USMLE you'll get more interviews than if you do not have one. Obviously the risk of failing must be contended with, but that's the logic for you.

To the OP, I think a week of rest would do you far better than another week or 2 of study. Most people end up getting within a couple points of their averaged NBMEs, so 198-202 or so is probably a realistic landing spot for you. 195-205 maybe in your range also. Not a good score, but a passing score, and it will invariably give you more interviews than no USMLE, but you'll get fewer with a failure.

how many programs are usmle only that also are specifically going to rank someone with a 200?

like I dont see the point in taking it unless you're at least going to hit a 210.

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[DocWinter]

how many programs are usmle only that also are specifically going to rank someone with a 200?

like I dont see the point in taking it unless you're at least going to hit a 210.

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I just gave you the point... to get more interviews. And once you're in the door, personality comes into play. Who wouldn't rank a great fit/ personality with a lower score over a jerk with 20 more points?

 

[Drrrrrr. Celty]

I just gave you the point... to get more interviews. And once you're in the door, personality comes into play. Who wouldn't rank a great fit/ personality with a lower score over a jerk with 20 more points?

let me rephrase. is a 200 going to get more interviews than someone without?

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[TheoryOfEverything]

I appreciate the feedback, I will plan to not take it unless I somehow see a large improvement soon.

Is there a definitive answer on whether or not Step 1 needs to be reported during residency application? I've seen in previous threads anecdotes of students not reporting their USMLE and only reporting their COMLEX score. I'm guessing the merger would change this, and any Step 1 attempt would need to be reported?

 

[DocWinter]

let me rephrase. is a 200 going to get more interviews than someone without?

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In short yes, absolutely. You can apply to more programs, programs who distinctly say "must have USMLE". More applications/more options/better options can only grant you more interviews*. I think you're a year behind me (?) so you probably are entering 4th year and the cycle soon. Having gone through the application process, I saw many, many programs that had that requirement.

*Only PDs can actually grant interviews, and in full disclosure I am not a PD, but my math still holds🙂

 

[Drrrrrr. Celty]

In short yes, absolutely. You can apply to more programs, programs who distinctly say "must have USMLE". More applications/more options/better options can only grant you more interviews*. I think you're a year behind me (?) so you probably are entering 4th year and the cycle soon. Having gone through the application process, I saw many, many programs that had that requirement.

*Only PDs can actually grant interviews, and in full disclosure I am not a PD, but my math still holds🙂

Yes, I'm going into 4th year and the match soon. I'm surprised that a 200 really will open many doors. But I suppose if you're already somewhat of a weak on paper applicant having an extra mark against you by not having usmle might be significant enough.

Shrugs

 

[Eagles6389]

Yes, I'm going into 4th year and the match soon. I'm surprised that a 200 really will open many doors. But I suppose if you're already somewhat of a weak on paper applicant having an extra mark against you by not having usmle might be significant enough.

Shrugs

Would agree with this. Sure, in theory, you can now apply to programs that are "USMLE only", but how many of those programs are going to then look at your 200 Step 1 and screen you out or not rank you very high due to a step 1 that low?

Someone with an average COMLEX but only a 200 Step 1 would have been better off without the step 1 in the first place. Because although without that 200 Step 1 you'll get filtered/screened out of more places, at least the places that give you an interview won't see such a subpar USMLE score.

Of course, taking Step 1 and scoring > 210 trumps not taking it at all.

 

[AlbinoHawk DO]

honestly I dont believe that. I dont think a 10th or under percentile leaves anyone with an advantage of any sort and the risk of failure is frankly too unacceptably high.

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If you are in a failing range in your practice scores, definitely don't take it. I've said that. However, if you score >200, don't feel in the dumps because it's still better than COMLEX alone. Chances you'd be COMLEX 700 with 201 USMLE are close to zero, so realistically we're talking about 400-500 COMLEX with USMLE vs no USMLE. Personally, I think if you have about a >210 on your NBME, you should take the test. If you are below that, definitely do not take

My anecdote on this is one pediatrician that I worked with that was in the interview committee for his mid-tier program. He said as long as you had 200, you will be looked at, and he said they've turned down applicants with better scores if the rest of the package convinces them. If you apply there with COMLEX, you will not be looked at.

 

[Eagles6389]

If you are in a failing range in your practice scores, definitely don't take it. I've said that. However, if you score >200, don't feel in the dumps because it's still better than COMLEX alone. Chances you'd be COMLEX 700 with 201 USMLE are close to zero, so realistically we're talking about 400-500 COMLEX with USMLE vs no USMLE. Personally, I think if you have about a >210 on your NBME, you should take the test. If you are below that, definitely do not take

My anecdote on this is one pediatrician that I worked with that was in the interview committee for his mid-tier program. He said as long as you had 200, you will be looked at, and he said they've turned down applicants with better scores if the rest of the package convinces them. If you apply there with COMLEX, you will not be looked at.

Yeah, I could see how a 200 Step 1 could help you more than without one at all, as you pointed out in the above scenario. But I think its more situation or residency specialty specific: some programs that are USMLE only with very low cutoffs, it would help you. But it could hurt you at ACGME programs that actually take COMLEX only. Let's say two students apply to a COMLEX friendly ACGME program: both students have around a 500 COMLEX, one student has no Step 1, the other scored 200. Who do you think looks better? Same with now ACGME accredited formerly DO programs, a very low Step 1 score doesn't help you at all when applying to a program that takes a look at students with only COMLEX.

 

[Neopolymath]

You can take Step 2 without taking Step 1? Furthermore, is that a thing people do?

I know several people who have done this.

 

[smukke]

My anecdote on this is one pediatrician that I worked with that was in the interview committee for his mid-tier program. He said as long as you had 200, you will be looked at, and he said they've turned down applicants with better scores if the rest of the package convinces them. If you apply there with COMLEX, you will not be looked at.

I had a couple PDs say the same thing.