Mar 16, 2014
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Hey all,

Need an honest opinion of where to go from here. I honored and high passed all of my classes in medical school. I studied 6 weeks for boards. I ended up getting a 199, and am still shell shocked. My med school has a reputation of not preparing their students well enough for step1. Also had some family stuff going on, a parent sick and should've pushed my exam back but school wouldn't let me. No excuse is really going to matter any way, the score is what it is. I know I am not stupid. I'm on my surgery rotation right now and my attending has commented on how impressed they are by my clinical skills.
This score has literally destroyed me... feel like I worked my tail off and sacrificed so much and now I'm going to be labeled stupid and a failure to anyone who sees my score.
Further, is it even worth continuing? If I don't have a future matching anywhere should I quit now?
I wanted to go into neurology or possibly IM. I also wanted to match at an academic center and participate in neuro clinical trials which seems like that will be impossible now.
I need people to actually give me some sort of perspective/reality of how much step1 is weighted. Right now it feels like my future is over.

Please help! Any advice appreciated!
 

AcademicNeurosurgery

2+ Year Member
Apr 1, 2017
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Your future in medicine will certainly be over if you quit. If you stick with medicine, which you certainly should, your future is far from over. The score is in the books so it's time to divert your attention to the rest of your application - clinical performance, LORs, Step 2 scores, and research are the things you still control.

You can still match IM or neurology, based on https://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes-US-Allopathic-Seniors-2016.pdf. For IM, 98/112 people matched with a Step 1 score in your range; 6/9 for neurology.

On a personal level, only you can decide how you will handle the score. Some would use it to motivate them to work harder due to fear of scoring low again on Step 2, others may use the score as motivation for proving that they are not defined by their Step 1 score. Allow yourself some time to be upset, talk to your mentors, and come up with a game plan for the rest of your app moving forward. Regarding your career ambitions, I admittedly don't know how competitive academic IM programs are - we all know the top academic programs are extremely competitive but there may or may not be some academic programs that are less competitive. Even if there aren't, you can still do clinical trials at a community program and there are ways down the road to get into academics from community programs. Regardless of the path, it takes hard work and that process begins now.

Regarding the issues you faced during dedicated, what were your practice exam scores like? If you were hovering around 200-210 and scored 199, your score isn't much of a surprise and your personal issues may be the reason your dedicated time was less productive. But if you were scoring >220, you may need to look at what happened on test day.

Also, you may get a better response in the general Allopathic forum rather than the class forum. @Ismet @neusu @AlteredScale

Head up, my friend!
 
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mw18

5+ Year Member
Jan 7, 2014
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From what I know about matching different specialties (which is admittedly pretty little), those two specialties are not bad targets for a low step 1 score. You're not matching at Harvard, but matching should be a possibility in neuro/IM. If you really improve on step 2 and take it early you should be fine. People who fail their first time match, so just decide to outwork everybody and apply very broadly to less competitive programs when the time comes and you should be fine.
 
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neusu

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Feb 13, 2012
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How is your application otherwise? What were your first and second year grades like? How how is this year going so far? Do you have any research?

In general, nothing is absolutely ruled out as of yet. If you absolutely have your heart set on something with a very high average board score, it is increasingly difficult with a low Step score, but with overcompensation on the other parts of your application, it can be done. For IM, FM, and neuro, there are a lot of programs out there. I hate to say it, but some of the programs simply want a warm body that will do the job well. As you have already surmised, Step 1 is used as part of the selection process, and the more competitive programs, be it for academic reasons or location desirability, or some mix therein, certainly can use it as a filtering tool to set a cut-off for applications they would even consider.

As a resident, your role participating in clinical trials is minimal. For the most part, you simply enroll the patients. Perhaps, if you happen to be a particularly savvy resident, and collegial with the attending at your institution on that particular trial, he or she would introduce you to the behind the scenes magic. I can tell you, though, that much of it is really boring and more business like and political than what you would expect.

Finally, don't count yourself out yet. Hypothetically, say you do not match in to a program with an academic reputation, that has no clinical trials. Simply work hard, get through residency, and do fellowship in the field which you would like to practice at a center that does have these features. As a fellow, you are much more intimately involved in these processes, and your reputation is generally carved out from the last place you were. That is to say, you could have gone to no name college, no name med school, no name residency, and then THE BEST fellowship, and people will remember you as having trained at THE BEST place.
 

AcademicNeurosurgery

2+ Year Member
Apr 1, 2017
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That is to say, you could have gone to no name college, no name med school, no name residency, and then THE BEST fellowship, and people will remember you as having trained at THE BEST place.
While true, it is important to understand that being at a 'no name' institution each step of the way makes it exceedingly harder and harder to end your training at the best place. Some people fall into this trap and never 'get out' - in high school, they say they'll go to a no name college and get into a good medical school. Then they settle for a no name medical school with hopes of getting into a top residency. Then it's 'I'll just work hard in residency and get a solid fellowship' and before you know it, you've missed the boat.

And I say this only for people who have goals to go to the big, flashy programs. You can become a perfectly competent physician/researcher/whatever-you-want by going to a state college/med school/residency/fellowship.
 

neusu

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While true, it is important to understand that being at a 'no name' institution each step of the way makes it exceedingly harder and harder to end your training at the best place. Some people fall into this trap and never 'get out' - in high school, they say they'll go to a no name college and get into a good medical school. Then they settle for a no name medical school with hopes of getting into a top residency. Then it's 'I'll just work hard in residency and get a solid fellowship' and before you know it, you've missed the boat.

And I say this only for people who have goals to go to the big, flashy programs. You can become a perfectly competent physician/researcher/whatever-you-want by going to a state college/med school/residency/fellowship.
Some important distinctions to make, with respect to the difference between the two settings, are work ethic and intrinsic ability. In my limited experience, the people at the top of the intellectual and academic pyramid at a no name school have a very high intrinsic ability and good work ethic. Resting on ones' laurels in this environment, however, does not portend to success. That's not to say someone at name brand school can kick back either, simply the competitive environment typically surrounds them with similar high achievers and motivated individuals. My point is, nonetheless, good things come to those who work hard and do well. While it is easy to tell oneself that they will buckle down and make the leap, actually doing so is difficult. Having a good work ethic and metrics for measuring success helps ensure it comes.
 
May 1, 2019
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Some important distinctions to make, with respect to the difference between the two settings, are work ethic and intrinsic ability. In my limited experience, the people at the top of the intellectual and academic pyramid at a no name school have a very high intrinsic ability and good work ethic. Resting on ones' laurels in this environment, however, does not portend to success. That's not to say someone at name brand school can kick back either, simply the competitive environment typically surrounds them with similar high achievers and motivated individuals. My point is, nonetheless, good things come to those who work hard and do well. While it is easy to tell oneself that they will buckle down and make the leap, actually doing so is difficult. Having a good work ethic and metrics for measuring success helps ensure it comes.

People at name brand schools can absolutely kick back, and they do, compared to the others at DO and Caribbean schools. With step 1 possibly becoming pass/fail and more med schools opening up, the value of a top school or a well-connected school for what you want to do is about to skyrocket.

If you want some residency opportunity that many others want, you are going to work a lot harder if you’re not from a top school or if you’re not connected to the program(s) in some other way. It just be like that
 

neusu

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People at name brand schools can absolutely kick back, and they do, compared to the others at DO and Caribbean schools. With step 1 possibly becoming pass/fail and more med schools opening up, the value of a top school or a well-connected school for what you want to do is about to skyrocket.

If you want some residency opportunity that many others want, you are going to work a lot harder if you’re not from a top school or if you’re not connected to the program(s) in some other way. It just be like that
This notion is patently false, and misses the points I made entirely.

Indeed, coming from an institution with a lauded reputation is an advantage. This is both part environmental factor and part based in reality, and translates across most all products we deal with. Do you personally prefer Apple products or another brand? How about shop at Whole Foods or the local discount supermarket? In the latter example, perhaps the best seafood available at the market may be decent quality. Perhaps, even that particular discount market has a predilection to selling quality seafood. Regardless, across the board, you can walk in to any Whole Foods in the country, and you are likely to find a product of a minimal quality standard.

What I am saying is that students, like anything else, are a product. Residency programs are the consumer of that product. Each individual student does his/her best to market their individual accolades to entice the program of their choice, in the field of their choosing, to select them. Even so, bias is part of being human, and some/many/most programs are conservative with their selection.
 
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