What can I do to improve my application for reapplying to psych next match?

[goingpsych]

---

Members don't see this ad.

Hey guys,

I wanted to get some feedback from everyone on here about my situation. I'm currently in my last few weeks of clinical rotations in the states and I did not match this year.

A bit about me, I went to a big 4 carib school. step 1-201 (1st attempt), step 2-224(2nd attempt), step2cs-pass (1st attempt). Honored all rotations, good evals, good-strong LOR's. What really messed me up was step 2ck; I took step 2ck in late july last year and had everything (LORs, evals, transcripts, personal statement) ready to go to apply on sept 1, but then at the end of august i got my step 2ck score and i didnt pass by a couple points. devastated, i thought things through and decided i need to hold off on applying this year and re-study for step 2ck and pass it before anything and probably just apply next year. As i was studying for step 2 ck again, in october, i was encouraged to just apply (by the prog i rotated at and by my school) so i went ahead and applied with a failing step 2 score (to about 70 programs). then i took step2ck at the end of oct and got a passing score in late november. i managed to get 3 interviews at that point. 3 interviews were not enough and i didnt match.

I'm thinking what hurt me this match period was 1.failing step 2ck which caused me to apply late which is another thing that hurt my app. The combination wasn't good and by the time my passing score came out, it was late november which I believe is pretty late and I had to rely on other cancelling their interviews in order for me to get any.

Right now I'm thinking about research and taking step 3, before applying in september at the earliest possible date. I'm hoping that will be enough to land me some interviews.

What are your thoughts on my situation, is it possible? Any suggestions on what i should do to improve my app? I greatly appreciate your opinions and suggestions, thank you.

 

[splik]

sorry to hear you didn't match but all is not lost! you have a solid passing score for step 2 ck it is not like you have barely passed on retaking it and that will partly mitigate it. if the rest of your application is as good as you say - well great but if not see what you can do.

I would say do not do research unless you are interested in research. most of the sorts of places you will be looking at for the next match will not be research places - your clinical skills, knowledge, professionalism, and enthusiasm for a career in psychiatry will be more valuable. plus publications are more valuable than research per se - you do not have time to get publications between now and september with the exception of a letter to the editor or an invited editorial (which you are unlikely to have the opportunity to write).

There are many other ways of showing your commitment and interest in psychiatry - you could for example get involved working with a mental health charity and do some advocacy/activism related work, get some experience in mental health at a public health department to understand more about policy, you could get involved with some public education work, or schools based mental wellbeing workshops, or write some mental health related articles on a blog or for a magazine or newspaper.

You should also look at getting an LoR from someone after you finish medical school. What you have been doing since will be a big question, and you also have the opportunity to perhaps get an LoR from someone well known or vaguely respected in the location you are keen to apply in.

I would also caution re: step 3 - passing it will allay any anxieties programs may have. but if you fail it you will not be helping yourself. it is a lot more difficult to prepare for step 3 if you have not done internship - it is not the kind of thing you can read, but no doubt doing usmle world questions is helpful. if you think there is a strong probability of failure I would advise you not to do step 3 at this time especially as your retake score for step 2ck is a solid pass.

 

[whopper]

First off, pat yourself on the back for doing as well as you did. What apparently happened to you was major bad luck and from you mentioned not a real representation of your abilities.

I agree with the above. Getting Step 3 out of the way is a major monkey off your back should you enter residency and not have to worry about it but don't take it if your'e not ready for it. Better to not take it now, with a risk of failing it then to make sure you take it well-prepared. (Maybe you are, however, very ready to take it, you would know this better than I).

 

[Abider]

First off, pat yourself on the back for doing as well as you did. What apparently happened to you was major bad luck and from you mentioned not a real representation of your abilities.

I agree with the above. Getting Step 3 out of the way is a major monkey off your back should you enter residency and not have to worry about it but don't take it if your'e not ready for it. Better to not take it now, with a risk of failing it then to make sure you take it well-prepared. (Maybe you are, however, very ready to take it, you would know this better than I).

Does a 4th year have the requisite knowledge base to begin prepping for this exam? (I'd love to have it done before intern year)

Good luck OP!

 

[st2205]

It looks like you have a pretty solid application to me. I think you just got caught in applying late in conjunction with that failing score. I think, especially if you have step 3 passed and apply in September, that the failing score won't be as much of an issue. I think you should do ok in the upcoming match. I'd just work on step 3 and use that as a real selling point.

 

[digitlnoize]

I loathe these board exams, or more accurately, I hate how they are used.

I didn't fail any, but I know people who did, and the shame and ostracization that occurs is nothing short of traumatic for most students.

The fact is that people have bad days, and meeting or not meeting an arbitrary number by a few points shouldn't really matter. Is there a statistical difference between a 178 and a 182? Probably not. Why should someone who got a 182 be treated better than someone who got a 178? Now if you're getting a 150, that's probably significant, but missing by "a couple points" shouldn't matter, and it's a sign of our dysfunctional system that we're selecting doctors this way.

The fact is that the NBME has repeatedly stated that the numerical scores for Step 1 and 2 were never meant to be used to compare applicants. This is, and has been, a pass/fail exam. In fact, the NBME wants to make it pass/fail only and do away with the scores, but has caved to pressure from the PD's to keep the scores so they can have SOMETHING to use to compare applicants, because an inappropriate comparison is better than no comparison. Right?

Anyways...don't let it get you too down. Apply broadly, and to places that have a strong history of taking people from your school.

 

[goingpsych]

Thanks everyone for your responses so far!

Splik: Thanks for all your input. I will definitely look into other things i can do such as you mentioned (mental health charity work, public health policy, etc) to better my app. As far as step 3; you practically read my mind on my main concerns about it. I absolutely agree that if i pass, it'll help a great deal but if i push myself to take it without the preparation an intern year will provide, i may be shooting myself in the foot. From the looks of it, I will be done with my 4th year in exactly 1 month, so I'll have May, June, July to study and if I'm prepared and confident to pass it, i'll take it but if not, then I won't. Also during these months and during app season, I'll hopefully have found something to involve myself in that shows my commitment. Thanks again for your input, its always welcome!!!

whopper: Thanks for the input and the encouragement; It was pretty damn devastating to have everything for my application prepared and then open that step 2 ck score result in mid-august to learn that i've failed. I pretty much thought that was the end of it, but here i am with a passing score, hoping for the best for next match. Thanks again for your words!!!

st2205: Thanks for your advice. I'll begin preparing for step3 during my last rotation, or possibly by the end of April and see how it goes. Thanks!!

digitlnoize: Mannn, I felt more confident for step 2ck than i did for step 1. my step 1 score was low and when i was doing practice q's for step 2ck i felt much more confident and ready. My NBME's were estimating around 220-225. I took the test and thought it went decently, and i was thinking i'd do a whole lot better than i did for step 1. turned out i didnt pass it and couldnt figure out why, just had to get myself together and study again and 2nd time around i think it represented my understanding better. Who knows what happen, probably just a bad test day. But you're absolutely right, i truly wish they did away with this system. Personally its done a number on me. PD's will see a failed attempt, due to what most likely was just a bad test day for me, instead of seeing it as a 23 point increase from my step 1 score and a nearly 40 point increase from my 1st step 2ck attempt. Thanks for your input!!!

Please keep the inputs and suggestions coming, I'm open to hearing everyones thoughts and suggestions!!! Thanks in advance

 

[TexasPhysician]

Intern year is not needed for Step 3. Us psych people only get 4 months of primary care during intern year anyways. It's pretty similar in detail to step 2 ck.

 

[psychattending]

Goingpsych,

I think you mainly had a problem with the lateness of your application. The vast majority of the programs probably had 99% of their invitations sent by mid to late November. One would have a big hurdle in getting an invitation to interview with a failure on CK with no results on the repeat exam. I would think you would have much better luck next year if you submit your application in September.

I would strongly caution you against taking Step 3 as I think the likelihood is high that you will do poorly on the exam without having done some months as an intern. Getting a non-passing score on the exam would severely damage your chances in the future. As a PD I do not expect people to take Step 3 (an even question their judgement if they take it without having done some post-graduate training) and do not hold it against them. Even when an applicant passes it without post-graduate training, it is usually just by several points. I don't think I have ever seen a score above 200 in that scenario.

 

[TexasPhysician]

I would strongly caution you against taking Step 3 as I think the likelihood is high that you will do poorly on the exam without having done some months as an intern. Getting a non-passing score on the exam would severely damage your chances in the future. As a PD I do not expect people to take Step 3 (an even question their judgement if they take it without having done some post-graduate training) and do not hold it against them. Even when an applicant passes it without post-graduate training, it is usually just by several points. I don't think I have ever seen a score above 200 in that scenario.

Interesting. My home program admitted to me that they do not rank any IMGs or re-applicants that don't have a passing Step 3. They have been burned in the past, so now it is a requirement.

 

[mkeguy]

id suggest taking another look at your personal statement and have someone you trust read it and be very critical of it. maybe there was some red flag in there that held you back that is easily fixed.

 

[whopper]

I would strongly caution you against taking Step 3 as I think the likelihood is high that you will do poorly on the exam without having done some months as an intern

Hmm, well given your experience, I think you got some merit in what you wrote.

But from my own experience I haven't seen it that way. Most of step III is similar in format to step II minus the computer simulation portion (unless they've changed it since I last took it and that was about 4 years ago).

Psychiatry exposure to internal medicine is pretty limited. Four months in many programs. In fact I think being a psychiatry resident makes it tougher to pass step III because as a PGY I, you're overloaded and when you have free time it's usually spent trying to catch up on sleep or your fading connection with your inner feelings that have been distanced from you from the workload. Studying for step III is just adding more weight to the camel's back.

That's just my opinion.

I do recall seeing questions on the exam that where I could never find literature on how to do it, but it was taught to me by senior residents...e.g. someone in DKA being put on insulin, the transition from IV to IM and then to oral meds, but never ever saw how to do that in a book, but I found those to be a minority of the questions.

I do, however, realize that you seem to be in a position where you go through quite a few applications so I will yield to your experience.

 

[notdeadyet]

But from my own experience I haven't seen it that way. Most of step III is similar in format to step II minus the computer simulation portion (unless they've changed it since I last took it and that was about 4 years ago).

Most of my intern class took the course within 5 months of starting, which means some only having a couple months of non-psych rotations, and everyone passed. At the end of the day, I don't think that there's anything you can't study from books and practice. Without the experience of intern year, it just means you'll be studying things that will be rote for folks with intern year done.

The one reason I'd tell goingpsych to hold off on the Step III is that he failed the Step II when he thought he was ready. Unless he went in to the Step II thinking he was inadequately prepared (which isn't the impression I'm getting), he may not be a good guage of when he's ready for a test or suffer from performance anxiety or somesuch. This may cause Step III to be a repeat performance, and while a successful Step III under his belt will help his case a little, failing it would be pretty devastating to his application.

 

[goingpsych]

Thanks for the continued replies and suggestions. It seems like what many of the suggestions here indicate is that I should be very careful in considering to take step 3 before application season because thought a pass would help my app, a fail would be devastating. I understand and agree with this thought. I believe then what I should be focusing on right now is to find something that will help my application during the meantime (research, other projects). I will also study for step 3 during my down time since I will be finished with medical school in April but I will not aim on taking it just yet.

I know Splik offered some insight into what activities i should do in his above post (work with public health policy, mental health advocacy groups, etc). Is there any faculty members that can suggest what types of activities they would consider to stand out in a strong applicant? Any other suggestions?

Thanks again for all the information and support, especially during a time like this when I'm open to suggestions to continue working hard in improving my application, I appreciate it!!