What could solely an elite Step 2 get you?

[IntoTheNight]

If someone had a 280+ or even 290+ Step 2, with very little else on their resume, could they match into a competitive specialty? Let's assume maybe 2-3 pubs but nothing else significant on their resume.

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[Putkernerinthehall]

Probably an investigation into potential cheating! Seriously, I don't know. There are so few scores over 275, I doubt anyone on here knows such people and what their resumes look like. As rare as hen's teeth.

 

[NotAProgDirector]

I think the answer is "nothing". I think step scores more often are used as a low pass filter. If your score is too low, then you don't get considered. Once your score is above some minimum, then you are considered. Once it's beyond some other higher level, it's "good enough" and it doesn't factor much more -- although perhaps is used to break ties when there's nothing else. So a super high score with nothing else will get your app looked at, but if it doesn't have the other things that programs are looking for, then you won't get much love from there.

 

[GotToGetThatGPAUp]

Consistency is key.

Step 2 of a 280 with all clinical passes, nothing else going on <<< Step 2 of 260, honors/HPs throughout clinical, research/ECs, etc

 

[operaman]

Probably buys you more mileage in less competitive fields where they might be more impressed by it. The competitive ones see so many high scores anyhow that even an outlier like a 280 gets barely more than an eyebrow raise.

Had a kid at my med school back in the scored S1 days get a 280 and end up going unmatched in ENT. You really do need the whole package.

One of the posters here many years ago used to say it was more about NOT closing doors than any one thing actually opening a door. High step scores keep all those doors open while a low S2 probably closes many. But a 260 or 270 probably keeps equally as many doors open as the 290. Sadly it doesn’t really compensate for severe deficiencies elsewhere.

 

[Esmolol]

I humbly agree with the above. However, sadly in the linear orthobro community, a 280-bro > 275-bro. It’s the bench-press mentality. /s

 

[medschoolaspirant]

If someone had a 280+ or even 290+ Step 2, with very little else on their resume, could they match into a competitive specialty? Let's assume maybe 2-3 pubs but nothing else significant on their resume.

I think this is very hypothetical situation. Step 2 score is reflection of your clinical grades. It has direct corelation. If you have all H or a rare HP. You will score high on step 2. If you are all Pass with rare HP or H, direct corelation will be seen on Step 2 to be lower. So it doesnt happen to have high step 2 and lower clinical grades.

 

[mrbreakfast]

The short answer is no. I don't know how every program evaluates candidates, but for example our program looks at a number of factors, weighted equally, as well as subjective factors, and bonus points that can be given for exceptional performance in a category. Academic performance is one category; a 280+ on step 2 would get you the max score + a bonus point for the academic category, and that's it.

An applicant with a 280-290 on Step 2, 2-3 minor pubs, and everything else (letters, grades, ECs, etc) bland, would likely not be considered a highly competitive applicant at a top program, even in a less-competitive specialty. We see applicants with scores like this every year (though not a lot); I myself interviewed someone with a ~280 this year. Additionally, someone with an exceptional test score and mediocre evaluations would be flagged for that; if you are being evaluated at or below average, with a step 2 score that suggests you are crushing your shelf exams, then what are you doing wrong? It's clearly something.

The days of high test scores opening every door ahead of you end at medical school. If an applicant is truly brilliant, it will be reflected in other categories (evals, scholarship, awards, etc). We're less interested in a prodigy who doesn't actually apply their genius.

 

[voxveritatisetlucis]

IM, FM, EM, Psych, Neuro, Rads. Maybe gen surg?

 

[voxveritatisetlucis]

An applicant with a 280-290 on Step 2, 2-3 minor pubs

Don’t most med students only have a few real pubs? This wouldn’t be enough to match a top program in path, neuro etc.?

 

[LunaOri]

Don’t most med students only have a few real pubs? This wouldn’t be enough to match a top program in path, neuro etc.?

It shows aptitude, but wouldn’t make up for lukewarm LOR or any hint of a personality issue.

 

[Ho0v-man]

Scores alone will probably top out at matching well in rads and anesthesia. Surgical specialties and derm will want more.

 

[CJhooper123]

Consistency is key.

Step 2 of a 280 with all clinical passes, nothing else going on <<< Step 2 of 260, honors/HPs throughout clinical, research/ECs, etc

In general, this is the right mentality.

It's still pretty program-dependent. I think clearing 255 puts you in a pretty good position for almost anything (given you have a strong application otherwise).

 

[mrbreakfast]

Don’t most med students only have a few real pubs? This wouldn’t be enough to match a top program in path, neuro etc.?

2-3 minor pubs (late authorship in low-impact fluff piece/predatory journal or poster presentation) is not going to move the needle much.

You are aware that top IM, neuro, etc programs are about as competitive as surgical subspecialties, correct? Applicant pools are full of people with 250s-260s, multiple high-end pubs, straight honors, great letters/ECs, AOA, etc. It is not the case that all the strong med students apply to surgical subspecialties; every field has stars, and has spots for which the stars will compete.

 

[Mr.Smile12]

Residency directors are being encouraged to review applications holistically. It is one of many factors, including qualitative background and MSPE references, to show consistent excellence and fit.

 

[Goro]

If someone had a 280+ or even 290+ Step 2, with very little else on their resume, could they match into a competitive specialty? Let's assume maybe 2-3 pubs but nothing else significant on their resume.

Nothing. You have to remember that residency is a job. Nobody's going to hire you for 3 to 7 years on the basis of just a score. They want to know if you're going to be a good team member, and a nice person to work with

 

[ChordaEpiphany]

Probably buys you more mileage in less competitive fields where they might be more impressed by it. The competitive ones see so many high scores anyhow that even an outlier like a 280 gets barely more than an eyebrow raise.

Had a kid at my med school back in the scored S1 days get a 280 and end up going unmatched in ENT. You really do need the whole package.

One of the posters here many years ago used to say it was more about NOT closing doors than any one thing actually opening a door. High step scores keep all those doors open while a low S2 probably closes many. But a 260 or 270 probably keeps equally as many doors open as the 290. Sadly it doesn’t really compensate for severe deficiencies elsewhere.

At the very top (e.g., T20 competitive residencies) I assume everyone is pretty excellent in terms of grades + step scores. Would you say better pubs, ECs, and connections could win out over better grades and scores, assuming both are excellent? For example:

Applicant #1: Mid-tier MD + nearly all H + 260s + multiple 1st author pubs + out of the box accomplishments + great connections from a T10
Applicant #2: Mid-tier MD + all H + 270s + a few middle author pubs + okay connections from home program

Is there a point where PDs just say, "okay they're good at school," and start looking for things that indicate the type of career success that will make an impact (e.g., strong leadership, research, entrepreneurship, networking skills)? Or should an applicant really be pushing hard to score 270+ and honor virtually everything to stand out?

 

[operaman]

At the very top (e.g., T20 competitive residencies) I assume everyone is pretty excellent in terms of grades + step scores. Would you say better pubs, ECs, and connections could win out over better grades and scores, assuming both are excellent? For example:

Applicant #1: Mid-tier MD + nearly all H + 260s + multiple 1st author pubs + out of the box accomplishments + great connections from a T10
Applicant #2: Mid-tier MD + all H + 270s + a few middle author pubs + okay connections from home program

Is there a point where PDs just say, "okay they're good at school," and start looking for things that indicate the type of career success that will make an impact (e.g., strong leadership, research, entrepreneurship, networking skills)? Or should an applicant really be pushing hard to score 270+ and honor virtually everything to stand out?

I think applicant 1 would be my pick here. Depending on the applicant pool, might not even interview #2.

The all honors for #2 is the biggest plus ( the difference in step scores isn’t even statistically significant), but with mediocre letters and meh research, probably not making the interview cut. All honors tells me you can probably get along well with everyone assuming the clinical grades at that school are based partly on evals. The thing that might get #2 over the hump would be a personal phone call on their behalf from someone I know, or a really good story about deciding late on a field and has a number of projects cooking.

I think striving to honor everything is a good idea - definitely won’t hurt! 270 vs 260 probably doesn’t matter, though will have to see how the meta evolves in a post S1 world. But it really comes down to the other applicants and if there are enough good candidates with stronger apps. Strong candidates tend to be strong across the board - quite a few look like applicant 1 in my field. There’s not really a way to game the system, just consistent hard work in all areas.

 

[mrbreakfast]

Would you say better pubs, ECs, and connections could win out over better grades and scores, assuming both are excellent? For example:

Applicant #1: Mid-tier MD + nearly all H + 260s + multiple 1st author pubs + out of the box accomplishments + great connections from a T10
Applicant #2: Mid-tier MD + all H + 270s + a few middle author pubs + okay connections from home program

Applicant 1 will be ranked higher at 95%+ of programs.

As has been mentioned in this thread and elsewhere: step scores open the first of several doors. Programs want all-rounders.

If there is a single thing that can get you admitted to a program almost regardless of the rest of your application, it is effusive letters from that program (e.g. from an away), followed (for some programs) by truly exceptional research, e.g. an applicant who has their own novel research project, from which they have produced multiple publications, and which they would like to bring to/expand at a larger center.

 

[MDMechEngr]

Home program prestige with great connections/resources will get you great mileage once you reach the point of deminishing returns around 260 +/- S2. Jefferson's home ophthomology program is ranked #2 behind Bascom Palmer. They just matched 17 M4 into ophthomology 3 weeks ago. That is a record.

 

[voxveritatisetlucis]

Home program prestige with great connections/resources will get you great mileage once you reach the point of deminishing returns around 260 +/- S2. Jefferson's home ophthomology program is ranked #2 behind Bascom Palmer. They just matched 17 M4 into ophthomology 3 weeks ago. That is a record.

Don’t they also have like 250 students per class though so per capita it’s similar to other schools

 

[MDMechEngr]

Don’t they also have like 250 students per class though so per capita it’s similar to other schools

Even with 250 students, ophthomology is a very small field and it has become an extremesly poplular speciality in the last few years. I would compare it to ortho in terms of competitiveness. Matching 17 students to Ophthomology is crazy good.

 

[nibhighfootballrules]

Why do letters of recommendation carry so much weight? It’s more important that 1-3 people really go to bat for you than showing years of putting in hard work to get good grades, produce research, and have strong clinical evals across all fields? Or are we just assuming that those boxes are already checked so LOR's is the final differentiating factor...

I don’t really understand the expectation of getting strong non home program letters of recommendations either. Seems unrealistic that someone who didn’t take a research year at an outside institution will be able to build a meaningful, longitudinal relationship with an attending during medical school at an outside program. Even during away rotations that’s four weeks you get with the majority of that time most likely not being with the letter writer. Seems incredibly subjective.

Maybe I am way off but the expectations for a meaningful letter of recommendation seems wild (multiple year relationship with someone whose in an important position thats seen you in multiple environments (research, clinical, etc)). Would love to know if I am overthinking how difficult it is to get a good LOR.

 

[mistafab]

Looking behind the scenes at a top psych program.

All the candidates within the ranking bubble have high scores, track record of research, decent grades (lowest weight here), good letters (an IQ test, really - can only sink you). Other factors include school name/ prestige, and “mission fit.”

Those get you in the door. Then the interview has a disproportionate effect. It can hugely sink you. It can lift you up if you’re well liked across the board. For most it doesn’t move them up or down a bunch.

That’s just n=1 from psych.

 

[mrbreakfast]

Why do letters of recommendation carry so much weight? It’s more important that 1-3 people really go to bat for you than showing years of putting in hard work to get good grades, produce research, and have strong clinical evals across all fields? Or are we just assuming that those boxes are already checked so LOR's is the final differentiating factor...

"Dear academic physician: if you had to give this particular applicant a grade (H/HP/P) on how good of a candidate they'd be to continue to train directly under you for the next several years, and then potentially be hired as your colleague, and they wouldn't see your grade, what would that grade be?" That's what a letter of recommendation provides. And before you say "if someone's writing you a letter, isn't it going to be a H?" the answer is no; it's probably going to be a P or HP. If you read enough letters, the scores start becoming obvious. The whole idea of "everyone gets honors!" applies only to clerkships.

It's not that someone is going to write you a letter that says "this person was mediocre." You just have to read between the lines, and letters are written to make that easy. And besides, it's a far better measure of clinical talent than scoring high on a standardized test or publishing a poster based on data entry from an Excel sheet, and all medical students know how poorly clerkship grades can sometimes correlate with actual performance.

I don’t really understand the expectation of getting strong non home program letters of recommendations either. Seems unrealistic that someone who didn’t take a research year at an outside institution will be able to build a meaningful, longitudinal relationship with an attending during medical school at an outside program. Even during away rotations that’s four weeks you get with the majority of that time most likely not being with the letter writer. Seems incredibly subjective.

More of a quality check for the home program. There is tremendous variation in the quality of med schools. Almost every applicant we get, for example, is one of the better med students at their home program. How well would they fair at a stronger program, with higher expectations, and without any external pressure to over-hype students to keep the match rate high? This is why med school reputation matters so much.

And as for meaningful letter recommendations for aways; an away here means you're spending 60-70 hours a week at my side in the hospital, for example. You're right in that it's still a limited sample size, but it's enough to compare you to the other med students and interns I work with (if you do a fourth year rotation you'll be evaluated relative to clerkship students, other acting interns, and actual interns), which is about 90-100 people/year for me. I don't necessarily need to know everything about you to describe where in that spectrum you land.

 

[nibhighfootballrules]

"Dear academic physician: if you had to give this particular applicant a grade (H/HP/P) on how good of a candidate they'd be to continue to train directly under you for the next several years, and then potentially be hired as your colleague, and they wouldn't see your grade, what would that grade be?" That's what a letter of recommendation provides. And before you say "if someone's writing you a letter, isn't it going to be a H?" the answer is no; it's probably going to be a P or HP. If you read enough letters, the scores start becoming obvious. The whole idea of "everyone gets honors!" applies only to clerkships.

It's not that someone is going to write you a letter that says "this person was mediocre." You just have to read between the lines, and letters are written to make that easy. And besides, it's a far better measure of clinical talent than scoring high on a standardized test or publishing a poster based on data entry from an Excel sheet, and all medical students know how poorly clerkship grades can sometimes correlate with actual performance.

Thank you for the thorough response this really helps clarify the role of a LOR. Its interesting that as a student you most likely will never know what that "read between the lines" grade is and therefore I guess just need to trust in the relationship you've built/ the work ethic you have shown. Would you advise asking your letter writer in advance if they would be able to write a strong letter of recommendation so that they can be honest if they would not be able to?

More of a quality check for the home program. There is tremendous variation in the quality of med schools. Almost every applicant we get, for example, is one of the better med students at their home program. How well would they fair at a stronger program, with higher expectations, and without any external pressure to over-hype students to keep the match rate high? This is why med school reputation matters so much.

And as for meaningful letter recommendations for aways; an away here means you're spending 60-70 hours a week at my side in the hospital, for example. You're right in that it's still a limited sample size, but it's enough to compare you to the other med students and interns I work with (if you do a fourth year rotation you'll be evaluated relative to clerkship students, other acting interns, and actual interns), which is about 90-100 people/year for me. I don't necessarily need to know everything about you to describe where in that spectrum you land.

Very good point, this would explain why schools emphasize applying to programs previous students have been accepted to because I guess then that program can have something to fall back on when estimating how prepared applicants are from a certain institution. Thanks again for the insight it is much appreciated.

 

[mrbreakfast]

Would you advise asking your letter writer in advance if they would be able to write a strong letter of recommendation so that they can be honest if they would not be able to?

Yes. You should be able to hopefully get a feel from feedback that you get throughout/at the end of the rotation. You are almost certainly not going to get turned down, even if the writer didn't necessarily love you. If you're really worried about this, you can always ask if they feel like they worked with you enough to write you one, as this is typically the "out" for attendings who strongly don't want to write a letter for you. You can also tell them at the beginning of the rotation that your goal is to perform at an intern letter and possibly earn a strong letter, and that you would like constructive criticism to help you get to that point. A statement like that would certainly catch my interest. It would otherwise be quite uncommon for someone to decline to write a letter. (unless you ask months after the fact. Please don't do that)

It's not like there is really such a thing as a "bad" letter. It should just accurately reflect your performance, with a little fluff. For example, I wrote three residency LORs for people doing AIs this year. Person A was fine, very smart but with some issues with presentations, not a ton of drive. They'll make a good resident, probably not here though. Person B wasn't quite as smart, but worked hard and was personable. I'd be happy to have them as a resident. Person C was outstanding, saw more cases than the residents, never left my side, read about cases overnight, had great off-the-wall plans, great attitude. I really want them as a resident.

So while all three got letters, and all three had positive attributes, you can tell by how I describe them that the letters will not read the same. A letter isn't going to hurt you. But when your letter says "this is one of the best medical students I have ever worked with" or "this student would be a great fit anywhere, but honestly it is my hope they decide to remain at our program for residency" it'll catch some eyes.

What I would recommend is working very hard during your acting internship, or aways, and be cognizant of your performance. You should be killing it, or altering your performance to make sure you're killing it. We all work with a ton of medical students, and if you stand out it'll be noticed, so that should be your goal. It blows my mind that some people seem to be in cruise control on aways or acting interships, but it happens every single year.

Also note this is all just my opinion. Not everyone looks at applications the way I do, and not every program cares as much about letters. But a good letter can only help you.

 

[nibhighfootballrules]

Yes. You should be able to hopefully get a feel from feedback that you get throughout/at the end of the rotation. You are almost certainly not going to get turned down, even if the writer didn't necessarily love you. If you're really worried about this, you can always ask if they feel like they worked with you enough to write you one, as this is typically the "out" for attendings who strongly don't want to write a letter for you. You can also tell them at the beginning of the rotation that your goal is to perform at an intern letter and possibly earn a strong letter, and that you would like constructive criticism to help you get to that point. A statement like that would certainly catch my interest. It would otherwise be quite uncommon for someone to decline to write a letter. (unless you ask months after the fact. Please don't do that)

It's not like there is really such a thing as a "bad" letter. It should just accurately reflect your performance, with a little fluff. For example, I wrote three residency LORs for people doing AIs this year. Person A was fine, very smart but with some issues with presentations, not a ton of drive. They'll make a good resident, probably not here though. Person B wasn't quite as smart, but worked hard and was personable. I'd be happy to have them as a resident. Person C was outstanding, saw more cases than the residents, never left my side, read about cases overnight, had great off-the-wall plans, great attitude. I really want them as a resident.

So while all three got letters, and all three had positive attributes, you can tell by how I describe them that the letters will not read the same. A letter isn't going to hurt you. But when your letter says "this is one of the best medical students I have ever worked with" or "this student would be a great fit anywhere, but honestly it is my hope they decide to remain at our program for residency" it'll catch some eyes.

What I would recommend is working very hard during your acting internship, or aways, and be cognizant of your performance. You should be killing it, or altering your performance to make sure you're killing it. We all work with a ton of medical students, and if you stand out it'll be noticed, so that should be your goal. It blows my mind that some people seem to be in cruise control on aways or acting interships, but it happens every single year.

Also note this is all just my opinion. Not everyone looks at applications the way I do, and not every program cares as much about letters. But a good letter can only help you.

great advice and insight... thank you

 

[nibhighfootballrules]

@mrbreakfast I was wondering what your thoughts were on doing away rotations in competitive fields.

1) If you know you want to be in a geographic region that is heavily populated with programs does it hurt you to do all of your aways in that area?

- my thought here is maybe other programs not in this exact region wont take you as seriously but I have heard conflicting information about whether you need to report where you do away rotations on ERAS so I guess potentially they wont know.

-additionally is it sometimes worth risking not doing an away at a program you would definitely want to match at in order to do one in another region to "open up" that area to potentially get more interviews overall?

2) I have been told to do away rotations at places you would definitely want to go to for residency because where you rotate = best chances of matching there. What confuses me is how do people end up matching at programs they didn't do aways at? I would imagine that most competitive programs have enough candidates to fill their spots between those that did aways there and students from their home SOM. Does it really come down to people just impressing programs on interviews/better applications trump the 4 week rotators sometimes?

 

[mrbreakfast]

- my thought here is maybe other programs not in this exact region wont take you as seriously but I have heard conflicting information about whether you need to report where you do away rotations on ERAS so I guess potentially they wont know.

-additionally is it sometimes worth risking not doing an away at a program you would definitely want to match at in order to do one in another region to "open up" that area to potentially get more interviews overall?

My personal opinion is that the idea of "region" being a big factor in aways is overrated. I personally would not particularly care if you have a letter from an away that was at a program 100 miles away vs 1000 miles. Programs typically like folks who are from/doing medical school and I am not certain the best way to overcome that (maybe a letter of interest?). It's not like it's a huge advantage, though. It just so happens that, with a few big-name exceptions, programs get more regional applicants vs non-regional applicants due to applicants' own preferences.

I would always advise doing aways at programs you are very interested in over picking an away for any other reason.

I have been told to do away rotations at places you would definitely want to go to for residency because where you rotate = best chances of matching there. What confuses me is how do people end up matching at programs they didn't do aways at? I would imagine that most competitive programs have enough candidates to fill their spots between those that did aways there and students from their home SOM. Does it really come down to people just impressing programs on interviews/better applications trump the 4 week rotators sometimes?

Away rotations are like dating. The likelihood of you going on a date in the future with a particular person is likely higher if you have previously gone on a date with that person, because you know them, and may have enjoyed that date. Having gone on a first date does not mean you will actually go on a second date, though. The date might have been a flop or boring. Also, you may have enjoyed a few casual dates with a nice person, but if some gorgeous person pops up on your Hinge feed with a catchy line, you might choose to go on a first date with them rather than another date with the person you were seeing before.

If you apply for an away at a program, it will likely increase you chances of matching there (not necessarily). But it won't make you ranked to match by any means. If you apply for an away and we have space, we'll let you rotate; it doesn't mean we're going to match anyone who rotates here. But if you do an away and do a phenomenal job, you are going to shoot up our rank list; to go back to the dating analogy, a second date is going to happen if the first date went great. I think the same is true for any other program.

The take-away is that aways show you are very interested in a program, which is nice to see. But the real benefit is you get a chance to show you are put-together, professional, personable, and are a culture fit. Keep in mind during residency interviews we are trying to find good candidates, but much more importantly we are trying to detect and avoid duds - people who look good on paper but are terrible, for one reason or another, in practice. If you can somehow demonstrate a guarantee that you aren't a dud (which, as an aside, is why letters are important) it will go a long way.

 

[nibhighfootballrules]

@mrbreakfast Amazing, thank you for the very insightful response as always

 

[Med Ed]

If someone had a 280+ or even 290+ Step 2, with very little else on their resume, could they match into a competitive specialty? Let's assume maybe 2-3 pubs but nothing else significant on their resume.

Seen this.

The answer is SOAP.

 

[LeaveNoTrace]

Seen this.

The answer is SOAP.

That sounds about right...if they didn't have a backup specialty.