What is worse? Low step 1 score or a failure?

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Just cure my curiosity here. I’ve wondered for a while but haven’t had an answer.

Passing score for Step is super low. I don’t think many enter the match with a 196 but from some data I saw, somewhere.. something like 1 of the 3 applicants matched with this score.

So what is worse? A 196 or a failure?

My step 1 is a 10 days away. Nervous wreck.
Interested in peds, psych, and EM mostly.

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What did they match into is the question, followed by their other boards scores and the rest of their application.
 
They're both terrible. I don't know which I'd rather have to be honest. A fail with a high retake would be preferable to a low score I guess, but if you retook and scored low you'd be doubly screwed
 
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They're both terrible. I don't know which I'd rather have to be honest. A fail with a high retake would be preferable to a low score I guess, but if you retook and scored low you'd be doubly screwed

If something like this happened..what would you do? Drop out before paying for third year tuition since you won’t match anywhere?
 
If something like this happened..what would you do? Drop out before paying for third year tuition since you won’t match anywhere?
If I had a fail and low retake? If it was sub-200, I'd probably cut my losses. If I had a low Step 1 with no prior fail I'd keep going. But that's just me. Some people are less risk-averse
 
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If something like this happened..what would you do? Drop out before paying for third year tuition since you won’t match anywhere?
Barring professional problems, a fail and a low retake can still match in less competitive FM
 
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If I had a fail and low retake? If it was sub-200, I'd probably cut my losses. If I had a low Step 1 with no prior fail I'd keep going. But that's just me. Some people are less risk-averse
I don't know about DO, MD still can match FM and community IM with your scenario. I don't think it would be wise to leave med school for that...
 
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I think a failure is worse. From what I remember, several peds program websites explicitly stated they wanted USMLE passes on the first attempt. I’m not sure if other specialties do this as well. Would suck to get automatically screened out for a fail, even if your retake, step 2, clinical grades, etc were much improved.

OP - sincerely, I think worrying about this is just going to make you more anxious. Just focus on preparing for the test. If you really think you’re not ready, then push it back. Best of luck.
 
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I think a failure is worse. From what I remember, several peds program websites explicitly stated they wanted USMLE passes on the first attempt. I’m not sure if other specialties do this as well. Would suck to get automatically screened out for a fail, even if your retake, step 2, clinical grades, etc were much improved.

OP - sincerely, I think worrying about this is just going to make you more anxious. Just focus on preparing for the test. If you really think you’re not ready, then push it back. Best of luck.

Thank you.

Unfortunately I will never think I am ready lol that is just how it goes for me. Do i think I am doomed to fail? No, I don’t. Thank god.
 
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Thank you.

Unfortunately I will never think I am ready lol that is just how it goes for me. Do i think I am doomed to fail? No, I don’t. Thank god.
Dk your practice scores but chances are you wont fail unless youre scoring 170s-180s. Very few people fail even if their practice scores were poor.
 
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Dk your practice scores but chances are you wont fail unless youre scoring 170s-180s. Very few people fail even if their practice scores were poor.

I got a 198 on NBME 15 with very little dedicated review. I basically used my prep for our comprehensive exams and ran with it.

I suck at anatomy.
 
Failure is worse than low. I don't even think it's that debatable.

But like others have said, what are you aiming for? The more competitive specialties could be off limits either way.
 
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If I had a fail and low retake? If it was sub-200, I'd probably cut my losses. If I had a low Step 1 with no prior fail I'd keep going. But that's just me. Some people are less risk-averse
What happens if you still match in the middle of nowhere?



Lol sorry MJ I couldn’t resist
 
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Failure will auto-screen out you at most programs. Low score won't. You can make up for a low score with other parts of your application, like high CK score.
 
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Failure is worse than low. I don't even think it's that debatable.

But like others have said, what are you aiming for? The more competitive specialties could be off limits either way.

Nothing super competitive.
Peds, psych, EM are my primary interests right now.

I know for sure i dont want surgery and i dont have the resume for something like derm even if i was 99th percentile on step 1
 
Just cure my curiosity here. I’ve wondered for a while but haven’t had an answer.

Passing score for Step is super low. I don’t think many enter the match with a 196 but from some data I saw, somewhere.. something like 1 of the 3 applicants matched with this score.

So what is worse? A 196 or a failure?

My step 1 is a 10 days away. Nervous wreck.
Interested in peds, psych, and EM mostly.

For EM (which is most competitive on your list followed by Psych), I think the fail is worse, but only slightly (with makes sense for a 1 point difference). Yes, EMRA says that certain places have Step 1 cut-offs for away rotations and possibly interviews, but what you don't see is people most likely getting passed up for an interview for having 197 or being at the bottom of the rank list. For EM, your job is to survive Step 1 (220+) and improve on CK. They don't care as much about the board exams (so long as you clear them with ok scores) as opposed to great SLOEs.

BTW based on your current NBME score and my personal experience, your score is probably going to be somewhere between 200-260...:rolleyes:
 
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What happens if you still match in the middle of nowhere?



Lol sorry MJ I couldn’t resist

Then you do residency in the middle of nowhere. You get to be friends with a few IMG's. . . . . .

I don't know many with as bad a step 1 as me. I passed my IM boards, I'm working. . . . life goes on. I'm not going to go into competitive fellowship, despite the fact that I was top PGY1, 2, 3, and a Chief resident, (granted it was a community program), I'm never going to get into cardiology or GI. Median income for Internist is still, what top 5% of income in US? I wouldn't drop out, but you do need to be realistic.

EDIT: at my medical school, you get to open your letter of acceptance to residency on stage. (granted half the class was pretty sloshed). It felted kind of surreal.
 
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I got a 198 on NBME 15 with very little dedicated review. I basically used my prep for our comprehensive exams and ran with it.

I suck at anatomy.
What was your pre-clinical GPA?
Agree with NITRAS and the other posters above that a failure is much more of a red flag than a low score. A low score means you go to a community hospital in Jonesboro, AR or Kalispell, MT.

BUT:
"We are not interested in the possibilities of defeat; they do not exist.".
Queen Victoria

Now go rock that exam!!!
 
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What was your pre-clinical GPA?
Agree with NITRAS and the other posters above that a failure is much more of a red flag than a low score. A low score means you go to a community hospital in Jonesboro, AR or Kalispell, MT.

BUT:
"We are not interested in the possibilities of defeat; they do not exist.".
Queen Victoria

Now go rock that exam!!!

We’re on a pass/fail system so I don’t have an actual GPA. It isn’t great, though (by my definition lol, i have no failures) EDIT: ~2.64

I did rural for the first 20 years of my life and my husband’s job isn’t set up for middle of nowhere. More incentive i guess?
 
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Being a nervous wreck regarding hypothetical board scores is more likely to prevent you from getting EM than either of those. Imagine how you'd deal with exsanguination.
 
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Being a nervous wreck regarding hypothetical board scores is more likely to prevent you from getting EM than either of those. Imagine how you'd deal with exsanguination.

Im nervous about step 1 so i automatically will suck in EM? Hardly.
 
Pretty sure he was saying that being overly nervous and focusing on bad outcomes will likely cause you to do worse than just focusing on the studies.

Ahh, i see.
My bad, you’re absolutely right.
 
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We’re on a pass/fail system so I don’t have an actual GPA. It isn’t great, though (by my definition lol, i have no failures) EDIT: ~2.64

I did rural for the first 20 years of my life and my husband’s job isn’t set up for middle of nowhere. More incentive i guess?
Now is the time to start practicing mindfulness techniques!
 
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Two related questions...
1) Is there a way one can know in advance which programs auto-screen out for failing board scores? (aside from obvious competitive academic places)
2) Do certain programs advertise they will consider an application with step 1 retakes? OR do you just have to cast as wide a net as possible, target the community programs, and cross your fingers?

I'm just kind of curious. I've seen a few people say that retaking boards isn't the end of the world if you don't have any other red flags and that your best bet is community programs "in the middle of nowhere"...but does anyone actually know specifics?
 
Two related questions...
1) Is there a way one can know in advance which programs auto-screen out for failing board scores? (aside from obvious competitive academic places)
2) Do certain programs advertise they will consider an application with step 1 retakes? OR do you just have to cast as wide a net as possible, target the community programs, and cross your fingers?

I'm just kind of curious. I've seen a few people say that retaking boards isn't the end of the world if you don't have any other red flags and that your best bet is community programs "in the middle of nowhere"...but does anyone actually know specifics?

Many residency program websites will mention whether they have a step cut off or whether they consider step retakes. If they don't, your best bet would be to contact the program you're interested in and ask. If someone fails and has to retake, I would encourage them to be proactive and seek this information so they don't waste money on programs that are just gonna screen them out.

Edit: I am thinking more of fields like IM, peds, FM, etc. I do not think someone who fails has any realistic chance at competitive fields like plastics, ortho, derm, etc.
 
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I don't know about DO, MD still can match FM and community IM with your scenario. I don't think it would be wise to leave med school for that...

I know a DO that failed his level 1 once, level 2 once and multiple failed classes in pre clinical years. He eventually managed to graduate on time somehow. He matched at a terrible ACGME program in IM in the middle of nowhere believe it or not. Apparently he did well as a resident and they even asked him to stay back another year as a chief. He’s now working as a hospitalist, his hoping he’s not killing people.
 
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In my eyes, a failure is worse.

Why? The standard error they state is plus or minus 6 points. So if you fail, then you really just sucked at understanding the first two years of medical school. Like, you were completely incompetent. You drank too much beer and never studied. You really should not have taken the test at all, and you needed to spend time to relearn stuff.

If you have a low score, then hey, at least you passed. You can write it off as a really bad day and show that the score was just a low point in med school (depression or something). That despite XYZ, you still passed. You still have what it takes. A passing score shows you are relatively bad at test taking in a pool of really good test takers, but doesn’t really reflect how good you potentially could be at doctoring. You at least have what it takes.

Does it make sense? No. But I don’t care.
 
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In my eyes, a failure is worse.

Why? The standard error they state is plus or minus 6 points. So if you fail, then you really just sucked at understanding the first two years of medical school. Like, you were completely incompetent. You drank too much beer and never studied. You really should not have taken the test at all, and you needed to spend time to relearn stuff.

If you have a low score, then hey, at least you passed. You can write it off as a really bad day and show that the score was just a low point in med school (depression or something). That despite XYZ, you still passed. You still have what it takes. A passing score shows you are relatively bad at test taking in a pool of really good test takers, but doesn’t really reflect how good you potentially could be at doctoring. You at least have what it takes.

Does it make sense? No. But I don’t care.

But it does make sense lol
Different perspective which i think made it look at it differently.

THANKFULLY, i doubt i will fail.
 
How low is low? The specialties you listed seem to be able to look past a lower Step 1; for pediatrics, psych, and EM, all ranges of Step 1 were more likely to match than not per Charting Outcomes. Of course, you never know what other experiences or connections people might be bringing to the table. Do you think more time would help? I pushed mine back a week just because I wanted to be sure I put my best foot forward, and I know lots of people who pushed it back even further. No shame in that whatsoever! I don't think anyone should go into the test if they think there's a legitimate possibility they'll fail. Lots of programs will likely screen out board failures and thinking that a failure is on the table might mess with your confidence and affect your performance. That being said, you're not going to fail, I'm confident you'll do great. Good luck!
 
How low is low? The specialties you listed seem to be able to look past a lower Step 1; for pediatrics, psych, and EM, all ranges of Step 1 were more likely to match than not per Charting Outcomes. Of course, you never know what other experiences or connections people might be bringing to the table. Do you think more time would help? I pushed mine back a week just because I wanted to be sure I put my best foot forward, and I know lots of people who pushed it back even further. No shame in that whatsoever! I don't think anyone should go into the test if they think there's a legitimate possibility they'll fail. Lots of programs will likely screen out board failures and thinking that a failure is on the table might mess with your confidence and affect your performance. That being said, you're not going to fail, I'm confident you'll do great. Good luck!

Thanks man! You too!!

And i take my second NBME either Sunday or Monday. If my score isn’t where i am satisfied with, I will very much considering postponing, as unideal as it is given my clerkship stuff with my school.
 
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Agree that 99.99% of the time a fail is worse than a low score. If there's some kind of event or extenuating circumstance to the failure and then you rock a 240+, many programs may consider that to be better than a sub-200 score. Other programs will auto-screen a failure though. Really just depends on the program I'd think.

Failure will auto-screen out you at most programs. Low score won't. You can make up for a low score with other parts of your application, like high CK score.

How many programs is that true for? I applied to around 75 and I don't remember seeing a failure as an auto-screen at any of them. Also depends what field you're shooting for. Fail and get a 250 and you've still got a chance at competitive fields/programs if you can explain why you failed (family death or something). Get a 200 and certain fields and programs will also auto-screen you out.

Two related questions...
1) Is there a way one can know in advance which programs auto-screen out for failing board scores? (aside from obvious competitive academic places)
2) Do certain programs advertise they will consider an application with step 1 retakes? OR do you just have to cast as wide a net as possible, target the community programs, and cross your fingers?

I'm just kind of curious. I've seen a few people say that retaking boards isn't the end of the world if you don't have any other red flags and that your best bet is community programs "in the middle of nowhere"...but does anyone actually know specifics?

Best way is to check FREIDA for initial screens of programs you're interested in, then go to the actual websites in info isn't on FREIDA. I don't think most programs will advertise that they accept failures, it's not exactly a positive thing to have failures. I also don't think a failure dooms you to community programs if you see that as a bad thing. It will significantly limit your options though (the extent of that limitation depends on the rest of your app).

Anecdotal, but a guy (DO) a couple classes ahead of me failed Step 1 and never retook it (passed COMLEX). Ended up getting into an academic ACGME radiology program in a mid-sized city (~300k pop). So a failure won't necessarily doom you, but it'll definitely hurt.
 
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This is the wrong mindset to be in just before Step 1. Now what you should be considering is—if I hit 270, will programs think of me as a socially-inept genius? Will I have to pursue derm/plastics/ortho? How will I rid my doorstep of PDs bearing flowers and wooing me into their programs with renditions of “I will always love you” and offers to rename their hospitals after me?

In all seriousness, if you are scoring in near-fail range, it is better to postpone the test rather than risk failure. Because if you do fail, you’ll have to find time to retake before you can start clerkships anyways.
 
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This is the wrong mindset to be in just before Step 1. Now what you should be considering is—if I hit 270, will programs think of me as a socially-inept genius? Will I have to pursue derm/plastics/ortho? How will I rid my doorstep of PDs bearing flowers and wooing me into their programs with renditions of “I will always love you” and offers to rename their hospitals after me?

This is not entirely ridiculous -- There are applicants who suddenly discover a passion for more competitive fields after scoring significantly higher than expected.
 
They're both terrible. I don't know which I'd rather have to be honest. A fail with a high retake would be preferable to a low score I guess, but if you retook and scored low you'd be doubly screwed

I am sure most people would take a 188 (one point below failing when I took it) followed by a 270, but in reality this is not what happens. Usually it's 188 then a 195 or something. Passing is always the best scenario, because if you failed it in the first place, there are some major deficiencies in your education that won't be made up with a few extra weeks and a repeat exam. Either you were a questionable admit (i.e., admitted based on factors other than academic merit), or you did not study during M1/M2 and did not study for the exam. I had a friend who did the bare minimum M1/M2, then was too lazy to study for step 1 properly and spent a few hours a day passively watching prep videos. Guess what? FAIL by one point.

This is not an exam where a failure should be unexpected. It's not like you are getting 90%-tile on practice tests then walk in and fail.
 
Hey guys I'm just curious as to if the NBME/CBSSA 3 digit step one score is accurate.... I took NBME 15 form got a 68.5% correct and that equates to a 184? And like a 75% is barely passing? Surely that isn't the case on the real test.. thoughts?
 
Hey guys I'm just curious as to if the NBME/CBSSA 3 digit step one score is accurate.... I took NBME 15 form got a 68.5% correct and that equates to a 184? And like a 75% is barely passing? Surely that isn't the case on the real test.. thoughts?

Ive wondered this myself.
 
Update: took USWA1 and got a 232. Now i now they tend to overinflate..but this I want to think i am in an okay place..right?
 
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Update: took USWA1 and got a 232. Now i now they tend to overinflate..but this I want to think i am in an okay place..right?

One would think but I went down from a 209 on UWSA1 - after 2 weeks of dedicated to a 184 on NBME after 4 weeks studying.. also my % correct on UWSA1 was only like 59 while my NBME was like 69
 
Update: took USWA1 and got a 232. Now i now they tend to overinflate..but this I want to think i am in an okay place..right?
It probably overestimates a bit, but I seriously, seriously doubt you could go from 232 on UWSA1 to failing. You're probably on pace to score at least a 215-220 if you were to take it today.
 
By the way, I'd bet that at least part of the reason that UWSA1 is known to overestimate is because for whatever reason it's a practice test that people generally take towards the beginning of dedicated. It's probably much more accurate if you're taking it pretty close to your exam!
 
By the way, I'd bet that at least part of the reason that UWSA1 is known to overestimate is because for whatever reason it's a practice test that people generally take towards the beginning of dedicated. It's probably much more accurate if you're taking it pretty close to your exam!

How does that lead to overestimation?
 
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Update: 215 on NBME 18.

Not sure how to feel about any of this. I have to decide today if I am gonna postpone, and if I do, it can only been until the 15th. I am not sure if 4 extra days makes a difference? (My school has dictated this..if i postpone beyond the 17th without their approval, I risk a disciplinary write up..and the deadline to apply to for the deferral has already gone..)

So:
NBME 15: 198 (4 weeks)
UWSA1: 332 (1.5 weeks)
NBME 18: 215 (1 week)
 
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Update: 215 on NBME 18.

Not sure how to feel about any of this. I have to decide today if I am gonna postpone, and if I do, it can only been until the 15th. I am not sure if 4 extra days makes a difference? (My school has dictated this..if i postpone beyond the 17th without their approval, I risk a disciplinary write up..and the deadline to apply to for the deferral has already gone..)

So:
NBME 15: 198 (4 weeks)
UWSA1: 332 (1.5 weeks)
NBME 18: 215 (1 week)

Take UWSA 2 and then decide. If you hit higher than 230 on that... take it.
 
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