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Now What?

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Students studying

After a momentous week filled with high profile Snaps, tweets and controversial video recordings, I am sure you are all wondering what should I do now about the on-going celebrity feud between #TeamTSwift and #TeamKardashiWestPerry….. Hmmm, no? Did something else important happen last week? Is that not why you come to this blog? Oh right… Step 1 scores came back for many of you! That is a much bigger deal than anything that US Weekly or People can drum up. With you having gotten your score back, you next question is… Now What?

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Clearly that is a complex and nuanced discussion that is based in part on what your score is combined with what specialty you were considering going for. Rather than list all of the different possibilities and discuss from there, I am going to stay a bit general and work from there.

First, head to the AAMC’s Careers in Medicine web portal. They are going to have most of the objective information that you are going to want to be looking for. Namely, average Step 1 score for a given specialty. How do I find that? Well, you can read up on this previous post for some simple navigation directions. Once you sign in, there is a site for each specialty which has a wealth of information, including average Stephttp://final.localhost/mckenna/2015/10/05/careers-in-medicine-101/ 1 score for students entering the specialty. These numbers do not include this year’s graduating class, but they probably will not go up significantly once those are eventually added. Is your score at or above the average for the specialty or specialties you are interested in? If yes, then you are in business! Certainly, this is not a guarantee that you will match, but provided you have a commensurate academic record and some solid extra-curricular activities (the characteristics of these are also conveniently listed on the site…) you are well on your way to a strong application.

But what if you fell short of the average? Should you give up your dream specialty? Well…. that depends.

  1. How far away from the average score are you? There is a big difference between being one point off the average and 30 points off the average. For the most part just a few points off is probably not that big of a deal, all though it depends upon which specialty you are considering. Speaking of which…
  2. How competitive is your dream specialty? The more competitive the specialty, the less wiggle room you will probably have on your overall application. The problem is that the residency program end of ERAS has a way that programs can filter applications based upon Step score. So, it is possible that competitive specialties may not see your application if it is below the average. The same goes for competitive programs in less competitive specialties. On the other hand, you just never know what the true cutoff is for a given specialty or program as it is quite possible that they program would dip down below the listed average or cutoff in order to make sure they have a diverse and deep pool of candidates to choose from. This is why it is especially important for students with less than ideal application profiles to cast a wide net among potential residency programs and to have a back-up plan.
  3. How committed to this dream are you? If you really think that you were meant to be a [fill in the blank] but your Step score is not really in line with what that specialty expects, you don’t necessarily have to give up on your dream if you are especially committed. Every year, there are a handful of students who match into a specialty that we were not sure sure they would be able to match in. It does mean that you have a lot of work to do in order to try to buff up your application in order to improve your chances. I would also strongly consider a back-up specialty, because while it is great to reach for the stars, you still want to have a cushy cloud to fall back on just in case. Additionally, while I think every student should talk with a Career Mentor about how to make better connections to the department and specialty they are interested in, it is of utmost importance for students whose application is not as competitive as you would like to work with the Career Mentors to see what you might be able to do to give yourself the best shot possible. I also would urge you to listen to them if they say that you have no shot at a specialty.

Finally, for those of you out there who got a higher score than you thought you might…. Feel free to take that high score out for a spin and see what specialties might be available to you that may not have initially considered or even thought about before. Each and everyone of you has worked so hard and given blood, sweat, tears and time away from your loved ones to commit yourselves to the practice of medicine. You have earned the right to take the time to explore what you really want to specialize in. But also remember that your life is not graded. If you have a 280 and you decided you “only” want to go into a low competitiveness specialty (like say…. Pediatrics), you have earned the right to do what makes you happy. Why else have you worked so hard?

In the end, your Step 1 (or 2 or 3 for that matter) score does not define who you are or how good of a physician you are going to be. No study has shown any correlation between how well you do on Step 1 and how good of a resident you will be. But programs are free to set their bar wherever they would like, especially those that are especially popular and competitive. Remember that there are a number of other resources out there and other ways to help make your application as best as it can be. You can always contact me (mpmckenn@iu.edu) to talk through some of these questions. But I’d prefer if you didn’t surreptitiously record our conversations and then send them out later on Snapchat.

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The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Author

Michael McKenna

Dr. McKenna is a graduate of IU School of Medicine, where he also completed a pediatric residency. He served as chief resident and was an Assistant Professor in the Department of Pediatrics and the Associate Program Director for the pediatric residency p...