Thursday 21 April 2011

The best programs for applicants with multiple attempts on step 1

Step 1 is exceptionally powerful indicator of opportunities of interview. One cannot emphasize how important it is to score well on the step 1. However in spite of the best of efforts many international and American medical graduates are faced with the misfortune of not passing the step 1 in the first attempt. This could be for any number of personal, professional or even medical reasons. How does having an attempt in step 1 affect your interview chances? Are there particular specialties that someone with attempts must avoid in order to improve their chances of securing an interview and subsequent match? What programs to apply if there is an attempt to step 1? The following graphs answers those questions

Specialties and programs that will not invite applicants with attempts

As seen from the figure 1, there was a lot of variation amongst the specialties and programs regarding their outlook towards applicants with multiple attempts in Step 1. The difference is obvious as the trend shifts towards surgical specialties.

Dangerous specialties for applicants with attempts in step 1
Surgical specialties seemed unsafe for applicants with attempts in step 1. General surgery was on the top of the list with 45% of programs saying they will not interview applicants with more than one attempt on step 1, this was followed surprisingly by anesthesia at 28% and pathology at 24%. Ob- Gyn was at the bottom with 21% on par with medical specialties.

Middle tier
Neurology, Internal Medicine (IM) and emergency medicine (EM) were the middle rung with a range from 16% to 21% of programs refusing to grant interview to applicants with attempts.

Less dangerous specialties for applicants with attempts in step 1
These are family medicine, psych and pediatrics. Only 3 to 6% of these programs refused to grant interviews for applicants with multiple attempts on step 1

Specialties and programs that will most often invite applicants with attempts

Figure 2 is even more revealing about the workings of the programs when it comes to granting interviews. This graph shows how often a program will invite applicants with attempts of step 1 based on specialty.

Unsafe specialties
Neurology, Surgery and anesthesia are amongst this category. They were least often prepared to invite applicants with attempts in step one.

Moderately safe
This is the same middle tier with IM and EM as above with the exception of neurology. So if you have attempts on step 1 then you will hear from these programs anywhere from 10 to 18% of the time. Even Pathology and Ob-Gyn programs said they will often interview candidates with attempt 12 to 18% of time.

Very safe
This is the clincher. Family medicine will invite applicants with attempts up to 50% of time. This is followed by psychiatry and pediatrics at 37 and 25% respectively.

- the best specialties to apply for applicants with attempt in step 1 are Family medicine, psychiatry and pediatrics.
- Neurology though excluded candidates with attempts only 20% of time, invited applicants with attempts only 3% of time.
- Internal medicine was a stable middle tier choice.

This article will help focus your application to the right place, while you are scoping out your competition.


  1. Any specific programs you or your friends can mention for IM to apply to for a person with attempts only on step 1 and scores in 80s.

  2. There are programs in midwest and south that you should focus on - MIssouri, Arkansas, Oklahoma, Tennessee, Georgia.

  3. any info on what programs a IMG should apply who passed CS on 2nd attempt with other scores above 95 and finished step3 with score of 80

  4. anythig sililar for cs attempts...plzzzzz

    1. Hi Dr. Ramesh, so far I have not found any specific data regarding step 2 CS. But I will have an article ready as soon as I find something. Thanks

  5. thanks a lot, we need data on step 2 cs attempt if possible please.

  6. Hi friends ,
    I would be glad if someone can say abt attempt on step3 .. just before applying and are there any programs or areas where they will consider calling for interviews . In surgery and IM.

    thanks in advance

    1. step 3 is hardly a major factor in invitation for interview applicants. it does have minor role at the least.

  7. Droidor, thanks for the article, maybe I still have the MLE lamp burning bright ...

  8. Hi thr , am an Old Grad(2004) with All passed Steps at one go with Low Scores Somewhat, step1 84, 2- 78 ... I failed Step 3 ...I am Pediatrician with flare for Critical Care...Kindly Ghuide me

    1. you need to pass step 3 with good score. try for USCE and get some US experience to buff up your resume, make contacts along the way. and then apply. good luck!

  9. Any advice on applying for a family practice residency with 2 attempts on step 1 and 1 on step 2 but have not passed any yet and have been out of school for over 10 years.

    1. family medicine programs have tended to be more lenient as far as attempts and scores go, but there is no harm in trying. you have very difficult credentials to begin with - 2 attempts on step 1, 10 years out from graduation. what have you been doing these years? have you been currently involved in clinical work? if you have it may affect you less. your best chance is to find someone who will be able to put in a word for you, so that you get invitation for interviews./


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