Wednesday, 20 April 2011

Step 1 score and Chances of interview

First Step to Opportunity or Misfortune
Step 1 score has always been the initial point of decision for granting or not granting an interview. What makes the program directors tick? what are the decisions that lead them to chose one applicant over another? Is there a particular score below which programs do not grant interviews? What is the least I have to score to be safely considered by programs? These questions plague every residency match applicant.

At last, there is some respite to nagging questions like these. This is a very interesting graph I made from data gleaned from NRMP website. The explanation follows the graph



This graph aims to answer the question - is there a cut off score which affects interview chances positively or negatively?

The X Axis
Subspecialties are listed on the x axis and include some of the perennial IMG favorites and considered as IMG friendly. To know more about these check out this link, IMG friendly specialities. I have not included those specialities that are not IMG friendly on the abscissa.

The Y Axis
This is the step 1 score. The three digit step 1 score is listed and the ordinate starts at 188. The reason for choosing 188 is because for step 1 - a three digit score of 188 is considered a passing score. Anything less than that will be considered a failed attempt.

The Red Line
The red line connects all the lower values for the respective specialities. The program directors indicated that these represent average scores below which they do not grant interview. Therefore any score below the red line will not get an interview under average circumstances. There is a variation to the lower cut off limit. Family medicine and psychiatry have the lowest cut off of any speciality. The specific subjects and the lowest cut off are indicated in the chart. 

The Blue line
The blue line connects the three digit step 1 scores above which the programs almost always invite applicants. Family medicine and psychiatry had lower top cut of values. 

The Black Line
The black horizontal line represents a score of 228 which was the least score you needed to obtain on step 1 to be safely above the blue line for all specialities and thus fall in the 'always get called for interview zone'

The Green Zone
This is a free for all, zone where programs may or may not call applicants for interviews.

Bottomline
- Step 1 scores more than 228 will encourage programs to invite you for interviews
- Step 1 scores less than those indicated below the red line will make programs disinclined to send interview invitations.
- family medicine tends to have more relaxed criteria for granting interviews based on step 1 scores.
- Internal medicine and pathology have more stringent criteria for granting interviews based on Step 1 scores.
On a related note, I would also like to highlight the main points here from my other article (20 steps to boost your residency chances)

  1. Plan your time
  2. Coordinate with your medical schools and colleges so that your paper work is done on time
  3. Spend a lot of time, I mean a lot, on your personal statement. You are speaking to an audience, make an impression.
  4. Brush up on your correspondence skills, 80% of correspondence is written by email, learn to write impressive emails with appropriate subject headings and striking content
  5. Be organized, use a filing system (in person) and on computer to sort and store important documents (scanned or original)
  6. Be sure to upload your documents to ERAS on time and that your packet is complete by September 15.
  7. If there are any deficiencies in getting ECFMG certified, go ahead and take care of them
  8. Most programs will need Step 1 and Step 2 CK scores before application. Incomplete applications that do not satisfy criteria tremendously reduce chances of getting an interview.
  9. Choose which approach you are going to take - Shotgun™ or Sniper™ and stick with it.
  10. Shotgun strategy is applying all over in multiple specialties without restriction, while sniper strategy is to focus on one subject and hammer out the applications finely tuned to that specialty. You could be specific to the extent of applying to few chosen states but this may reduce your chances of interview.
  11. Make a careful selection of programs - if you are indiscriminate in applying (you can increase your chances but expenses will also mount), if you are too critical in choosing places (you may not get interviews) find a balance in either strategies.
  12. Brush up your interview skills, if you have an accent - work on it to improve it. A phenomenal impression in an interview can often overcome an inadequate resume
  13. Keep your resume up to date. If you find there are gaps in your CV, explain them in your personal statement.
  14. Keep your CV evolving; a static CV is not impressive. As a norm, you should add one new accomplishment to your CV every 6 months.
  15. If you are an new graduate - fresh out of medical school, look for few volunteer or quasi research/research experiences to add to CV
  16. If you are an old graduate but have been in clinical practice - make sure you justify why you want to change careers in your personal statement
  17. If you are an old graduate and have not been active clinically - do everything it takes to get US clinical experience.
  18. Policies have changed in 2011, with ‘all or none’ phenomenon for programs – either all seats are through NRMP or not. Prematches – out of match offers for positions will go down but still exist and one can get residency outside of match system.
  19. Keep a positive attitude.
  20. Network, network and more network. Find connections and folks to put in a word for you.  Candidates who have someone vouch for them have a far greater chance than those without connections. IF you cannot get connections – make them. If you think you do not need connections – you had better have triple 99 (250+) and a stellar resume.
For a related articles which deals with the number of interviews and chance of matching read up here also make sure to check out the relationship between step 2 scores and chances of interview. 

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124 comments:

  1. If I dont get my step2ck scores on time I apply(1st sept) and I hv my step1 210, which is better for me to apply with high ck scores later or only step1 on 1st sept and update ck score later? I'm trying hard to complete ck wid high scores on time to b able to apply on 1st sept but what if I'm late as I hv limited time for CK prep?plz do help. Thanks

    ReplyDelete
    Replies
    1. best to have as much of your application complete as possible before applying. Incomplete applications have a very poor chance of being considered for interviews as far as IMGs are concerned.

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  2. i have the above problem , i have got step 1 score which is 250 and step 2 ck which is 273 but i have taken cs recently which its score will not be declared until october, should i wait for CS score or apply for residency in September ?

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    Replies
    1. Wow Dude, those are fantastic scores you may do alright if you apply on Sept 15th. Hopefully with these strong scores the programs may be willing to wait till your CS scores are declared!

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  3. hi i m a fresh graduate with a step 1 score of 235 and I m waiting for my CK results which I expect to be around 250. I am applying only to categorical internal medicine. will my bad score affect my chances of interview?

    ReplyDelete
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    1. Hi Dr. Indikar, 235 is not a bad score. if you do get a 250 on your CK, then you dont have to worry about your scores affecting your interview chances adversely. Even otherwise unless you do very poorly on step 2 CK, you may still get a few interviews based on how your total application looks.

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  4. Hi, I had to retake step 1, passed on 2nd attempt 207/85 (old system), passed CS, studying for CK currently. I also am in need of J1 visa as I am canadian.

    I have gone to a Cali and NY approved carib school with USCE and I have good LORs.

    I want to match in FM, IM, or peds. Should I apply on spet 15th to FM to show I'm serious and send in my CK scores when I get it in late OCT or should I wait until then to apply?

    ReplyDelete
    Replies
    1. There are some major issues with your application which are unfortunately not correctable [retaking step 1]. FM or actually peds would be better options as your profile may not be the best for IM. In any case, you should apply on time, there will be schools that may reject your application because it is not complete on sept 15th but at least you will be further up in the line for programs who are okay with your profile. applying with a complete package later on puts you very low on the list because most of the interviews are sent out in the first few weeks.

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  5. hi,i am planning to do an observorship in canada as i have a relative there who is a doctor in edmonton uni.will this be counted as usce???

    ReplyDelete
    Replies
    1. Technically it will be counted as CCE (Canadian clinical experience). :) jokes aside. Being clinically active will be useful as it is better to be busy than to have glaring gaps in your CV. Though not as prized as USCE, your CCE will be useful

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    2. the thing is he's ready to write off my experience as externship.so i am planning to do 2 months in canada n 1 month of observorship with a doc in chicago.will that be enough????

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    3. waiting for you to reply!!!!:)

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    4. as long as you can make most of it, it may work. 2 weeks is too less and 6 months is too much. breaking your obsie down, its one month in US. should be enough. if you are doing these back to back with nothing to show/do for rest of the year till application then you might want to do one more month of obsie in US.

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  6. This comment has been removed by the author.

    ReplyDelete
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    1. There is no hard cutoff per say. The cut off can operate in two ways, if the programs set their PWDS ERAS filter to 200 and up, then all applicants below that limit will be left out. Thus in that regard it is a hard cutoff. However, the programs may be able to grant interviews on individual cases based on merits of each applicant. Thus an applicant may have a score of 199 but have glowing recommendation from a top FM physician who can vouch for you personally to a program. You may still be able to bypass the 'cutoff' value. Whether to take an applicant who has scored well on second attempt over one who passed with a low score is dependent on applicant, program and circumstances of examination. If the applicant is able to explain and make a case for why he failed in first attempt (personal reasons - health, mental, relations etc etc) and convince the program that his reasons were exigent and then demonstrate that he was able to perform better the second time, that applicant may very well be give as good of a chance as any other as long as the filter does not exclude them from the interview pool.

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    2. do most or all programs use these "filters"?

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    3. Yes, given the sheer volume of applicants the programs have to process in a relatively short amount of time. Almost all of them do use some form of filtering mechanism.

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  7. hi my dear, i started my usmle by step 2 ck, and for some reasons i wasnt well prepared and couldn`t delay my exam bec it was the end of my eligibility period extension. Finally i got 205 in this step. ur advice to continue to the rest of steps. i wantint medicine as iam a cardiologist in my country and have MBBch.

    ReplyDelete
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    1. Hi Mahmoud, I am sure I dont get a question here but 205 in step 2 is something you cannot change. You should focus on other aspects of your profile and try to make up for some of this disadvantage.

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    2. SORRY i wasnt clear in my question,
      iam asking about ur advice to me to continue or to stop and leave the usmle?
      i mean if i got a good score in step 1, do i still have a good chance for (IM) residency or my way has already become extremely difficult and no need to suffer more in the USMLE trip as this low step 2 score has already made my chance very difficult?

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    3. HI Mahmoud, the question that you need to answer is how important is it for you to pursue graduate medical education in US? if you are decided on it, then go ahead and follow through. There are multiple instances where folks with poor scores have also matched due to other factors like connections etc. If you think it is not worth the time, effort and money then you can decide to not pursue the USMLEs

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  8. Hi I am an IMG and recently got my step 1 score and scored 219. Was expecting 224 but couldnt get my desired score. I am kind of dissappointed and thinking of what I should do next. Should I give up or keep going for a good step 2 score which I am confident that I can do upwards of 230 as I am good at clinical sciences.
    Really depressed the last 2 days and havent been able to concentrate on step 2 preps as a result. People say I do have a good score but I see scores upwards of 240 on many such blogs.
    Your initial piece made sense and hence I have decided to ask you your view on what I should do next.

    I do have 3 US LORs 1 in psych and 2 in IM the psych one was an elective and the IM ones were observeships but nevertheless are excellent LORs.

    I really want to know on what I should do next as I am feeling a bit low at this point.

    You know my status so can you tell me if I will get any interviews for the 2013 match?

    I am confident of passing CS at one go and plan to finish all my exams by July 2013.

    Will really appreciate if you can guide me here.

    God Bless you,
    AdiDoc

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  9. Hi I had a score of 213 on my step 1 exam. I'm taking step 2 in February.. what score do I need in order to get interviews for IM.. or should I forget about it already? Thanks

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  10. Hello i had 194/79 on step 1 (2009) and on Step 2 a 219/79 which i took a month ago and passed step 2 CS which i took a couple of months ago... passed all on first attempts...and i just graduated from a Caribbean school in Dominican republic in July. I applied when my application was complete which was Oct. 25 2012. I have applied to neurology, psychiatry as my 2 primary and internal medicine. also i applied to 5 joint neuro/psych programs the only ones that were available. I had one U.S LOR and 2 from my school. I would like to know what are my chances of getting into these programs and what can i do to make myself look more competitive. And would it make any difference if took step 3 and had the score before the residency results in March. Thanks

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  11. Hi, im an IMG, i scored 214 on step 1. My question is the next. If i score in step 2 between 220-230, Do 5 months of Final year Clinical rotations in internal medicine in the US still as a medical student in university hospitals, and get very good 3 LORS. How are my chances to get interviews for internal medicine? thanks.

    ReplyDelete
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    1. the most important thing you can achieve with your 5 months of clinical rotation in US is exemplary letters of recommendations and contacts. This will prove invaluable in your residency application. Your chances are not going to be the best - in view of your 214 on step 1 but doing the rest will certainly may you competitive in the process.

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  12. I need suggestion. I am an IMG with step 1 199 (first attempt) step 2 ck 245 and cs passed on first attempt. I have 2 years’ of experience in Gynae/Obgyn.I graduated in 2008. I also have strong recommendation letters. Any chance of getting residency? If yes, then which specialties. Looking for your reply. Thanks

    ReplyDelete
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    1. There is always a chance of getting a residency. the only time there is 0 chance is when you do not apply. barring your step 1 score you seem to have a fair chance of residency. Do you have any contacts or USCE? do you have large gaps in medical education/training? those are things you should focus on to improve you chances

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  13. Hi Droidor,
    Please suggest me what to do next. I'm an IMG from India with step 1 204/84 and step 2CK 246/99. Fresh grad of 2012. My CS is in Jan 2013 and i have NO usce. Trying to get 2-3 months of observerships when i'll go to US for my exam. I;m interested in IM/FM only. Please advise if i should proceed or say good bye to USMLE and keep trying Indian Pg's. Thanks!

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    1. hi Rakshit. refer to the correspondence on facebook for the same. good luck!

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    2. Hi Droidor. A slight change in my resume. I'm going to have 3 months of Hands-on USCE (Externship) and LOR's possibly on a Teaching hospital letterhead affiliated to a university.
      Does this change anything in terms of possibilities for matching to FM/IM as most people have Observerships which is not Hands on.

      Another question is from the statistics of NRMP that says average step-1 score of those matching to FM was 204 in FM. Do these averages apply in real life situations too or are they no good?
      Thank you very much for your advise!

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    3. by definition observership is not hands on but seems like you may have secured some kind of go between for the training. This is slightly better than just plain observing. The utility of these exercises is not to showcase what you have learnt but to demostrate that you have kept in touch with medical education after graduation. Also use this to make contacts. the Avg score is not applicable to real life situation, the better the score, the better your chances of being invited for an interview.

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  14. Very good post... I'm chasing preliminary surgery. Step 1 = 226 (1st try). I'm a IMG graduated in 2008... currently I'm working on CK. What chances do I have? I'm looking for some insight. I have no USCE nor LoRs. Have 1 publication and a lot of faith and motivation. These are times of despair...

    Thanks!!!

    P.S.
    I am looking for observerships, so far no luck. Yes.. I know I must get son USCE/US LoRs

    ReplyDelete
    Replies
    1. faith is important and so is the desire to pursue your dream. keep working at it and you will surely find your right path. Hard to predict just based on one score but looks like you are motivated enough to make things happen, so it will!

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  15. Hello,

    I am an international student, but I currently live in the US. I just got my step 2 ck exam score and it is 79/219. I will take step 1 and cs exams before August this year. How do you see my chances to get an admission and what specialties should I think about?

    Regards,
    Samer

    ReplyDelete
    Replies
    1. one score is not enough to comment on your chances. Focus on getting fantastic results on the other exams and make your application more competitive. It is too early and premature to comment on what specialties you should apply, while in fact you should apply to those specialties that you have interest in.

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  16. Hello Droidor. First and foremost, I really enjoy your articles. They are insightful and contain information that is difficult to find otherwise. My question is similar to those that have commented above.
    Step1 - 195 first attempt
    Step2ck - 223 first attempt
    Step2cs - pass first attempt

    I just submitted my application yesterday. I know I'm really late with my application and my step 1 score isn't great so I'm being realistic with my expectations. I applied strictly to Family Medicine programs. Now I know my chances of matching aren't that great due to my tardiness but I am hopeful. I'm cautious but optimistic. Any thoughts on my chances? Thanks in advance. Keep up the good work.

    ReplyDelete
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    1. December is too late to apply even with excellent score. The reasons being most of the programs have had sent out interview invitation before that. With good luck you may get an interview or two but applying on time is one of the most important factors of ensuring decent chances of receiving interview invitations.

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  17. Hi Droidor! I'm a US citizen and an IMG from the Carribean. I got a 233 on step 1 and will be taking step 2 in a couple months. What are the chances at categorical general surgery positions? I will have almost 2 years USCE, 3 LOR from surgeons, but no research or publications and no connections.

    ReplyDelete
    Replies
    1. for surgery, you should be good since you have experience in surgery and LORs from surgeons. IMGs from carribean fare better than IMgs from other countries and you are a US citizen as well which greatly improves your chances. Cat. Surgery is harder than medicine but certainly not out of reach for you. Focus on your step 2 exams and try to work on getting connections (what about the LORs you got from the surgeons? can they network for you)

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  18. Hi Droidor!I am an international medical graduate graduated at 2010, and I am not an US-citizen or green card holder. I got 259 for step1, but my CK score is much worse, it is only 234. and I will spend 3 or more months on US hospitals for hands-on clinical experience, and 3 or more LORs are guaranteed, it is all about IM. I will take CS exam in May. So, for my situation, what specialty should I focus? high step1 score and low CK score

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    1. Hi Dr. Tan, your scores are good and seems like you taking the right steps to fill in the blanks in your application. What do you envision your self to do? At this time, you should reflect on what you want to do rather than do something that is dictated by circumstance. Chose a specialty (within reason and amongst the IMG friendlier ones) that you want to pursue and go for it! it is better to do something you enjoy and with enjoying something to do. IM, peds, FM, psych, neuro, Ob etc are likely all fair game. good luck!

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  19. Hi Droidor, am an Indian Grad, who failed Step 1, am currently doing a grad course in the UK, while studying for my re-take. Do you think, a single failure could put a spanner on the works for the USMLE. I recently read that what the PDs see is the final score and only later check which attempt that is, so in effect if on the retake one gets a really good score (and also aces Step 2 CK) then there is not much to be worried about (though a failure is a failure)...... Your comments.

    ReplyDelete
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    1. Hello Dr. Swami, attempts on USMLE are a big hurdle to cross and often lead to applicants being filtered out from the PDWS software that sifts through the applicant pool. while not the end of the line in itself, it does make it tougher for applicants with attempts to get interview. It depends on what and how the programs sets the filters, if they choose only the score (without attempt) then someone who did well second time may pass through but many programs do want to take those with no attempts. you cannot fix the issue on the record but you can work on improving you connections and other aspects of CV to ensure that you get called in for interviews

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  20. Do you think it is worthwhile for someone with a failure in Step 1 to still pursue with the USMLEs and try for a residency spot in the US ? (Please don't be diplomatic, but brutally honest, as I need an honest opinion from someone with a knowledge of the system. )

    ReplyDelete
    Replies
    1. Droidor, its been a long time, would you please post a reply to my question ? I've been mulling over quitting USMLE Prep (because of the perceived lack of opportunities my failure in step 1 may bring about) though I would'nt like to ..... I've not got a proper answer that discusses the issue @ hand from people I've spoken to....

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    2. Hello, apparently your Q got overlooked because of a slew of questions here, and on FB. having a failure in step 1 in itself is not a reason enough to quit. There are many applicants who have failed in one exam only to recover with excellent scores and get back into the game. if USMLE and residency was something you were thinking of and now do not want to do it then that is a very reasonable decision as well. Having an attempt in step 1 is definitely an obstacle but as year after year you can see, there are those that do surmount it and get interviews. The question you must ask yourself, how badly do you want to pursue this?

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  21. Hello Droidor,

    Thanks for all your help. I'm a Canadian citizen graduating from an Irish University in 2014. Step 1 score is 216 (really disappointed), and I'm scheduled to take all remaining steps before September 15. I have lined up some USCE in big institution for the upcoming summer. I have a published an article in a top 3 medical journal, and I'm working on some more research. I was wondering what my chances are of matching into a prelim surgery spot in the US. What can I do to increase my chances of getting accepted?

    Thank you

    ReplyDelete
    Replies
    1. as long as you perform excellently in remainder of your exams, you are still on track to have a decent chances to secure interviews. If you are interested in surgical specialties, try and obtain letters of recommendation from high profile folks in the field.

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  22. This comment has been removed by the author.

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  23. Hello Droidor
    I am an IMG from India, planning to appear for Interviews this year (2013). I scored 274 on my step 1 and am scheduled to appear for step 2 ck in may 7. I just found out that all the dates on and before 13th July for the step 2 cs, 2013 are filled. If I schedule after that, I won't have my CS results ready by September. The earliest I can have them is by October 7th. What should I do? Should I give my cs on July 14th and hope that someone will call me for interview in spite of my incomplete application or should I just give up this year and start preparing for interviews next year and look for research experience in the US?

    I have very good academic background as well as research background (3 pubmed indexed journal publication).

    6 April 2013 12:22

    ReplyDelete
    Replies
    1. go ahead and keep working on the application for this year. if you indicate that your step 2 CS is scheduled for October 7th, you may still get interviews, in any case, IMGs often start being called for interviews late October and November so you should still be on track. worse case scenario, you do not receive any interviews because your application was incomplete, you will still be done and ready but eh time it is ready to apply for next year. Good luck

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  24. Hi Droidor,
    I'm an IMG from Thailand and hoping to apply for the OBGYN residency in the near future. I'm currently in my last year of med school. I scored a 210(not great,i know ) on step 1, passed my CS (both 1st attempts) and planning to do my CK in a few months. I recently went for a hands on clinical rotation in OBGYN in Chicago for which I got an LOR. (Is that considered as USCE?) I was also involved in clinical research at MSU during the next month and received an LOR from the Chairman and director of the lab.
    I still have a year before I apply for the match, so i was wondering if you could advice how I should prepare myself and what I could do improve my chances. Thank you.

    ReplyDelete
    Replies
    1. yes, hands on experience in OBgyn from chicago hospital will be considered as USCE. you are doing well in terms of getting the requisite letters and referrals. the best thing you could do to aid your application is get superb scores on your step 2 (and if you are prepared on your step 3 as well). this will to some extent off set the lower scores on step 1. good work on getting letters from people who you have worked with and are in a position to write referral letters for you. keep busy and try to minimize the blank time spots on your CV. good luck!

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  25. Hi Droider
    I am an IMG 2011 graduate interested for Radiology residency.Since I have graduated I have worked as a Senior House Officer/House Staff in my medical college and after that at a private hospital as a Medical officer.Planning to go to the US for 6 mnth research fellowship in Radiology at very good hospital. and I plan to do more research in radio. I am yet to take my steps. Have been preparing for step 1 but postponing because of low mocks.If I apply in 2015. will the gap be too much. Do u think with such a big gap from my year of grad my chances of radiology will become nearly nil.or would working somewhere and doing research fellowship count or will there be still a gap. Should I think of other specialities? I'm also interested in IM(i have no clerkships) I would be highly grateful if you advice.

    ReplyDelete
    Replies
    1. congrats on your research fellowship in a US hospital in radiology. unfortunately the best gauge of how responsive the programs are going to be to you is still strongly dependent on your USMLE scores. doing the research fellowship will count towards a radiology residency., it may not as much for other programs. it is good to hedge your bets in one other specialty but you have to make sure that your application is competitive for that as well. good luck

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  26. i recently took step 1 and got my score yesterday...its 226 i am form India and what do u suggest me about my score.I didn't do any clerkship a recently completed my undergraduate degree also i didn't do step 2

    ReplyDelete
    Replies
    1. hello Dr. Badugu, the best assessment is with a complete application profile which includes step 2 CS and Step 2 CK. however, it always helps to have high step 1 scores. you need to finish all steps in order to be eligible for application. focus on excelling in step 2 and pass the step 2 CS. Good luck!

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  27. hi, I am a Pathologist from india. Step 1 232, step 2 219 [very dissapointed, was hoping a 230+]. what are my chances?
    The average score mentioned on the report is 237.

    ReplyDelete
    Replies
    1. lower then average scores adversely affect your interview chances. Do you have other path experience? publications research? that may help.

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  28. i just want to thank droidor for actually answering questions. they help more than the person asking the question in gaining perspective

    ReplyDelete
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    1. Thank you for the kind comment! Regards and good luck!

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  29. hi . I am an IMG from India , my step 1 score is 197 ( have not come to terms with that yet ) , CS passed 1 st attempt and gonna give step 2 CK now ( hopefully will get a good score)... I was interested in IM till my step 1 score..my hubby is doing Peds residency in us..am a green card holder and gonna do us experience in NYC. My hope is now on Peds , FM or Psychiatry..have some LOR S from India and work experience too ..Can you tell me which specialty I should concentrate on among the above options or any other options for me ? ...Thanks

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    Replies
    1. a poor score really hurts your chances in pretty much all fields. That being said, focus now on maximally improving your step 2 CK score. if you husband is going pediatric residency in US then speak with the program there and see if you qualify for their pool of applicants - sometime personal qualifications can supersede standardized test scores. Since you have a good connection in pediatrics, you could focus on that and use your network to full benefit. Psych and FM are getting choosy as well in their applicants, if you are thinking of those then make sure your letters reference your inclination to do those specialties. also try to get LORs from specialty specific physicians for all choices mentioned above.

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  30. Hi
    I'm an IMG from India with step1/218,step 2/215, CS appeared,I am worried what are my prospects with these??

    ReplyDelete
    Replies
    1. poor scores on step 1 and 2 are very hard on the match and interview chances. That being said, it does not preclude you from trying. There have been instances where folks with poor scores have made it. be optimistic but also realistic at the same time. if you feel that you have tried and given it your best shot and still have no luck - reconsider your options and chose a different path. good luck!

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  31. Hi Mr Droidor.

    Im an IMG from Pakistan. Here are my credentials which I am going to use this year for residency application. Kindly let me know how much chance you think I have to get a General Surgery, Internal Medicine or Family Medicine Residency (will apply in all 3, but will focus on General Surgery):

    Step 1 - 223
    Step 2 CS - Passed in 2nd attempt
    Step 2 CK - Will give on July 25th and expect result by end of August.
    Expect to become ECFMG certified before Sept 15th when application opens.
    Have 4 months of USCE (clinical rotations in Surgical specialties)
    Have 1 month of research experience at Harvard (Surgical lab)
    Have 1 month of US Observership rotation (CV surgery)
    Have 4 excellent LORs from US Surgeons
    Have 2 publications (with my name in contributors sections)
    Have 2 case reports submitted for publication (as first author in collaboration with US surgeons)
    Am BLS and ACLS certified (by American Heart Association)
    Did a Microsurgical skills training course at Emory
    Have loads of volunteer work experience (including in Africa)
    Member of Mensa Organization (due to IQ of 172)
    Have a gap of 1 year since I graduated from medical school last year in which I only studied for USMLEs and wrote the case reports, ie no clinical practice (i am worried this might be interpreted as time spent away from medicine)

    PS: I actually want to go into Plastic Surgery but as it is almost impossible for IMGs to get into it I have planned to do its residency after Gen Surgery (IF I get into Gen Surg tht is).

    Thanks.

    ReplyDelete
    Replies
    1. Hello Dr. Naseem, So far the only negative in your application is the attempt in clinical skills (assuming that you have excellent scores in step 2CK. Your biggest asset is the connections you made while you did your USCE, in Harvard, your referees. Plastic surgery is supercompetitive even by AMG standards, your step 1 score and attempt may go against you. 1 year of gap is not bad at all especially if you have been productive (your activities listed fall in the gap?). Of the 3 programs you have mentioned categorical GSurg is tougher than medicine or FM, you have a higher chance of getting just a prelim surg spot but that a very risky proposition if can get on to a PGY2 cat program (happens more often than you think)

      Delete
    2. Thanks for your input. I have been thinking about going towards Physical medicine and rehabilitation and leaving the Surgery path altogether. Because I only wanted to go into G Surg in order to eventually land into Plastics. But as Plastics is impossible for IMGs, especially for me, Im planning on leaving surgery altogether and aiming for PM&R which Im starting to feel excited about. What are my chances in getting a residency in it? I just started a housejob in the top PM&R department in my country in order to get experience in it and get an LOR.

      Delete
    3. PM&RS is an outlier for IMGs. Not many foreign physicians apply as compared to some of the canonical IMG pathways - FM, IM peds etc. So it is hard to say how you will fare. The fact that you have a PMRS related position in home country will certainly boost your application chances. Let me know how this go for you, may be you can even do a little article about your journey for the benefit of other applicant

      Delete
  32. Hi DROIDOR,I am an IMG looking for Cat- IM this year - my credentials are 237/231/cs pass first/2month clerkships in IM/need visa/graduated last month, i am planing to do some research volunteering from august and give step3 by September, how many interviews can i expect and how much weightage does step3 have on my ivs?

    ReplyDelete
    Replies
    1. number of interview is directly proportional to number of programs you expertly apply to. Step 3 has a minor role in securing IVs, it is more for visa category option. For an applicant you has lower profile Having a good score on step 3 will help a little otherwise its contribution is not very high.

      Delete
    2. erratum: For an applicant *who* has lower profile

      Delete
  33. I am IMG,
    step 1: 226,
    step 2cs: passed (first attempt)
    step 2 ck: july 27, expecting score 230.
    6 months of Observership at University Hospital.
    4 letters of recommendations.
    should I postpone my step 2 ck until middle of august to get a better score and send my application in september 25, or send my application early with the above scores.

    please, help me.

    I will apply to Internal medicine

    ReplyDelete
    Replies
    1. I have replied to this question before. have you posted this on another article?

      Delete
  34. hi my step 1 score is 210 and CK score is 230.....my CS is scheduled on 14th sept...i dont hanu USCE ....shd i apply in this match?

    ReplyDelete
    Replies
    1. you can certainly try but 2 things are poised against you. One is the low step 1 score and second, your application packet will not be complete. But then again, if you have the means, you can certainly try

      Delete
  35. Hi

    I am an Indian graduate. Did my MBBS and finished my MS Orthopedics recently. My scores- Step 1 247, Step 2 CK- 238. Scheduled for Step 2 CS this December. Joining as a research fellow in Orthopedics this November in the united states. Do not have USCE/ US LORs. Need Visa. Have LORS from the residency program director/ attendings of the institute where I did my MS Orthopedics in India. Applying broadly to over 100 orthopedic programs this year.

    What do you think are my chances? And how do I improve on my chances of a match.

    Thanks

    ReplyDelete
    Replies
    1. Try to obtain US LORS from your research fellowships in orthopedics. Your chances are still not as good as AMGs. Ortho is very competitive but you are as best prepared as you can get. Good Luck!

      Delete
    2. Droidor. Thank you for the insight.

      Delete
  36. Hi Mr Droidor,

    With Scores like (Step 1 - 245, CK-250, CS- Pass on first attempt), how important is it to really do USCE to get LORs? If so, the minimum & maximum periods for USCE and the number of LORs required? I really wanted to avoid research line.

    Also, I'm an IMG with H4 visa? My husband and I are most probably going to get a green card before I apply for residency. Does that improve any of my chances? Or am I considered the same as any other IMG with a visitor visa? And I graduated in mid 2010..

    I live in Boston,MA and I heard it's not an IMG friendly state..??

    What do you think of my chances of residency in FM,IM or Obgyn?

    Thanks.

    ReplyDelete
    Replies
    1. If you have excellent scores (250+ x 3 etc) then having USCE is not as crucial. Minimum 1 month max as much as you can get typically 6 months. 4 LORS required (3 minimum from referees from the specialty you are applying to). US LORS count more than external LORS hence USCE provides a little more benefit than just the CE. Green card + means more opportunities are open for you to get more experiences since you are legally employable. GC just but itself has a marginal advantage because some programs do not want to sponsor visa, they are open for you in the program pool. Year of graduation 2010 is not too old. Boston MA has great opportunities for you to improve your CV, volunteer, clinical exp, research (even though you donot want to entirely devote your time to it, small efforts here and there still do count). FM and IM good. Ob Gyn is not the usual IMG supportive field.

      Delete
  37. Hi Mr. Droidor.
    I am an IMG and old graduate 2004. I have Step 1 result of 225, step 2 -214. CS second attempt. Last year I didn't have any interview invitation, I guess because applied too late. I had to wait long for all LORs, and CS be ready and applied end of October. I have 2 month USCE - one observership and one externship in private clinics.
    This year my applying also seems to being delayed. After paying for token I thought they would send some confirmation email so that I would be able to register, then forgot forgot about that (I was very busy at work on July, then worse on August. Then when realized that I forgot to register token and they will not send any information on email, I checked and found token number in ERAS support services in OASIS. I only registered token on 14th September. Now I found they need some time within 2 weeks to send my documents from previous year to ERAS.
    My question is with all that, and with 2 weeks delay(or less, whatever it will take them) will it decrease my chances for being invited to interviews? If yes, what can I do? Can I write each program individually and ask if I can apply without LOR-s, medical school transcripts and MSPE, and then have them added by 28-29 September at most?

    ReplyDelete
    Replies
    1. Hello Dr. Mogy I see 2 reasons why you did not secure interviews lat year - late application and your profile. Programs start downloading your applications on September 15th and due to the sheer volume of applicants there is often a first come first serve basis for initial screening. Once the initial screening is done (filtering) applicants are selected based on scores, YOG etc. Thus applying late already put you behind in the game but there is not much you can do really. You expressed writing to individual programs to let them know about your application - most likely what is going to happen is thet teh PC wil read it and
      1. you may get a generic reply
      2. you may not get any reply

      There is a very slight chance that you will get anything more than a 'thank you for letting us know' but the sheer amount of effort to write to each and every programs may not be worth the input.

      At this time, just ahead and apply and assure that there are no more delays and hope for the best.

      Delete
  38. Hey Mr. Droider

    I am an IMG from India recently graduated in 2013. I just gave my Step 1 few days back and I had severe anxiety through-out the test duration for don't know waht reason and happened for the very first time to me. Due to that scored a low 194 where as I was scoring consistently 230+ in the mock exams I had been giving. Score seems to low to even continue for other steps.

    Would you recommend to further pursue other steps and try my luck In Family Medicine or Pediatrics? If i get 240+ in CK and pass CS in first attempt along with 4-5months of observership, will I have a chance to get residency with such low step 1 scores? or should I drop the plan completely.

    Your help would certainly clear a lot of dilemma in my head. Thanks in advance.

    ReplyDelete
    Replies
    1. it is hard to say how you will do with respect to interviews especially since we dont have your step 2 CK scores. If you do very well 250+ in step 2 and step 3, you may still have a chance as you can explain away the poor performance in one exam. There may still be a chance if you do very well on other exams.

      Delete
  39. I am an American but a foreign medical student who was an honor student and in the top 20 of my class. On my practice exams with U-World I consistently scored 230-240. I just got m actual results from the Step 1 and it was a 205. What options am I left with? What would give me the best chances at landing a residency in 2016? What residency fields should I stick with(who would still take me)?

    ReplyDelete
    Replies
    1. Hello, I am sorry to hear that you did not do well at all on your step 1 exam. Unfortunately, you passed so you are stuck with this score for next 7 years. this does place a red flag on your application but the best recourse is to focus on finishing other exams with 245+ scores. When the program directors look at applicants, they can be a little more forgiving if one exam score is an outlier and others are excellent. Plus you can then provide an explanation for your poor performance - personal etc.If you are a citizen, then I recommend volunteering or finding work experience in hospital or university affiliated hospitals so that you are in touch with the physician faculty. This will help generate support for your application should you decide to proceed.

      Delete
  40. Hi, I am a US citizen studying medicine abroad. I have given Step 1 recently and acquired 229. How bad is that score? I am freaking out that my possibilities are less for competing in the residency program as my seniors are acquiring in the range of 240's. I will work even harder for my Step 2 CK. What score should I aim for in Step 2 CK? Please guide me. I don't have any other options! I need to come back home and practice in the US. I don't have much of USCE, had a shadowing experience. I have research experience from high school. Recent research is in the process of completion. I want to go for Match 2015. I am not done with my course and don't have the time to do USCE. Is it really important to acquire USCE? What are my chances? Thanks in advance!

    ReplyDelete
    Replies
    1. 229 is numerically less that 240 when you compare yourself to your peers but that in itself is not the only benchmark. Focus on step 2 CK, CS and on getting some experience and use that experience to build contacts. It is not necessary to acquire USCE but often becomes a helpful tool. A goal score for step 2 CK would be 245+. This will offset some setback but then again, work on building a 'complete packet'.

      Delete
    2. Thank you for a very prompt reply! :)

      Delete
  41. hii.I am an img from India and i graduated in may 2013. i scored a 250 on my step1.i m really interested in pursuing obgyn or surgery.since I am a fresh graduate i hav no Indian clinical experience.and also i hav no research r publications.curently m applying for observership positions and studying for step 2ck. how good is americlerkship and fmg portal in providing clerkships?will the lors from those physicians b helpful ?

    ReplyDelete
    Replies
    1. 250 on step 1 is great. good work.
      There are several topics of discussion regarding these commercial services on popular blogs. I do not have first hand experience with these companies. Thanks for asking though.

      Delete
  42. Hi,

    how are my Chances for IM 2015... I got Step 1 223 and CK 221. I have very good LORs from Euro Profs and some publications from Euro high ranked University and I am just doing my residency in Europe...

    ReplyDelete
    Replies
    1. With you being from a n European medical school you chances are a little better than those from other countries. There can set in a candidate fatigue to see applicant after IMG applicant from SE Asia and middle east. Not to say it is bad, but it is what it is..so a candidate from for example, Denmark or Sweden on UK stands out as unusual and in this process anything that can make you stands out (in a good way) is good.

      Delete
  43. Hi Dr,
    I am an international student. I will graduate in 2 months God willing.
    I read that programs filter applicants who don't fulfill a specific score. My usmle step one score is 238.
    1-Will I be filtered out because of this score?
    2-What is the score used by Highly COMPETITIVE programs to filter applicants out?

    Thank you Dr.

    ReplyDelete
    Replies
    1. 238 is not a bad score. In fact it will filters in many a programs. Just keep in mind to be careful where you apply. If the program explicitly states that they will only consider applicants 240 and above then that may not be a good place to apply. Fortunately, there are many other programs who don't set the bar exceptionally high

      Delete
    2. Thank you.
      1-where does each program state its minimum requirements?
      2-What do you mean by " it will filters in many a programs" ?
      3-I was planning to go for radiology but after getting that score I decided to go for Internal medicine? Do you think it's a right decision?

      Thank you for your help.

      Delete
    3. Hi, I am put up your answer at http://www.mleresidencytips.com/2014/05/question-and-answer-session-1.html. Thank you Q1

      Delete
  44. Hi Dr. ,
    I am an IMG.I got a 204 in step1. I am now considering applying to FM but apparently a 204 is still a low score even for FM. I didn't do step2 yet since I am discouraged. But I heard that a high score in step2 and step3 can overcome a low step1 score.Does a good step3 score help my application? what will I change? thank you

    ReplyDelete
    Replies
    1. simply stated, if 'x' is a bad score and 'o' is a good score let me offer you a choice of 3 applicants.
      IMG A: Step 1 x, step 2 o, step 3 o
      IMG B: Step 1 o, step 2 x, step 3 x
      IMG C: Step 1 x, step 2 x, step 3 x
      IMG D: Step 1 o, step 2 o, step 3 o
      IMG E: Step 1 o, step 2 x, step 3 o

      D > A or E > B > C will be be roughly the chance of being selected for interview,, everything else being equal and once 'filter' conditions do not apply. So yes

      If your profile is Step 1 x and nothing else, your chances are very poor
      If you profile is step 1 x and then fabulous scores in rest, your chances are much better than previous condition

      Delete
  45. Hi Dr. Droidor,

    Great work on the blog.
    My wife in an IMG preparing for her 2015 match. I am helping her on the admin side of things. So far, Step 1 she has got 251. She plans to take Step 2 CK in May and CS in June end.

    1) Is this a good schedule to keep for the 2015 Residency Applications?
    2) She wants to do that an Observership in June and then take CS as she feels some sort of experience in the clinical system there might help her crack the CS. Do you recommend doing an Observership like this?
    3) What is the best strategy to apply to the right program?
    4) Her core interests are in Internal Medicine or Radiodiagnostics. Are IMGs accepted in these easily?

    Thanks a ton for your guidance.
    /Nandith

    ReplyDelete
    Replies
    1. 251 is fantastic - congrats to your wife. Your application 'packet' should be 100% complete by the deadline.
      I dont know if there is correlation between doing an observership and step 2 CK scores but the clinical observership may offer only a small glimpse into the broad clinical application type questions. Strategy for application to right program is to maximize your chances to match in a program of your choice - start by applying to many programs. apply to 1/4 top tier programs, 1/2 middle tier and 1/4 bottom tier programs. iM is always an IMG favorite with decent chances of matching, radiology is getting competitive

      Delete
  46. hi, I really appreciate the advices you give on this forum. I am 2011 graduate with the following scores 242 in step 1 and 229 in step 2 and cs cleared at first attempt. I intend to apply for IM in the upcoming match. I reside in the US as a permanent resident. I am concerned about the drop in my CK score and how this would affect my application. Thanks.

    ReplyDelete
    Replies
    1. It will affect some but not to the degree you fear. You have an otherwise good profile. You need to give a reason in your PS why you did relatively poorly on step 2.

      Delete
  47. Hi Droidor,
    1.I am an International student (no GC ,no US passport), fresh out of european med school in 2014, Step 1 226, step 2ck 226, and CS pass, i have 3 Hands on US LORs and 1 US obsevership LOR, did some research with my school but didnt get published, what do you think my chances are honestly of matching in Internal Med in 2015?
    2. do i need to take step 3 in september 2014 to increase my chances significantly? Thanks

    ReplyDelete
    Replies
    1. having step 3 certainly improves your overall application but does not increase your application chances by a great margin. There is always the concern that if you however fail a step 3, then that will look poorly when you apply. If you are from an European medical school, your application may stand out and ask your seniors who have or are doing residency in US which schools they are in. Programs are likely to take candidates from medical schools they are familiar with/have heard than those totally unknown.

      Delete
  48. Hi Droidor,
    i am an IMG and graduate of 2011 with step1 score of 199 and step 2 score of 207 both cleared in first attempt,plan to take cs by may and sit in 2015 match for Psychiatry residency not because of my low scores but also because i have interest in the field.i have done 1 year intership in my home country(with three months in Psych) too and hve been working as medical officer since finishing my internship in 2012,have two publications and m working on the third one. i dnt hve a USCE uptill now but m working my way to get some observerhip or externship which uptil now hasnt been futile.....
    can you plz help me with your guidence in this matter plus what are my chances of getting in desired residency programs???

    ReplyDelete
    Replies
    1. Psychiatry is not as easy to get into as one may think. There are alot of applicants who prefer psychiatry for a number of reasons (life style, work hours, kind of profession etc). One way to break the score barrier is to get to know faculty and physicians from programs that can vouch for you as a candidate and are prepared to overlook your low scores. If your publications are psychiatry related in good impactful journals then it may mean something. If yes, then make sure that piece of information comes out in your CV and your personal statement. If not, then those publications sadly may not mean very much. Your chances of getting a residency in psych thus depend on 1. how well you are connected to program (s) 2. Do you have accomplishments that could offset the low scores on USMLEs?

      Delete
  49. Hi, I am an IMG and recently completed STEP 1, and got a score of 245, I was really expecting more than that but what can I say. I'm interested in residency programs in psychiatry. I plan to give STEP 2 CK in the next few months. Just wanted to ask how my score was in comparison to the usual IMGs being matched for psychaitry and how much should I really get in my CK to keep the ball rolling and get into a competitive residency program. Thanks !!!

    ReplyDelete
    Replies
    1. Hi! Thanks for writing. I have answered your question (Q8) with few other questions here http://www.mleresidencytips.com/2014/05/question-and-answer-session-1.html

      Delete
  50. HI I am old grad ,I have done radiology residency in home country,Now in USA because of Husband.
    Step1-229
    Step2-229
    Cs-Passed 1 st attempt
    Searching for radiology observership and research...

    What r my chances of getting into residency?I have no publications,no contacts...is it impossible?

    ReplyDelete
  51. Hi. I am an indian med student ...is getting good scores in all steps enough to get u into residency ?

    ReplyDelete
  52. Hi, I am a US citizen FMG and I have a 229 for step 1, but a 217 for step 2. I'm currently doing research and planning to apply for psychiatry residency. I know I have a relatively low step 2 score, so I'm wondering what I can do to help become more competitive for the match?

    ReplyDelete
  53. hello!
    i'm an old IMG whose dream was to be a pediatrician in the US! But easier dream t than done! Unfortunately, I failed twice on CK in 2008, 2009.
    I want to give up on my dreams: but that's hard too! Do I have any chances if I start with the steps again, given the fact that I am on old graduate?
    I also did peds observer ship in US and have LOR and have some research experience.

    I really need an honest answer as it will help my decision
    thanks

    ReplyDelete
  54. US-IMG from well known carrib school- step 1- 235, step 2- 209 --> dealing with family health issues..chances of matching? really do not want to do psych or fam

    ReplyDelete
  55. Step 1 : 250
    Step 2 : 251
    CS : Pass
    All first attempt
    1 year research at MIT and BWH/Harvard in stem cell
    2 year research outside US
    Currently working at MGH/Harvard
    Will get Two LOR from US
    No hands on or observerships
    YOG: 2011, IMG
    20+ papers mostly in radiology outside USA, 1 review in US and few paper working
    5 abstract as poster presentation done in US.
    20+ case reports in radiology and medicine
    Interested in radiology and oncology (IM)

    Where should I apply? What is the best for me to go with?
    I really don't want to end up not matching this year.
    Please help as I have no clue about how and where to apply.
    Is there a book that could give me an insight about it?

    ReplyDelete
    Replies
    1. your application is strong. Both in respect of scores and research experience. You are also not an 'old' graduate. Did you apply and not match? if so, I would take time to analyze and take a critical look at your interview performance. With a stellar CV like this, what might have happened? Did you apply to few programs? did you apply to wrong places? Did you come off in a wrong manner during interview? There are some books on Amazon which are highly rated. If this is the first time you are applying - work on the interview aspect - how you convey and conduct your self, how do you project your self? assured or confidant? etc.. you cv is very good, deliver at the interview and you have a very good chance of matching!

      Delete
  56. I'm a person in a unique situation, and I dont know how my chances match at all.

    I lived in the US till i was 12 (hence US citizen) but went to medical college in India .

    Finished step 1 - 249.

    Projecting good grades, step 2 score, 3-4 publications, and the usual few months of USCE with LORs..

    What do you think my chances really are? I dont know if I will qualify as a US IMG or a non-US IMG (seeing that im indian trained but with US citizenship)

    I honestly really want surgery, and in a decent program. I cant do the whole community thing. But if thats completely unrealistic for me, then I can live with that.

    Will IM/psych/neuro be a better option?

    Thanks, if i get a reply. You're really the only person who seems like they can help me :)

    ReplyDelete
    Replies
    1. Hello Dr. Sahu, I believe that you would qualify as a US-IMG. 1) you are a US citizen and 2) you are a graduate from an international medical school. Nice score of step 1. Continue with this and you will likely have a good chance of matching. There is nothing undesirable about community programs as long as you research which program you are applying to. Some community programs are on par with mid and top tier academic institutions. If you want surgery, you should work toward bulking up your application surgery wise (research/experience/letters etc).

      Delete
  57. hi i'm an IMG n i graduated recentli n my step 1 score is 192 which is borderline performance. which residency programs do i qualify for. initially i wanted internal medicine but after my score i dont thnk its possible. Do u thnk i should go ahead with my step2 ck n cs? do i still stand a chance ? hoping to get a reply.

    ReplyDelete
  58. hi, Iam ramakanth from India graduated in 2008 and finished anesthesia residency from India in 2012, my step 1 score is 255, step 2 score in 266, scheduled cs exam on jan 5th 2015 which is late, no USCE, Hopefully if I pass CS exam in first attempt,will I be eligible to apply for SOAP or do I need to apply for 2016. Also will I be eligible to apply for fellowship directly without entering US residency

    ReplyDelete

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