Gen Surg chances -- low step 1 and preclinicals, otherwise good

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Hello all, I am at the end of my third year hoping to get some advice on applying to general surgery and if some of the strengths of my application can salvage the two major weaknesses.

Cons:
-Step 1: 217
-Bottom 25% of class in preclinicals
-Pass in peds

Wash: mid-tier state MD school

Pros:
-Honors in surgery, psych, neuro; HP everything else.
-Good research: First author journal article in infectious disease/international research, multiple first author posters, 1 second author, 1 sole author article in medical anthropology focusing on effect of war on surgical services (medical social science but still IRB human subjects research - totally my project from start to finish including approvals for international research, funding, IRB, etc.), 4 posters in medical anthropology w/ surgical development slant.

Not sure how much this matters but I should have an extremely positive dean's letter (have had multiple clerkship directors, attendings, and residents tell me and put into writing on evaluations that I am one of if not the best student they've had from a clinical and teaching perspective; extremely positive reviews on every single clerkship).
-Confident that I will have strong LORs but they will not be from huge names

I was not highly motivated enough during preclinical years and unfortunately I did not figure out an effective standardized test study method until well into my third year. The reason my first semester rotations were HP (and P in peds) was due to shelf score cutoffs (e.g. overall grade A in all rotations even with shelf averaged in but our school also uses hard cutoffs for shelf score).

Essentially I had a personal M&M over the winter break when I realized I loved surgery and changed my approach to testing/school. Since then I have done very well on shelf exams (95%+) and I think I can score significantly better on Step 2 as I will be studying more and more efficiently than I did for step 1.

I am planning to apply to a ton of community programs (50+) as well as a handful of reach university programs (e.g. Baylor, Emory, Cincinnati, reach programs w/ international focus given my interests). Would be happy going to a decent community program, no real regional restriction--my primary goals at this point are good surgical training with the hope of being able to do a lot of international work when I finish (lived and worked abroad before med school, all my research has an international/medical development slant to it).

I know a low step 1 alone can be overcome--but does my combination of low step 1 and low preclinicals from an average school put me out of contention for general surgery? One of the advisors in surgery (not mine) sent out an email earlier this year essentially stating that people with step 1 <220 and low preclinical grades are not going to match. Assuming I get a solid step 2 (240+) I would have a strong upward trend and I think I can explain my change in approach effectively, as well as my motivations for general surgery and continued interest in international work and research. I generally do well on interviews if I can get enough of them.

Secondary question: I am able to retake one shelf exam--do you think it would be more beneficial to retake medicine to have honors in medicine and surgery (+psych/neuro) or to retake peds so I don't have any passes? I only need 1-2 more points to get over the cutoff to increase the grade on either clerkship.

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I would apply to all General Surgery programs and do a few aways.

I think you have shown improvement throughout the years. With your clinical strength it would be beneficial to do aways at places where you think would be a good fit

Your research is above average and will also be helpful. Make sure you have some of your supporters call on your behalf.
 
Hello all, I am at the end of my third year hoping to get some advice on applying to general surgery and if some of the strengths of my application can salvage the two major weaknesses.

Cons:
-Step 1: 217
-Bottom 25% of class in preclinicals
-Pass in peds

Wash: mid-tier state MD school

Pros:
-Honors in surgery, psych, neuro; HP everything else.
-Good research: First author journal article in infectious disease/international research, multiple first author posters, 1 second author, 1 sole author article in medical anthropology focusing on effect of war on surgical services (medical social science but still IRB human subjects research - totally my project from start to finish including approvals for international research, funding, IRB, etc.), 4 posters in medical anthropology w/ surgical development slant.

Not sure how much this matters but I should have an extremely positive dean's letter (have had multiple clerkship directors, attendings, and residents tell me and put into writing on evaluations that I am one of if not the best student they've had from a clinical and teaching perspective; extremely positive reviews on every single clerkship).
-Confident that I will have strong LORs but they will not be from huge names

I was not highly motivated enough during preclinical years and unfortunately I did not figure out an effective standardized test study method until well into my third year. The reason my first semester rotations were HP (and P in peds) was due to shelf score cutoffs (e.g. overall grade A in all rotations even with shelf averaged in but our school also uses hard cutoffs for shelf score).

Essentially I had a personal M&M over the winter break when I realized I loved surgery and changed my approach to testing/school. Since then I have done very well on shelf exams (95%+) and I think I can score significantly better on Step 2 as I will be studying more and more efficiently than I did for step 1.

I am planning to apply to a ton of community programs (50+) as well as a handful of reach university programs (e.g. Baylor, Emory, Cincinnati, reach programs w/ international focus given my interests). Would be happy going to a decent community program, no real regional restriction--my primary goals at this point are good surgical training with the hope of being able to do a lot of international work when I finish (lived and worked abroad before med school, all my research has an international/medical development slant to it).

I know a low step 1 alone can be overcome--but does my combination of low step 1 and low preclinicals from an average school put me out of contention for general surgery? One of the advisors in surgery (not mine) sent out an email earlier this year essentially stating that people with step 1 <220 and low preclinical grades are not going to match. Assuming I get a solid step 2 (240+) I would have a strong upward trend and I think I can explain my change in approach effectively, as well as my motivations for general surgery and continued interest in international work and research. I generally do well on interviews if I can get enough of them.

Secondary question: I am able to retake one shelf exam--do you think it would be more beneficial to retake medicine to have honors in medicine and surgery (+psych/neuro) or to retake peds so I don't have any passes? I only need 1-2 more points to get over the cutoff to increase the grade on either clerkship.

You still have a chance at surgery. Being from a US MD school isn't a wash, its a plus for you. Compare your stats to a similar IMG and your chances of matching are much much better. You'll likely end up at a community program, but those programs can and do train good surgeons. University programs may be a reach, but can still be had. You need a good Step 2 score and if you have good LORs, particularly from well known people, that can help offset your Step 1 score.

I would apply to a bunch of programs and see how it goes. I know that adding a bunch of programs gets expensive, but going through the match a second time because you only have a prelim surgery spot is more expensive.
 
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Gonna concur with ThoracicGuy. Apply to all programs and rank every single one. You DO NOT want to get caught in prelim limbo. It's a bad place to be and you don't need the added anxiety. Having said that, you can match. Good luck. Cheers.
 
Hey, first time poster so I hope I can provide some help. I am applying to general surgery as well as feel like I could provide some insight. There were just a few things I would like to address.

First of all, you are right that a low step 1 score can be overcome with good clinical grades and LoRs. Especially for general surgery, a really high step score (although definitely a plus) is not an absolute necessity to be accepted (as it is in optho/neurosurg, etc). So I would say you are on the right track with regard to you clinical rotations and trying really hard on step 2 CK.

With regard to you preclinical grades, I would not worry too much. According to the research I have done, preclinical grades are one of the least important factors to PDs. I think they sent out a survey for PDs for order 15 different factors in order of importance. Step 1, LoR, clinical grades were all in the top 5, but preclinical grades was #12 or #13 if I remember correctly.

If you are asked about low scores during the interviews, I would be completely honest and tell them exactly what you wrote on the post. I am sure they would appreciate the honesty and it will convey a high degree of maturity.

With regard to retaking a shelf exam, I would suggest trying to get honors in medicine/surgery as opposed to raising you Peds grades. Of course this is only my opinion. However, I think it kind of makes sense that surgery PDs are just more likely to value high grades in surgery/medicine because it will reflect a greater ability to do well on the ABSITE.

You are on the right track though with applying to a bunch of residency programs, both academic and community. Keep your head up and stay positive! I'm sure you will do great. I hope this helps and feel free to message me if you have any other questions.
 
I am in a similar situation. Unfortunately, I only pulled a 213 for Step 1, average preclinical grades, and am rotating through my Year 3 clerkships currently (4 S+, 1 S so far). Midwest, mid-tier, state medical school in Michigan. I should have a co-1st author article coming soon to a mid-tier journal, 4 abstracts (1 co-authored), 2 national poster presentations, 1 state chapter ACS presentation, working on several research projects currently, and studying to blow Step 2 out of the water. I should also be able to get several good LORs, as I was a prosector for my school and did excellent work there. I'm planning on applying to one of the programs that my school often fills with new grads, but am open to applying to several states (all midwest or south), but I am still worried that I won't make it to anything that will allow me to pursue an uncompetitive fellowship, like Transplant, afterwards.
Any ideas or impressions on whether I should try for Gen Surg or should I give up and start looking at Internal Med?
 
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You definitely have a shot, but it will be a good idea to apply broadly and do some away rotations. I was personally a little surprised to see how many programs had a minimum of 220 for Step 1. I knew that was a suggestion to be above 220, but seeing it printed on the website was a bit jarring even when you are above it. But that isn't all the programs by a long shot! Keep your head up, use your mentors, and do an away if you can still do one!

Best of luck!
 
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