Low COMLEX score, can I still do internal?

[medheadinternal]

Got my COMLEX level 1 score back today - 428. Never been good at standardized testing, and would def say I had a ****ty test day. Currently on my 3rd year rotations and I'm totally digging internal and the whole hospital environment in general and could positively say I would choose this over family. With a COMLEX score that low am I pretty much locked in family or could I match a community IM program with that score? Does killing level 2 compensate at all?

I appreciate any help, thanks all.

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[ForgotUserName]

I am guessing you only took the COMLEX and not the USMLE? Scoring well on the USMLE would essentially negate the poor COMLEX but doing poorly on the USMLE would probably close the doors to ACGME programs. I think matching into an AOA IM residency program is realistic but you'd have to apply broadly. A caveat though is that I would be skeptical of applying to a current AOA IM residency program that isn't already ACGME accredited. I honestly do not know how a poor COMLEX is viewed by an ACGME community IM program, but perhaps others will chime in. If I had to guess, most ACGME community programs would probably prefer a poor USMLE over a poor COMLEX, but this is just pure speculation on my part.

 

[hallowmann]

Got my COMLEX level 1 score back today - 428. Never been good at standardized testing, and would def say I had a ****ty test day. Currently on my 3rd year rotations and I'm totally digging internal and the whole hospital environment in general and could positively say I would choose this over family. With a COMLEX score that low am I pretty much locked in family or could I match a community IM program with that score? Does killing level 2 compensate at all?

I appreciate any help, thanks all.

You'll be fine. There are plenty of community IM programs that take anyone with passing boards. You should apply broadly, but at the lower end community IM and FM are pretty similar in terms of competition.

 

[medheadinternal]

I am guessing you only took the COMLEX and not the USMLE? Scoring well on the USMLE would essentially negate the poor COMLEX but doing poorly on the USMLE would probably close the doors to ACGME programs. I think matching into an AOA IM residency program is realistic but you'd have to apply broadly. A caveat though is that I would be skeptical of applying to a current AOA IM residency program that isn't already ACGME accredited. I honestly do not know how a poor COMLEX is viewed by an ACGME community IM program, but perhaps others will chime in. If I had to guess, most ACGME community programs would probably prefer a poor USMLE over a poor COMLEX, but this is just pure speculation on my part.

Only took COMLEX, due to my passion for really wanting to match internal I'm flirting with the idea of studying for USMLE STEP 1 all through 3rd year and take it at the end of the year, I'd have to research some ppl who actually attempted this to determine if this is a feasible option. With the merger happening in 2020 I don't want to risk have a low 400 COMLEX score with no STEP.

 

[medheadinternal]

You'll be fine. There are plenty of community IM programs that take anyone with passing boards. You should apply broadly, but at the lower end community IM and FM are pretty similar in terms of competition.

Does lower tier mean poorly trained because the lack of acuity seen? Also, if later I decided I enjoyed endocrine or pulm for example, are fellowships later down the road eliminated as an option?

 

[Angus Avagadro]

Does lower tier mean poorly trained because the lack of acuity seen? Also, if later I decided I enjoyed endocrine or pulm for example, are fellowships later down the road eliminated as an option?

Lower tier in terms of acgme accreditation, unmatched positions, size of hospital, number of outsourced rotations, cardiology,derm, research opportunities, board pass rate, etc.

 

[AlbinoHawk DO]

Does lower tier mean poorly trained because the lack of acuity seen? Also, if later I decided I enjoyed endocrine or pulm for example, are fellowships later down the road eliminated as an option?

Not at all. In fact the opposite can be true. Every attending I had who trained at Arrowhead Regional Medical Center in So. Cal was a master in the field. They could see tons of patients with the craziest presentations with no problems. A few of the UCI trained physicians I saw were not up to par with ARMC graduates. The reason was that the UCI program would limit the amount of patients a resident would carry to about 10, and the acuity of being in a hellhole in San Bernardino (ARMC) gave people much better exposure.

Some fellowships will become very hard to match such as cardio, heme/onc or GI coming from community, but many such as endo, infectious disease or rheumatology should be no problem for you.

 

[hallowmann]

Does lower tier mean poorly trained because the lack of acuity seen? Also, if later I decided I enjoyed endocrine or pulm for example, are fellowships later down the road eliminated as an option?

Not necessarily. It usually means less desirable location, smaller programs/hospitals, less in-house fellowships, and can in some cases mean a more malignant or less supportive environment (but thats certainly not exclusive to lower tier programs).

As for fellowships, it will certainly hurt your chances of going to fellowships, and as I said, most community programs don't have in-house fellowships (though some do), so that'll make it a bit harder. With regards to things like Endo and Geri, I think its definitely not going to prevent you from doing that, because they are usually looking pretty hard for people to fill those spots. Pulm might be harder, but again not impossible. Things like Cards or GI could basically be considered a no-go unless you are at a program with in-house fellowships in those and you impress them.

 

[sunshinefl]

Not necessarily. It usually means less desirable location, smaller programs/hospitals, less in-house fellowships, and can in some cases mean a more malignant or less supportive environment (but thats certainly not exclusive to lower tier programs).

As for fellowships, it will certainly hurt your chances of going to fellowships, and as I said, most community programs don't have in-house fellowships (though some do), so that'll make it a bit harder. With regards to things like Endo and Geri, I think its definitely not going to prevent you from doing that, because they are usually looking pretty hard for people to fill those spots. Pulm might be harder, but again not impossible. Things like Cards or GI could basically be considered a no-go unless you are at a program with in-house fellowships in those and you impress them.

What about Rheum, Infectious disease, and Allergy & Immunology?

 

[medheadinternal]

Not necessarily. It usually means less desirable location, smaller programs/hospitals, less in-house fellowships, and can in some cases mean a more malignant or less supportive environment (but thats certainly not exclusive to lower tier programs).

As for fellowships, it will certainly hurt your chances of going to fellowships, and as I said, most community programs don't have in-house fellowships (though some do), so that'll make it a bit harder. With regards to things like Endo and Geri, I think its definitely not going to prevent you from doing that, because they are usually looking pretty hard for people to fill those spots. Pulm might be harder, but again not impossible. Things like Cards or GI could basically be considered a no-go unless you are at a program with in-house fellowships in those and you impress them.

Can you expand on what is meant by "malignant or less supportive environment?" Or at least how to spot that? I do not want to find myself in that situation, at all. I want to be great, and not have to worry about politics not in my best interest.

 

[ASGD1983]

Can you expand on what is meant by "malignant or less supportive environment?" Or at least how to spot that? I do not want to find myself in that situation, at all. I want to be great, and not have to worry about politics not in my best interest.

It means (among many other things), that many community residencies are lately taking in carribean duds that bring their "filth" with them and poison the environment. I don't mean anything racial lol, I mean their "box of snake" attitude - they are used to it while they have to survive and match - they go over the heads of their own classmates. The thing is this kind of attitude doesn't suddenly end when they got accepted to some residency. Nope. They continue to backstab and do everything to get ahead of you. You know dirty tricks, lies etc. An average AMG will feel not quite comfortable among such "colleagues" lol.
Just one example of many.

 

[hallowmann]

Can you expand on what is meant by "malignant or less supportive environment?" Or at least how to spot that? I do not want to find myself in that situation, at all. I want to be great, and not have to worry about politics not in my best interest.

Malignant meaning programs that aren't supportive of struggling residents, frequently violate duty hours and tell you to lie about recording it, blame you for shortcomings of the program, frequently drop people for reasons that are not justified, don't give residents leeway with regards to family issues (new birth, death, illness, etc.), basically programs that create a toxic environment for their residents. Its honestly hard to tease this out, but some ways are to just talk to residents about their programs. Everyone has things they hate about residency, but the program and especially the PD should be someone that has your back.

All that stuff about Carib grads is not at all what I'm talking about, nor do I even know what that poster's talking about. Sounds like they're speaking from some previous back experience. I've interacted with plenty of Carib grads, and I know many from before med school. The ones that make it are just like everyone else. They may on average have a higher threshold for crap just given what they had to deal with on the islands, but I have not experienced a "box of snake" attitude from them. If anything, I've seen more AMG gunners than anything else.

 

[Neopolymath]

Malignant meaning programs that aren't supportive of struggling residents, frequently violate duty hours and tell you to lie about recording it, blame you for shortcomings of the program, frequently drop people for reasons that are not justified, don't give residents leeway with regards to family issues (new birth, death, illness, etc.), basically programs that create a toxic environment for their residents. Its honestly hard to tease this out, but some ways are to just talk to residents about their programs. Everyone has things they hate about residency, but the program and especially the PD should be someone that has your back.

All that stuff about Carib grads is not at all what I'm talking about, nor do I even know what that poster's talking about. Sounds like they're speaking from some previous back experience. I've interacted with plenty of Carib grads, and I know many from before med school. The ones that make it are just like everyone else. They may on average have a higher threshold for crap just given what they had to deal with on the islands, but I have not experienced a "box of snake" attitude from them. If anything, I've seen more AMG gunners than anything else.

I wouldn't call them malignant, but programs that are known for that "we just want cheap labor" vibe and not prioritizing training/protected learning time come to mind as well.

 

[SereneApple]

Got my COMLEX level 1 score back today - 428. Never been good at standardized testing, and would def say I had a ****ty test day. Currently on my 3rd year rotations and I'm totally digging internal and the whole hospital environment in general and could positively say I would choose this over family. With a COMLEX score that low am I pretty much locked in family or could I match a community IM program with that score? Does killing level 2 compensate at all?

I appreciate any help, thanks all.

Hi I was wondering if you ended up matching IM and if so, can you please DM me which programs offered you an interview and/or the program you matched with?

 

[Obnoxious Dad]

Got my COMLEX level 1 score back today - 428. Never been good at standardized testing, and would def say I had a ****ty test day. Currently on my 3rd year rotations and I'm totally digging internal and the whole hospital environment in general and could positively say I would choose this over family. With a COMLEX score that low am I pretty much locked in family or could I match a community IM program with that score? Does killing level 2 compensate at all?

I appreciate any help, thanks all.

Focus your attention on the State of Michigan. Do some IM rotations as a fourth year student there. Michigan has 34 internal medicine programs and many of them are DO friendly. They are hospitable to DOs because Michigan State's DO school is huge and many of the IM programs are affiliated/sponsored by the MSU DO school.

 

[AlbinoHawk DO]

Focus your attention on the State of Michigan. Do some IM rotations as a fourth year student there. Michigan has 34 internal medicine programs and many of them are DO friendly. They are hospitable to DOs because Michigan State's DO school is huge and many of the IM programs are affiliated/sponsored by the MSU DO school.

Thread is from 2018. They have likely matched and are towards the end of residency