Next Best Step? Failed Surgery Shelf and Low Step 1

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crunchygranola

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Ill try to refrain from "what are my chances" dialogue and just simply (and humbly) ask for advice in how to proceed

USMD student
Preclinicals with all P's
Step 1 224
Clinicals with all P's till now

Failed surgery shelf, will have to remediate rotation and retake exam with 4 weeks at beginning of 4th year- best i can do is a pass with below pass also noted in my transcript/deans letter i think.

Super bummed but i did it to myself by what i believe is not preparing well enough. I had honors (5/5's) on clinical evals in both months (promoting some false confidence? IDK) .... but clearly an issue of properly studying IMO. Ill also note that im usually below average in my shelf exams with this one finally catching me below the pass line. Uworld and prestanis were my primary resources.

Im now Mid-Year MS3 who is thus far an undesirable surgery applicant but nevertheless cant see myself doing anything else. Ive little to no ties to our program other than those i made on this rotation and really have been relatviely undecided in specialty of choice until recently. My #1 goal now is to apply and match into surgery. Dont care where, just wanna do what i gotta do to get into residency.

Ive been thinking long and hard over the break about how to proceed with the rest of my time in medschool (prelim?, catagorical or bust?, other specialties? Who to contact? Study plan? Is there really time to rectify this?)

Was hoping reach out to see what everyone thought were some key things to focus on moving farward.

This community has often been a lifeline for me since applying to medschool and im always extremely appreciative.

Thank you in advance for any helpful advice in what to do next.

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step 1 - talk to your surgery clerkship director and/or program director of your home program
step 2- talk to your dean of student affairs
step 3 - think about which of the following you would hate the least: psych, peds, obgyn, IM, FM
step 4 - decide if you would rather do one or even two surgery prelim years followed by 5 years of categorical surgery vs. do an easier 3-4 year residency and not be a surgeon
 
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Thanks a lot. Seems trivial but it really helps fwiw.

What are your thoughts on any redeeming qualities for a successful shelf retake with high percentage? Also, care to comment what to focus on (if any ine more than another) considering stepII success vs PD aquaintnece vs aways/LORs from aways (should go?)
 
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1) Take Surgical Sub-I beginning of 4th year/end of 3rd year, get H and have it noted in your Dean's Letter and final transcript (sent out with application)
2) Apply with high Step 2
3) As above, make local contacts who will go to bat for you
4) Aways are double edged sword; they may help a candidate like you (i.e., looks better in person than on paper) IF that's really you. Ask others to honestly assess how you come off outside of scores.
5) Have a Plan B; as above decide what you'll do if you don't match/get interviews (I think you kids refer to them as "II"s?)
 
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Lot of good advice, I think with your situation honestly its gonna be tough, failing surgery rotation is a fairly big strike against you, and it doesnt seem like you have a ton of other things to compensate for that, so the question becomes, what other applicant are they going to choose you over and why? I would still apply if you are dead set on it, and just apply broadly and smartly. I would also apply to a handful of the top prelim programs for matching into GS spots (Mayo? Honestly I dont really know what the good ones are) but I would still view a prelim as a backup plan and not your primary plan. A year in a lab might be a year better spent depending on where you do your prelim, but if you end up doing a prelim you have to have the goal of being the best prelim that program has ever had. Same with your sub-I rotation and while I totally agree with WingedScapula that aways are a double edged sword and I actually believe that on average they are a negative for general surgery, in your case you've got little to lose and should consider it. Pick a program or two that you think you legitimately may have a shot at matching at, go there, and make every resident there think that "man I would love this person to be in our program next year." We had one person do an away like that while I was in residency whose scores were not great but he was just genuinely the hardest working guy any of us had ever seen as a student and he clearly just got it and was a rockstar in the OR, so we all gave him rave reviews and he did end up matching at our program. I dont know exactly the rest of his application and his scores but I'd guess there was a real chance we were his only real shot at matching.
 
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time to be honest with yourself. failing a surgery clerkship makes you a very unattractive candidate. your chances will be poor at best and if you do match, it will be at a subpar program.

best to find another specialty.

good luck.
 
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This all very good advice and i thank everyone for taking time to comment on here- much obliged.

Are prelims something one applies to like in regular match or are they more something that gets filled after the fact?

Ive Read a lot on prelims here and gather they are typically dead end or other specialty end- like 50-80%? And those that actually match after word are typically more competative anyway as they are those that applied to more competitive subspecialties to begin with...tru?

Is there experience from anyone here who sees from the selection side of things as to what type of prelim applicant actually lamds a catagorical position?
 
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Prelim positions are positions filled through the match just like categorical general surgery positions, its just that they are for obvious reasons less desirable since there is no defined end point or guarantee of anything fruitful and so there are almost always a bunch of prelim spots that go unfilled that you could scramble into. That being said, prelim positions are basically just slave intern labor for programs that take advantage of desperate applicants with the promise, very often unfulfilled, of a future possible spot. Most dont end up being successful at getting into a categorical spot from there, but obviously some do. My understanding is that some programs are much better than others and have rates of putting their prelims into categorical programs that are much better, I just dont know exactly which programs those are. I'm sure someone else could fill you in better.
 
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... Pick a program or two that you think you legitimately may have a shot at matching at, go there, and make every resident there think that "man I would love this person to be in our program next year." ...

How does one go about selecting programs like this? i.e. those with the best odds of matching someone like myself given compensatory performance and connections
 
How does one go about selecting programs like this? i.e. those with the best odds of matching someone like myself given compensatory performance and connections
Its a good question but usually when someone says something like what I'm saying they are using it as a euphemism for "bad or bottom-tier programs." That being said, even the worst programs give you an opportunity to graduate and become board eligible, and I think a properly motivated resident can accomplish almost anything they want from almost any program. You just wont have things as easy or as many resources as at a better program.
 
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I talked to Clerkship director earlier this week- after reviewing my record and evals in detail (thank you 'jebus' for good impressions), he said I should still have a shot at categorical slot. Mentioned excelling on the the shelf-retake, applying with strong STEP2, relevant Letters, and opting to do aways as everyone above has stated. He said my step1 would be screened at some but not most programs...but how much it weighs in will vary (mentioned our average for accepted applicants last year was around 240)

Apparently we have a structured "shadow the PD for a week" set up for interested students to get to know them more personally etc. I've got this scheduled for later in the semester. Apparently we also have a few heavy hitters in a certain field that share similar background as I do that would likely go to bat provided I make a good impression with them as well.....so got some good direction. Will proceed with caution.

As far as prelims, i was told not to worry about those till later since its really a non-factor in terms of competitiveness. Said some programs interview for them others don't (opting to wait till after the match). Said our program does a little of both - picks up a few that want to stay at our institution provided they wont match and leaves the remaining spots open for SOAP.
 
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I'm surprised nobody mentioned research.
I would start doing research for a "heavy hitter" now.
 
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I'm surprised nobody mentioned research.
I would start doing research for a "heavy hitter" now.

Thanks bannie ill see what i can do about this as well.

A fewthings on that: i have some pretty good research as it is. My concern would be time put into something like that vs preparing properly for remaining/redoing shelves and step2. I would admit that i probably would have picked up a few better grades here and there if i hadnt put so much emphasis on research in the past. Maybe looking into some case reports? Or would those only be of marginal benefit?
 
Thanks bannie ill see what i can do about this as well.

A fewthings on that: i have some pretty good research as it is. My concern would be time put into something like that vs preparing properly for remaining/redoing shelves and step2. I would admit that i probably would have picked up a few better grades here and there if i hadnt put so much emphasis on research in the past. Maybe looking into some case reports? Or would those only be of marginal benefit?

Likely it would be marginal benefit, particularly if you already have research. Doing well on step 2 and your remaining rotations is probably higher yield.
 
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Hope it doesn't come to this, but the Baptist Health Systems program in Birmingham, AL (4 categorical spots and 2-4 prelims/year) is probably the most fair place I've ever heard of for prelims to get serious looks at getting a spot.

They get the exact same schedule as categorical and they've probably kept about 8-10 on as categoricals over the last decade. Some have had to repeat a pgy1 and some slid into pgy2 spots when a categorical quit after their intern year to switch specialties (which happens about every 2-3 years). Having sat in on the ranking meetings, they really give a lot of weight to knowing the person over a year when they re-interview people.
 
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Thanks for everyone's input

On a related note, anyone have some inspirational stories matching against perceived odds after Monday's match news?
 
UPDATE:

I feel like I haven't taken a day off in well-over 5mo's.
Scored 248 on Step II (solid jump from 224 Step I)
Honored Last 3 rotations
88% raw score on remediation shelf
Received 2 chair letters (I believe to be well-written)
Received other very strong, very personal letters from home faculty.
Am currently on my 3rd Away (I'm in no position to let my app talk for me)
-Away Strategy: Largest academic programs in my region. Figured the more spots to bid for the better. Also I, for several reasons, have decided this is the type of program I want to train at should I be given a choice. So, I'm doing everything I can to get there.
Applied to ~100 programs about 1 week after apps opened.
-Application strategy: Most programs with 5 or more cats/year. All program in my state, and 2 adjacent states. any other programs in locations, or with reputations/affiliations I wanted to be a part of. Any programs with what I considered to have significantly lower step cutt-offs and/or high IMG% among residents as per FREIDA reports. I included 3 prelim spots at the away programs and my home institution. All of which I feel relatively confident would accept me for such a position should I have no other choice.

So far, 2 weeks after app submition:
16 interviews
-hand full of 15-resident community programs
-hand full of med School programs
-a few large academic programs
-1 program I would easily consider to be "top tier"

still waiting on most home state invites as well as 2 away programs which Im told will go out soon...hopefully several more.

I think what is happening here is that I'm getting past the first screen and have yet to have my app scrutinized. Interview time will surely bring this on but I'm not sure what else to right now other than to go to every interview I'm willing to train at.

our programs PD and Chair gives us sort of a "free call" they'll each make if we should ask. That will be handy. Ultimately our PD really wants to help us get where we want to go. I don't feel great about my chances of staying with my program but would be honored to do so.

Will check-in in a few months.
 
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