Performed much better than expected on Step 1, what next?

[Azete]

So a few weeks ago I took Step 1 (took it early so I could get an extended summer break), and walking out of my exam I felt really bad. Based on practice tests, I was expecting a score in the 230 range, but after my test (which was absurdly pharm heavy) I would have been happy with any passing score.

Well, deserved or not, I scored much better than I thought (255-260). From the beginning I've had no interest in hyper-competitive specialties, and I've valued things like family time over doing research or joining clubs to boost my CV. I still have little interest in these specialties, but I'd like some feedback on what my options are at this point as far as IM programs. My ultimate goal would be a cards or nephrology fellowship, but again I've done very little during my first two years of med school other than just get good grades. No research, no clubs, no ECs.

So, what can I do from this point forward to make my fellowship dreams a reality? Aside from the obvious of doing well on rotations. I'm a DO so obviously I won't be pursuing top tier academic programs, and program prestige is pretty low on my priority list to begin with.

Other info that might be pertinent:
-Non-trad (over 30) that graduated from a top 5 law school
-Worked 10+ years in finance
-Chose DO over MD acceptance for family/location reasons
-Do not have a COMLEX score yet

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[DrfluffyMD]

Since you were in law, you outta understand the distinction between HYS and T14 and TTTs

I say at this point, don't force yourself into doing things you don't like, but rather, use the step score to get the most prestiguous IM residency you can get.

Unfortunately being a DO is a bit like being outside of the T14 or T20, you can still get good spots if you are top 5%, but the some of the best "firms" will not hire you

 

[68PGunner]

So a few weeks ago I took Step 1 (took it early so I could get an extended summer break), and walking out of my exam I felt really bad. Based on practice tests, I was expecting a score in the 230 range, but after my test (which was absurdly pharm heavy) I would have been happy with any passing score.

Well, deserved or not, I scored much better than I thought (255-260). From the beginning I've had no interest in hyper-competitive specialties, and I've valued things like family time over doing research or joining clubs to boost my CV. I still have little interest in these specialties, but I'd like some feedback on what my options are at this point as far as IM programs. My ultimate goal would be a cards or nephrology fellowship, but again I've done very little during my first two years of med school other than just get good grades. No research, no clubs, no ECs.

So, what can I do from this point forward to make my fellowship dreams a reality? Aside from the obvious of doing well on rotations. I'm a DO so obviously I won't be pursuing top tier academic programs, and program prestige is pretty low on my priority list to begin with.

Other info that might be pertinent:
-Non-trad (over 30) that graduated from a top 5 law school
-Worked 10+ years in finance
-Chose DO over MD acceptance for family/location reasons
-Do not have a COMLEX score yet

You and I have similar backgrounds. Personally, I would go with the specialty that has the most leverage power when you go to the bargaining table, as in high demand and low supply in order to maintain that lifestyle, money, and hour factors down the road. Medicine is usually a slow beast. The market that you graduate residency into can probably be expected to be that same market throughout your career.

Nephrology is a hell hole from my short trip the nephrology board. That leaves Cards on the table. I personally would reach out to talk to a few Cards right now in order to understand the landscape in order to make yourself a competitive person. I personally don't think that ECs are going to move much given your nontrad background. However, I do think that research is probably really important. At the end of the day, if that one factor is holding you back, you can always take a gap year to boost your research portfolio.

Big congrats on destroying Step 1. It's a great feeling to see the fruit of your labor.

 

[Major]

Nice, congrats on the score OP.

Mind sharing how you studied for it?

 

[Azete]

Nice, congrats on the score OP.

Mind sharing how you studied for it?

I'll definitely make a detailed post at some point over the next few weeks with my study methods (and schedule). I also made a lot of mistakes though, in hindsight, which will probably help people more than the things I did right.

 

[68PGunner]

I'll definitely make a detailed post at some point over the next few weeks with my study methods (and schedule). I also made a lot of mistakes though, in hindsight, which will probably help people more than the things I did right.

Look forward to that beastly schedule.

Can you tell me in hindsight of what materials would best prepare for your pharm quests? Pharm is actually one of my stronger subjects so I'm curious about your take.

 

[Major]

I'll definitely make a detailed post at some point over the next few weeks with my study methods (and schedule). I also made a lot of mistakes though, in hindsight, which will probably help people more than the things I did right.

Awsome. Looking forward to it. Thank you!

 

[Azete]

Look forward to that beastly schedule.

Can you tell me in hindsight of what materials would best prepare for your pharm quests? Pharm is actually one of my stronger subjects so I'm curious about your take.

Pharm was my weakest subject, so you might find an easier time with it. But, unfortunately, the latest FA was not sufficient for the pharm questions on my exam -- I'd say ~1/4 of them were nowhere to be found in the book and an additional ~1/3 were in there but very low yield points (I spent a depressing amount of time after my exam searching FA for the answers).

Of the resources I've looked at, I'd say Sketchy Pharm was the best just because they go into a lot of depth about mechanisms, but the videos are pretty long and they don't cover all of the drugs.

I spent most of my time learning classes of drugs and which drugs fell into those categories, but my exam really wanted us to go a step further.

Example: You're given X patient, and you figure out from the stem they need a B1 selective Blocker. But then you look at the answer choices and Acebutolol, Atenolol, Bisoprolol, and Esmolol are all on there. Based on their other conditions/drugs, you need to know which one to go for.

 

[68PGunner]

Pharm was my weakest subject, so you might find an easier time with it. But, unfortunately, the latest FA was not sufficient for the pharm questions on my exam -- I'd say ~1/4 of them were nowhere to be found in the book and an additional ~1/3 were in there but very low yield points (I spent a depressing amount of time after my exam searching FA for the answers).

Of the resources I've looked at, I'd say Sketchy Pharm was the best just because they go into a lot of depth about mechanisms, but the videos are pretty long and they don't cover all of the drugs.

I spent most of my time learning classes of drugs and which drugs fell into those categories, but my exam really wanted us to go a step further.

Example: You're given X patient, and you figure out from the stem they need a B1 selective Blocker. But then you look at the answer choices and Acebutolol, Atenolol, Bisoprolol, and Esmolol are all on there. Based on their other conditions/drugs, you need to know which one to go for.

WOW. LOL. Thank you.

 

[Oh_Gee]

Pharm was my weakest subject, so you might find an easier time with it. But, unfortunately, the latest FA was not sufficient for the pharm questions on my exam -- I'd say ~1/4 of them were nowhere to be found in the book and an additional ~1/3 were in there but very low yield points (I spent a depressing amount of time after my exam searching FA for the answers).

Of the resources I've looked at, I'd say Sketchy Pharm was the best just because they go into a lot of depth about mechanisms, but the videos are pretty long and they don't cover all of the drugs.

I spent most of my time learning classes of drugs and which drugs fell into those categories, but my exam really wanted us to go a step further.

Example: You're given X patient, and you figure out from the stem they need a B1 selective Blocker. But then you look at the answer choices and Acebutolol, Atenolol, Bisoprolol, and Esmolol are all on there. Based on their other conditions/drugs, you need to know which one to go for.

how do you think you did so well if pharm was your weakest subject?

 

[Azete]

how do you think you did so well if pharm was your weakest subject?

Wish I knew; I felt pretty bad walking out of the test. Some mnemonics our pharm professors gave helped a little, I'm sure some questions were trial questions and tossed, others I probably guessed well, and the scoring was probably more forgiving compared to other tests.

 

[67552931811]

So a few weeks ago I took Step 1 (took it early so I could get an extended summer break), and walking out of my exam I felt really bad. Based on practice tests, I was expecting a score in the 230 range, but after my test (which was absurdly pharm heavy) I would have been happy with any passing score.

Well, deserved or not, I scored much better than I thought (255-260). From the beginning I've had no interest in hyper-competitive specialties, and I've valued things like family time over doing research or joining clubs to boost my CV. I still have little interest in these specialties, but I'd like some feedback on what my options are at this point as far as IM programs. My ultimate goal would be a cards or nephrology fellowship, but again I've done very little during my first two years of med school other than just get good grades. No research, no clubs, no ECs.

So, what can I do from this point forward to make my fellowship dreams a reality? Aside from the obvious of doing well on rotations. I'm a DO so obviously I won't be pursuing top tier academic programs, and program prestige is pretty low on my priority list to begin with.

Other info that might be pertinent:
-Non-trad (over 30) that graduated from a top 5 law school
-Worked 10+ years in finance
-Chose DO over MD acceptance for family/location reasons
-Do not have a COMLEX score yet

Congrats, man. Stellar score!

 

[zukunft195]

OP, out of curiosity, why did you decide to transition from law to medicine?

 

[Azete]

OP, out of curiosity, why did you decide to transition from law to medicine?

To keep it simple, I made enough money and wanted a career I could be proud of.

 

[SLC]

Best residency you can get yourself into is the goal (for Cards fellowship). If Nephro, it basically won't matter where you go from what I remember being told (was interested in Nephro for a hot second in 3rd year).

Unfortunately (or fortunately, depending on how you choose to see it), this score doesn't change things all that significantly for you. It's a good score no doubt; but your residency program ceiling raises only slightly (IMO).

I'd still say to do everything you can to preen the rest of your CV; then apply broadly to residencies. A mix of reaches, safeties, but mainly programs you think you're competitive at as a solid DO applicant. I just don't think there are many IM programs out there that wouldn't take a DO with a 230 that would take one with a 260.

 

[LutGholein]

So a few weeks ago I took Step 1 (took it early so I could get an extended summer break), and walking out of my exam I felt really bad. Based on practice tests, I was expecting a score in the 230 range, but after my test (which was absurdly pharm heavy) I would have been happy with any passing score.

Well, deserved or not, I scored much better than I thought (255-260). From the beginning I've had no interest in hyper-competitive specialties, and I've valued things like family time over doing research or joining clubs to boost my CV. I still have little interest in these specialties, but I'd like some feedback on what my options are at this point as far as IM programs. My ultimate goal would be a cards or nephrology fellowship, but again I've done very little during my first two years of med school other than just get good grades. No research, no clubs, no ECs.

So, what can I do from this point forward to make my fellowship dreams a reality? Aside from the obvious of doing well on rotations. I'm a DO so obviously I won't be pursuing top tier academic programs, and program prestige is pretty low on my priority list to begin with.

Other info that might be pertinent:
-Non-trad (over 30) that graduated from a top 5 law school
-Worked 10+ years in finance
-Chose DO over MD acceptance for family/location reasons
-Do not have a COMLEX score yet

Congrats man!!! I look forward to your study schedule write-up!

I'd suggest something if I could but I think residents/4th year med students will give you way more valuable insight. I'm just happy to read when things work out better than expected!

 

[Azete]

Best residency you can get yourself into is the goal.

Unfortunately (or fortunately, depending on how you choose to see it), this score doesn't change things all that significantly for you. It's a good score no doubt; but your ceiling raises only slightly (IMO).

I'd still say to do everything you can to preen the rest of your CV; then apply broadly to residencies. A mix of reaches, safeties, but mainly programs you think you're competitive at as a solid DO applicant.

I think ultimately that's what I'm trying to figure out -- even if I pump out research and work my ass off the next two years to build my CV, is it going to make a difference? I see my ceiling as a mid-tier academic IM residency, and I'm not sure anything I do from this point is going to bump me to the "next level," even with a good step 1 score.

 

[SLC]

I think ultimately that's what I'm trying to figure out -- even if I pump out research and work my ass off the next two years to build my CV, is it going to make a difference? I see my ceiling as a mid-tier academic IM residency, and I'm not sure anything I do from this point is going to bump me to the "next level," even with a good step 1 score.

I generally think that's correct.

Maybe you'll be surprised if you do those things; and you should absolutely not sell yourself short. Working hard will never be a waste of time.

This all doesn't mean you can't get into a program that can put you into a fellowship in the field you're hoping for. It just means that you're not on the fast track to the ivory tower. But that was likely always the case once you started at DO school and that's fine.

 

[Moose A Moose]

Hey, OP.






Cool.

 

[SurgeDO]

sounds like you got yourself into quite the predicament, OP. i wish you the best of luck.

 

[Giovanotto]

Hey, OP.






Cool.

Look at this sour puss over here.

 

[RotationsSoFar]

case reports, case reports, case reports.

Get on a few easy clinical projects as well.

Those plus your board score... sdn will be arguing about whether your match is competitive or not in the match-list thread two years from now.

 

[68PGunner]

case reports, case reports, case reports.

Get on a few easy clinical projects as well.

Those plus your board score... sdn will be arguing about whether your match is competitive or not in the match-list thread two years from now.

On a serious note, how feasible is it to bang out multiple case reports during 3rd year in order to augment that research CV?

 

[IslandStyle808]

case reports, case reports, case reports.

Get on a few easy clinical projects as well.

Those plus your board score... sdn will be arguing about whether your match is competitive or not in the match-list thread two years from now.

Been trying to find some clinical work with the near by MD school to no avail (my DO school is on the newer end, so no luck there). Any tips?

 

[BorntobeDO?]

So a few weeks ago I took Step 1 (took it early so I could get an extended summer break), and walking out of my exam I felt really bad. Based on practice tests, I was expecting a score in the 230 range, but after my test (which was absurdly pharm heavy) I would have been happy with any passing score.

Well, deserved or not, I scored much better than I thought (255-260). From the beginning I've had no interest in hyper-competitive specialties, and I've valued things like family time over doing research or joining clubs to boost my CV. I still have little interest in these specialties, but I'd like some feedback on what my options are at this point as far as IM programs. My ultimate goal would be a cards or nephrology fellowship, but again I've done very little during my first two years of med school other than just get good grades. No research, no clubs, no ECs.

So, what can I do from this point forward to make my fellowship dreams a reality? Aside from the obvious of doing well on rotations. I'm a DO so obviously I won't be pursuing top tier academic programs, and program prestige is pretty low on my priority list to begin with.

Other info that might be pertinent:
-Non-trad (over 30) that graduated from a top 5 law school
-Worked 10+ years in finance
-Chose DO over MD acceptance for family/location reasons
-Do not have a COMLEX score yet

Derm: its time to develop the lifelong desire you always had for skin.

Opps you said cardiology, well then do a cardiac Derm fellowship. Seriously you need to get your priorities straight now.