Sacrifice Class Rank for Step 1

[doc2be245]

Ok. So I've heard of people dropping school to study for step 1, but that in my mind that seems convoluted because you are learning what shows up on Step 1 in your courses.

For me though, I have to take 2 classes at my school that are very non step 1 related but they are worth a ton of credits. I focus alot of my energy on Pathology, Pharmacology and Microbiology and do very well but end up just getting by in the rest of the classes that won't help me in Step 1.

Is it that bad to not focus on those non-relavant classes and have my class rank suffer in order to put more time on Step 1?

I use that extra time to review older material to keep it fresh and do more questions.


Can anyone who has done this shed some light on the topic?

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[padfoot777]

I was one of those who dropped everything for step 1, very happy that I did. I scored very well on COMLEX and USMLE. It's very hard for programs to compare students by grades because each school has their own grading policy, it's easy however for them to look at applicants based on their standardized test scores to compare them. My recommendation is to do whatever you feel comfortable with, obviously I am not suggesting putting yourself in danger of failing a course for boards, but I am definitely happy with my decision to abandon class work for boards material.

 

[DrFutureDO]

I was one of those who dropped everything for step 1, very happy that I did. I scored very well on COMLEX and USMLE. It's very hard for programs to compare students by grades because each school has their own grading policy, it's easy however for them to look at applicants based on their standardized test scores to compare them. My recommendation is to do whatever you feel comfortable with, obviously I am not suggesting putting yourself in danger of failing a course for boards, but I am definitely happy with my decision to abandon class work for boards material.

Hmmm

 

[sab3156]

Especially considering DO schools usually have faculty that are completely unaware of what's actually on the USMLE... you will be learning a lot of nonsense and irrelevant things, so you need to fill in a lot of holes yourself.

 

[SLC]

Are people honestly not able to do both?

Class rank isn’t that important coming from a DO school for ACGME interviews, unless your class rank is in the bottom 75%

 

[Postictal Raiden]

I’d be willing to go from being top of my class to the bottom for 10 pts increase on step1.

Just make sure you don’t fail anything

 

[IslandStyle808]

Especially considering DO schools usually have faculty that are completely unaware of what's actually on the USMLE... you will be learning a lot of nonsense and irrelevant things, so you need to fill in a lot of holes yourself.

My school is teaching us step II/level II material during year 2...

I'm filling a lot of holes here in the pathophysiology department...

 

[AnatomyGrey12]

My school is teaching us step II/level II material during year 2...

I'm filling a lot of holes here in the pathophysiology department...

The second years here swear by B&B as their hole filler.

 

[Giovanotto]

My school is teaching us step II/level II material during year 2...

I'm filling a lot of holes here in the pathophysiology department...

Unless we go to the same school, you're not alone. Nobody bats an eye, but we have had a 4 hours lecture on the clinical management of asthma.

 

[IslandStyle808]

The second years here swear by B&B as their hole filler.

Yep, that's my hole filler alright, especially epidemiology and biostats

 

[SurgDoc95]

The second years here swear by B&B as their hole filler.

B&B?


Sent from my iPhone using SDN mobile

 

[AnatomyGrey12]

B&B?


Sent from my iPhone using SDN mobile

Boards and Beyond

 

[DO2015CA]

Most schools don’t teach to the boards. Looking back I wish I would’ve done that earlier. I only did from March of second year on. I wish I would’ve the beginning of second

 

[sab3156]

Yep, that's my hole filler alright, especially epidemiology and biostats

What do you use for the subjects not taught in B&B?

 

[IslandStyle808]

What do you use for the subjects not taught in B&B?

It literally has everything physiology, pathology, pharmacology, microbiology, behavioral, and other subjects. Our schools curriculum has been pretty brutal so I only use it if there are subjects I don't understand. I will probably have to look over the videos on the subjects that were not taught to us well during winter break.

I also use pathoma, uslme rx, first aid, sketchy, and will soon use Uworld in January. So hopefully it covers all my bases.

 

[sab3156]

It literally has everything physiology, pathology, pharmacology, microbiology, behavioral, and other subjects. Our schools curriculum has been pretty brutal so I only use it if there are subjects I don't understand. I will probably have to look over the videos on the subjects that were not taught to us well during winter break.

I also use pathoma, uslme rx, first aid, sketchy, and will soon use Uworld in January. So hopefully it covers all my bases.

Do you think B&B is basically a board-focused medical school curriculum on its own? I was thinking about getting it.

 

[IslandStyle808]

Do you think B&B is basically a board-focused medical school curriculum on its own? I was thinking about getting it.

Not sure myself as to how good it is as an all around resource since I haven't taken my boards yet. I believe it is really good at going over most of the high yield stuff in all categories. However, I would highly suggest still getting pathoma and sketchy also to cover your bases.

You could also start it during your first year if you are willing to spend money for it.

 

[DrfluffyMD]

Are people honestly not able to do both?

Class rank isn’t that important coming from a DO school for ACGME interviews, unless your class rank is in the bottom 75%

If a candidate has 270 and is in bottom 25% class rank, I would assume the DO school’s ranking system is stupid.

If a candidate has a 210 and is in the top 25%, I would assume both the candidate and the school are mediocore.

Note, the above apply for acgme residency and DO school preclinical grades

 

[SLC]

If a candidate has 270 and is in bottom 25% class rank, I would assume the DO school’s ranking system is stupid.

If a candidate has a 210 and is in the top 25%, I would assume both the candidate and the school are mediocore.

Note, the above apply for acgme residency and DO school preclinical grades

Here we go again folks!

 

[DrfluffyMD]

Here we go again folks!

So what do you think of my comment? Let’s have a constructive discussion here.

 

[Chibucks15]

So what do you think of my comment? Let’s have a constructive discussion here.

Your comment isn't constructive. It tears down DOs in a sweeping manner that in no way is helpful or warranted. It again comes off as the 'all DOs are always worse candidates' which frankly isn't true or else no DOs would be matching ACGME residencies at all. Secondly, since this is a DO subforum, coming in here all hot like that with no actual evidence to back it up comes off as inflammatory

 

[DrfluffyMD]

Your comment isn't constructive. It tears down DOs in a sweeping manner that in no way is helpful or warranted. It again comes off as the 'all DOs are always worse candidates' which frankly isn't true or else no DOs would be matching ACGME residencies at all. Secondly, since this is a DO subforum, coming in here all hot like that with no actual evidence to back it up comes off as inflammatory

Ok, so let me explain my statement further.

Imagine if I am an ACGME PD. All I care about is step 1 and third year performence. Preclinical grades don’t really matter unless one fails.

If a candidate had a very high preclinical grade but very poor showing on step 1, I can’t help but to feel that those following scenarios are present:

1. The student did not acquire knowledges that USMLE step 1 measures and comes standard in my applicants. He/she instead acquired knowledge specific to their DO school. Again, as an ACGME PD I have no use for OMM. Did this student end up in 90% percentile because they are slightly above average in everything and completey aced OMM? A good grade in OMM means nothing to me.

2. The student did try to acquire those knowledge, but is subpar compare to the USMDs on average. Yet he manage to outperform most of their class. This could cast doubt on the entire class from that institution.

If a candidate had poor preclinical class rank and high step 1, there is only one explaination: this person did poorly on materials I don’t care about (OMM for example). That’s just fine.

 

[Chibucks15]

Ok, so let me explain my statement further.

Imagine if I am an ACGME PD. All I care about is step 1 and third year performence. Preclinical grades don’t really matter unless one fails.

If a candidate had a very high preclinical grade but very poor showing on step 1, I can’t help but to feel that those following scenarios are present:

1. The student did not acquire knowledges that USMLE step 1 measures and comes standard in my applicants. He/she instead acquired knowledge specific to their DO school. Again, as an ACGME PD I have no use for OMM. Did this student end up in 90% percentile because they are slightly above average in everything and completey aced OMM? A good grade in OMM means nothing to me.

2. The student did try to acquire those knowledge, but is subpar compare to the USMDs on average. Yet he manage to outperform most of their class. This could cast doubt on the entire class from that institution.

If a candidate had poor preclinical class rank and high step 1, there is only one explaination: this person did poorly on materials I don’t care about (OMM for example). That’s just fine.

Isn't Step 1 viewed as the great equalizer? If you know your stuff you know your stuff...you aren't getting a 270 if you're subpar to an MD applicant on average...

EDIT: I'm not saying that someone with below average boards and high class rank should get any preferential treatment solely because of class rank, because everyone knows how those can get. But if a DO outperforms an MD on Step 1 while maintaining at least decent ranking in classes that should show something.

 

[ortnakas]

My thoughts on OP’s original question:

Yes, it’s worth it, as long as you’re COMFORTABLY passing everything.

You mentioned just getting by in the classes you think aren’t Step 1 high yield, which is fine, until you “misunderestimate” an exam and end up on the wrong side of passing. Remediating a class like that when you wanted to be on dedicated board prep would be awful. So while it’s fine to focus on board prep and not worry about acing everything, I’d recommend studying slightly more for them to build a bit of a buffer.

 

[DrfluffyMD]

Isn't Step 1 viewed as the great equalizer? If you know your stuff you know your stuff...you aren't getting a 270 if you're subpar to an MD applicant on average...

EDIT: I'm not saying that someone with below average boards and high class rank should get any preferential treatment solely because of class rank, because everyone knows how those can get. But if a DO outperforms an MD on Step 1 while maintaining at least decent ranking in classes that should show something.

Yep, if DO outperforms a MD on step 1 then he/she is a better applicant based on step score. He/she may or may not be an overall better applicant but you can’t cheat the step score.

 

[deleted831695]

The student did not acquire knowledges that USMLE step 1 measures and comes standard in my applicants. He/she instead acquired knowledge specific to their DO school. Again, as an ACGME PD I have no use for OMM. Did this student end up in 90% percentile because they are slightly above average in everything and completey aced OMM? A good grade in OMM means nothing to me.

Lmao, you're not going to end up in 90th percentile just based off OMM. Think for a second.

Another explanation? The applicant does have good knowledge, but the school prepared them more for COMLEX than USMLE Step 1. The applicant may not have hard committed to the USMLE as much as COMLEX.

2. The student did try to acquire those knowledge, but is subpar compare to the USMDs on average. Yet he manage to outperform most of their class. This could cast doubt on the entire class from that institution.

Sod off man.

 

[Carbon090]

Exactly what I've been doing since September.

 

[sab3156]

I've been told the same by ophthalmology residents/faculty. DO class rank is nothing compared to your Step 1. High rank + mediocre Step 1 = bad DO application. Mediocre rank + hight Step 1 = much better.

 

[Mad Jack]

If a candidate has 270 and is in bottom 25% class rank, I would assume the DO school’s ranking system is stupid.

If a candidate has a 210 and is in the top 25%, I would assume both the candidate and the school are mediocore.

Note, the above apply for acgme residency and DO school preclinical grades

Or, you know, test taking abilities and class grades measure totally different things. Plenty of purely I know that got mediocre Step scores but were high up in their class and AOA on the MD side of things.

 

[Mad Jack]

If a candidate has 270 and is in bottom 25% class rank, I would assume the DO school’s ranking system is stupid.

If a candidate has a 210 and is in the top 25%, I would assume both the candidate and the school are mediocore.

Note, the above apply for acgme residency and DO school preclinical grades

Where are you in the training process, btw? Because your statements really come off as ignorant in regard to how PDs rank and think.

 

[SLC]

Where are you in the training process, btw? Because your statements really come off as ignorant in regard to how PDs rank and think.

Maybe he’s in a field where residents don’t get insight into the process. Our IM program is like this. Residents have no input at all into choosing incoming interns.

I’ve interviewed and participated in ranking meetings with our PD, Chair, and faculty for the past 3 years. I’m interviewing applicants tomorrow actually, and I can say with certainty that PD’s (at least in my real world experience) don’t select people like that.

At my program it’s basically board-score,letters,PS as an initial grading criteria, then interview has the potential to drastically alter that preliminary score. In the final rank meeting, when we’re finalizing the list, that’s when I’ve seen DO vs MD or the name of a med-school actually change someone’s ranking, and in those situations it’s usually to decide between two otherwise similar applicants.

But a DO with a 240, good letters and a well written statement, and an MD with the same, will be treated identically by our interview process. The MD may get ranked #19 and the DO#20 (as an example) in the end, if all else is equal. Or maybe the DO will interview better and beat out the MD or vice-versa.

We evaluate purely on objective criteria and interview impression though. No MD vs DO nonsense. My PD is on record as saying “I just want the best people, I’m less concerned about where they come from”.

 

[darknecrosforte]

Lmao, you're not going to end up in 90th percentile just based off OMM. Think for a second.

Yeah, but for my school, there's the extra clinical skills class every semester, the "tying-it-all-together" class, IPE, and the other random class . . . PLUS OMM. You factor that in and there is a lot more variance than what your posts suggest. At least one stdev's worth of grades to toy with

 

[68PGunner]

Ok, so let me explain my statement further.

Imagine if I am an ACGME PD. All I care about is step 1 and third year performence. Preclinical grades don’t really matter unless one fails.

If a candidate had a very high preclinical grade but very poor showing on step 1, I can’t help but to feel that those following scenarios are present:

1. The student did not acquire knowledges that USMLE step 1 measures and comes standard in my applicants. He/she instead acquired knowledge specific to their DO school. Again, as an ACGME PD I have no use for OMM. Did this student end up in 90% percentile because they are slightly above average in everything and completey aced OMM? A good grade in OMM means nothing to me.

2. The student did try to acquire those knowledge, but is subpar compare to the USMDs on average. Yet he manage to outperform most of their class. This could cast doubt on the entire class from that institution.

If a candidate had poor preclinical class rank and high step 1, there is only one explaination: this person did poorly on materials I don’t care about (OMM for example). That’s just fine.

I’m in a DO school where half of our clinicians are MDs from nearby hospitals and residency programs. Honestly, your thoughts are on point with what many of them inform us with regards to the USMLE and residency programs.

 

[68PGunner]

I've been told the same by ophthalmology residents/faculty. DO class rank is nothing compared to your Step 1. High rank + mediocre Step 1 = bad DO application. Mediocre rank + hight Step 1 = much better.

If you have high rank and a mediocre Step 1, that will amplify the whole DO ed is inferior mantra. High Step 1 means that you’re meeting the standards or exceeding the standards for your first two years. Afterward, it comes down to your third year rotations and letters. That’s why it’s not a bad idea to do an away rotation at your dream ACGME program early and get a letter from that PD to dispel any notion of your clinical ed being inferior to the standard.

 

[IslandStyle808]

If a candidate has 270 and is in bottom 25% class rank, I would assume the MD school’s ranking system is stupid.

If a candidate has a 210 and is in the top 25%, I would assume both the candidate and the school are mediocore.

Note, the above apply for acgme residency and MD school preclinical grades

ftfy

You could make the same logic with any MD school. There are MD schools that do a poor job to teaching to the boards. Which is why judging on pre-clinical curriculum is a moot point and judging based on the USLME tell a lot more about the student in comparison to everyone else.

 

[Mad Jack]

I’m in a DO school where half of our clinicians are MDs from nearby hospitals and residency programs. Honestly, your thoughts are on point with what many of them inform us with regards to the USMLE and residency programs.

Most of the residencies I've applied to know of my school's reputation because they've taken DOs from my school before. So it's not like they're working with an unknown, they know what to expect from our grads. One advantage/disadvantage of being a DO is that so few go through most ACGME residencies that when one does, they remember them, and if they leave a good impression, it sticks. So far, all the places I've been have had nothing but good things to say about the DOs they've brought on board.

 

[sab3156]

Most of the residencies I've applied to know of my school's reputation because they've taken DOs from my school before. So it's not like they're working with an unknown, they know what to expect from our grads. One advantage/disadvantage of being a DO is that so few go through most ACGME residencies that when one does, they remember them, and if they leave a good impression, it sticks. So far, all the places I've been have had nothing but good things to say about the DOs they've brought on board.

Which specialty? If you're talking about a non-competitive specialty at non-competitive programs, of course they have probably taken tons of DOs in the past, and will continue to do so. This isn't the case, though, at the vast majority of strong ACGME programs where your rank will hardly matter compared to your Step 1, because no one knows how the education is like in DO programs. If you have a high DO rank and are in an honors society, they still won't care. They want to see a very strong Step 1, and even then you're probably going to need someone to vouch for you. I'm not saying be at the bottom of your class, but you shouldn't think that your class rank or the name of your DO school is going to get your ahead of MD applicants. DO schools collectively have generally ONE reputation - the word is "inferior". Sad but true.

 

[Mad Jack]

Which specialty? If you're talking about a non-competitive specialty at non-competitive programs, of course they have probably taken tons of DOs in the past, and will continue to do so. This isn't the case, though, at the vast majority of strong ACGME programs where your rank will hardly matter compared to your Step 1, because no one knows how the education is like in DO programs. If you have a high DO rank and are in an honors society, they still won't care. They want to see a very strong Step 1, and even then you're probably going to need someone to vouch for you. I'm not saying be at the bottom of your class, but you shouldn't think that your class rank or the name of your DO school is going to get your ahead of MD applicants. DO schools collectively have generally ONE reputation - the word is "inferior". Sad but true.

Moderately competitive programs. Many of the programs I'm talking about have only taken a DO every other year or so. I've been surprised by the interviews I've gotten, but upon talking with the program directors, one factor was the quality of prior students from my school combined with my board scores.

 

[DrfluffyMD]

Or, you know, test taking abilities and class grades measure totally different things. Plenty of purely I know that got mediocre Step scores but were high up in their class and AOA on the MD side of things.

PGY5. Starting fellowship next year. Many new attendings start their foot in the door as an APD.

 

[DrfluffyMD]

Maybe he’s in a field where residents don’t get insight into the process. Our IM program is like this. Residents have no input at all into choosing incoming interns.

I’ve interviewed and participated in ranking meetings with our PD, Chair, and faculty for the past 3 years. I’m interviewing applicants tomorrow actually, and I can say with certainty that PD’s (at least in my real world experience) don’t select people like that.

At my program it’s basically board-score,letters,PS as an initial grading criteria, then interview has the potential to drastically alter that preliminary score. In the final rank meeting, when we’re finalizing the list, that’s when I’ve seen DO vs MD or the name of a med-school actually change someone’s ranking, and in those situations it’s usually to decide between two otherwise similar applicants.

But a DO with a 240, good letters and a well written statement, and an MD with the same, will be treated identically by our interview process. The MD may get ranked #19 and the DO#20 (as an example) in the end, if all else is equal. Or maybe the DO will interview better and beat out the MD or vice-versa.

We evaluate purely on objective criteria and interview impression though. No MD vs DO nonsense. My PD is on record as saying “I just want the best people, I’m less concerned about where they come from”.

I have been participating in rank meeting and interview candidates for the past 2 years. It’s possible that family medicine and radiology/interventional radiology rank applicants differently and base on different princples.

We have a tough board exam. We want people that can ace a standardized test.

 

[sab3156]

Moderately competitive programs. Many of the programs I'm talking about have only taken a DO every other year or so. I've been surprised by the interviews I've gotten, but upon talking with the program directors, one factor was the quality of prior students from my school combined with my board scores.

That's cool. It's nice that the DOs that do get into competitive places usually are very good and do well during their time there and make a good impression. For example, it seems to have happened at MGH anesthesiology, where last year they took a DO (for maybe the first time ever?), and this year they did, too.

But the issue is still that the Step 1 score matters WAY more than rank, especially for DOs. Don't be last, but you shouldn't be #1 at the expense of Step 1.

 

[IslandStyle808]

That's cool. It's nice that the DOs that do get into competitive places usually are very good and do well during their time there and make a good impression. For example, it seems to have happened at MGH anesthesiology, where last year they took a DO (for maybe the first time ever?), and this year they did, too.

But the issue is still that the Step 1 score matters WAY more than rank, especially for DOs. Don't be last, but you shouldn't be #1 at the expense of Step 1.

The MGH matches for anesthesia if I remember right
2015 it was a AZCOM grad
2016 it was a LECOM grad
2017 it was a NYIT and AZCOM grad

*edit made

 

[SLC]

I have been participating in rank meeting and interview candidates for the past 2 years. It’s possible that family medicine and radiology/interventional radiology rank applicants differently and base on different princples.

We have a tough board exam. We want people that can ace a standardized test.

We want that too, it’s why boards are the first thing we look at.

But we also want people with a good personality, people who we want to work with for the next few years, people who won’t cause problems for the rest of the residents (slacking, etc). And humanistic people with excellent bedside manner.

 

[Mad Jack]

PGY5. Starting fellowship next year. Many new attendings start their foot in the door as an APD.

Ah, a surgical resident. That explains everything

 

[DrfluffyMD]

Ah, a surgical resident. That explains everything

Not a surgical resident.

 

[IslandStyle808]

Ah, a surgical resident. That explains everything

Not a surgical resident.

He's a radiology resident

 

[SLC]

Ah, a surgical resident. That explains everything

Radiology, the field suffering from major brain drain and trying desperately to keep their illusory-eliteness alive.

 

[DrfluffyMD]

Radiology, the field suffering from major brain drain and trying desperately to keep their illusory-eliteness alive.

I have no illusion about how uncompetitive radiology residency is. It’s a blessing really because this way I got to meet one of my best friend who is a DO and probably would not have gotten in back in 2005.

DOs can routinely match into radiology. We definitely had more DOs in the noncompetitive years. Actually, you can just go look at the number of DOs in each class in an average mid tier ACGME radiology program by year to figure out which year was the uncompetitive year. It really sucks, but that’s just how things go, sadly, that the amount of DO in class correlate with toughness of match like this.

I am an interventional radiologist to be, however. You can consult ERAS to see how competitive that field is. I matched as a fellow, which was not a difficult match overall but got to the program I got to (top 10, think U Mich, MCVI, UVA, Stanford, Mt Sinai, Rush, Penn, UCLA) was quite competitive. This means I’ve experienced both competitive and noncompetitive match.

 

[DrfluffyMD]

By the way, DOs actually match fairly well into IR. 10/129 matches were DOs last year.

It’s better than 1 DO match out of 305 ENT positions, or 1 DO match out of 60 integrated vascular surgery positions, or ortho where there are 3 out of 727 spots. It’s probably because we don’t have the surgical bias and also there aren’t any AOA IR residencies.

One of my big aspiration is actually to start an IR program at a formerly DO institution like arrowhead or something where I can train folks that may be discrminated against.

 

[Mad Jack]

Not a surgical resident.

Rads then? Because that makes even more sense.