MD Step 1 241 - ortho possible? Need help planning years 3-4

[kingarty24]

Hi all - I need some guidance. I got my my score report last week, 241. I’m pleased, definitely glad the weeks I spent punishing myself weren’t for nothing.

To make a long story short - I’m interested in ortho but I’m not entirely sure how realistic this goal is with a score so far below the average of those who match. That said, I realize matching successfully entails more than a board score. So, any of you more experienced have advice to help plan/direct my future? Career advising at my school is basically nonexistent, and hardly any of the class ahead of me are interested in ortho. No home ortho program, so no luck there either.

Here’s me:

• Rising M3 (obviously)
• Very involved in school extra curricular activities (student government, interest club leadership, school ambassador, intramural sports)
• Non-ranking school, but generally perform above average on tests and quizzes. We do have AOA here so that’s something to shoot for I guess
• Worked in orthopedic surgeon’s office for 3 years between undergrad and starting med school as an MA, so may have some contacts in my home city
• Research (definitely a weak spot, at least I feel so): worked as a research assistant for a year in undergrad, nothing published/presented but worked with PhD candidates on data collection and helped with abstract writing. Have started 2 projects during school that fell apart due to crazy circumstances (PI left for a bigger school, other guy was let go by school), and started a 3rd late last summer at another institution in my hometown that may or may not be able to be revived. So, essentially next to nothing to put on a CV/resume.

What practical advice can y’all give me in terms of priorities for 3rd and 4th year?

• what to focus on (ie case reports/research)
• things I should look out for/prepare for
• Do I throw myself headfirst into this or have a backup plan?
• podcasts/books to consume
• websites/blogs to read
• tips/tricks for rotations
• advice you wish you’d received at this point

any and all comments/questions are welcome - as a I mentioned, up to this point I feel like I’ve been going through school blind, just focusing on making the next grade or clearing the next hurdle. Anyway, thanks in advance!

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[libertyyne]

your step 1 score is on the lower end of the IQR range.

Your research productivity is also on the lower end of the applicant range.

Coupled together they do not make a great combo.
You need to be productive in research and kill it on rotations.
You might even benefit from a research year.
Your home program is your best bet, do what ever is humanly possible to make them think you walk on water.

 

[kingarty24]

Thanks for that info! I’ll admit I don’t know what an IQR is, but I think I understand what you mean with the graphics. I figured I’ve got a lot ahead of me, but I appreciate you steering in the right direction

 

[GoSpursGo]

Your home program is your best bet, do what ever is humanly possible to make them think you walk on water.

No home ortho program in the original post, which I think is a major problem as well in a field where so much is determined based on networking and who you know.

Honestly, I tend to be relatively optimistic and tell people to aim high and be OK with reapplying if it comes to that. Even I really struggle to imagine a successful match here. That graph RE research projects and pubs/presentations doesn't do justice to how crazy of a rat race ortho is--the MEAN number of abstracts is 11.5, so if you don't have a few banked yet I'm not sure how you're going to get to a number that compensates for a score that, while something to be proud of, is still below average for the specialty you're interested in.

This is a situation where I think you would absolutely need to take a research year and be extremely productive in terms of both presentations/publications and networking to have a realistic shot.

 

[kingarty24]

No home ortho program in the original post, which I think is a major problem as well in a field where so much is determined based on networking and who you know.

Honestly, I tend to be relatively optimistic and tell people to aim high and be OK with reapplying if it comes to that. Even I really struggle to imagine a successful match here. That graph RE research projects and pubs/presentations doesn't do justice to how crazy of a rat race ortho is--the MEAN number of abstracts is 11.5, so if you don't have a few banked yet I'm not sure how you're going to get to a number that compensates for a score that, while something to be proud of, is still below average for the specialty you're interested in.

This is a situation where I think you would absolutely need to take a research year and be extremely productive in terms of both presentations/publications and networking to have a realistic shot.

If I were to take a research year, what would my first steps be, and are there programs to which I could apply?

 

[GoSpursGo]

If I were to take a research year, what would my first steps be, and are there programs to which I could apply?

It's almost always at your own school.

 

[sovereign0]

Maybe I'm being pessimistic, but a 241 with no home program is already an uphill battle. With no research and an empty CV, I think this will be a very difficult goal to accomplish. Perhaps some Ortho peeps can comment on specifics but I'd guess you'll need a productive research year, ideally with another institution that has an Ortho program so you can get some mentorship and build connections. You'll also need at least 4 total away rotations.

 

[kingarty24]

Maybe I'm being pessimistic, but a 241 with no home program is already an uphill battle. With no research and an empty CV, I think this will be a very difficult goal to accomplish. Perhaps some Ortho peeps can comment on specifics but I'd guess you'll need a productive research year, ideally with another institution that has an Ortho program so you can get some mentorship and build connections. You'll also need at least 4 total away rotations.

Thanks for this - any particular strategy to planning away rotations? Like when to apply or whatever/what that process is like? Is 4 a magic number, or just the number often acquired by those who match? Also, when you say “empty CV” are you strictly referring to publications? And if you could ballpark what you mean by productive, what would that look like to you? I ask because that’s the kind of thing I can set as a goal for myself (maybe a little easier to wrap my head around, compared to “just do a bunch”)

 

[libertyyne]

Thanks for this - any particular strategy to planning away rotations? Like when to apply or whatever/what that process is like? Is 4 a magic number, or just the number often acquired by those who match? Also, when you say “empty CV” are you strictly referring to publications?

publications are the only real thing that matter on a cv.

 

[kingarty24]

publications are the only real thing that matter on a cv.

Thanks! Had no idea what he/she meant by that.

 

[libertyyne]

Thanks! Had no idea what he/she meant by that.

you have a difficult task ahead of you. You need to do well on rotations honor as many as you can, and then you need to find orthpeadic program in your city that does research and you need to beg them for projects, case reports, reach out to as many as you can. This process is much easier when you have a home program.

 

[jhenj529]

What step score do you think would compensate for low research?

 

[kingarty24]

you have a difficult task ahead of you. You need to do well on rotations honor as many as you can, and then you need to find orthpeadic program in your city that does research and you need to beg them for projects, case reports, reach out to as many as you can. This process is much easier when you have a home program.

You speak the truth - like I mentioned in the first post, I feel like I’ve kinda been flying blind up until now. Not sure how the pass/honor system is set up at our program, but I’m sure it’s possible. We’ve had plenty of ortho matches in the past, just not this most recent class. What is a reasonable amount of research I could nail down in a year if I really buckle down? A handful of case reports and a couple of projects?

 

[libertyyne]

What step score do you think would compensate for low research?

none. realistically, getting to the median research publication number probably boosts match rates by 10-30%.

 

[Splenda88]

What step score do you think would compensate for low research?

As a poster already mentioned, it is a rat race in term of research output when it comes to these competitive specialties. The average step 1 for these specialties is ~250... I don't know how can someone compensate for low research output short of getting 270+ in both step 1/2.

 

[libertyyne]

As a poster already mentioned, it is a rat race in term of research output when it comes to these competitive specialties. The average step 1 for these specialties is ~250... I don't know how can someone compensate for low research output short of getting 270+ in both step 1/2.

its not even that, step is not neccessarily used in a linear fashion to increase match rates, although that may end up happening by just getting more invites.

Step is used as one tool to screen. Once you have screened now you interview and look at everyone's apps in more detail. This is where the sausage gets made. This is where the research shows that 1. you have genuine interest in the field. 2. you will be a productive resident. 3. you can follow projects through. After the interviews it is more dependent on interviews.

 

[Splenda88]

@libertyyne

Agree 100%... OP is in a tough spot... From a low tier school that has no ortho department with below-average step 1 and minimal research output, I would frankly look for another less competitive specialty that I will also be content with. I don't think the odd will be better than good even with one year of research.

 

[libertyyne]

@libertyyne

Agree 100%... OP is in a tough spot... From a low tier school that has no ortho department with below-average step 1 and minimal research output, I would frankly look for another less competitive specialty that I will also be content with. I don't think the odd will be better than good even with one year of research.

idk. The match rate for us seniors is 75-80% with zero research in ortho in OPs score bracket. Those odds are still better than the IR match even with 250+ . Everyone has different risk tolerances. I think the research year would work to build relationships for letters and research , but if OP can accomplish that in a year. Then it isnt a terrible place to be.

 

[kingarty24]

@Splenda88
@libertyyne

I appreciate the thoughtful input so far! I’m definitely in a tough spot, which prompted me to ask for your help (wouldn’t get it otherwise). I hadn’t realized the match % with no research was that high, but not totally comfortable with a 20-25% chance of not matching. May consider the research year if the ball doesn’t get rolling fast. Have toyed with the idea of switching to a less competitive specialty but not quite ready to give in just yet. My question remains, what is a good measuring stick to say I had a productive year research-wise?

 

[libertyyne]

@Splenda88
@libertyyne

I appreciate the thoughtful input so far! I’m definitely in a tough spot, which prompted me to ask for your help (wouldn’t get it otherwise). I hadn’t realized the match % with no research was that high, but not totally comfortable with a 20-25% chance of not matching. May consider the research year if the ball doesn’t get rolling fast. Have toyed with the idea of switching to a less competitive specialty but not quite ready to give in just yet. My question remains, what is a good measuring stick to say I had a productive year research-wise?

Number of publications. Letters of rec. Numbers of conferences attended connections made. Etc.

But idk it's the blind leading the blind here. I would reach out to recent alums who matched and see what they did. Or maybe someone on the Ortho forum Can give you more pointed advice

 

[VincentAdultman]

@Splenda88
@libertyyne

I appreciate the thoughtful input so far! I’m definitely in a tough spot, which prompted me to ask for your help (wouldn’t get it otherwise). I hadn’t realized the match % with no research was that high, but not totally comfortable with a 20-25% chance of not matching. May consider the research year if the ball doesn’t get rolling fast. Have toyed with the idea of switching to a less competitive specialty but not quite ready to give in just yet. My question remains, what is a good measuring stick to say I had a productive year research-wise?

If you’re not comfortable with that you can always apply to a backup as well.

I mean it’s obviously going to be tough because it’s going to take more than a board score. But not impossible. I’m not sure if there’s a nearby residency where you can try to make connections. Or if you can talk to the guys you worked with as an MA. Basically try to work any connection you may have developed sincenUG.

It’s going to be a grind but not impossible. But what you do comes down to how much interest in ortho you have. And only you know that.

 

[GoSpursGo]

idk. The match rate for us seniors is 75-80% with zero research in ortho in OPs score bracket. Those odds are still better than the IR match even with 250+ . Everyone has different risk tolerances. I think the research year would work to build relationships for letters and research , but if OP can accomplish that in a year. Then it isnt a terrible place to be.

Wait, what? How do you infer that there is a 75-80% match rate for people with zero research?

The curve relating step 1 score to probability of match is for all-comers and shows the match rate to be just under 80%, so I would assume that the applicants who are successful with a 241 have a lot of research and connections to compensate.

 

[libertyyne]

Wait, what? How do you infer that there is a 75-80% match rate for people with zero research?

The curve relating step 1 score to probability of match is for all-comers and shows the match rate to be just under 80%, so I would assume that the applicants who are successful with a 241 have a lot of research and connections to compensate.

If you look at the chart I attached. I specifically only selected people with zero publications. The match rate was close to 80percent in that category for American seniors .

 

[GoSpursGo]

If you look at the chart I attached. I specifically only selected people with zero publications. The match rate was close to 80percent in that category for American seniors .

I'm not familiar with that chart, but honesty that just mathematically can't be correct. Per charting outcomes it says only 3/6 applicants (any step score) matched with zero pubs, and your chart implies at least ~50 people applied with no pubs in the 240-250 range alone.

 

[libertyyne]

I'm not familiar with that chart, but honesty that just mathematically can't be correct. Per charting outcomes it says only 3/6 applicants (any step score) matched with zero pubs, and your chart implies at least ~50 people applied with no pubs in the 240-250 range alone.

View attachment 272619

That data is multi year 2014-2018. The data is valid. It is published by the nrmp just like charting outcomes.

 

[kingarty24]

Charting Outcomes™: Characteristics of Applicants who Match to Their Preferred Specialty

Interactive Charting Outcomes in the Match has been built using data visualization software and draws from the same data sources as the NRMP’s publication Charting Outcomes in the Match.

www.nrmp.org

@GoSpursGo I think this is the source of that information

 

[OrthoTraumaMD]

Read through my AMA which I have been running here continuously for more than 2 years. I talk about research in it, as well as other things. I do not “chance” people, but you may find some useful things in there.

 

[kingarty24]

@libertyyne
@GoSpursGo
@sovereign0
@Splenda88
@VincentAdultman
@OrthoTraumaMD

Almost 3 years later, just wanted to say thanks - I matched ortho last month! Took your collective advice to heart, worked like crazy, and did a research year to survive the pandemic's wrath on what would've been my 4th year away rotations. In the end it all worked out.

To anyone else who may see this, good luck!

 

[MilesDavisTheDoctor]

can you talk a little about what your experience was like the last couple of years and give some advice going through the application process?

 

[voxveritatisetlucis]

Congrats!

How productive would say that you were on your research year? What do you think is good productivity in terms of pubs? I heard that if one takes a research year and doesn’t get 10+ pubs it can be a red flag

 

[kingarty24]

can you talk a little about what your experience was like the last couple of years and give some advice going through the application process?

Congrats!

How productive would say that you were on your research year? What do you think is good productivity in terms of pubs? I heard that if one takes a research year and doesn’t get 10+ pubs it can be a red flag

For sure!

After this post, my main goal for 3rd year (other than doing well on shelf exams) was to connect with the orthopaedic surgeons at our hospital. Was in the OR with them any chance I could get, but super careful not to alienate classmates. Other basic stuff - took call/stayed late when I could, tried to find ways to help the team/take ownership of the patient as best I could. This helped a ton with LORs down the road, and generally applies to all 3rd year rotations.

1/2 way through 3rd year had made essentially no progress research-wise so I reached out to program alumni to probe for research fellowships at their programs and ultimately started googling/trolling orthogate. Applied to maybe 7-8 programs, interviewed at a handful, and was waiting to hear back when COVID hit. With all of the craziness that ensued with respect to clinical limitations and whatnot, I accepted a position at a program in my region. Ended up being a total fluke with the timing, but I avoided the app cycle with super limited aways and the first year of zoom interviews.

In terms of research productivity, all I can say is that you don't want to take a year away from school and have nothing to show for it. Charting the outcomes may help gauge the stats of something to shoot for, but ERAS has different categories for research-related items on your application that can drastically pad those stats. Personally I had 4 published manuscripts (only one 1st author), about 5-6 in submission, and maybe 40ish abstract/poster presentations at varying levels from state to national conferences. MORE IMPORTANTLY - I worked my tail off for my mentors and built strong relationships that may have been more meaningful than my "productivity". They happily wrote a LOR and made phone calls during interview season. Make the most of this opportunity if you have it!

When 4th year started, I pretty much kept the same attitude as 3rd year while on my away rotation. Was limited to 1 then but I think that is changing now. Application advice - I applied super broadly and I'm glad I did. Apply to more programs than you think you'll need and know that with how overwhelmed these programs get your results may vary and your friends will get some interviews you don't, and vice versa. I had interviews at places I knew nothing about, and was ghosted by programs I thought I'd surely hear from. Sounds silly, but it is worthwhile to follow programs on social media as they often have Q&A sessions. Some are more helpful than others. Idea is to be engaged and show interest.

Happy to answer other questions privately, otherwise, good luck!