MD Surgical Sub + High Step 1, Risk Step 2 Score Drop or Delay?

[Neopolymath]

I didn't take any practice NBME's for step 2 and only used a 2 week dedicated after 2 months of grueling sub-is. Still outscored my step 1. The minutiae you grinded for step 1 will definitely be helpful on step 2 as well, as long as you understand the sick/not sick and stable/unstable aspect of step 2 questions.

Agree completely.

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[operaman]

I feel like he already won the lottery. If he delays the exam he’s going to have to ‘start over’ with studying. I know that isn’t entirely true, but literally everyone in this thread also knows what I mean when I say he will have to start over with his studying and preparing for step 2 and that’s an awful feeling. I think OP is in such a strong position that he really can’t hurt himself that much even with a lukewarm step 2. I also would not be particularly interested in a program that needs to distinguish between applicants by ten points on their step 2.

My point is that he already passed all the barriers to get interview invites literally everywhere. The interviews are what matter now, his step 2 is quite frankly not going to be relevant whether he does amazing and gets 275 or does so so and gets 245.

That’s why I feel he will not hurt himself by getting it over with, and it will make him happier to do so. But if he decides to delay, it is certainly not wrong. Not at all. That level of OCD is kind of par for the course tbh. My emphasis remains though that the sort of programs I personally would recommend ANY surgical applicant seek out are the ones where you meet the bar to get an interview (he does) and then they decide to rank you based on how much they liked you on the interview. Not by counting your pubs and adding your steps together.

That’s just me. Opera isn’t wrong. I’m not wrong either. OP will be fine whatever he does and will probably get a freaking 280 anyway and this is all irrelevant.

Agreed. There’s no obvious right answer and there are trade offs for each. The nice thing about delaying is that even a 220 doesn’t hurt because you can delay scores indefinitely for most programs (or at least you could 7 years ago when I did it). California programs required it before ranking but no others did that I can recall. With delaying you just have to pass. In my day we had CS as well that definitely scared me because we all knew of someone who unexpectedly failed it, so having the option of not releasing carried even more meaning back then


So many people delay that I can’t imagine PDs would penalize for that. People just assume the applicant is waiting for after aways or in the case of high step 1 scores just waiting til after submission.

Taking a step exam when you’ve scored 99th percentile on your last one and you only need to pass is about as low stress as it gets. Hopefully he puts his anki cards away and just goes all in on delaying snd focused on more important things like aways and letters and pubs.

 

[theokapi]

If you do delay, definitely don’t waste any time on aways studying. The whole point of delaying is not to maximize your score, but to make your score a non issue and give you control over when programs get to see it.

The only ding I see on your app will be your clinical grades and even that is fairly minor, especially if your honored surgery and Medicine. Your research sounds good. That usually means you will have some strong letters as well. It’s always hard to predict how someone will do based on limited info but an app like yours should fare rather well.

I still think that your step 2 at this point can only hurt you. A strong performance will simply keep the status quo of an already strong application. A bad day could add a ding to good app which is why I chose to delay.

I will say that approximately 0% of the PDs I’ve spoken to know or care about the percentile differences between step exams. So long as the numbers are close I don’t think anyone will notice or give a crap.

Hi Operaman! Im applying this year, and I am interested in knowing what program you went to based on what youve said about it. Would you be able to message me or post?

 

[Deecee2DO]

This was the exact thread I was looking for-dont mean to hi jack but does anyone have any experience with academic IM? Applying with a mid 250s step 1 afraid of dropping and im doing subIs this august/september. Reason im doing Sub Is is im USDO applying midtier and some top tier (probably donations being that im a DO lol) academic IM. I believe my application to be competitive (multiple 1st and 2nd author pubs in reputable peer review journals and honored all M3 shelves and core rotations) aside from being a DO and I dont want to fudge up anything jumping the gun on CK and underperforming. I was going to take CK in November or December do you think same holds true for IM with mid 250s Step 1 as it does for ENT 260s Step 1? This thread is like a gold mine for me as I was looking for answers/direction bc its a big decision for me. And thank you @Welshman for walking us through your decision it is definitely helping me

 

[operaman]

This was the exact thread I was looking for-dont mean to hi jack but does anyone have any experience with academic IM? Applying with a mid 250s step 1 afraid of dropping and im doing subIs this august/september. Reason im doing Sub Is is im USDO applying midtier and some top tier (probably donations being that im a DO lol) academic IM. I believe my application to be competitive (multiple 1st and 2nd author pubs in reputable peer review journals and honored all M3 shelves and core rotations) aside from being a DO and I dont want to fudge up anything jumping the gun on CK and underperforming. I was going to take CK in November or December do you think same holds true for IM with mid 250s Step 1 as it does for ENT 260s Step 1? This thread is like a gold mine for me as I was looking for answers/direction bc its a big decision for me. And thank you @Welshman for walking us through your decision it is definitely helping me

You might do better with your own thread. The key difference between IM and ENT is that ENT was an early match for most of its existence and only switched to the main match about ten years ago or so. As such, step 2 was never even available for the vast majority of applicants. Many people reviewing applications are accustomed still to not having CK so that combined with a high step 1 is pretty common.

IM and other similar fields have always been a more traditional match and I don’t know how they are accustomed to looking at scores and how this plays in to their thinking. They also get far more applications than ENT so I’m sure most programs do more high level filtering just to cope with the volume of applications.

I think you’ll be best served with some IM-specific experience that speaks to how these scores traditionally factor into interview invites.

 

[efle]

This was the exact thread I was looking for-dont mean to hi jack but does anyone have any experience with academic IM? Applying with a mid 250s step 1 afraid of dropping and im doing subIs this august/september. Reason im doing Sub Is is im USDO applying midtier and some top tier (probably donations being that im a DO lol) academic IM. I believe my application to be competitive (multiple 1st and 2nd author pubs in reputable peer review journals and honored all M3 shelves and core rotations) aside from being a DO and I dont want to fudge up anything jumping the gun on CK and underperforming. I was going to take CK in November or December do you think same holds true for IM with mid 250s Step 1 as it does for ENT 260s Step 1? This thread is like a gold mine for me as I was looking for answers/direction bc its a big decision for me. And thank you @Welshman for walking us through your decision it is definitely helping me

For IM or EM I'd plan to have a CK score. They care about that more than the surgical subs that just need to screen people via step 1

 

[Deecee2DO]

For IM or EM I'd plan to have a CK score. They care about that more than the surgical subs that just need to screen people via step 1

They do? I was told to wait till interview season since i wont need a CK score for an interview with mid 250s Step 1. Im also doing SubIs so I wont have time to study till october. If i rush and take now or take while on a subI wouldnt i risk shooting myself in the foot with a lower score potentially under 250s

 

[efle]

They do? I was told to wait till interview season since i wont need a CK score for an interview with mid 250s Step 1. Im also doing SubIs so I wont have time to study till october. If i rush and take now or take while on a subI wouldnt i risk shooting myself in the foot with a lower score potentially under 250s

Agree if you're not gonna be ready to hit same or better on CK until past October then def don't test. Waiting until you're ready is more important

 

[aldol16]

If you have a high step 1, there is no benefit to you of taking Step 2 early. There is no upside and unlimited downside. People will say yeah, if you outscore your Step 1 and do well on Step 2, then it shows programs that you can continue to do well on standardized tests and it can help your application. That's not false - it's just that nobody can predict with arbitrary uncertainty how you will do on Step 2, regardless of what your practice exam scores show. You can increase your confidence by consistently doing well on practice exams, but if you already have a strong Step 1, why risk it?

 

[halamadrid17]

Sort of related question to OP, with a 260ish Step 1, what would be the lowest step 2 CK score you would want to send after ERAS submission but before interviews are extended for ortho, ent, etc?

 

[Banco]

Sort of related question to OP, with a 260ish Step 1, what would be the lowest step 2 CK score you would want to send after ERAS submission but before interviews are extended for ortho, ent, etc?

Close to the average step 2 score for matched applicants I suppose.

 

[aldol16]

If your Step 1 score is super strong, I would not send a Step 2 score unless the Step 2 raw number at least matches the Step 1 raw number.

 

[Phloston]

Hi everyone, I got some really great advice on away rotations a few weeks ago and wanted to hear some more opinions on my latest conundrum. Unfortunately, my school doesn't have any faculty from competitive specialties so their advice tends to be very superficial; I kid you not after presenting this same situation to a dean, their only response was that scoring well will help me. Anyway, without further ado...

Background: My school takes step 1 after third year, step 2 is usually scheduled shortly after that, and I'm applying to a surgical subspecialty this cycle. I recently received my Step 1 score and was ecstatic to get 260-265. I'm currently scheduled to take step 2 in 4 days. Right now, my practice exams average ~250 with ~6 point range; based on Reddit data, these are typically under-predictive by about 10 points, and score predictors I've used so far are projecting a 260. I'd be more than happy with this score, but I'm doubtful I can attain it. I poured a lot of my soul out for step 1 and was so burnt out trying to transition straight into Step2 studying that I haven't put nearly as much into it as I should have; ie I won't complete a full first pass of UW before testing even after carrying over >50% during rotations, my peers are ~50% through a second pass of all the Qs. I find Step 2 questions pretty difficult and frequently find myself going with my 'gut' rather than explicitly knowing the info cold. To an extent this is the nature of step 2 questions, however, I'm concerned about ending up on the wrong side of a lot of my 50:50s and underperforming my practice tests. A lot of my performance feels like luck.

My question is, given the increasing importance of Step 2 and coming from a no-name school, after scoring 260-265 on Step 1 would it be advisable to take Step 2 at all before ERAS is sent out? This would give me the option to not send the score until after receiving interview invites if needed. Or would it be better to take it, likely perform worse percentile-wise but maybe the same numerical score, to get it out of the way so my full application is complete for ERAS and I don't have to worry about it while on aways?

For what it's worth, I would really like to take it and never think about it again, coming off step 1 and dedicated I'm likely the most "in the mind" of the NBME than I'll ever be but probably a bit underprepared step2 content-wise. I just don't want to make a rash decision and spoil my previous hard work. As an added note, if I delayed, I wouldn't take it next until at least mid/late-October. Thanks for all your help guys!

TLDR. You won't get interviews at various places without a 2CK. Just take the exam before applying.

 

[Welshman]

TLDR. You won't get interviews at various places without a 2CK. Just take the exam before applying.

Didn’t take it. ERAS was due last month. Will update everyone in a week with how interview invites go

 

[WhittyPsyche]

Didn’t take it. ERAS was due last month. Will update everyone in a week with how interview invites go

Surgical sub as well. None of my cohort at my institution applying took Step 2 before the season. We are all doing very well in the cycle.

 

[aldol16]

TLDR. You won't get interviews at various places without a 2CK. Just take the exam before applying.

That's not even true.

 

[Phloston]

That's not even true.

You apply without a 2CK. Let us know how that goes for you.

 

[Captain_Falcon]

Apparently M4s at my school last year and this year applying to competitive fields without a Step 2 score shot themselves in the foot more often than helped themselves out

 

[Lawpy]

You apply without a 2CK. Let us know how that goes for you.

I think it depends on the year. It's not an issue for this year but will likely be a big problem next year

 

[WhittyPsyche]

Apparently M4s at my school last year and this year applying to competitive fields without a Step 2 score shot themselves in the foot more often than helped themselves out

Last year and this year I know of 15+ people each that did not have Step 2. At my institution M4s take it between Dec-Feb. but of course we have strong Step 1s, hence the competitive specialty. Our cohort this year all have 20+ interviews.

Next year if you have a Step 1 score I think it still won’t be end of the world to not have it. Take it before/in time for rank list submission. The people that may have P/F score for apps then I would say take it by the summer.

 

[Captain_Falcon]

Last year and this year I know of 15+ people each that did not have Step 2. At my institution M4s take it between Dec-Feb. but of course we have strong Step 1s, hence the competitive specialty. Our cohort this year all have 20+ interviews.

Next year if you have a Step 1 score I think it still won’t be end of the world to not have it. Take it before/in time for rank list submission. The people that may have P/F score for apps then I would say take it by the summer.

I can only go off based what faculty advisors at my school have told us, because I myself have a high step score (+/- 250) so I asked "should I delay to take it in the fall instead of trying to get it done in the spring?" Their response was essentially "Look, you already have shown you are a great test taker, and you don't want anything very competitive so you should take it and then be able to focus on sub-i's and audition rotations. Even if you were interested in something competitive, we'd tell you the same thing because people targeting competitive fields like derm and ortho have done what you asked - and ended up not receiving very many interviews until after their Step 2 scores came in come November."

 

[Welshman]

I can only go off based what faculty advisors at my school have told us, because I myself have a high step score (+/- 250) so I asked "should I delay to take it in the fall instead of trying to get it done in the spring?" Their response was essentially "Look, you already have shown you are a great test taker, and you don't want anything very competitive so you should take it and then be able to focus on sub-i's and audition rotations. Even if you were interested in something competitive, we'd tell you the same thing because people targeting competitive fields like derm and ortho have done what you asked - and ended up not receiving very many interviews until after their Step 2 scores came in come November."

It’s easy for the faculty member to say who hasn’t taken a step exam in 10-20 years. I think it’s also easy for them to say “you’re a good test taker what could go wrong”, I’m sure it works most of the time and their skin isn’t in the game. But with step 2 there is such a huge standard error it’s not worth the risk if you’re borderline. A friend of mine never scored below 280 on 4 practice tests ended up in the low 260s. Amazing scores that anyone would be happy with but if you extrapolate that performance to other tiers it becomes much dicier… my average in June was around 250, a fine score, but 230-240 are well below average

I would also comment that it seems hard to say if their scores come back in November if it was their scores or just the regular release cycle for interviews… November doesn’t seem that late for some specialities. Also people don’t tell their advisor about their interviews unless something is going wrong and they’re worried so I imagine theres a self selection bias for students whom the advisor is aware of no interviews.

 

[Lawpy]

It’s easy for the faculty member to say who hasn’t taken a step exam in 10-20 years. I think it’s also easy for them to say “you’re a good test taker what could go wrong”, I’m sure it works most of the time and their skin isn’t in the game. But with step 2 there is such a huge standard error it’s not worth the risk if you’re borderline. A friend of mine never scored below 280 on 4 practice tests ended up in the low 260s. Amazing scores that anyone would be happy with but if you extrapolate that performance to other tiers it becomes much dicier… my average in June was around 250, a fine score, but 230-240 are well below average

I would also comment that it seems hard to say if their scores come back in November if it was their scores or just the regular release cycle for interviews… November doesn’t seem that late for some specialities. Also people don’t tell their advisor about their interviews unless something is going wrong and they’re worried so I imagine theres a self selection bias for students whom the advisor is aware of no interviews.

The huge standard errors are one of the worst parts of Steps

 

[aldol16]

You apply without a 2CK. Let us know how that goes for you.

I mean, it's going quite well right now, thanks for asking.