Updated July 2022
Knowing if you are an applicant that will raise "Red Flags" in the mind of a Program Director is really important for planning your application strategy. You will need to do everything you can to make these "flags" as small as possible.
What are common "Red Flags"?
Failing a step of the Boards. A great fear for program director's is that their graduates will not pass the boards when they finish. Not passing the USMLE or COMLEX is a strong predictor of struggling to pass later exams. Most advisers will recommend addressing any mitigating circumstances that led to failing the boards in your Personal Statement. Even low scores, borderline for passing, can scare off some programs.
Repeating a preclinical course or year. Another sign of academic struggle. Also needs to be addressed.
Repeating a clerkship. Failing a clinical experience will almost always be interpreted as a result of professionalism deficiencies. These are deal breakers to most Program Directors and need to be explained.
Academic misconduct. Get caught cheating and you are in a lot of trouble. For your school to still graduate you, you must have convinced them that it was a misunderstanding or that you have been rehabilitated. In a competitive specialty like EM, there is little reason for a Program Director to bother taking the chance.
Unexplained gaps in your career. Big unaccounted for chunks of time are concerning. There can be really good reasons that these happen. But if left unexplained, application reviewers may assume the worst.
What do I do if I have a "Red Flags"?
There are two approaches that most applicants use:
- Hope they go unnoticed or that some reviewers of your application will not be dissuaded. This is wishful thinking, and is very unlikely to succeed.
- Get in front of them - Use your Personal Statement to explain mitigating circumstances and how you emerged from this better prepared for a career in EM. This is what you need to do. Addressing the issue head on shows maturity and strong character. Use the opportunity to create your narrative of why, so program directors can see see you as a well rounded individual and consider your application.
For a lot more on navigating application "Red Flags" take a look at this guide for At Risk Applicants.
I just found out I failed Step2CS. I am an average applicant. How much of trouble am I in for the upcoming cycle?
ReplyDeleteWhile probably not as bad as failing the clinical knowledge portions, this is going to be a problem. Programs that don't know you are going to be concerned about your ability to connect with patients and work with staff.
ReplyDeleteYou need to retake and pass ASAP to prove that it was a fluke. You should also start working on a back-up plan should you not get enough EM interviews. If you need to match this year, you may want to consider an additional specialty to apply in. If extending med school is an option for you, that would allow you to retake CS and to complete more rotations that will show up in next years application - more data that better describes your actual communication skills. Have a look at: http://emadvisor.blogspot.com/2015/03/so-you-did-not-match.html
For this years application - this needs to be discussed in your Personal Statement: http://emadvisor.blogspot.com/p/applying-personal-statement.html That is the first place most application reviewers will go looking for an explanation.
Happy thanksgiving Adam!
ReplyDeleteIn spite of a redflag that I am worried about, I currently have a total of 9 interviews and waitlisted at a couple of places. I am however still very concerned about not matching. I have a feeling a lot of programs did not offer me an interview because I was filtered out. The truth is, even if I have 20 interviews, a part of me would still be concerned about not matching.
Do programs go back and re-analyze applications before final rankings or are rankings based solely on how you interviewed? .i.e. is it always true that once you get an interview, you are on a level playing field with everyone else being interviewed at that program?
How comfortable should I feel about matching with only 9 interviews?
I think you are in a pretty safe position to match. Programs where you rotated could have given you a courtesy interview, or not be worried because they feel they know you. But, any program that invited you solely on the strength of your application is not that worried about your Red Flag. Each program is looking for different qualities in an applicant and believe in different predictors of success. So it is not surprising that something that scares off one program won't matter to another.
ReplyDeleteAs for danger of not matching: 9 interviews is great at this point, and you will probably get a few more. The match rate with 9 last year was well over 90%. There is no number of interviews that get's you to a match rate of 100%. There will always be a few people who have great applications that get them lots of interviews but who really struggle at those interviews. There are no guarantees, and having a back-up plan is always a good idea, but based on having 9 interviews already you should be okay.
Hi,
ReplyDeleteI have a question regarding application for EM. I am an Osteopathic student who ran into a few issues when trying to take my Comlex and USMLE Step 1. Basically family and personal health problems and was recovering from Surgery. I took the comlex but did poorly not because of my lack of knowledge but rather my inadequate testing skills. I passed by the skin of my teeth, however because I passed I cannot retake it. I also canceled my Step 1 because I was afraid failing it or doing really poorly would look worse.
I am now realizing into my fourth year that I should have taken it anyways. So I am trying to apply to both AOA and ACGME programs however, I have a terrible comlex score looming over my head and I intend to do much much better on Comlex 2 and Step 2 towards the beginning of August so that my scores are released by early September. My question is, how will my late SLORS and late score submissions by the AOA application's standards affect my overall application and chances of interviews. If it does affect me, how badly do you think that would be and what can I do to really improve my application for the AOA match? I am trying to get some additional research on my CV and I have rejoined the fire department, because I also love being a firefighter/EMT. Your advice is truly appreciated.
Having a low comlex/step 1 score is difficult to overcome. The best action you can take is exactly what you are doing: take step 2 early. Your score should be with plenty of time for ACGME programs to use it as part of their decision whether to offer an interview or not.
DeleteThe AOA application process starts so early that there is going to be less you can do. You should certainly address your low score in your Personal Statement. When your COMLEX 2 posts, that will be a good time to politely update AOA programs on the additional information in your application. Hopefully that will help you secure a few late interviews (and they all count).
A low step 1 is going to rule you out for some progams. However, most look at you as a whole applicant and recognize that test scores are not the most important determinant of your success as an EM resident. Excelling on your EM rotations (and getting good SLOE's) will make programs want to ignore a low step 1.
Good luck!
Hello,
ReplyDeleteI want to take your opinion about a critical issue in my plan. I am an intern(the final year med student) in Turkey. I am currently studying for Step1. I will take the test in September, I suppose. But I am going to graduate soon. Nowadays I am considering the idea of taking a time out (leave of absence) from my faculty just before my graduation, so I will be able to search and apply for an elective as a student. Some people around me say it worths, some say it doesn't.
I heard that Hands-On USCE is positive and the gaps during the medical education is negative. So I am trying to calculate the net effect of the two opposite impacts of these two factors on my future residency applications.
Okay, let's say somehow I will be able to start my two months long clerkship just two months after Step1. In that scenario, I will be extending my faculty 8 months for 2 months of electives.
I wonder your point of view. Is this a wise strategy or an absurd idea?
Looking forward to hear your advice.
Thank you for the question. I don't have enough knowledge of the system for EM training in Turkey, so I am going to try to answer based on the ASSUMPTION that you are planning to try to get a residency in the United States.
DeleteThis is going to be hard as an International Student, but not impossible. You need to do rotations in a hospital with an EM residency in the United States. If you cannot get those clinical experiences you will not be able to match directly to EM. You may need to match into another specialty and then reapply for EM once you have clinical experience as a resident physician.
I don't entirely follow what your options are as you have laid them out - but the one you need to pursue is the one that gives you the best chance to rotate in a U.S. ED with a residency.
I hope that helps.
Hello,
ReplyDeleteI have some red flag issues I need to address. I was convicted of a misdemeanor reckless driving charge prior to medical school. I drank and drove and was pulled over on my way home. I take ownership for what I did and acknowledge my mistake. It has been almost 5 years since the incident. Otherwise, I am a competitive applicant (250+ Step 1, several honors). How do I approach this red flag on ERAS and my personal statement? What are my chances of matching?
Thank you
Your chances of matching are very good. This will hurt you with some programs, particularly those in states where it is difficult to get a medical license with a DUI/OUI. That can be a hard thing to predict so you will want to make sure you apply to multiple states (a necessity anyway, except in NY).
DeleteThere is a field in the ERAS application that gives you a chance to explain any legal troubles. This is where you will want to explain this episode and what you have done to remediate this. You should not need to further explain elsewhere in your application unless you feel that this was a particularly formative experience on your road to EM.
I hope that helps.
Now that ERAS is upon us 2018ers I desperately need some advice. I'm a DO student who did well on my COMLEX but only got a 189 on my USMLE step 1. I passed the COMLEX Level 2 PE and I'm taking the Level 2 CE in August. Besides board scores I have decent grades/class rank, leadership positions in interest group school organizations, etc. I had hoped to be able to devote myself to just the AOA match but with the single accreditation there are fewer EM programs participating in AOA in 2018, and there are some ACGME programs I love with all my heart. Can I go with just my COMLEX score, or do I absolutely have to submit both scores if I do the ACGME match? Should I try to take the USMLE Step 2? What are my chances of matching in the ACGME match and what do you think I should do?
ReplyDeleteThank-you so much in advance for your thoughts!
You should be able to go with just your COMLEX. Programs that give serious consideration to DO applicants, especially those that were recently AOA, will be find with a COMLEX. What you lose by not having a USMLE is the traditional ACGME programs with tepid interest in DO applicants. And most of them would likely be scared off by your USMLE score.
DeleteHi I'm a u.s. citizen IMG and just found out that i failed step2 cs...obviously devestated...I scored ok on step1 224 and am expecting around a 240 on ck. I really want to match EM but idk if this will be possible now and now I'm afraid i won't match at all even IM or FM. Any advice for me?
ReplyDeleteYou need to retake CS as soon as possible so that a pass shows up in your application this year. EM was going to be difficult as an IMG and this does make it more unlikely. Your best chance of EM residency would be to match into IM or FM and attempt to reapply as you build some clinical experience. So long as you pass CS as quickly as possible, IM or FM should be possible.
DeleteHi! Hoping for some advice on a tricky situation. I got back my COMLEX step 2 and did worse than my COMLEX Step 1 ( 538 -> 496). I have good clerkship grades and good LOR/SLOEs (at least I've been told they are good). Are my chances pretty much shot as a potential EM candidate or should I still think about applying? Thank you.
ReplyDeleteYour scores are still comfortably above the pass threshhold. While going down a little from step 1 to step 2 isn't that common it is certainly not the death of your application. All programs look at board scores but very few prioritize them above SLOE's and other clinical performance. If EM is what you want you should still apply. You do have the option to also apply to something else to have a back-up in place should your application not turn out to be as otherwise strong as you hope it is.
DeleteHi Dr. Kellogg,
ReplyDeleteThank you for your blog. I have questions related to Board Scores, red flags, and "getting ahead of it." I finished my M2 year and pushed back my first rotation to take more time to study for Step. My score is still improving as I think I have finally realized how to study properly for this exam. I am thinking of pushing back my second rotation also; however, this would put me a off-cycle, graduating with my year but applying to residency with the next. I also would then have a Leave of Absence on transcript if I do so. Already taking off one rotation subtracts one away I can do (we don not have an EM program). A couple of sources told me pushing the second rotation would be fine while another told me it would be better to get a 210 or so and not have a "LOA flag" on my transcript while be off-cycle for away rotations. I guess my questions are 1) What is your perspective? 2) Is a summer LOA a red/yellow flag? I know different programs have different scoring techniques, but generally, would I be more likely to get cut from the pool for a low score or a LOA? 3) If not, is it legitimate to explain that I was studying for Step and (not in jail) or is that unacceptable as my classmates did not need the extra time? 4) What else should I (not) be considering?
Thank you ahead for your insight.
I think you are considering the right factors. An LOA can be a concern, depending on the reason. If you took that extra time to study and didn't do average or above on step 1 that would be more concerning than a below average score with a typical time to prepare.
DeleteOn the other hand, if that delay in applying results in more opportunities to complete away EM rotations (with no home program) then it is probably worth it.
EM rotations where you do well are more important than step scores. You need to clear a bar of test performance to get considered but the decision on who to interview is much more heavily influenced by SLOE's.
Hi Dr Kellogg,
DeleteI delaying step 1 in my 2nd year of medical school, and ended up taking it last October and received a slightly above average score. My practice exam scores put me at risk for failure so I used a few more weeks to change my study methods and focused more on questions which really helped improve my score. I took the additional time off after step to do research, and started 3rd year rotations this July. Assuming I do well in my rotations, step 2, and receive good SLOEs, will this gap in my education be a major hindrance to landing a residency in EM? or should I look to less competitive fields that also interest me?
Thanks for taking the time to answer our questions!
A gap in your application is not a deal-breaker for getting into EM, just something that needs to be explained. This is not the kind of gap that will typically create enough concern in a reviewer to disqualify you from interviewing. That could be different, depending on the reviewing program, if there is significant academic struggle documented in your transcript/MSPE.
DeleteHi, I got a Step 1 of 200, and am pending CK, which comes out in a few weeks. Passed CS. Got my 2 SLOE's and pretty certain they are above average, both programs I rotated at said people loved me. Got H in IM and EM, and likely to get 2nd highest "category ranking" on my deans letter. What are my chances of getting interviews this year considering EM has gotten so competitive? Obviously a high Step 2 CK will help, but assuming thats average ~220-230. Thanks for helping answer questions for us!
ReplyDeleteYou will still get interviews but should focus on programs that do not filter out applicants with lower Step 1 scores. EMRA Match can help you find these programs. The advantage to having the SLOE (though it does provoke some anxiety by forcing "ranking" of students") is that EM can emphasize board scores less when considering applicants.
DeleteEM is more competitive because each applicant is applying to more programs. The overall pool of applicants has not changed in size relative to the number of training spots (both are steadily increasing). Programs are adjusting how they evaluate applicants to account for the growing number of applicants who apply to them without being particularly interested in that program.
Hi Adam, thanks again for all of your valuable advice!
DeleteMy step 2 CK score came back, 228.
Now, with all the pieces from above and now step 2, should I be looking into applying for a preliminary spot? Or is it likely I'll get 10+ interviews with my stats (I know, a little hard to tell, but just based off whats been given).
Also, for those programs that screen low step 1 scores, if I am interested in the program, am I able to reach out to them and ask if they can review my application as a whole?
Thank you!
Based on the info provided there is nothing to make me think you won't match unless you apply mostly to programs that emphasize high board scores. Unless there is a red flag not mentioned you shouldn't need to apply to a back-up specialty.
DeleteI would not recommend contacting programs that volunteer that they screen scores to ask them to look at your application anyway. They are sharing that information to save you money by NOT applying to them in the first place. Spend your money elsewhere.
This is different than contacting a program later in interview season to let them know about your interest in them that may not have come across in your application. With Board Scores, they already have the info they are looking for.
Dr. Kellogg,
ReplyDeleteHow do programs view student applicants with previous substance abuse issues that have completed treatment?
That is a tough question to answer as I think this will vary a lot by program. Some will have had bad experiences with residents in recovery and will be more reluctant to interview students with that history. Particularly if there were legal problems related to this. Obtaining state licensure can become even more complicated than it already is.
DeleteHowever, many programs will be appropriately concerned BUT will still consider the student if their is evidence that they have been successful in their recovery. The personal statement is the common place this is addressed, though there is also a spot for legal disclosure in the ERAS application. The MSPE may also address this if med school work was affected.
Hello Dr. Kellogg,'
ReplyDeleteDO student here.
I went from 242 (step 1) -> 226 (step 2). Believe i got a middle 1/3 on my first SLOE. I applied 60+ programs. Should I be concerned about matching EM? thanks!
It is not common to drop step 1 to step 2 but your scores were not bad.
DeleteUnfortunately I cannot accurately answer your question based on the information available. What I can say is that IF you had a reasonable application strategy (more than half of those programs are welcoming to DO students) and your letter is a supportive middle 1/3 letter, and there is nothing else about your application that is going to hurt you, THEN you should be competitive for interviews and have a good chance to match.
Hi,I posted earlier regarding my drop in score.I’m sorry but I didn’t notice this is for EM.I am applying to IM.Any idea how good my chances will be?
ReplyDeleteBased on my understanding of the competitiveness of IM programs, you should be fine.
DeleteHello Dr Kellogg
ReplyDeleteI am in my last year of Medical School in Brazil.
Everybody knows gaps are red flags most of the times and I got stuck in a bad place considering my personal life because my husband is 48 and waiting to have our kids after at least 8 years from now considering I'll be finished the Residency at that time is not really an option.
I've been studying the past 6 months for the Step 1 aiming 250+ (scheduled for next March) and take all the other Steps in 1 year range in order to get over with this, get pregnant twice and then apply for my Residency, because I don't want to impair my training process neither to harm my future residencymates with any absense of mine. This scenario would give me around 3 years of gap between my Step 1 and my application for the Residency and 2 years between the last test taken. Is it too bad approaching this way or will be better if I start the process later to have my Scores "fresher".
My first caveat is that I do not know anything about the intricacies of training in EM in Brazil.
DeleteIf your plan is to come to the United States you will need to take the USMLE. Timing for step 1 is less important than for step 2, which you will want to take closer to when you are actually applying.
More importantly, to have a reasonable chance of matching into EM in the United States you need to gain clinical experience in an ED with a residency that has a history of taking students who trained internationally. This will be difficult to accomplish if your school does not have a relationship with a US hospital. After graduation, when no longer a student, doing clinical rotations will be impossible because of malpractice insurance. "Observerships" are not adequate experiences.
Hello Dr.Kellogg
ReplyDeleteI am a internal medicine resident in Brazil, YOG 2014, step1 215, step2ck 234, cs (2nd attempt), 1year research HSPH w/ 6 publications, 6 months observership (US medical schools-cardilogy, ID, ICU), 5 LORS, 1 month sub-I urology at Columbia, currently getting GC. I want to match in EM or IM, do you think its possible?
It is getting more and more difficult for IMG to match in the US as the number of residency spots has not grown with the number of graduates from US schools. However, IM is still a viable match for well qualified IMG's. EM is significantly more difficult, though not impossible. They key is to be able to complete an EM elective in the US at a program that takes IMG's. That is typically difficult to find. Most IMG's who successfully match to EM start in another specialty first (IM, surgery, etc), build clinical experience and connections, and then transfer to EM.
DeleteHello Dr. Kellogg,
ReplyDeleteI have a somewhat similar question to one above but I would like to ask it anyway. I have a misdemeanor DUI charge from 5 years ago and am other wise an average to competitive applicant (step 1 257 and honors/high pass on rotations). I go to University of Cincinnati but would like to return to the West Coast where I was born and raised and went to undergrad. What do you think my chances are of accomplishing this and do you have any advice other than writing about the incident in the ERAS application?
Thank you so much for your advice!
You should certainly be able to match to the west coast. Doing a rotation there will be very important to have a "west coast SLOE". How your EM rotations go will have a big impact on how truly competitive you are, including for the west coast. There is a special field to explain legal issues in ERAS and you will want to clearly tackle this in that space.
DeleteIf the charge is expunged, there's no need to report it.
DeleteHello Dr.Kellogg,
ReplyDeleteI am a US MD student who is very interested in EM. Due to family problems, which required me to be the sole financial provider for my family during my first year of medical school, I had to work a full time job to help support my family and had a tough time adjusting to medical school. I failed one course my first semester and just was not able to get back on track and thus took a LOA during my second semester and repeated first year. I came back and successfully repeated my first year successfully and was doing fine second year until my dad had an accident and ended up in the hospital a few days before my finals exams for 2 blocks and ended up failing those by 1 point. I have successfully remediated those blocks and finished up 2nd year. Having to deal with the repercussions of my dads accident and the financial burden it put on my family, I decided to take a second LOA to deal with my family problems before I studied for step 1 which I plan to take at the end of the year and start rotations in January of 2019. With all these red flags is it possible to still match into an EM residency? I am willing to go absolutely anywhere(will definitely apply to all 220 programs if monetarily possible) and have been active in research to show my continued interest although I have had so many unfortunate events taking away from my medical school career. My 2nd LOA was taken as I wanted to once and for all deal with the family problems I have been having and not let it affect my last 2 years of medical school. What is the best way to address these gaps and put my self in a position to maybe get a residency spot? Thank you for your time and advice!
First, applying to "all the programs" is never a good answer. With a little homework any student can figure out which programs are more realistic to their circumstances (geography, interests, personal competitiveness) and substantially narrow that list.
DeleteTo your specific circumstances: the reason multiple course repeats and LOA raise "red flags" to an application reviewer is the concern that this will happen again and the applicant won't finish residency. There is a strong association between early training struggles and later training difficulties, both anecdotally and in the education literature.
So any applicant with this type of "red flag" needs to convince the residency program that these issues are in the past and DO NOT predict your future performance in residency. #1 - do well on the rest of medical school with nothing to raise concerns. #2 - invest time into step exams as corroborating proof that you can "get it done" academically. #3 - you have to explain what happened, usually in your personal statement (that is where programs will look for an explanation after seeing the gaps in your transcript/MSPE) AND take ownership of what happened.
You CAN match into EM if you address these concerns. Though if you continue to struggle in third year, having to repeat shelf exams or clerkship, your chances of matching in EM really will disappear. Best of luck!
Hello Dr. Kellogg,
ReplyDeleteI am a US MD student with 2 LOA's on my record. One for medical reasons after not being able to cope with the stresses of medical school and the other to deal with family issue after my second year. I have 3 failures on my transcript also that I needed to remediate. I will be taking step 1 soon. With an average score, will I still be a candidate for EM residency? Or should I focus my efforts to another field? Thank you for your time!
It is hard to assess someone's candidacy in a "yes/no" fashion based on limited information. I can certainly tell you that matching into EM is going to be a very tough road as you will need to do a lot to reassure programs that you will successfully complete their residency. You would need a well above average clinical performance on your EM rotations to get programs to even consider overlooking the issues in your transcript.
DeleteAdditionally, EM is mistakenly considered a "lifestyle" specialty by some because the hours look better than most specialties. And yet EM has been found to have the highest rate of "burnout". The work can be incredibly rewarding, but is also high pressure, high risk, and done mostly at "off-hours". I would recommend you seriously look at what draws you to EM and consider if this really makes sense as where you can have a long and fulfilling medical career.
Hey! Do I need to explain a "yellow flag" on my PS? I am in the 4th quartile but my step 1 and step 2 scores are both in the top 25%
ReplyDeleteSorry for the delayed response - issue with comment moderation.
DeleteNope! I would not worry about that. So much of medical school class rank is determined by performance that is less important to EM PD's.
Hello Dr. Kellogg,
ReplyDeleteI am a US MD student with a first year drop out after 6 months due to severe headaches/migraines. I completed the rest of my regular themes in the repeat year but failed a longitudinal them due to which the school forced me to take LOA and remediate the longitudiral them in the next 3 months. I will start second year in 2019 July and take step1 in may 2020.
Am I at risk of not matching at all?
I did not fail any regular themes except the longitudional theme. Dean's letter won't mention this since it is a longitudinal theme but i need to explain the LOA.
With an average Step1 score, will I still be a candidate for EM residency? Or should I focus my efforts to another field? Thank you for your time!
Sorry for the delayed response - issue with comment moderation.
DeleteWhether you can still match in EM is going to come down to how convincing you can be that you will not fail future clinical experiences. If program directors see a pre-clinical failure it is rare for them to give an interview UNLESS it is well explained. You need to take ownership of what happened, what you learned from the experience, and explain why it won't happen again. It is also very important that you have no further issues as a second "red flag" would likely be disqualifying in EM.
hello! quick question- i'm a US-IMG planning to apply for this year's match. Step 1 & CS are done, and I have CK planned for the first week of September. I was wondering if applying a weekish late would be hugely detrimental to my application? (i'll be applying to psych) thank you so much!
ReplyDeleteSorry for the delayed response - issue with comment moderation.
DeleteDon't delay applying. Submit everything. Your Step 2 score will catch up with the rest of your application. (That would be my EM advice. The Psych match may be way more chill.)
Dr. Kellog,
ReplyDeleteThanks for your great post. I was wondering how a drop in board scores look like. Im a Northeast DO applicant, applying broadly. I dropped from a Level 1 535 --> Level 2 455. Unsure of how that happened despite strong practice test scores, but regardless the predicament I am in is that. I have 5 away rotations set up, strong LOR's, one third year SLOE with good ties to my home institution, and another SLOE in the process. High pass grades throughout all specialties, and strong endorsements on my Dean's Letter from faculty. Do you have any suggestions , aside from applying back up IM/FM?
Sorry for the delayed response - issue with comment moderation.
DeleteAn application reviewer is going to look for evidence that this was an aberration - that you will have no problems with future tests. This happens infrequently but seems to be more often with COMLEX recently. I don't think this sinks an otherwise solid application. Personally, I would look at rotation grades/comments to find out if you had trouble with shelf exams to confirm/disprove any test-taking issues. Without knowing that it is hard to recommend on whether to apply in a back-up as well. Sorry.
Hello - thank you for all of your advice!
ReplyDeleteI am in a 'red flag' situation and was hoping for some input. I failed Step 2 CS and retook it as soon as possible - that means my new score will be reported now Oct 10th at the earliest. Is that too much of a delay in releasing STEP scores to programs? Would you recommend releasing them in September and updating them once my new score comes in, or waiting to release them until I can show a passing score?
Thank you!
Sorry for the delayed response - issue with comment moderation.
DeleteYou probably already made this decision, but I would not delay releasing them. Programs will be expecting you to retake them. CS is not generally considered to be disqualifying. You will definitely want to let programs know when your passing score comes in so they can download an updated transcript. You should be able to get wait-list consideration if there are otherwise no issues with your application.
Hi Dr. Kellogg,
ReplyDeleteI am a US DO student who got a USMLE Step 1 score of 229 but failed Step 2CK by 1 point. I took and passed COMLEX Levels 1 and 2 comfortably. I've heard conflicting things--is it required to send my USMLE transcript? If it is an optional disclosure, I did retake Step 2CK--if I get my score back and do well, would that change whether I should report?
Sorry for the delayed response - issue with comment moderation.
DeleteThat is a tough call. I do not believe that as a DO you need to release a USMLE transcript, BUT to share any USMLE score you need to share all. Probably not worth it, unless your step 2 score was above average (>240).
Hello Dr. Kellogg
ReplyDeleteI am an img graduated in the year 2014 with step 1 244 and ck 246. Unfortunately I have an attempt on cs. I know that it’s difficult to get EM residency should I try for IM or quit the entire process. Thanx for your valuable time.
Sorry for the delayed response - issue with comment moderation.
DeleteI cannot speak to whether IM is viable (outside of my expertise), but I am afraid that EM is unlikely to happen. Being an IMG applying to EM is very difficult and requires clinical rotations in academic ED's in the US and you can't really have any flaws in your application.
Would getting Passes in the two EM rotations (MS3 home + one MS4/sub-I away) I've done so far be considered a red flag? The main reason I only got a Pass on my away sub-I was because I didn't do well on their in-house exam. Granted, I definitely should have studied harder but I also didn't have the benefit of experiencing a NBME or SAEM shelf as my home EM rotation doesn't make us take an exam.
ReplyDeleteAll that being said, the clinical comments I've received have been positive, so I hope that the SLOEs won't turn out too badly (but who knows, they've already been uploaded). Step scores are pretty average. No other red flags. How is all of this going to affect my chances for matching into EM?
Sorry for the delayed response - issue with comment moderation.
DeleteThe impact of a "pass" depends on a programs grade distribution. If very few people get "pass" then that would be concerning and would at least count as a "yellow flag" if unexplained. Some rotations grade tougher or don't have "high pass" between Honors and Pass. The contents of your SLOE's will be way more important as they will give context to everything. If you had good clinical comments, hopefully that is what your SLOE will say. Average scores should somewhat reassure programs that you don't have a "test taking issue" (that would be the concern raised by the in-house exam issue).
Hello
ReplyDeleteI am a US IMG from India, 251 and 263 on Step 1 and Ck. Have 3 LORs from observerships in reputed hospitals. Just found out I failed Step 2 cs, I retook the test yesterday, but what are the chances of matching into a good program for IM this cycle?
Sorry for the delayed response - issue with comment moderation.
DeleteThis early in the process, you should be able to get a passing CS score in time to reassure programs. In EM, this would unfortunately be disqualifying as all interview decisions will likely be made prior to your new score being available. HOWEVER, I don't know how IM program directors deal with CS. Sorry to not be more helpful.
Dear Dr.Kellogg,
ReplyDeleteGreeting!
I am an IMG with some red flags , applying for IM residency in 2018-2019 season. As an IMG can i post my question here?
Sorry for the delayed response - issue with comment moderation.
DeleteHappy to try to help. I don't have much expertise with the IM match and what IM PD's look for, but will try to give you the best advice I can.
Dear Dr. Kellogg
ReplyDeletethanks for all your clarifications
I am an IMG with CS attempt,(step 1 217, Step 2 253)retaking this month,to IM, result wont be out till november, applying and to update programs later. Do you think I should address the CS failure in my PS?.
I do think you should address the PS failure. Your step 2 CK should be really helpful getting IM interviews, but that CS fail will worry programs about your communication skills and language proficiency. You will want to use the PS to preemptively address those concerns.
DeleteDear Dr Kellogg,
ReplyDeleteI did average on comlex 1, 2 and step 1 but now just learnt of my failing comlex pe , I believe it was reported by error. Do I still stand a chance to match? How do i go about it? Earliest score retake would be back for December. I applied for a backup besides EM in primary care but seems that backup is slightly competitive but not as EM
If you really think it is an error you need to contact the COMLEX administrators. But you do need to accept that is unlikely and make a plan to retake ASAP.
DeleteMatching to EM programs without a PE pass is very unlikely BUT you may still be able to get some interviews. They will make your being placed on their Rank List conditional on passing PE.
This will make getting EM interviews harder, so you should put some effort into making sure you have enough "backup" interviews.
Hi Dr. Kellog,
ReplyDeleteThank you so much for answering all of our questions and helping us wade through this process. I am a US MD applying to EM, and my only flag is my low board scores (215 step 1, 232 Step 2). I was told that I did not need to address this in my personal statement, but after only receiving two interview invites thus far (1 home institution, 1 in the me state as my away) I am starting to freak out a little bit. My home SLOE was at least top 1/3rd if not top 10%, and I do not know about my away (most likely middle 1/3rd or top 1/3rd). Middle of the pack class rank with HP in all clerkships except medicine and surgery, which were honors. Thanks in advance for you help and advice!
I understand your concern and hope that a few offers have come in since you posted your comment on October 13.
DeleteBased on the information provided you should have more interview offers by now.
If not, there is something in your application scaring programs away that you are unaware of. Maybe your SLOE's are not as good as you believe or there is something else that you did not consider a problem but concerned programs (examples are: misdemeanor conviction, early MS LOA or course repeat).
Your scores are a little below average but fine and did not need explaining. They were likely to cap how many interviews you got in october but are not going to hurt you overall.
Either this has corrected in the last 10 days or there is something else in your application hurting you.
(My apologies for the slow response, especially this time of year. We are having issues with the platform.)
Hi Dr. Kellogg,
ReplyDeleteI am a DO student applying EM and have so far gotten 11 interviews, 3 to AOA programs and the rest ACGME. I recently found out that I failed COMLEX 2 PE. I have not released that score and because it was released so late in the cycle, the soonest I can reschedule is in early January and would likely not be back in time for rank lists in the ACGME and certainly not for AOA programs. So effectively programs would not have any PE score at all on my file during rank lists. What options do I have?
That is a tricky one. This is going to come down to whether the individual program requires a PE score in order to rank you. I suspect that many of them will not look for this, though some will. Any program that needs insists on your PE score is also likely to take you off their list if they see you have failed and not yet passed on a retake. Clearly you need to retake it and pass ASAP so you can start residency, BUT I think the best course of action at this point is not to release that score to programs unless asked for it.
DeleteI would highly recommend discussing this with your Dean.
I would give the same answer.
ReplyDeleteUnfortunately many programs will not rank you without step 2.
All will not rank you, if they see this score.
From a professionalism standpoint this is very dicey. Programs expect you to post when you have the score. If you match without posting, they will be upset and feel that you have betrayed their trust.
Think long and hard if that is how you want to begin residency.
You absolutely need to sit down with a Dean ASAP and develop a backup plan.
Hi,
ReplyDeleteI'm an non-us IMG with a score drop from 252 in step 1 to 244 in step 2. How screwed am I?
This should not hurt you at all. A concerning score drop would be either a big drop (8 points isn't that big a drop) or when the step 1 score was already low, followed by an even lower step 2 score.
DeleteHello,
ReplyDeleteI am a US-IMG entering 3rd year. I really love EM, I worked as a paramedic for around 10 years prior to medical school and I have a hard time picturing doing anything else. I am a bit discouraged with my Step 1 score (221), I was really hoping for >230 for EM. With an improved Step 2 and good SLOE's is it possible to still match EM? Thank you for any advice you may have.
Improving step 2 will help, but the most important thing you can do is get rotations at EM programs that have a history of taking IMG's. That is what is really going to decide if you will be able to match into EM.
DeleteHi there,
ReplyDeleteI am a third year medical student at an MD school. Failed Step 1 with 193 and retook within a month with a 211. I am not sure if I would even be considered for EM anymore, wondering what you think.
Failing step 1 is not disqualifying from EM. You will need to do some extra work to convince programs that you will not struggle with the boards in the future. The single best thing you can do is to put extra work into step 2 prep. An average or above score will do the most to reassure programs.
DeleteYou also want to make sure there are no additional concerns in your application. Many programs will look past one "red flag", but not two.
Hi,
ReplyDeleteDO applicant; STEP 1 201, Level 1 451, Failed COMLEX PE once (retook it, scores are pending). I am having trouble setting up auditions in SLOE months of July-Aug. My home institution denied me an EM audition, and most of the programs I applied to on VSAS are still pending. I don't know if I should keep going or consider doing another specialty. I can a few auditions set up in Sept/Oct/Nov, but getting a SLOE would most likely be too late by then? I recently also got a pass on one of my clerkship rotations (OB/GYN). I have one LoR from an EM ultrasound clerkship back in my 3rd year.
Thanks for your advice!
Unfortunately you have a few things counting against your application that are going to make EM tough, but not impossible. You should definitely start planning to apply to another specialty as well. A big jump on step 2/level 2 and a PE pass will help with your application. Look at non-VSAS programs to try to get that July-Aug rotation. A september rotation still gets letters in time for review for wait-list and later offered interviews (your scores will already keep you from getting many "early" interviews). Even if you are only able to get a few EM programs on your rank list ahead of the other specialty, all it takes is one program ranking you high enough to match.
DeleteHi Dr. Kellog! Would also like your advice:
ReplyDelete1. MD US grad at an average midwestern med program
2. Step 1: 220 Step 2: 239 Step 2CS: pending - God willing, a pass
3. 3 Honors (IM, psych, neuro), 1 NH (OBGYN), 3 pass (FM, Peds, Surgery)
4. 2 aways one at a top institution and another at a community program.
5. EM SLOEs -pending. Currently on my first rotation. I am consistently getting avg - good reviews. One attending gave me top 1/3 sloe; another gave me mid middle 1/3 sloe - so I am hoping for an all in all top/high avg sloe.
Where do you think I fall? Will I need to dual apply into say IM?
I can only assume your question is prompted by the 220 step 1? With your improved step 2 the majority of programs will not be concerned. There is nothing about the information you provide to suggest needing to dual apply. You describe an average EM applicant, and those folks all match.
DeleteHi Dr. Kellog,
ReplyDeleteI recently found out I failed step 2 CS, specifically the ICE portion. I have yet to take step 1 and step 2 CK. I plan to apply for radiology and IM match 2020/21, a year from now. Is it a good idea for me to focus on completing at least step 1 before retaking CS?
Will residency programs not like it if there is a delay in retaking CS even if I take step 1 and possibly step 2 ck in between?
Also I am a US IMG, if I score really well on step 1 and ck will that be good enough for programs to overlook my failed cs attempt? I intend to fully address my first attempt failure in my personal Statement.
Thank you!
I don't know if IM and Rads put more stock in the CS than other specialties, my knowledge is pretty focussed on EM where so long as you pass the CS on the retake we don't tend to worry about it.
DeleteStep 1 and Step 2 are more important to your application and deserve more attention and prioritization.
As an IMG it is going to be important to have passed CS before applications go out to reassure everyone that there is not a language barrier based communication deficit to blame.
Hi Dr. Kellogg,
ReplyDeleteI recently found out I failed the ICE portion of Step 2 CS in late August of this year. I forgot to include vitals/pertinent physical exam negatives into my notes during the exam. At this point, I will be retaking on October 14th which corresponds to a score release on December 11th. Otherwise, I am a 4th year US senior, 230s STEP 1 and 240s STEP 2 CK, 5 Honors/2 HP across third year, EM leadership across my school/EMRA, and at this point, 2 SLOEs that are supportive HPs (My MSPE include supportive comments on clincial skills/ H&Ps as I am sure the SLOEs will as well), and unsure of third SLOE at this point (will be in app mid-October). I've included this failure on my Personal Statement in detail. What do you believe my chances of matching are this cycle?
This is going to hurt you some, BUT you are by no means sunk. Getting a pass on CS as soon as possible is the right thing to do. You may get a few less interviews but many programs will still be willing to interview you. The big impact is that programs will not rank you without a passing CS (similar to step 2). It is reasonable to briefly explain this on your PS, so long as the emphasis is on making it clear this is an anomaly and not reflective of your interpersonal skills. Reviewers will be looking harder than usual at your letters for communication/teamwork questions and might even look at your SVI.
DeleteHello Dr. Kellogg,
ReplyDeleteI was caught in a situation of academic misconduct where I cheated on an assignment during medical school. As your post mentioned, my school will still graduate me. I am very regretful of my actions and this incident. This will be noted on my MSPE and I will address this on my personal statement as well. Step 1 230s, Step 2 pending, Clerkships all Pass, with exception of one where I have to repeat the Shelf exam. What are my chances of matching into a family medicine residency or am I doomed to match anything? I would really appreciate your realistic and honest opinion.
Thank You,
US Medical Student
I am not an expert on the Family Medicine Match so I would consult with an advisor in that specialty. If you are graduating in good standing and can take ownership of your mistake I would think matching will still be possible.
DeleteHi Dr. Kellogg,
ReplyDeleteThank you for creating this straightforward guide for prospective EM residents. I am a third year DO student who took two years off due to my father's illness and failing comlex level 1. I finally got everything sorted out and scored just over 500 on my level 1 retake. I will be redoing my third year per my school and am considering taking step 1. Do I have a shot at EM due to my past failure and extended LOA? My aim is to do well on Step 1 but if I can only score around average on step 1 is it still worth it? Should I take step 2 (with level 2) instead? I am definitely applying to IM not sure if if EM is worth trying in my situation.
Thank you for your time!
You do have a shot at EM, but a lot will have to go right to get there.
DeleteAny failure of a knowledge portion of either board exam is going to hurt your chances. That being said, IF there is a good reason for what happened, AND evidence that you are likely to pass future tests (doing well on retake and subsequent tests), THEN you will get consideration from some EM programs.
The rest of your record/application will need to be without further concerns and you need strong EM letters (SLOE's) to give programs incentive to take a chance.
I would take step 1 and step 2 if you are able: the more data points you give application reviewers the more likely they are to believe these troubles are behind you. Best of luck!
Hi Dr.Kellogg,
ReplyDeleteI am an MS4 in my sole EM audition rotation due to COVID. I was late to a shift today by a couple hours from reading the schedule wrong, but made up the time at the end of my shift and apologized. I have received only good feedback on my shift evals and was told not to worry about it by the residents, but am now worried about my SLOE since it is completed by the attendings. I did report being late to our clerkship administrative coordinator and head resident and am worried it come back to hurt me. Do you find students with one, isolated incident of being late for something during their month rotation to be considered worth mentioning in their SLOE? Do you have any advice on how to handle this? Thanks for your time in advance and for doing this thread.
Isolated incidents don't usually make the SLOE. So this needs to be the only time. You are now the student who is 10 minutes early to EVERYTHING. Take no chances.
DeleteHi Dr. Kellogg,
ReplyDeleteI am worried about my chances this cycle. I scored a 480 on COMLEX I, worked really hard for COMLEX II but, to my great disappointment, got 473. Not only did I not improve, I had a slightly lower score. I tried some new methods for studying but it probably ended up hurting me some. Of course, I was devastated. But I know I love EM and this is what I have to work with.
I have 5 Honors including IM and EM. I should have a strong SLOE from my home rotation (affiliated with UNC) and will do everything I can to excel on my upcoming EM rotation. I also have a SLOE from palliative care and one from an EM faculty. Otherwise, I'm pretty average with class rank and grades for the first two years.
I am networking like crazy and trying my best to control whatever I can to better my chances. I have selected only DO friendly programs that do not have a cutoff. Will be applying to 50-60 programs. Have 2 interviews confirmed at this point (one from away rotation and another granted from another program I wanted to do an away at)
Do I have a shot? I'm truly a bad test taker/can't deal with text anxiety and but I've never failed any exams/classes/clerkship. I just worry with both low COMLEX I and II scores my chances are extremely low.
Thanks for your input and taking the time!
Your scores are going to worry some programs but if the rest of your application comes across as described you still have a good shot at matching. If you are really worried then apply with a parallel plan (back-up less competitive specialty) so that you know you will match somewhere.
DeleteScores are not the number that truly matters. Getting 11-12 interviews is what will have you in the 95%+ match range, even with low scores. Your letters, even this year, will be most important. You describe a well targeted application of realistic programs, which will give you the best chance at those 11-12 interviews.
Thanks Dr. Kellogg for your honest feedback! I'll continue to work hard and hope for the best!
DeleteDr. Kellogg,
DeleteOh I forgot the obvious question--Is this something I should address in my personal statement? Obviously I'm not gonna make any excuses for the scores but any tips on how I should approach this, if I do need to? Is it something I would just mention briefly and focus on the positives? I'd hate to spend too much space on this aspect unless I need to!
Thank you again.
I don't think you need to discuss this in your PS, UNLESS you think these scores DON'T represent your standardized test taking proficiency. That only makes sense if there is one score that is out of line with others. Programs that put a big emphasis on testing will be less likely to interview you, but many programs think they do a good job with test prep for their residents and won't be afraid. You are right that the most important thing to do is NOT make excuses in your PS.
DeleteDear Dr. Kellog,
ReplyDeleteFirst, thanks for your great advice. I am a non-US IMG. I have an excellent CV with unique experiences in research, US clinical experience and also volunteer. Even some doctors from the US have been impressed with it. However, despite passing Step 1, CK and CS on the first attempt, my scores are way below average (21x in both). Some people tell me to address that in my PS, some people don't. What do you think would be the best approach?
The concern below average scores creates is that you could struggle to pass your EM boards. Board pass rate is an important marker by which EM residencies are evaluated. I would address this in your PS if you believe you can explain it in a way that reassures application reviewers that these scores do not represent how you will do on an EM test. If you don't feel that you can make that case I would NOT bring it up. Let them draw their own conclusions.
DeleteHello Dr. Kellog,
ReplyDeleteI am US IMG with Step 1 and CK in 220s. I am applying IM/FM. I failed Step 2 CS before the pandemic and could not retake it cuz CS is canceled for 18 months. Should I address my CS failure in PS and if yes, how can I address it? Thank you.
I don't think a CS fail will be a dealbreaker in IM/FM, but that is outside my expertise. I would explain it in the PS. Your goal is to make it clear that you will pass when you are allowed to retake it. That means an honest explanation of what went wrong and what you are going to do to make sure it doesn't happen again.
DeleteHey man, American IMG here. Step 1 221 and step 2ck 228 applying to EM and FM back up. I really want EM and although i already got some intervuews, i wanted to know how best to address medical ethics, a class i did not pass in my 2nd semester. What is the best way to answer this question with confidence?
DeleteHonesty. What went wrong that you had to repeat and (most importantly) what did you learn that has made you more successful going forward so that NOTHING like this ever happens again. That is what I want to know about ANY course repeat or board struggle - what did you learn and have you grown so that it won't happen again.
Delete