You will find many different opinions about when is the optimal time to take Step 2 CK. I believe this decision should be based on one main question: What can you do between June and August to best strengthen your application? I know it is frustrating to have such a broad answer, but I think that is the best answer, and it takes into consideration a few of the following factors: 1 – Step 1 score, 2 – away rotations, 3 – letters of recommendation, 4 – study time needed to do well (please note that I am not giving score cutoffs…that is up to you/your mentor to determine into which category you best fit).
If you did great on Step 1, then Step 2 is somewhat less of a priority for ophthalmology applications. While other specialties may look more heavily on Step 2 performance, the reality is that Step 2 is not looked at nearly as carefully as Step 1 is for ophthalmology, largely because not everyone has taken Step 1 by the time they apply so it is difficult to compare performance between applicants. If you rocked Step 1, you will likely rock Step 2 (smart people are smart). If you are in this group, it may be a good idea to strengthen your application in other ways (research, away rotations, etc). In my opinion, someone that rocks Step 1 has more to lose by taking Step 2 early (May-July) than they have to gain by rocking it, so it might be best to take it after your application goes in.
If you did poorly on Step 1 but still think you have a shot at matching into ophthalmology, then your answer to the main question of how best to strengthen your application will likely be to improve your Step 2 score. Take it early enough that you will at least have a score that you can report to your potential programs by the time they start screening applications. If you get it to them when they have already invited for interviews, it is too late, as they likely already screened your application out by having a somewhat lower USMLE score than they typically invite. My recommended timeline would be to report your score by mid to late September or early October if you hope they will have it in time for reviewing your application. If you just want them to have it by the time you interview, then give yourself a month before the bulk of interviews take place to take the exam.
If you didn’t rock Step 1 but you didn’t do poorly either. Blast…welcome to the group in which most of us find ourselves, in the cluster of 1-2 standard deviations from the perpetually-increasing mean. Unfortunately, the decision isn’t quite as clear for this group in my opinion. Again, what can you do to best strengthen your application?
Are you weak in research? Do a research rotation
Are you somewhat weak in clinical grades or have had little clinical exposure to ophtho clinically? Do an ophtho rotation
Will an away rotation at some other rotation be the best use of your time? Go away
Will a rotation at your home program and a subsequently awesome letter of recommendation be the best for you? Stay home
If at the end of the day you feel that doing well on Step 2 is the best use of your time to strengthen your application, then that’s your answer.
Whenever you decide to take Step 2, take into account how much time you needed to study for Step 1 and if you felt that was enough to do well. Were you ready for Step 1 in 2-3 weeks of hardcore studying? That might be all you need for Step 2, or even less. Did you need 4-6 weeks or more to really feel ready? Plan accordingly, but keep in mind, if you study for this much time during May-July/August, you are doing so at the expense of giving your all in some other area of application-strengthening, and it may be best to take Step 2 a bit later (after application goes in) so that you can submit your newly-strengthened application in other areas before you get your hardcore study on.
Sorry for the generalities, but you are unique (ahh precious) and the strategy of how to schedule your fourth year must also be unique. As evidence of this, among the four classmates from my school applying for ophtho, one took Step 2 in June, one in October, one in December, and one in January.
What was my story? I was in that blasted middle category of standard deviation clustering about the mean. I felt as though the time it would take me to study well enough to do well on Step 2 was not worth the application-strengthening of June-August, and thus chose to take Step 2 after my application had gone in. I did 8 weeks of research in June-July, sent in the application, did a month of ophtho at home program, then studied for Step 2 from mid-September to mid-October and took it the third week of October right before interviews started. I got my score back in enough time to be able to tell programs my score if they asked me at interviews. For what it’s worth, however, out of the 13 interviews I did, I think only two asked about my Step 2 score.
US allopathic student I got a 236 on Step 1 and just got the result of my Step 2 and they were a very disappointing 230. I knew I needed to get a higher score on Step 2 to make up for my Step 1, but now seeing the score actually drop I am thinking my chances may have been shot.
I took a research year after MS2 and got a first author publications in Retina and IOVS, 4 first author Case Reports, and co-author on three more manuscripts still under review. My class rank is on the lower end as well; pretty much all high passes with two passes which dropped my rank to the bottom quartile. I am thinking that the low Step 1 and even lower Step 2 coupled with class rank essentially preclude chances of matching. So my question is should I still pursue my away electives I have set up, or use that time to perhaps begin gearing up for attempting to match a different specialty?
Was very set on ophthalmology hence the research year, but I am beginning to think it’s simply not feasible with those numbers.
James,
Thanks for your comment. Standardized tests are just plain awful and getting a lower score than you were expecting can be discouraging and make you want to throw in the towel and quite following your dreams and passions. Getting a fairly average (no offense, it’s just factual) Step 1 score and then a slightly lower Step 2 score is discouraging but is NOT the end of the world. You just happen to be talking to someone who is overall very “average” when it comes to all tests at all levels of my post-kingergarten era, and there are many like us. Keep in mind that the average is just an average – sure your score may be lower than the average for matched applicants, but that’s just an average. You have some seriously legit publications, and your dedication and interest in the field will go far as you apply to residency. Going into medical school, I knew that I would not be a 95th percentile Step 1 test-taker, so I really pushed myself to do as much clinical research as possible, and like you, had several publications, that I believe, did make up for some lost points on Step 1. Others in my med student class did virtually no research but dominated standardized tests and clinical rotations (which include tests, arrrgh!), and they matched at very similar programs to the one at which I was very fortunate to match. There are many different roads to the finish line, so don’t be discouraged when it seems like you are off the road and you can’t even see anyone else on the trail with you. You’ve got this. Apply broadly, don’t be discouraged, do well on interviews, stay passionate and hungry, and you will match, just like the rest of us who find ourselves having ‘regressed to the mean’ despite our most hopeful dreams. Stay in touch and thanks for posting! – Steve
Hi, I am an IMG (almost 5 years out of med school), hoping to apply for SF Match in the coming cycle. I have been a research fellow doing research in Ophthalmology for almost 4 years, and have presented posters at ARVO over the past years. I recently took my step 1 and scored 236. My overall score is below the national average, and am concerned about 1) whether I stand a chance of matching into an Ophthalmology program; 2) Also, based on my score what do you think would be the right time to take CK? Do you think having a CK score before submitting the application would be better or getting it by September before the applications are looked at would be reasonable? Thank you in advance for all your assistance.
Sam – thanks for your comment. Have you been doing research at a US medical school or research institution? Do you have actual research publications from those 4 years or just ARVO posters?
Thank you for the prompt response. I am doing research at a University program in the US and have more than 10 publications in ophthalmology (1 first author, few are 2nd author, rest are names in collaborated projects; also to mention that few of the publications are published clinical trials).
Sam – congrats on your hard work and research. I think you have a good shot at matching in ophthalmology, given your extensive research background. Your step 1 is below average, but as we know, an average is just that. Many others match with your same score (or lower!). I would apply broadly and ask your mentors to help connect you with programs that may be a good fit. I would recommend taking Step 2 before the application, but only if you feel you can do as well OR BETTER than your Step 1 score. With you being so far removed from training, programs will want to know that you are competent in the foundational concepts in medicine tested on Step 2. If you don’t take it before applying, they may wonder why, in the four years you’ve been doing research, didn’t you take test? They may wonder, and this doubt may be detrimental. I think you have a good chance – good luck and let us know how things go!
Thank you very much! I truly appreciate your advice.
Hi Steve! I am an MD-PhD student who is returning back to Med3 this year. My score was a 243 on the USMLE Step1, and I have reached out to the program director here to pursue a career in Ophtho. I was wondering if you had any advice on matching into Ophtho? I have been interested in this speciality after we covered it in med 1, however do not have a ton of experience in it. I saw the SFmatch Step 1 scores are going up more and more each year so even though my 243 was pretty good back then, it is not as great now.
Thanks for your advice!
Thanks for your comment! Congrats on finishing your PhD work and now returning to the hospital and clinical medicine! Your step 1 score is plenty strong to be viewed very competitively. Yes, it’s not maybe in the 99% percentile, but it will be just fine. I like that you have already reached out to the program director – he/she will be an important mentor as you gain clinical experience, get involved in clinical projects, and prepare your letters/application in the coming years. Your PhD will get you immediate cred among residency programs, and will be a huge strength to your application. Assuming you have performed well and your PhD mentors like you, your ability to perform research will not be doubted by anyone (and with good reason!). If I were in your shoes, I would simply do as well as you can in your clinical rotations. Try and get involved in a few clinical research projects, but not necessarily to the same extent as someone without your research experience. Unless your PhD work directly involves the eye, few will really understand your research to the extent it deserves, but it’s worth understanding that in ophthalmology we really look to ophthalmology-related projects as a demonstration of committed interest in the field. If you can fit an ophthalmology elective into your third year, that would be great. Try and start getting to know some of the clinical faculty, volunteering in “something,” especially if it is ophthalmology-related, and start thinking about whom you may eventually ask to write you a letter. I’m excited that you are interested in ophthalmology! Thanks again for your comment! Let us know how things go!
228 Step 1. Prior experience: ophthalmic tech for 2+ years, community service related to ophthalmology (vision screening, presentations), published in RETINA. Planning to present at ARVO 2018. Based on score and extracurriculars, do you think I need to take Step 2 early to submit along with my application? Average scores are only going up and I’m right at the average for 2016. Even considering doing a gap research year if I have low chances of matching but hoping it’s not necessary.
Hi Steve. Thanks for your comment. You are in a tough spot, as you sound like you are very interested in ophthalmology and have demonstrate your interest with a solid publication in Retina, plans to attend ARVO 2018 (in Hawaii!), and have other extracurriculars/service, but your scores are below average for the ophthalmology match and falling near the range of the average for unmatched residents. I think when you intend to take step 2 depends on two things, 1) your confidence in scoring higher on step 2 and 2) the opportunity cost of the time you may need to significantly boost your score.
1) Was Step 1 a good demonstration of how you did on practice tests, the NBME shelf exams, and in class? Do you hover right around the average or just slightly below? If so (which is fine!), then step 1 probably was a pretty good demonstration of where you are at on standardized tests, and notwithstanding a Herculean effort to increase your score, you will probably end up right around there again on Step 2, which won’t necessarily do anything to help (or hurt) your chances. On the other hand, maybe your step 1 was a fluke, and you think you really should have scored much, much higher. In that case, maybe you will score higher on Step 2. In my experience, with my “n” of 1, and having observed where my classmates ended up on Step 1 in relation to where I thought they would end up, I think Step 1 does a pretty good job at recognizing the high score test-takers, the low score students, and the rest of the ~70% that lies somewhere in the middle.
2) What would it take for your to substantially increase your score? I’m not talking about getting at 230, or a 235. I’m talking about getting at the minimum 240 or higher. I think only a significantly higher step 2 score will overshadow an average step 1 score. To get that score, will you have to take months off from research time, community service, and other worthwhile activities? If so, then it may not be worth the risk of only “moderately” increasing your score (or getting a lower score!), because you could have spent all that time doing other activities that would strengthen your application.
Hope those thoughts help. I can’t tell you what I think you should do. What I can recommend, however, is that you apply very broadly, go on as many interviews as you can, use ARVO 2018 to meet residents at the various programs around the country, and try and connect with others that may be able to help you land interviews to show that you are one of those that will be an amazing doctor and colleague in the future! You’ve got this. Good luck! – Steve
I am ophthalmology resident in egypt , got 209 in step 2 ck .
Is this score greatly affect my chances ?
Or the excellent step 1 score will correct this problem ?
Thanks for your comment, Sharef. You mentioned your great Step 1 score but didn’t actually say what it was. Regardless of whether it was 210 or 260, I do think a Step 2 CK score of 209 may make it more difficult to match into a US ophthalmology residency immediately out of residency in Egypt, but it’s certainly not impossible and I am, most certainly, no expert on the matter! Thanks again for reaching out. If any other readers have tips for Sharef please leave a comment!
Hi Steve- I am a current MS4 on my research year before applying next cycle. I scored well on my step 1, but have not taken step 2 yet. Since I will technically be an “MS5” by the time I apply next year, would programs expect me to have a step 2ck score? Or is it okay for me to maximize research (which I am lacking) and ophtho clinical rotations, take step 2ck a year from now, after apps are sent? Thank you for all your posts, I enjoy reading them a lot!
Henry – Thanks for your comment and I hope your research year is going well. Congrats on your decision to pursue ophthalmology and on your efforts to strengthen your application. And congrats on having done well on Step 1, that is huge. My recommendation would be that you DEFINITELY take Step 2 CK and have your score before submitting your application. In my opinion it will be a red flag if you will have had an entire year to take the test but chose not to, even if the reason was so that you could focus on your research year. You have to take the test eventually, so just buckle down and get it done. If you can set a few weeks aside (or even a month) to really study hard, that may be sufficient. Also, the longer you wait the tougher it will be to study (arguably) and the more of your Step2 CK knowledge will begin to vanish from your memory. Your situation is unique, in that you aren’t doing a research year because you didn’t match, but because you wanted to strengthen your application so you will match. If you rocked Step1, chances are you will rock Step2, so study hard, and get it done. Also, as an aside, be sure to submit an abstract to ARVO so you can present at that meeting in the Spring. Abstracts are due typically around the end of November. Hope that answers your question – if not, let me know, and thanks for reading the blog!
Henry! I’m so sorry I never replied! I just saw your comment! If I were you, I would try and have my Step 2 CK score by the time my application is submitted. I wish I could definitively say that it wouldn’t matter whether your Step 2 CK score was listed or not, but I do think that programs may wonder why you don’t have your score yet when you will have had an entire extra year to study and take the exam. They may NOT notice, but if they do, I think they will look poorly upon your delaying the test and wonder why you didn’t just take it as an MS4 or even an early MS5! Since my response is so embarrassingly delayed, what did you end up deciding to do?
hey steve,
You actually did reply back in august, so thank you very much for that. It made sense to me to take it early after considering your advice. I ended up taking step 2ck during my gap year and scored well. Right now I am in the thick of my research year and gearing up applications soon. Again thank you for your encouragement and suggestion.
Hi Steve, thanks for this article. I am a MS3 halfway done with my rotations. My step 1 is 250, but so far my clinical grades are disappointing so far. (Peds-Pass, surgery-NH). I started ophtho research recently. I have two other research projects unrelated to ophtho. I really enjoyed my ophtho rotation but I like IM rotation as well. What do you think about dual applying to ophtho and IM? My reason for dual applying is 1) I am limiting myself to the East coast and SE and maybe Midwest because my significant other is in SE. 2) ophtho is competitive and I am afraid I might not match anywhere. Have you heard of people dual applying? Thanks for your input.
Ally – Thanks for your comment. Glad you liked the article. First of all, I’m excited that you are interested in ophthalmology. It is a great field. Internal medicine is also a great field which I also considered pursuing. I think your step 1 score will open doors to a successful match in either field. I am admittedly unfamiliar with the IM match and criteria for resident selection, but my guess would be that clinical grades me be more carefully scrutinized in internal medicine than in ophthalmology, granted that you pass and do at least fairly well. Matching into ophthalmology does not require honoring every rotation by any means. Continue becoming more and more involved with ophthalmology research and getting to know the faculty who will help write your letters of rec. I guess the bottom line is keep doing what you are doing as you are on a good path for a successful ophtho match. As for dual applying, I don’t know anyone that did so, but I’m sure it can be done. As you prepare your letters of rec you’ll want to be extremely careful that your writers know you are dual applying and can possibly even write two letters (one for ophtho one for IM) so you optimize your chances of matching into both. Having an ophtho letter of rec that states you will be a successful internist could be bad for your app, and vice versa. Anyway, hope that helps! Best of luck! – Steve
considering last match mean score for IMG qualifying into ophthal residency was 245
I’m not ever going to say you shouldn’t pursue your dreams, and I am definitely not any sort of expert on what score you need to match, as so much goes into it beyond just your step 1 score, but the numbers aren’t in your favor. Hopefully your prior experience can help you. It sounds like you are already an ophthalmologist and are now trying to do residency in the US?
Thanks Steve found it very helpful.Yes the numbers aren’t in my favor though i tried hard-my nbmes predicted otherwise.Yes am already an ophthalmologist moved to USA following marriage to a US citizen, was pursuing a research fellowship in USA..Ophthalmology is my passion and i want to get back to it-thanks again, hope you don’t mind my queries in future
Hi steve am a IMG just got my step1 results -222, i thought i prepared very well for exam but panicked on exam day and dint do well. I have more than 8yrs of ophthalmology experience-residency,fellowship and practise in my home country. Is it possible to get into ophthalmology residency with these scores if i do well in CK? am currently pursuing research fellowship here in US. Is it possible to get back to ophthalmology residence here or should i consider other branches like FM? I do have a few publications. Hoping for your reply and many thanks for your time and patience
Hello steve, I am an international student (us citizen) and got a 220 on my step 1. I know I need to improve my step 2. When do you recommend taking step 2 if application opens June 1?
Kari – Thanks for reading the blog and for your question. If you know you need to improve your Step 2 CK score in order to improve your application, you should take the exam with enough time to have your score back in time for you to include it in your application. Given that most applications are due in the fall (I believe most deadlines are in September), and that it takes a few weeks to process your SF Match application after you submit it (submitting in August), and that the Step 2 CK score takes around 4-6 weeks to be sent, you should probably attempt to take Step 2 CK in the summer, maybe in June or July. Another option might be to send all of your programs the score as an update to your application in September/October, and thus you could take it in August/early September, but then you run the risk of your application being screened by virtue of them only looking at your Step 1 score OR not getting the updated score into the hands of the selection committee until after they have made their decision on whom to invite for interviews. If I were you I would try and take it in the summer just to be safe. Good luck!
Thank you for the response, Steve. It along with your page has definitely helped me in this residency process. I saw on the sfmatch page that registration opens June 1 and a “target” CAS submission date is Sept 2 and some schools could have a different deadline. Does that mean the earliest I can send it in is Sept 2 or it’s available to the schools immediate in June? Just trying to see what the earliest submission date is so I can have my step 2 scheduled a month ahead to have y scores sent in with the application. Thank you, Kari.
Hello, I am also an international student and currently a ms3. my step 1 score is 238. I am interested in ophthalmology but we are given very less info on application process. When I talked to another ophthalmologist, he was saying that we have to first apply for a prelim year in either internal med or surgery as an MS4. Then in prelim year, we have to apply for optho through SF match list. Is what I understood correct? Or do MS4 apply directly and get into both prelim and optho residency at once? If latter is the case, can I still apply to a normal prelim year and later as an internal resident apply to optho? Also, can u do a categorical and still apply to optho in PGY-1? Finally what score would you recommend for me to get in my step 2 ck? Thanks so much.
Thanks for your comment. As you mentioned, the application process for ophthalmology is a bit different than for other specialties, complicated even moreso due to it being part of the “early match.” I am not personally very familiar with how to go about applying for ophthalmology as an international student, but perhaps I could point you to two different resources you may find useful. Here is the “Iowa Guide to the Ophthalmology Match,” which is a great overview of the application process. You might also consider posing your question to one of the online forums on studentdoctor.net, where others may be able to help you navigate the application process as an international student. The vast majority of applicants apply and interview for ophthalmology residency during the fourth year of medical school, but before beginning residency they must complete a year of internship, thus the two applications (residency and internship) are both during the MS4 year. I don’t have any particular knowledge of how the process differs for international applicants, though I can say that it is much more difficult to match into a US ophthalmology residency than if you were already a medical student in the US. That being said, I’m sure it is possible and that it has been done before. Best of luck and thanks again for the comment!
Abhi – Thanks for your question. I am not an expert at applying to ophthalmology residency as an international student, though I am certain it is extremely competitive. If you are absolutely certain that you need to complete ophthalmology residency in the United States, I would recommend you attempt to arrange clinical rotations at programs in the USA. With a USMLE step 1 score of 203, your chances at being accepted into an ophthalmology residency in the USA are limited, though your already being a retina specialist in India may substantially improve your chances compared to other applicants with a score of 203. I would recommend arranging clinical rotations in the USA and possibly even a research fellowship in the USA, which would allow you to improve your English (programs will want to be sure you can speak, read, and write well to consider your application), as well as give you the opportunity to publish, and finally to make connections with other ophthalmologist whose recommendations will be very important to your application. As for when to take Step 2, I would defer taking this test until just before you apply, though you must realize that a significantly improved Step 2 score will be absolutely necessary to have even a chance at being accepted into ophthalmology residency in the US. Thank you once again for your question and comment, I sincerely hope you find this useful and wish you all the best!
Hi i am an international student. I an retina specialist surgeon in india and just gave my step 1. My scores are not good 203. I am doing research fellowship for one year. I was wondering what are my chances of getting optho residency and when should i give my step 2. What else should i do to strengthen my application…………..,
Do you mind telling me what you matched in? I am also at the national average for step 1 and studying for step 2 now. Thanks for your help.
John: Thanks for your visit to the site. Glad you found it useful. I matched into ophthalmology and am currently completing internship (transitional) at Methodist Hospital in Indianapolis, IN and will then go to the University of Iowa for ophthalmology residency. Best of luck on USMLE Step 2! Keep in touch!