If my Step 1 Score Isn’t as High as I Hoped, Can I Still Apply to Orthopaedics?

Dongyeon Joanna Kim, MD | Ryley Zastrow, MD

February 23, 2023

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You’ve studied day in and day out (for multiple months) for your Step 1 (or 2) exam. You’ve mastered First Aid, you’ve done UWorld (maybe even twice), and you clicked on that space bar too many times to finish your Anki card for the day. On the day of the exam, perhaps it did not go as planned or you had a bad night’s sleep, or you felt sick. You get your score back and it doesn’t reflect your efforts, or it is not as high as you hoped. 

I am here to say that it is still possible to apply to orthopedic surgery. Take a deep breath! Your step score is only one part of your application. There are other ways to stand out. If you are passionate about orthopedic surgery and you have a clear understanding of why you want to pursue orthopedic surgery as a career, it is now time to make sure other parts of your application are rock-solid.

1Clinical Shelf Exams and Evaluations

Shelf exams and your clinical grades reflect your ability to stand out in both academic and clinical settings. Getting honors in your clinical rotations is one of the ways to show residency programs that you are capable in clinical settings. Always get there on time, be present, know your patients, read up on literature, and study up on disease presentation and pathogenesis. Make a thorough assessment and plan for your patients. Get to know them by going by their bedside after rounds. Follow up on tasks. Back your presentations with evidence-based medicine. Know your relevant and landmark studies. Not only will this prepare you well for shelf exams for each clinical rotation, but it will show your preceptors and advocates that you can perform at the highest level throughout the year. Remember Step exam is one day out of your 4-years at medical school, while your clinical rotations reflect your ability throughout the year. 

2Sub-Internships and Away Rotations

This is your time to impress your home and away program. Programs want to match students who will fit well with their program and have a growth-oriented mindset. Consider it your month-long interview – the programs are interested in how you interact with residents, faculty, AND support staff. Continue the hard work you put in during your clinical years – always prepare for your operative cases, help the consult resident, read literature, and learn from your mistakes. But now as a sub-intern, try to think beyond your clinical years and think a step ahead. Offer to start a consult note and get a basic history/exam. Get the room set up for a reduction. Coordinate and communicate with your team. This is your time to shine and demonstrate to your programs how you would work with others and as a resident. 

3Research and Gap Years

With Step 1 now being pass/fail, more and more programs are placing a heavier emphasis on research. Taking a research year might be a good idea to allow you to get to know your institution, sharpen your knowledge, take ownership of a project (or projects), and even submit to regional or national societies. Research is another way of demonstrating how you are able to gather, analyze, and interpret data, which are critical skills as residents and physicians. During your research year, take time to shadow in OR or clinic, help residents within the program, network, and boost your application in other areas. If you get a chance to attend national meetings, attend events for medical students, and network with future mentors. 

4Letter of Recommendations

This is possibly one of the most important parts of your application. Get to know your faculty – this doesn’t always mean setting up frequent meetings but standing out during your clinical or sub-internship rotations. From updating handoffs to nailing your anatomy knowledge questions in the OR, attending are aware of how you contribute as a part of the team. Your faculty mentors and letter writers are vouching for your performance as a student and your potential as a future resident, and your performance will reflect in their letters. Ask for letters in advance and ask mentors that you feel would best support you. Send them your CV and your personal statement and set up a meeting to discuss your goals. Be upfront and honest about how you see your future career trajectory and what your interests are to help better tailor their letters to your personal interests. 

5Leadership and Volunteer Activities

I think that leadership and volunteer activities are underrated portions of the application. Being president of a club, leading projects, and organizing activities take a lot of coordination, communication and effort. It allows you to demonstrate how you are able to start and finish a project and while doing so, manage many logistical tasks and coordinate with peers. Not only that, but these extracurricular activities provide the opportunity to explore your passion and interest outside of medicine. These are all valuable experiences and what will make you stand out as an applicant. You are more than just scores or research papers – demonstrate this by incorporating your passion projects as a part of your extracurricular activities!

6Step Scores

Now, you might be wondering why residency programs place such a heavy emphasis on Step scoresWith so many schools going pass/fail with clinical grading and evaluations becoming more and more subjective, Step scores (now with more emphasis on Step 2) are being emphasized to standardize between students and medical school. Also, your step score reflects your ability to obtain, interpret, and apply knowledge, which are all useful skills that will set you up as a great resident. However, there are so many other factors that go into a well-rounded application, as above. Prove to others and yourself that your Step score does not define your ability to perform at the highest level and be a well-rounded resident. 

Take a deep breath and prove to yourself that you are more than your Step score. Make sure other parts of your application can showcase how capable, competent, and ready you are for residency. Good luck! 

DISCLOSURES: Dr. Kim This individual reported nothing to disclose. Dr. Zastrow This individual reported nothing to disclose.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.

Copyright© 2023 by the American Academy of Orthopaedic Surgeons

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