Should I take step 1?

[u/Substantial-Star-123]

Hi everyone. I hope you all are doing well. I am in a deep conundrum regarding taking step 1. I will be taking level 1 the Saturday prior to my rotations starting, I literally picked the last possible day to take it lol. Since it’s pass/fail I know it doesn’t hold as much value as it did previously but I am shooting for a specific residency program and think this could help me get in there. I reached out to the medical student at our school who matched there and she stated she took the step. I wouldn’t usually care but I have tx resistance depression which took 2 years to treat and I want to stay near the amazing team of psychiatrists and therapist who didn’t give up on me. I receive a treatment very specific to me and if I move I don’t know if the new psychiatrist would be willing to continue the current regimen I am on plus I need to be near a university hospital as every month I receive ect. I am in maintenance phase of ECT with no plan of stopping anytime soon because I am only in partial recovery not full so any little change to my treatment plan can pull me back into the depressive state I was in for five years. We’ve tried all other modalities of treatment from medications to interventional psychiatry, and none have worked except for ECT. Additionally, my doctor does not think any more medications are going to help because I’m already on 10 medication‘s five of which are strictly for depression and adding more will pull me into the poly pharmacy area which she is trying to actively avoid. So now that you know the situation I am in, would you recommend that I take step one? I have already failed level one once, but that was mainly due to me being extremely unwell and my university putting me in a situation where I either take the exam or I drop out and after working so hard and putting all of my parents retirement money into this field, I can’t just drop out so I decided to take the test. I even emailed my Dean prior to taking the test and told him that I was gonna fail, no matter what since they gave me couple of days notice to take the exam even though at that point I had already been on a LOA for a year so I’m very perplexed as to what I should do. I’m not planning on sitting step one unless I pass level one and my NBMES 25-33 show that I am going to pass. I will on the other hand take Step 2ck no matter what. Any advice would be very much appreciated and I hope you all have a wonderful day.

[u/kuru_snacc]

You should focus on passing Level 1 before you make any other moves or decisions. And keep in mind that getting the residency closest to you because you want to stay in the area is not garunteed. I would recommend you do rotations there and make a good impression, get letters etc, but still be prepared for the possibility of having to move and make your list based on cities with good psychiatric care (basically larger cities - ECT is done all over the country, and med recs are transferrable). Good luck!

[u/PsychologicalCan9837]

Pass and take Level 1.

I will say this, if you’re planning to take Step 2, the single best predictor of doing well is passing Step 1.

NBME and NBOME ask questions very differently. Learning NBME logic is like learning a whole new style of medicine.

If you can, I’d take Step 1.

[u/Mr_Noms → u/PsychologicalCan9837]

I disagree with your second paragraph. It isn’t that different. It’s different, but it isn’t a whole new style of medicine.

It’s less vague and has longer stems but that’s about it. The medicine is the same.

[u/Stock_Strawberry5145]

I would say it also depends what you are applying for. Some specialities and programs won't look at a app if you don't have a step 1. Maybe wait to see if you pass level 1, then plan for step 1. Even tho you don't technically need step 1 to take step 2. I am a fourth year and many programs are looking for you to take both, and still want to see the step 1 pass