The subject of step I scores seems to be a frequent topic in this forum, so much information can be gleaned by doing a search of the forum. From what I have gathered, here are some key points:

1) Some programs will not even download your application with a step one score below their cutoff. From what I can tell, most places that have such a cutoff have it around 225-230. You could have a letters from Dr. Campbell and Dr. Rockwell and it wouldn't matter. This is not all programs by any means, but the problem is that programs do not advertise their selection criteria so you don't know where you don't have a chance.

2) For programs that look at your whole app, a significant bump in your step II score may mitigate your step I to some degree, and therefore it is worth taking early and working hard for. However, I don't know that there is any evidence behind this theory even though it has been mentioned countless times on this board.

3) Programs will frequently look at their rotators regardless of their step I scores. Therefore, it is in your best interest to rotate as many places as you can to increase your number of interviews and chances of matching. Given that you are "near the end of your third year" in november and you just got your step I score, I'm guessing that you are not following the traditional 4-year track. Spending some of those spring months during which programs don't normally have sub-I's rotating may give you the opportunity to show yourself and get more one-on-one action to impress the attendings and be of help to the residents.

That's just my opinion, I could be wrong...

gamma

As long as you are a good candidate outside of your step I scores you should not worry. However, I would advise to take a different strategy than apply to 50-60 programs and wait for the interviews - you may receive less b/c of board scores below the majority of applicants. Instead, focus on a a small number of programs you would enjoy spending 5-6 years and go for it. This is accomplished by doing an elective and then returning for perhaps a research elective or primary care sports elective to gain that much more exposure. Then, as always, do the things that separate the candidates who rotate:
1. take call and actually be helpful
- your first day learn where the ER is and where they keep supplies
- when seeing a consult (preferably prior to the junior resident) have the
films ready, cast materials, injection supplies and note written
2. Do something unique
- if they have anatomy sessions ask to help w/ the dissection and then
present to the group
- gather a case or two for fracture conference and present them
- participate!
3. Display a pro-active personality
- do not ask the over-burdened junior how to get somewhere or what
cases are tomorrow - instead utilize the computers, ask the
secretaries...
it always looks good being prepared w/o nagging
4. lastly - know the anatomy for the specific cases: all you need is the
intervals the approach goes through and what to watch-out for (ex/ PIN
when exposing the radial head/neck)

My first post and just my two cents - but I have been at this for a while and this is what works at out program

SDM

the question is will your score hurt you. The answer is yes it will. But that does NOT mean you cannot match. You need to apply broadly both geographically and program wise. It starts getting expensive after 30 programs, if they still do it the same way it jumps to like 25 buck per program over 30 applications, but dont cheat yourself. The stories of people with 210's matching and those with 260's not matching are not just stories, I personally know someone in each of those categories. Just do your best from this point on, thats all you can do. Good luck

debarsy-- with your other numbers, it probably is worth it for you to study like crazy for step 2 (plus if you are doing well in third year, you will very likely do better on it if you study). my step 1 score is VERY low, but i did well in clinicals and rocked step 2, and i have been told by a couple of programs, including my home program, that this will be a factor. regardless of how great your grades are, there are no grades in residency, just the oite, and if you can't pass that no one cares how great you are. now, i am speaking partly from conjecture, as i am currently in the whole process, but i am getting interviews despite my step 1 score.

as far as what everyone else said, i agree (and the sub-i advice is right on) but as someone who did 3 sub-i's and canceled a fourth, really choose your programs carefully. a month is a long time, and it can be very difficult to maintain your energy and enthusiasm even though you're doing something you love.