How can I overcome a low USMLE Step I score?

Nemanja (not his real name) writes: I am a fourth year medical student at a US school. I am planning on applying to general surgery in the next month. I have a few concerns and questions about my application and competitiveness. 

I did very well years 1 and 2, all but one honors. I got a 209 on USMLE Step 1 and a 243 on step 2. The caveat about my step 1 score is as follows. I had a family tragedy 1-2 months prior to taking step 1. In retrospect I probably should have deferred and not taken it but hindsight is 20/20.

After that poor step 1 score, I did well on my clinical rotations. I received a high pass in surgery and honors in 4 other clinical rotations with no grade less than a high pass. I expect to receive strong letters of recommendation from my program director and clinical faculty. I am interested in applying to programs in the northeast portion of the US.

How can I let a program director know about my situation (e.g., in my personal statement, in my dean's letter). Some of the people at my institution have led me to believe that this is an important part of my story and something that may provide an explanation for a below average step 1 score. I am afraid that I will be filtered out due to my step 1 score from many university based programs. What do you think is my best approach to this situation? 

Your question is a good one. I am sorry about your family tragedy. 

I suggest you explain it in your personal statement and ask the dean to mention it in his letter too. You need to emphasize the fact that your Step II score is very good. Strong letters of recommendation will help.

If you search PubMed for "USMLE Step I," you can find a fair amount of information about the weight program directors put on it. One paper says it is the single most important factor used by PDs to screen applicants. Another says that a Step I score of < 200 is associated with a higher risk of failing part I of the general surgery board exam.

Here is a link to a PDF from the NRMP about match outcomes. If you go to page 84, you will find some interesting data about the 2011 general surgery match.

I have some screen shots for you. 

Here's a table listing some summary statistics.

This is a graph indicating that a USMLE Step I score of 209 gives you about a 75% chance of matching in surgery.

But here is a chart showing that a Step II score of 243 gives you a very good chance of matching. No graph was provided.

The message is very clear. Get the PDs to look at your Step II score

You may want to apply to some community hospital-based programs to be safe. I think you will match in a categorical position.

Good luck. Please let me know how things turn out.