Tough times in getting a position: Failed step 1

QUESTION

I am an IMG and in the middle of applying to programs for 2010 match. I graduated in 2004 and have a low step 1 score with 2 attempts, however step 2 and CS were passed on the first attempt. I have previous clinical experience in Pakistan and also did a year of house job training. I do not have any US clinical experience except for a 2 month observership. It is really hard to get hands-on experience in a US setting for that matter.
So far I have received negative response form programs and it worries me if I can even get a single interview call.

I would like your advice as to what options do I have for the next year in case I do not get into residency? Some say I should do MPH. I have also been advised to do post doctoral fellowship which honestly, I don’t know much about.

Can you please be kind enough to give some giudeline in this matter?

ANSWER

I am so sorry for the difficulty you are having. The main issue is the failure on step 1 is VERY hard to overcome. There is no way to hide the previous attempt. Also, when you get to being five years or more since graduation, it is also difficult.

I suggest you try to get a VERY high step 3 score, or spend time in a place where you have a REAL chance of getting in.  I am sure you have applied broadly to increase your chances, and that you are looking at family practice.

Good luck

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