I’m a US MD student at a mid-tier medical school applying to Internal Medicine this cycle. I’m interested in university and university-affiliated programs such as Duke, Vanderbilt, UNC, Wake Forest, Ohio State, and similar programs.

My application:

• Step 1: Pass on first attempt
• Step 2 CK: 267
• Honors in Surgery, Neurology, and Clinical Medicine
• 4,500+ hours of EMS experience
• Strong leadership, teaching, mentoring, and community service
• Some undergraduate lab research and a medical school QI project
• No publications, abstracts, or significant research output
• Interested in Pulmonary/Critical Care long term

How much will having no publications hurt me at competitive academic IM programs? Can my clinical performance, Step 2 score, EMS background, and leadership compensate, or is research essentially expected at programs like these?

I’d also love to hear from anyone who matched at a strong academic program without publications. Is it worth trying to complete a small case report or project now, or would it be unlikely to make a difference this cycle?

Thanks for any honest feedback!

I graduated residency in 2022 off cycle as I had to take multiple medical leaves of absence due to mental health struggles. My first attempt I failed and was crushed and then took second attempt in 2023 whilst I was working in outpatient practice. I had to leave my practice due to medical disability and canceled my 2024 and as of recent 2026 exam. I had never failed a board exam or any exams prior to this. My anxiety with test taking accelerated with ABIM. I don't want to practice clinically anymore but careers in utilization review as a physician advisor require board certification. I still want to sit for 2027 ABIM. How can I explain to employers that I failed and now will be sitting again? How can I reframe experience and set myself up for success? Any advice for others out there that had to pivot is much appreciated! Guidance for passing this exam as well as advice on other career paths. I still hold active medical licenses, falling behind on CME.