USMLE Why do foreign grads always use the 2-digit score when talking about the USMLE?

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And why do so many of them think that the 2-digit score is a percentile? The lab I work at is hiring and interviewing people for the upcoming year and we get a lot of foreign med grads who weren't able to match this year that are applying. The majority of their CV's just list their 2-digit scores for the Step 1 and Step 2 and some of them even put "99th percentile" instead of just 99. It's kind of weird they put this considering the 2-digit score isn't a percentile or that it isn't even sent to residency programs.

Anyone know why 2-digit score reporting is rampant amongst foreign grads while US students/grads refer exclusively to their 3-digit score? Is it just lack of knowledge or are they being disingeious? The difference between a 230 and 260 is HUGE, yet both are 99 scores (under the old system) and the former is nowhere close to 99th percentile.

Fortunately with the new scaling system for the 2-digit score (and 2-digit score eventually getting phased out) this should happen less as it will be near impossible to get a 99....but it's still kind of curious yet frustrating.

You sound like someone who shouldn't be a doctor.

Originally Posted by SteinUmStein

ha ha!

Originally Posted by flatearth22

And why do so many of them think that the 2-digit score is a percentile? The lab I work at is hiring and interviewing people for the upcoming year and we get a lot of foreign med grads who weren't able to match this year that are applying. The majority of their CV's just list their 2-digit scores for the Step 1 and Step 2 and some of them even put "99th percentile" instead of just 99. It's kind of weird they put this considering the 2-digit score isn't a percentile or that it isn't even sent to residency programs.

Anyone know why 2-digit score reporting is rampant amongst foreign grads while US students/grads refer exclusively to their 3-digit score? Is it just lack of knowledge or are they being disingeious? The difference between a 230 and 260 is HUGE, yet both are 99 scores (under the old system) and the former is nowhere close to 99th percentile.

Fortunately with the new scaling system for the 2-digit score (and 2-digit score eventually getting phased out) this should happen less as it will be near impossible to get a 99....but it's still kind of curious yet frustrating.

This is a massive pet peeve of mine. I can't stand it when people dedicate their lives to a test without ever taking the time to understand the scoring. And I know I shouldn't care what my relatives think, but I do care what my relatives think... and they keep saying "oh, my sister-in-law got her score back, and she was in the 85th percentile! That's great, right? Why can't she get a residency?" And I'm thinking "OMFG, she wasn't in the 85th percentile, she had an 85... or a 210, which is a below-average score."

I've chalked it up to the fact that people just want their score to sound higher than... people like to say that they got a 99, especially if they're talking to somebody who doesn't understand what that means. They also really like to share their scores. I'm originally from Pakistan (and my parents have a lot of Pakistani friends), so I find myself repeatedly explaining to people why I won't be getting a 99 on my test...

One of my favorite terms in a lot of my parents' circles is the term "double-99", which means that you got a 99 on Step 1 and Step 2CK. It's like that means something.

Surely, people know that 235 isn't 99th percentile... right? Or is it just ignorance?

Anyway, I don't think I've added anything to this discussion... just a bit of a rant.



P.S. Phloston - was that meant to be a joke of some sort?

Originally Posted by shan564

This is a massive pet peeve of mine. I can't stand it when people dedicate their lives to a test without ever taking the time to understand the scoring. And I know I shouldn't care what my relatives think, but I do care what my relatives think... and they keep saying "oh, my sister-in-law got her score back, and she was in the 85th percentile! That's great, right? Why can't she get a residency?" And I'm thinking "OMFG, she wasn't in the 85th percentile, she had an 85... or a 210, which is a below-average score."

I've chalked it up to the fact that people just want their score to sound higher than... people like to say that they got a 99, especially if they're talking to somebody who doesn't understand what that means. They also really like to share their scores. I'm originally from Pakistan (and my parents have a lot of Pakistani friends), so I find myself repeatedly explaining to people why I won't be getting a 99 on my test...

One of my favorite terms in a lot of my parents' circles is the term "double-99", which means that you got a 99 on Step 1 and Step 2CK. It's like that means something.

Surely, people know that 235 isn't 99th percentile... right? Or is it just ignorance?

Anyway, I don't think I've added anything to this discussion... just a bit of a rant.



P.S. Phloston - was that meant to be a joke of some sort?

I usually try to ignore ignorance. Btw, Shan, thoughts on my "plan". Posted a thread. Dying for some feedback. Gracias!

Originally Posted by shan564

P.S. Phloston - was that meant to be a joke of some sort?

I think what Phloston meant was that OP sounds a bit prejudiced, at least that's what I thought to be honest.

Originally Posted by Chirurg

I think what Phloston meant was that OP sounds a bit prejudiced, at least that's what I thought to be honest.

I don't have anything against foreign grads. I'm just curious as to why the 2-digit score reporting (and mistaking the 2-digit score for a percentile score) is more common with foreign grads while US grads pretty much ignore it altogether.

I can imagine how frustrated some of them will be if they get a 260/88 this year and think their buddy who took it the year before beat them with a 235/99. Whatever it takes to stop this "99/99" business is good by me though...

Because telling someone you got a 99 sounds better and typically does not, to the average person, merit additional inquiry regarding how the exam is scored.

Over at usmle-forums.com, there's a thread once every few days saying "WTF!!! I got a 235, and somehow that's only an 84!!! What's going on???"

I guess it's just a cultural thing. I've felt like people in some parts of the world are just used to having scores between 1 and 100 on everything.

For instance... I'm going to med school in Australia, and when people talk about their grades, they don't say "A, B, C, D, F", they just give you a number between 1 and 100. The same is true for the GAMSAT, which is their version of the MCAT. When I talk about my MCAT score and say "it's usually about half of what you'd expect on a GAMSAT score" (which is true), they get confused and say "so it's out of 50? Why do they do that?" And then I have to explain that it's a scaled score out of 45.

I think that those of us who grew up in the US are used to scaled scores... SAT, ACT, MCAT, (maybe) GRE, and now USMLE. And we all have friends who took the LSAT, GMAT, OAT, DAT, etc. Even before the SAT, we had those random standardized tests in middle/high school that were meant to measure our school's performance. So we know that every score has an associated scale.

In other countries, all of the tests are out of 100. So when you tell your parents that you got a 230 out of 300, they translate that to 77%. So instead, you tell them that you got a 99. And then they tell their friends that you got a 99. And then before you know it, everybody has heard that you got this magical "99" score. Pretty soon, the 2-digit score becomes the standard score for people to report.

I have a cousin going to med school in Pakistan... he keeps telling me about how so many students at his school get 99's. He thinks of it as a major accomplishment.

I once heard somebody say that he was trying to get 100.

What does the 2 digit score even mean? I didn't even know you got anything other than the 3 digit score until I read about it on here.

Originally Posted by SteinUmStein

What does the 2 digit score even mean? I didn't even know you got anything other than the 3 digit score until I read about it on here.

I've heard that it exists because some medical schools use it as part of their grading system. I don't know if that's still true.

Originally Posted by shan564

I've heard that it exists because some medical schools use it as part of their grading system. I don't know if that's still true.

Yeah, can't imagine that was very useful under the old system... anyone with an above-average score or higher was getting a 99. I haven't heard of any US schools still using it, but there are plenty of schools that I'm not familiar with.

Originally Posted by shan564

I've heard that it exists because some medical schools use it as part of their grading system. I don't know if that's still true.

I remember reading somewhere that in the past a few state medical board required a 2 digit score of a 70 to grant licenses.

Originally Posted by SteinUmStein

anyone with an above-average score or higher was getting a 99.

Well, that was only true in the last few years... before that, I think you needed a higher score to get a 99.

Also, the average score increases a bit every year too (I wonder how much of that is due to resources like FA and UW). So that's another contributing factor.

funny stuff, I was JUST listening to Goljan's lecture on CV and he uses the 2-digit score to encourage his class to study

Originally Posted by shan564

I've heard that it exists because some medical schools use it as part of their grading system. I don't know if that's still true.

This may have been true, but its original purpose was licensing in some states that required a 2 digit score.

As a foreign grad I can attest to this being really prevalent. Like others have said I think it all boils down to the fact that to the unexperienced friend/family member, a number in the high 90s is inequivocally a good grade (just how good, is a whole different question).

At my school, while many people attempt to study for the USMLEs after graduation, not too many actually know anything about the test. I have taken it upon myself to point out that a "99" is definitely a good grade, but it can be anywhere from "pretty good, above average" to "holy crap that's amazing". I made sure to only tell my parents my three-digit score and explain sort of where it fell on the scale.

Some of my more mathematically inclined friends understand a percentile better and so I have sometimes used the calculated UW percentile, eg. "it's somewhere around 88-91st percentile" - even though that's for the people who did UW, not for the exams per se. Also, I have seen some members on different forums calculate their percentile based on the mean and SD that is listed in the score report but that would assume a perfectly bell shaped curve which I guess is not necessarily the case, so I don't know how accurate that would be...

Originally Posted by shan564

I once heard somebody say that he was trying to get 100.

I know one particular gunner girl from my (foreign) school who is also preparing for USMLEs - when the 2 digit scoring method was changed, she was overheard saying that she now wanted to get a 90something (can't remember the exact number) and when told by someone that what really counted was the 3 digit score, and that probably no one else except the state board would ever see that 2-digit score, she said "it's a personal thing". I always wondered why she didn't just have a stable 3 digit target score from the beginning - eg, "I'm aiming for a 260+". That wouldn't have changed when the 2 digit scale was modified. I guess some people just like numbers.

BTW I suspect US grads/students who aren't too familiar with FMGs would be really surprised to hear the kinds of myths/legends/rumors about the exams that are constantly repeated in some foreign schools. The whole thing about 99s is just the tip of the iceberg from what I have seen.

Originally Posted by quique2

BTW I suspect US grads/students who aren't too familiar with FMGs would be really surprised to hear the kinds of myths/legends/rumors about the exams that are constantly repeated in some foreign schools. The whole thing about 99s is just the tip of the iceberg from what I have seen.

Ha, yeah, I know what you mean...

Originally Posted by Phloston

You sound like someone who shouldn't be a doctor.

haha, agreed. Look at it from their vantage point and cut them some slack.

Originally Posted by theRainmaker78

haha, agreed. Look at it from their vantage point and cut them some slack.

I think that if you looked at it from the OP's vantage point, you'd see that he's trying to look at it from THEIR vantage point, but can't figure out the rationale, so he wanted to see if anybody else might know the answer. Not everybody has a thorough understanding of every international culture, but I respect somebody who makes an effort to learn about the basis behind a particular cultural difference.

He's really just pointing out a valid observation and trying to understand the rationale behind it. I don't see anything overtly discriminatory in his post unless you want to be hypersensitive to details that are probably misinterpretations of the initial message. I generally prefer to give people the benefit of the doubt, and I find that they usually deserve it.

Originally Posted by Chirurg

I think what Phloston meant was that OP sounds a bit prejudiced, at least that's what I thought to be honest.

Someone else sees it.

Originally Posted by shan564

I don't see anything overtly discriminatory in his post unless you want to be hypersensitive...

I think it's best for us to all move on.

Originally Posted by Phloston

I think it's best for us to all move on.

Fo shizzle.

Originally Posted by quique2

BTW I suspect US grads/students who aren't too familiar with FMGs would be really surprised to hear the kinds of myths/legends/rumors about the exams that are constantly repeated in some foreign schools. The whole thing about 99s is just the tip of the iceberg from what I have seen.

I am an IMG. I know all about three-digit scores and that it doesn't help to compare two-digit scores. But try explaining that at usmle-forums! (I tried...)
They even have a page on usmle.org explaining it, but not many people seem to have read it.
Anyway, I was just wondering what other myths/legends/rumors there are?
Although I hope I am not falling for any myths, maybe I could learn something new!

Originally Posted by Val7

I am an IMG. I know all about three-digit scores and that it doesn't help to compare two-digit scores. But try explaining that at usmle-forums! (I tried...)
They even have a page on usmle.org explaining it, but not many people seem to have read it.
Anyway, I was just wondering what other myths/legends/rumors there are?
Although I hope I am not falling for any myths, maybe I could learn something new!

A lot of people have told me that IMGs need some super-high score to get a job, just by virtue of being an IMG. But according to all data, the average scores are the same. Most of the insiders who I've spoken with say that they either accept IMGs or they don't, but they don't have different cut-off scores for the two.

I think the rumor/myth started because a lot of IMGs don't have the best language/communication skills, so they need a higher score to make up for that.

Or maybe I'm entirely wrong.

Originally Posted by Val7

I am an IMG. I know all about three-digit scores and that it doesn't help to compare two-digit scores. But try explaining that at usmle-forums! (I tried...)
They even have a page on usmle.org explaining it, but not many people seem to have read it.
Anyway, I was just wondering what other myths/legends/rumors there are?
Although I hope I am not falling for any myths, maybe I could learn something new!

I also frequent usmle-forums because they post a lot more personal experiences (and it's less biased towards high achievers than SDN, so I feel like reading from both gives me a more realistic approach.). It's basically 100% IMGs so it's good reading about people in similar situations, but some people on that site are lost cases...

Here are some of the rumors I've heard that I can remember now. Well, not all of these are rumors, but misconceptions/myths/common utterances among students at the school I graduated from (and where I teach some courses):

1. Lots of rumors about experimental questions, eg. "the weird questions are experimental" and then I have to explain that "experimental" means it's a question that's going through a trial run (to see around how many answer correctly and stuff) and it can be even the easiest of questions, so you'll never be able to pinpoint which they are
2. Just today someone told me that the experimental questions are all in one block which isn't marked at all, and they said this like they were 100% sure (this person has not taken any of the tests)
3. Some IMGs believe Step 2 CS is "harder" for IMGs in certain centers because of cultural bias. While I'm sure that in certain places the standardized patients or staff could definitely feel more prejudiced towards foreigners, I'm also sure the exam is designed to be standardized and as objective as possible so an IMG's experience should be the same regardless of the center. This kind of thinking is rampant on usmle-forums, where the spoken English part of the test is a major concern for many test takers...
4. Similar to above, people who don't understand the grading system prefer to take the exam in other cities (even flying to the US to take their exams) because they think it's easier or harder. Certainly there may be some advantage but not grade-wise. I took it in my home country, where the power is known to go out - I didn't believe anyone about this until it happened to me during my CK. Luckily it was fixed and I started the test exactly like I had left it.
5. "The test is just First Aid". Here on SDN everyone knows that FA is pretty good and all but not everything is in there. Without a good foundation to work on, FA is just full of seemingly random facts. I have seen way too many IMGs with very weak foundations stating "First Aid is all you need" and recommending this to other people without having taken the test themselves. When I hear this I get a little shiver down my spine.
6. Lots of misconceptions about the actual registration process, but I think this is understandable since it's actually a convoluted process. Some schools don't have dedicated officials to act as a liaison between the school and the ECFMG. Best source of information for this is the ECFMG website itself but some people just like asking on forums for some reason.
7. I've heard this one frequently: "Pay for the exam and schedule it for a date when you think you'll be ready; that will put pressure on you and make you study!" Oh boy. It's usmle-forums all over again, people scheduling tests for dates when they don't even know when they'll be ready! For both my Step 1 and CK I waited until 2-3 days before my desired dates. I risked the Prometric center being full for the day and not being able to select the date but big deal, I could take it a few days later no problem. That way I wouldn't have had to pay if I had to reschedule for some reason.
8. And the classic: "I'll do awesome on my Step 1 so I can get into residency." If only it were that easy

Originally Posted by shan264

A lot of people have told me that IMGs need some super-high score to get a job, just by virtue of being an IMG. But according to all data, the average scores are the same. Most of the insiders who I've spoken with say that they either accept IMGs or they don't, but they don't have different cut-off scores for the two.

I think the rumor/myth started because a lot of IMGs don't have the best language/communication skills, so they need a higher score to make up for that.

I think that the averages are quite similar simply because those that actually match are predominantly well-rounded candidates with decent-ish applications (CV, etc.) and not just scores. I know people who have matched with just good scores and no US clinical experience, no work experience even in their home countries, no visa/GC, etc. but these seem to be the exception rather than the rule. Also, they seem to tend to match at crappy programs for obvious reasons...

Disclaimer: This post might make me sound like an ass but I'm just trying to be as realistic as possible

Originally Posted by quique2

I also frequent usmle-forums because they post a lot more personal experiences (and it's less biased towards high achievers than SDN, so I feel like reading from both gives me a more realistic approach.). It's basically 100% IMGs so it's good reading about people in similar situations, but some people on that site are lost cases...

Here are some of the rumors I've heard that I can remember now. Well, not all of these are rumors, but misconceptions/myths/common utterances among students at the school I graduated from (and where I teach some courses):

1. Lots of rumors about experimental questions, eg. "the weird questions are experimental" and then I have to explain that "experimental" means it's a question that's going through a trial run (to see around how many answer correctly and stuff) and it can be even the easiest of questions, so you'll never be able to pinpoint which they are
2. Just today someone told me that the experimental questions are all in one block which isn't marked at all, and they said this like they were 100% sure (this person has not taken any of the tests)
3. Some IMGs believe Step 2 CS is "harder" for IMGs in certain centers because of cultural bias. While I'm sure that in certain places the standardized patients or staff could definitely feel more prejudiced towards foreigners, I'm also sure the exam is designed to be standardized and as objective as possible so an IMG's experience should be the same regardless of the center. This kind of thinking is rampant on usmle-forums, where the spoken English part of the test is a major concern for many test takers...
4. Similar to above, people who don't understand the grading system prefer to take the exam in other cities (even flying to the US to take their exams) because they think it's easier or harder. Certainly there may be some advantage but not grade-wise. I took it in my home country, where the power is known to go out - I didn't believe anyone about this until it happened to me during my CK. Luckily it was fixed and I started the test exactly like I had left it.
5. "The test is just First Aid". Here on SDN everyone knows that FA is pretty good and all but not everything is in there. Without a good foundation to work on, FA is just full of seemingly random facts. I have seen way too many IMGs with very weak foundations stating "First Aid is all you need" and recommending this to other people without having taken the test themselves. When I hear this I get a little shiver down my spine.
6. Lots of misconceptions about the actual registration process, but I think this is understandable since it's actually a convoluted process. Some schools don't have dedicated officials to act as a liaison between the school and the ECFMG. Best source of information for this is the ECFMG website itself but some people just like asking on forums for some reason.
7. I've heard this one frequently: "Pay for the exam and schedule it for a date when you think you'll be ready; that will put pressure on you and make you study!" Oh boy. It's usmle-forums all over again, people scheduling tests for dates when they don't even know when they'll be ready! For both my Step 1 and CK I waited until 2-3 days before my desired dates. I risked the Prometric center being full for the day and not being able to select the date but big deal, I could take it a few days later no problem. That way I wouldn't have had to pay if I had to reschedule for some reason.
8. And the classic: "I'll do awesome on my Step 1 so I can get into residency." If only it were that easy

I think that the averages are quite similar simply because those that actually match are predominantly well-rounded candidates with decent-ish applications (CV, etc.) and not just scores. I know people who have matched with just good scores and no US clinical experience, no work experience even in their home countries, no visa/GC, etc. but these seem to be the exception rather than the rule. Also, they seem to tend to match at crappy programs for obvious reasons...

Disclaimer: This post might make me sound like an ass but I'm just trying to be as realistic as possible

I agree completely with the post above, esp the CS exam one. I have seen these over and over again.

I'm an IMG also, and thought I would add a couple to this list. I frequent valuemd a lot and see a ton of stuff there as well as among my classmates.

And it may make me seem like an ass, but I can't stand how all my classmates & profs only refer to the 2 digit score....

9. If you take the Step exam in May-June you will get a lower score because that's the same time all the AMGs take it.

10. You must wait two chronological years (rather than academic) before being eligible for the step exam. Thus one who started basic sciences sept 2010 isn't allowed to take it until sept 2012

11. If you get a 99 you wont ever have a problem matching.

Originally Posted by flatearth22

And why do so many of them think that the 2-digit score is a percentile? The lab I work at is hiring and interviewing people for the upcoming year and we get a lot of foreign med grads who weren't able to match this year that are applying. The majority of their CV's just list their 2-digit scores for the Step 1 and Step 2 and some of them even put "99th percentile" instead of just 99. It's kind of weird they put this considering the 2-digit score isn't a percentile or that it isn't even sent to residency programs.

Anyone know why 2-digit score reporting is rampant amongst foreign grads while US students/grads refer exclusively to their 3-digit score? Is it just lack of knowledge or are they being disingeious? The difference between a 230 and 260 is HUGE, yet both are 99 scores (under the old system) and the former is nowhere close to 99th percentile.

Fortunately with the new scaling system for the 2-digit score (and 2-digit score eventually getting phased out) this should happen less as it will be near impossible to get a 99....but it's still kind of curious yet frustrating.

So they can tell there parents and friends they got 99% lol

Originally Posted by quique2

1. Some IMGs believe Step 2 CS is "harder" for IMGs in certain centers because of cultural bias. While I'm sure that in certain places the standardized patients or staff could definitely feel more prejudiced towards foreigners, I'm also sure the exam is designed to be standardized and as objective as possible so an IMG's experience should be the same regardless of the center. This kind of thinking is rampant on usmle-forums, where the spoken English part of the test is a major concern for many test takers...
2. Similar to above, people who don't understand the grading system prefer to take the exam in other cities (even flying to the US to take their exams) because they think it's easier or harder. Certainly there may be some advantage but not grade-wise. I took it in my home country, where the power is known to go out - I didn't believe anyone about this until it happened to me during my CK. Luckily it was fixed and I started the test exactly like I had left it.

Disclaimer: This post might make me sound like an ass but I'm just trying to be as realistic as possible

I had 2 AMGs from Florida or Miami --I don't remember where they were from.-- at my CS in Ca. They flew in the day of the exam and ended up running late. When I spoke to one, she told me that instead of taking it close to where they lived. They decided to fly over just for the CS. She did open up about how, the Ca testing center favored AMGs. Yup, rolled my eyes at that one. She thought that I was an AMG,... so I guess that's why she let me in on the info. lol....

Anyway, you don't seem like an ass, because these myths are prevalent.

Originally Posted by Lioness12

I had 2 AMGs from Florida or Miami --I don't remember where they were from.-- at my CS in Ca. They flew in the day of the exam and ended up running late. When I spoke to one, she told me that instead of taking it close to where they lived. They decided to fly over just for the CS. She did open up about how, the Ca testing center favored AMGs. Yup, rolled my eyes at that one. She thought that I was an AMG,... so I guess that's why she let me in on the info. lol....

Anyway, you don't seem like an ass, because these myths are prevalent.

AMG = American Medical Graduate (eg. an LCME student or Grad)

Who every said that those with a 99 were reporting the 2 digit score anyways?

Originally Posted by Siggy

Who every said that those with a 99 were reporting the 2 digit score anyways?

OMG that was freaking hilarious!!!!

Originally Posted by SteinUmStein

I'm a little late on this, and I never post on any forum, but well done sir...