Will Low Step 2 Scores Hurt me?

Well, it's certainly not going to help. The question is will it make a difference. If your 3rd year grades & LOR are solid, I doubt it will matter much.

But in the end, you get to the question of what you should do if it does hurt. Your 3rd year grades are set, you've presumably done your AI's, interview invites are going out. Really not much left to do. At the point where you have a #1, you can have faculty make phone calls, but anyone would do that.

So have a beer and don't worry about it.

n.b. to the lurkers - this is a prime example of why if your Step 1 score is good you should NEVER take Step II early in the year unless forced to by your med school. With a Step 1 of 257, a step II score can do absolutely nothing but hurt you. If you get about the same score, than you have met expectations. No surprises. You can't even get a meaningfully higher score. That leaves the only possible effect of a Step II score is to (potentially) hurt you if it's markedly lower than Step I.

Do you have to pass the written before you can take the practical?

Blade28 said:

You mean Step 2 CK vs. CS? I believe you can take them in any order.

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You can take Steps 1, CK and CS in any order.

Pilot Doc said:

n.b. to the lurkers - this is a prime example of why if your Step 1 score is good you should NEVER take Step II early in the year unless forced to by your med school. With a Step 1 of 257, a step II score can do absolutely nothing but hurt you. If you get about the same score, than you have met expectations. No surprises. You can't even get a meaningfully higher score. That leaves the only possible effect of a Step II score is to (potentially) hurt you if it's markedly lower than Step I.

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Sure, if you're a complete **** But if you know it wasn't a fluke you can cruise in and get step two out of the way.

dynx said:

Sure, if you're a complete *****. But if you know it wasn't a fluke you can cruise in and get step two out of the way.

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What about regression towards mediocrity? I don't know what the correlation is between steps 1 and 2, but I bet that the vast majority of people who rock step 1 will do worse on step 2. It's just statistics, but programs don't care about that.

dynx said:

Sure, if you're a complete *****. But if you know it wasn't a fluke you can cruise in and get step two out of the way.

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I hesitate to respond to this. Nevertheless...

Wise physicians don't expose themself (or their patients) to a risk with no possibility of benefit. That's exactly what taking step II with a 257 step 1 does.

As for "getting it out of the way," there's no merit in that. If you scored superbly on Step I you will not flunk Step II. All you have to do is pass after the rank lists are in. Takes 2 days - no studying needed at all.

I ended up in a simlar (though on a smaller scale) boat. I got a 218 on Step 1, and took step 2 early to try and get a high "impressive" score. After a month of studying hard, I found out today I got a 210. URGH!

My question is related and somewhat devious; can I hide this score from programs? I was told that if I take step 2 after submitting my applications (which I did two weeks before taking the exam), that I could with-hold the score report for step 2 CS.

Firstly, is this true?
Secondly, if it is true, do the programs know that I even took the test?
And thirdly, is this something I might get asked about on the interview trail? If asked about it, I would obviously have to be honest, but I am hoping to avoid the topic all together.

Thanks so much!

When NBME uploads your score report to ERAS, it reflects all scores and attempts at exam. Therefore, if this report is uploaded before your score for Step 2 is reported, it may not appear on the report.

However, I am not sure whether or not the report states that Step 2 is pending (ie since you would have scheduled it before the report went out). Doesn't ERAS ask if you are taking the exam? If yes, and you answered in the affirmative, you might expect to be asked about it. Even if you didn't, programs may very well ask and you have to be truthful.

Perhaps aPD can weigh in on whether or not the report will say "test scheduled" or "scores pending" etc. if the exam happens after the uploading to ERAS.

Asdf77 said:

I ended up in a simlar (though on a smaller scale) boat. I got a 218 on Step 1, and took step 2 early to try and get a high "impressive" score. After a month of studying hard, I found out today I got a 210. URGH!

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I don't think that step 2 score hurts you. In the absence of a Step 2 score, the assumption is that you'll do about the same. That's what you did.

No one's going to look at a Step 1 of 218 and think, "I bet he'll make a 240 on Step II."

Your Step 1 of 218 puts you squarely in the middle of US seniors who match into GS. The Step II is a bit lower, but not markedly. (See http://www.nrmp.org/data/chartingoutcomes2007.pdf)

You're not going to waltz into MGH with those numbers but they're not going to force you into family practice, either.

Thanks for the info and advice! I know you're right, it was just a bit hard NOT to freak out today even though I know I'll probably still match at a decent place. Thanks.

Pilot Doc said:

I hesitate to respond to this. Nevertheless...

Wise physicians don't expose themself (or their patients) to a risk with no possibility of benefit. That's exactly what taking step II with a 257 step 1 does.

As for "getting it out of the way," there's no merit in that. If you scored superbly on Step I you will not flunk Step II. All you have to do is pass after the rank lists are in. Takes 2 days - no studying needed at all.

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The possibility of benefit is showing that your step 1 was indeed not a fluke. It is also taking the time to review important aspects of other fields that you may need to know in your future residency/practice. And finally, by getting it out of the way I don't mean blowing it off with two days to study, I mean taking the time to review material, do well and learn in the process all while not interfering with your interview schedule etc.

To whom ever took offense to my original post and reported it as a TOS violation. Go **** ***** if the word **** offends you then you're a ****.

dynx said:

The possibility of benefit is showing that your step 1 was indeed not a fluke. It is also taking the time to review important aspects of other fields that you may need to know in your future residency/practice.

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No PD would consider a 257 Step 1 score a fluke. Even if you "deserved" a 240 and had a really good day, that's still a superb score.

As for using Step II as a crutch to review all of medicine, even if you believe that is useful (I don't), there's no reason you have to take Step II early to spend extra time reading.

Step II is a hoop to jump through, nothing else. All you have to do is pass. It has nothing to do with clinical competence and if you try to associate the two you can hurt your career.

Pilot Doc said:

n.b. to the lurkers - this is a prime example of why if your Step 1 score is good you should NEVER take Step II early in the year unless forced to by your med school. With a Step 1 of 257, a step II score can do absolutely nothing but hurt you. If you get about the same score, than you have met expectations. No surprises. You can't even get a meaningfully higher score. That leaves the only possible effect of a Step II score is to (potentially) hurt you if it's markedly lower than Step I.

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I agree with you somewhat, and that was the philosophy that I prescribed to during the match. However, as a warning to current med students: Some programs will look poorly upon you putting off Step 2.

I put off Step 2 until near match time (and I actually did better on it, so maybe it would have strengthened my application), and I personally had 1 program say it wouldn't rank me since their university policy was that students must complete both steps. I had another program say it may affect my ranking, although I did end up matching there, so who knows....

Pilot Doc said:

Step II is a hoop to jump through, nothing else....It has nothing to do with clinical competence.

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Well, now that's just plain wrong.

SLUser11 said:

Well, now that's just plain wrong.

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No it's not. Some people are incompetent. They tend to score poorly. Others are very competent; they tend to score well. But if you take two equally competent people one of whom studies for 8 weeks and the other takes it hung over, does the 40 pt difference in their score mean anything. No.

And it's so broad as to be useless. Take an experienced surgery attending - do you think he remembers (or needs to) anything about fifth disease or stages or labor or the factors common to Cluster B personality disorders.

It's a hoop to jump through. Your score is meaningless.

SLUser11 said:

Some programs will look poorly upon you putting off Step 2.

I put off Step 2 until near match time (and I actually did better on it, so maybe it would have strengthened my application),

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The people who shouldn't take Step 2 are those with very high test scores. For people with low to medium scores, they have less to lose and sometimes a lot to gain.

If your scores were mediocre, then a higher Step 2 might have helped you. If you made 257 on Step 1 and 265 on Step 2, that would not have helped you.

Pilot Doc said:

No it's not. Some people are incompetent. They tend to score poorly. Others are very competent; they tend to score well. But if you take two equally competent people one of whom studies for 8 weeks and the other takes it hung over, does the 40 pt difference in their score mean anything. No.

It's a hoop to jump through. Your score is meaningless.

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That's ridiculous reasoning. The same can be said for step 1. Two equally competent people that study different amounts are going to have a similar 40 pt difference, and their score on that exam means the world.

Step 2 is broad because it represents the scope of what a med student should have learned during his/her clerkships. It tests clinical knowledge more than step 1, and is the less meaningless of the two steps from that regard.

Nobody is arguing that Step 2 knowledge is critical to being a good surgeon, but proclaiming it as worthless is unnecessarily singling out a test no different from the other five hundred worthless displays of knowledge we're forced to do.


You act like the Step 2 exam killed your father or slept with your wife or something.......

Pilot Doc said:

The people who shouldn't take Step 2 are those with very high test scores. For people with low to medium scores, they have less to lose and sometimes a lot to gain.

If your scores were mediocre, then a higher Step 2 might have helped you. If you made 257 on Step 1 and 265 on Step 2, that would not have helped you.

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I had a very high step 1 score. I waited and took step 2 late based on your previously described logic. In hindsight, I would have taken it earlier because there are several programs, two of which I encountered personally, that place a large emphasis on Step 2 specifically.

SLUser11 said:

there are several programs, two of which I encountered personally, that place a large emphasis on Step 2 specifically.

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One of which you matched at so it can't matter that much And you have to balance that against the possibility of doing poorly on the exam.

I didn't say that Step II didn't matter - just that it has no bearing on your abilities as a physician. All you have to do is pass. There is no point in studying for it hoping to do better than pass as someone suggested above

Step I is obviously different. It is equally if not more irrelevant to your clinical competence, but the score, as you mention, is of utmost importance. And the reason is that Step 1 is the only piece of standardized data that exists on every single residency applicant. Step 2 does not and so it is vastly less useful. If every 3rd year Med Student had to take Step 2 on June 1 each year, it would become more important than Step 1. But they don't. That's the point - the SAT, MCAT, Step 1 all matter because everyone has a score and it's used to stratify people. Step 2 is used much less so if at all.

Kimberli Cox said:

When NBME uploads your score report to ERAS, it reflects all scores and attempts at exam. Therefore, if this report is uploaded before your score for Step 2 is reported, it may not appear on the report.

However, I am not sure whether or not the report states that Step 2 is pending (ie since you would have scheduled it before the report went out). Doesn't ERAS ask if you are taking the exam? If yes, and you answered in the affirmative, you might expect to be asked about it. Even if you didn't, programs may very well ask and you have to be truthful.

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to the original poster, i took step II after submitting my application, however i did not check the "immediately attach scores to ERAS application" box since i wasn't sure how i'd do. i too dropped significantly from step I. so i never submitted the scores to my application.

no one ever asked me about my scores. had they, i was prepared to 'fess up. did that play into my competitiveness in matching? i do not think so. however, if they are splitting hairs on you and see the "USMLE taken in october" without scores submitted they may suspect a drop in scores.

i found that during this whole application process we freak out about these details (none of which are trivial), but in the end the programs want PEOPLE. well rounded preferably. team players. with common sense. if you interview well and are perfectly honest about yourself. why you did drop scores, etc. people will respond well to that. my grades were significantly lower after taking time out in med school. i was only asked about that in one interview and i responded honestly about it. the answer was well-received.

and in the end, i matched well. and love my current program. best of luck.

Pilot Doc said:

One of which you matched at so it can't matter that much And you have to balance that against the possibility of doing poorly on the exam.

I didn't say that Step II didn't matter - just that it has no bearing on your abilities as a physician. All you have to do is pass. There is no point in studying for it hoping to do better than pass as someone suggested above

Step I is obviously different. It is equally if not more irrelevant to your clinical competence, but the score, as you mention, is of utmost importance. And the reason is that Step 1 is the only piece of standardized data that exists on every single residency applicant. Step 2 does not and so it is vastly less useful. If every 3rd year Med Student had to take Step 2 on June 1 each year, it would become more important than Step 1. But they don't. That's the point - the SAT, MCAT, Step 1 all matter because everyone has a score and it's used to stratify people. Step 2 is used much less so if at all.

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True enough.....still, I love to argue......

SLUser11 said:

True enough.....still, I love to argue......

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Me too.

Keeps the lurkers happy