Does Step II score really matter?

[i61164]

Doesn't the match occur before you take step II? If so, as long as you pass, why should you care about getting a really high score?

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[Firion451]

Depends on both when you take it and how you did on step 1. At my school, it is mandatory that you take step 2 before the end of January, so if you delayed as long as possible you could keep PD's from seeing the score until after ROLs are done. Similarly you could take it whenever you want and just don't release the score in ERAS until after the ROL deadline. However, if you take it early (e.g. July) a PD could have the score by early August. This is mostly to your advantage if you did crappy on step 1.

In general, I think PDs assume you will do as well if not better on step 2. So if you rocked step 1, you should probably take step 2 as late as possible to avoid possibly shooting yourself in the foot.

Seeing how long it is taking to get 2 CS results back, definitely take CS as early as possible. By the end of 3rd year you know enough to pass without studying. The test is truly pass/fail and if you are unlucky enough to fail you want to allow as much time as possible to retake.

 

[i61164]

Depends on both when you take it and how you did on step 1. At my school, it is mandatory that you take step 2 before the end of January, so if you delayed as long as possible you could keep PD's from seeing the score until after ROLs are done. Similarly you could take it whenever you want and just don't release the score in ERAS until after the ROL deadline. However, if you take it early (e.g. July) a PD could have the score by early August. This is mostly to your advantage if you did crappy on step 1.

In general, I think PDs assume you will do as well if not better on step 2. So if you rocked step 1, you should probably take step 2 as late as possible to avoid possibly shooting yourself in the foot.

Seeing how long it is taking to get 2 CS results back, definitely take CS as early as possible. By the end of 3rd year you know enough to pass without studying. The test is truly pass/fail and if you are unlucky enough to fail you want to allow as much time as possible to retake.

Thanks for the info.

 

[chunkeroo]

I know someone who got 244 on Step 1, was a lock for Ortho.

Took Step 2 right away 4th year. Passed it by ONE POINT!. Did not match into ortho. He knows the Step 2 did him in.

Moral of the story: If you smoked Step 1, put Step 2 off as long as possible...

 

[b&ierstiefel]

I was faced with the same dilemma. I did well on step 1 as well but we cannot postpone the step 2 exam until too late. Our deadline for sitting for step 2 is Feb. 1st. So I will be taking Step 2 at the end of January.

I've heard of several stories, including the one above, where a person who rocked step 1 stumbles on step 2 and ends up paying for it when he/she didn't have to.

P=MD

 

[Tand]

quoted: "In general, I think PDs assume you will do as well if not better on step 2. So if you rocked step 1, you should probably take step 2 as late as possible to avoid possibly shooting yourself in the foot."

2 Followup questions on that: I'm in one of the lucky programs, where we only have to take Step II some time before graduation. I have it set for next week and didn't automatically release my scores.

1) Is it true that programs don't know you've taken the Step II at all unless you send scores to them? What are the ethics of this, I wonder.

2) Since it's unlikely Step II will affect my matching, I assume all I need to worry about is its effects on fellowships down the line. Some of the ones I'm looking at may be what you'd call competitive - Robert Wood Johnson (if it's still around!) etc. Anyone have any feel at all for how much difference it makes?

Thanks, folks.

 

[carrigallen]

I'll edit this then:
One residency director directly told us that you should delay taking your Step II for as long as possible. His rationale was the following:

1. If you did well on Step 1, then taking Step II can only hurt you.

2. If you did poorly on Step 1, then your Step II score isn't going to matter anyway..they will still frown on your application.

That said, it does seem at odds with what I would think and the other ideas on here.

 

[dr_almondjoy_do]

Program directors have directly told us that you should delay taking your Step II for as long as possible.

1. If you did well on Step 1, then taking Step II can only hurt you.

2. If you did poorly on Step 1, then your Step II score isn't going to matter anyway..they will still frown on your application.

And which program directors would these be? Are these from "competitive" programs? Because this just doesn't sound like reliable information. How can someone who passed the Step I, but did poorly on it, do well on Step II, and still be "frowned upon"? What would the program directors have to say about all the knowledge they currently have and prove by doing well on Step II? Is it not good enough based on how a person performed on Step I?

I need to know, because, unless you score in the 90%, doing well on the boards is a relative term from program to progam.

 

[fuzzyerin]

I've had program directors say the exact opposite ~ that they are impressed that my Step II score is higher than my Step I score (and yes, I was one of those people who took Step II early because Step I wasn't so hot). They said that Step II tests what you actually know in clinical medicine and how to make decisions. Step I tests if you can memorize facts, minutiae, and things that really may not be relevant in your field.

I personally am happier that I did better on Step II than Step I. Maybe some programs didn't give me an interview because of my Step I score, but if that's the case, well, I didn't want to go there anyhow.

 

[Tand]

But what about effects of Step II on fellowship applications down the line?

 

[Arch Guillotti]

Program directors have directly told us that you should delay taking your Step II for as long as possible.

2. If you did poorly on Step 1, then your Step II score isn't going to matter anyway..they will still frown on your application.

I got a 200 on Step I and a 241 on step II. Matched at a top-notch gas program. The chair told me directly that step II helped my app tremendously

 

[neilc]

Program directors have directly told us that you should delay taking your Step II for as long as possible.

1. If you did well on Step 1, then taking Step II can only hurt you.

2. If you did poorly on Step 1, then your Step II score isn't going to matter anyway..they will still frown on your application.

ridiculous....if you do poorly on step 1 you will likely not get some interviews. but, taking step 2 and showing an improvement may open some doors.

all the residency folks i have talked to (not too many, granted) laugh at the med student obsession with step 1 scores. they think step 1 is pretty useless, they like step 2 scores better.

the major prob with a low step 1 will be getting through the eras screens that programs use. but, i high step 2 can give you ammo to call and plead your case for an interview

 

[Espion]

Interesting read whether you are pursuing surgery or not:

What predicts surgical internship performance?

Dorothy A. Andriole MD, , a, Donna B. Jeffe PhDb and Alison J. Whelan MDc

a Department of Surgery, Washington University School of Medicine, Campus Box 8073, 660 S. Euclid Ave., St. Louis, MO 63110, USA
b Department of Medicine, Division of Health Behavior Research, Washington University School of Medicine, St. Louis, MO, USA
c Department of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO, USA

Abstract
Background
Variables associated with postgraduate year 1 (PGY-l) performance in surgical training have not been fully defined.

Methods
Mean composite PGY-l evaluation scores were calculated from responses to questionnaires mailed to surgical program directors of 87 surgical graduates from 1997 to 2001. We analyzed evaluation scores for associations with sex, surgical specialty choice, United States Medical Licensing Examination (USMLE) step 1 and step 2 scores, Alpha Omega Alpha (AOA) election, and third-year clerkships' grade point average (GPA).

Results
There were significant first-order associations between PGY-l performance evaluation score and each of USMLE step 2 score and GPA. In a multiple linear regression model that included sex, surgical specialty choice, USMLE step l and step 2 scores, AOA, and GPA, USMLE step 2 score was the only significant predictor of PGY-l performance.

Conclusions
Multiinstitutional studies are warranted to determine the predictive value of USMLE step 2 scores in residency performance beyond PGY-l and to identify other predictors of surgical PGY-l performance.

 

[carrigallen]

Mmm..I think that my information was probably a bad sampling of opinions then.
I'll explain the source of it: Four doctors (a couple of whom were program directors) suggested it, in response to a student question at a "Competitive Residency" seminar they were hosting. One of the doctors said the actual statement, and the other three just nodded their heads.

Looking back, I would probably take his words with a grain of salt though.

 

[dr_almondjoy_do]

Hmmm.. using research to dispute opinions on SDN... could this be the new trend?

Just kidding.. It is encouraging to know that improved Step II scores can make a difference.

 

[shorrin]

I know someone who got 244 on Step 1, was a lock for Ortho.

Took Step 2 right away 4th year. Passed it by ONE POINT!. Did not match into ortho. He knows the Step 2 did him in.

Moral of the story: If you smoked Step 1, put Step 2 off as long as possible...

Moral of the story is one you haven't learned yet: a high score does not a lock make. If you boff the interview and the PD thinks you're a pin-head do you think you'll get the spot?

Moral is that getting a spot is multi-factorial.

 

[Dr.Evil1]

I am an applicant for Emergency Medicine, a moderately competitive speciality. I scored about average on Step 1 (215), I needed to take step 2 early in my 4th year in order to improve my application. I got a 248 on step 2. This has made me MUCH more competitive as far as interview invites and the attitudes that PDs have towards me. It has also helped my confidence in my application and my chances of matching to my top few choices. Taking step 2 early in the year was a big help for me.

If you had a great Step 1 score you will most likely do well on Step 2. I would argue that if there were 2 equal applicants out there with great Step 1 scores (say 240) and one took Step 2 with a 240 and one had no score reported then the PD would give an advantage to the person with the Step 2 score. This can be a benefit to people in ultra competitive specialities.

The only reasons you wouldn't do as well on step 2 is if you don't study enough (or not take the test seriously) or you didn't learn anything during clerkships. I would recommend taking a light month or a month off and studying just as hard as you did for Step 1. That way you will do well and maybe your app will be better than before.

 

[Allysine]

Moral of the story is one you haven't learned yet: a high score does not a lock make. If you boff the interview and the PD thinks you're a pin-head do you think you'll get the spot?

That's what people say who do poorly on step 1.

 

[shorrin]

I don't consider a 223 poor. No need to be rude man.

Look, I had another career before med school and I know that if you are an idiot in the interview that a big score won't look as shiny as it did before.

It's a lot of who you know and how well you interview as well as your credentials. I just wanted to make the point that if someone has a 240+ and think that they are a shoo-in then they might just want to re-think.

 

[Docta]

Seems to me that Step 2 is not a valid prediction of Clinical Knowledge simply because of the variance of how people prepare to take it. The people I know who scored below the mean for Step 1, then turned around and took Step2 early, when the MS 3 knowledge was still fresh. They gave 3-4 weeks of intense study time, and in general did much, much better on Step 2. People did significantly better than average on Step 1 delayed taking Step2, lost a lot of knowledge from 3rd year, did not allow as much time to study, and did not do as well.

The better predictor of the 2 tests is Step 1, which by and large everyone puts their best effort into, and the results speak for themselves. Third yeard clerkship grades are genrally tied into your shelf scores, which are also taken seriously by most students, and thus are the best predictor of clinical knowledge. Step 2 is nothing more than a blow-off test you have to pass for a lot of people, and it shows. I dropped 4 points on my Step 2 score, did not release it, and had nobody on the interview trail ask me about it. Rocking Step 2 after doing poorly on Step 1 should help you, but it is a joke to say that it is a "better predictor of residency preformance" than Step 1.

 

[neilc]

...but it is a joke to say that it is a "better predictor of residency preformance" than Step 1.

well, there is a study posted above that kinda disproves your thinking....about 4 posts up.

most people that did well on step 1 also did well on step 2. some people who sucked on step 1 busted ass and did well on step 2. if BOTH of these groups perform better in residency, then you can see how step 2 would be a better predictor. i don't know of a whole bunch of folks whe did a lot worse on step 2 than 1, but of the few that did, perhaps they did function a bit worse on the clinical level.

i think i can understand how the step 2 would be a better predictor....if you know the material on that test, you will likely be better prepped for the wards, regardless of whether you studied hard to learn the stuff after bombing step 1, or whether you learned it in 3rd year, or whether shelf prep helped.

 

[Hercules]

well, there is a study posted above that kinda disproves your thinking....about 4 posts up.

most people that did well on step 1 also did well on step 2. some people who sucked on step 1 busted ass and did well on step 2. if BOTH of these groups perform better in residency, then you can see how step 2 would be a better predictor. i don't know of a whole bunch of folks whe did a lot worse on step 2 than 1, but of the few that did, perhaps they did function a bit worse on the clinical level.

i think i can understand how the step 2 would be a better predictor....if you know the material on that test, you will likely be better prepped for the wards, regardless of whether you studied hard to learn the stuff after bombing step 1, or whether you learned it in 3rd year, or whether shelf prep helped.

I can see what you're saying neilc, but I think Docta has a point. Yes certainly the material for Step 2 is more relevant than the material for Step 1. The problem with using Step 2 to predict performance in residency is that not all of us are trying all that hard. I studied pretty hard for Step 1 and came out with a score I was comfortable with. I won't take Step 2 until the end of this month and the results won't be back until after the match and that makes it a P/F test for me. I would be shocked if my score didn't go down significantly since I won't put in anywhere near the effort I did for Step 1. The lower score I get won't reflect my clinical knowledge as well as my 3rd year grades and LORs did.

 

[neilc]

I can see what you're saying neilc, but I think Docta has a point. Yes certainly the material for Step 2 is more relevant than the material for Step 1. The problem with using Step 2 to predict performance in residency is that not all of us are trying all that hard. I studied pretty hard for Step 1 and came out with a score I was comfortable with. I won't take Step 2 until the end of this month and the results won't be back until after the match and that makes it a P/F test for me. I would be shocked if my score didn't go down significantly since I won't put in anywhere near the effort I did for Step 1. The lower score I get won't reflect my clinical knowledge as well as my 3rd year grades and LORs did.

i also see what you are saying...but, i think my point is that the fact that you worked hard and learned during your third year (and likely retained FAR more than you have retained the step 1 material) will prob assure you of a similar score on step 2. as you guys have pointed out, many, if not most, students take step 2 less seriously than step 1. yet, year after year, people tend to do as well on step 2 as they did on step 1. and, those that did poorly on step 1, and worked hard on step 2 will also have a larger fund of clinically relevent knowledge, that should help them succeed on the wards.

basically, the study should have controlled for all of this. it looked at step 1 scores as well as third year clerkship evals, and they did not have the correlation. if your argument was the more realistic situation, i am sure the study could easily have picked this up. i mean, the results are there, and the data do not usually lie, right?

anyhow, as usual, i am sure reality lies somewhere in the middle. if you totally blow the test off and do poorly, and do well in residency, you can be an outlier! i just think that even with blowing the test off, most people still do pretty darn well if they have clinical knowledge.

 

[supertigger]

just one more thing to consider....

at my school, the medicine department quotes some study (i don't know which one, but i wish i did) that basically said that if you add the 2-digit percentile scores from steps 1 and 2, those that add up to 160 or higher have approximately a 90% chance of passing boards the first time. I emphasize first, because it says nothing about 2nd or more tries. those below 160 apparently have a 60% pass rate first time. i don't know how they chose 160; for all i know, it's completely arbitrary.

the point of all that is, steps 1 and 2 are equal when thye use that method. period. i did much better on step 2 than step 1, and they were completely unimpressed.

 

[dr. neek]

I've been searching high and low for an answer...do FMGs have the option to not release their Step 2 scores when applying to the match...or does ECFMG release them automatically. I got a 240+ and I'm an FMG interested in ENT and Plastics...Will withholding my Step 2 score be counted against me? I must take it before applying to the match in order to get my ECFMG certification. Any help will be appreciated!

Thanks...