Importance of the USMLE in getting into a residency program

[Crow King]

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I'm entering medical school now (class of 2015) and am fresh out of the med school application process.

I knew going in it wasn't gonna be a CalTech style meritocracy in terms of admissions... nothing I can do about that until I'm on an admissions committee myself in 15 years.

Anyways, a high MCAT score for med school admissions didn't seem to really help me much in admissions... applied to 25 schools with a 39 MCAT- got interviewed at 7 and accepted at 3. Had a good GPA (over 3.8) from a top 10 undergrad but not much ECs.

So what I want to know is this: How important is the USMLE in getting into a residency program? Will a good score, say 2 standard devs about mean + good grades get you in to a good residency program with more certainty than getting a good MCAT + good grades will get you into med school?

 

[winkleweizen]

I'm entering medical school now (class of 2015) and am fresh out of the med school application process.

I knew going in it wasn't gonna be a CalTech style meritocracy in terms of admissions... nothing I can do about that until I'm on an admissions committee myself in 15 years.

Anyways, a high MCAT score for med school admissions didn't seem to really help me much in admissions... applied to 25 schools with a 39 MCAT- got interviewed at 7 and accepted at 3. Had a good GPA (over 3.8) from a top 10 undergrad but not much ECs.

So what I want to know is this: How important is the USMLE in getting into a residency program? Will a good score, say 2 standard devs about mean + good grades get you in to a good residency program with more certainty than getting a good MCAT + good grades will get you into med school?

Not if you suck in person. Two standard deviations above the mean which puts you at 270 is really realy high and will get you interviews most everywhere but if you suck you still can not match.

 

[Crow King]

Not if you suck in person. Two standard deviations above the mean which puts you at 270 is really realy high and will get you interviews most everywhere but if you suck you still can not match.

What is the criteria for sucking?

So you say a 270 would get you an interview most everywhere... is this an exaggeration or is a persons USMLE score considered along a spectrum instead of the "they have the score or don't" approach to medical schools admissions? (slight exaggeration there of course)

 

[WellWornLad]

What is the criteria for sucking?

One program director told me that they're very cautious when they see someone with a 270+, as it may be a harbinger of severe interpersonal/Asberger's type deficits in social interaction. Honestly, I'm not sure if he was serious or just had a very dry sense of humor.

Med school admissions is different than residency admissions. In the former, the interviewers/committee are detached from the consequences of their decision. I.e., if someone sucks, they probably won't see them on a daily basis for 4 years if they're admitted. Such is not true of residents, and no step 1 score is so impressive that it will outweigh 3-7 years of close interaction with someone they don't like. Not even close.

 

[IlDestriero]

High USMLE scores are critical for selection at very competitive programs and/or specialties.

 

[Elbowstoopointy]

I'm entering medical school now (class of 2015) and am fresh out of the med school application process.

I knew going in it wasn't gonna be a CalTech style meritocracy in terms of admissions... nothing I can do about that until I'm on an admissions committee myself in 15 years.

Anyways, a high MCAT score for med school admissions didn't seem to really help me much in admissions... applied to 25 schools with a 39 MCAT- got interviewed at 7 and accepted at 3. Had a good GPA (over 3.8) from a top 10 undergrad but not much ECs.

So what I want to know is this: How important is the USMLE in getting into a residency program? Will a good score, say 2 standard devs about mean + good grades get you in to a good residency program with more certainty than getting a good MCAT + good grades will get you into med school?

With a 3.8 and 39 you should have literally gotten interviews from 90% of the schools you applied to (statistically)

 

[Crow King]

Med school admissions is different than residency admissions. In the former, the interviewers/committee are detached from the consequences of their decision. I.e., if someone sucks, they probably won't see them on a daily basis for 4 years if they're admitted. Such is not true of residents, and no step 1 score is so impressive that it will outweigh 3-7 years of close interaction with someone they don't like. Not even close.

I'm guessing you are talking about social skills and a persons personality... as in, a poor communicator who is nice won't cut it, but neither will a social competent but arrogant jackass.

If they put a lot of weight into this I hope they use something more than a 45 minute interview to make their judgement

With a 3.8 and 39 you should have literally gotten interviews from 90% of the schools you applied to (statistically)

Shoulda coulda woulda

 

[DeadCactus]

Residency is different from medical school. You're not applying to be a student, you're applying to be an employee. GPA and test scores get you past the filters. Letters of recommendation, calls on your behalf, and the interview decide if you're someone worth working with...

 

[Crow King]

GPA and test scores get you past the filters.

High USMLE scores are critical for selection at very competitive programs and/or specialties.

OK so two different opinions here.

From what Cactus says, the process sounds like med school admissions in some sense- your MCAT score is above the threshold and you get an interview. MCAT score below the threshold, no interview. Filtered...

From then on out your MCAT matters little and rather it is the interviewers impression of you that is considered along a spectrum. The person is judged to be somewhere between a horrible and insufferable person to amazing.

From what Destriero says, it sounds like your USMLE score is what is considered along a spectrum... the score is fantastic, or excellent, or great, or pretty good, or good, or decent, or average, etc...

Anyone else want to comment?

 

[AlexMorph]

I'm entering medical school now (class of 2015) and am fresh out of the med school application process.

I knew going in it wasn't gonna be a CalTech style meritocracy in terms of admissions... nothing I can do about that until I'm on an admissions committee myself in 15 years.

Anyways, a high MCAT score for med school admissions didn't seem to really help me much in admissions... applied to 25 schools with a 39 MCAT- got interviewed at 7 and accepted at 3. Had a good GPA (over 3.8) from a top 10 undergrad but not much ECs.

So what I want to know is this: How important is the USMLE in getting into a residency program? Will a good score, say 2 standard devs about mean + good grades get you in to a good residency program with more certainty than getting a good MCAT + good grades will get you into med school?

You answered your own question. You said you didn't have much in terms of ECs. ECs, in my opinion, seem to matter a whole lot more for med school than for residency. If you are a reasonably decent person to be around, a high Step score will get you far, even if the rest of your app is not amazing.

For some fields like FM or Peds, if you have a pulse, they will take you. (Just joking...)

 

[AlexMorph]

OK so two different opinions here.

From what Cactus says, the process sounds like med school admissions in some sense- your MCAT score is above the threshold and you get an interview. MCAT score below the threshold, no interview. Filtered...

From then on out your MCAT matters little and rather it is the interviewers impression of you that is considered along a spectrum. The person is judged to be somewhere between a horrible and insufferable person to amazing.

From what Destriero says, it sounds like your USMLE score is what is considered along a spectrum... the score is fantastic, or excellent, or great, or pretty good, or good, or decent, or average, etc...

Anyone else want to comment?

What they are judging after you get to the interview process is whether or not you are a tool. They already know you are academically capable. Otherwise, why bother interviewing you? Once you get to this stage, you have to make sure you make a good impression. They aren't gonna grill you though about your ECs. They will just be curious about what you did and why you got involved.

 

[Crow King]

You answered your own question. You said you didn't have much in terms of ECs. ECs, in my opinion, seem to matter a whole lot more for med school than for residency. If you are a reasonably decent person to be around, a high Step score will get you far, even if the rest of your app is not amazing.

For some fields like FM or Peds, if you have a pulse, they will take you. (Just joking...)

Yeah I wasn't too surprised with the outcome owing to ECs and the lateness of my application.

Since ECs matter less for residency then obviously something else must be more important... glad to hear

 

[Crow King]

What they are judging after you get to the interview process is whether or not you are a tool. They already know you are academically capable.

So its like another filter, where this time they filter out the tools.

After that, would you suppose they go back to objective standards like Step score and start taking people from the top? I can't imagine, after filtering out the tools, they would start taking people based on likeability first, rather than start taking people based on something objective like Step scores... as in, start taking people with highest Step scores first.

 

[AlexMorph]

So its like another filter, where this time they filter out the tools.

After that, would you suppose they go back to objective standards like Step score and start taking people from the top? I can't imagine, after filtering out the tools, they would start taking people based on likeability first, rather than start taking people based on something objective like Step scores... as in, start taking people with highest Step scores first.

If you had to work with someone, would you pick someone who was smart enough and also well-liked or someone who is super smart but has the personality of a rock? Of course the people who are liked more get a higher preference. A 260 or a 275 really doesn't make that much of a difference. They both will make stupid mistakes as interns.

 

[Crow King]

If you had to work with someone, would you pick someone who was smart enough and also well-liked or someone who is super smart but has the personality of a rock?

Instead of smart enough and well liked, I'd pick sociable enough and very smart.

 

[Ortho Guy]

Test scores show if you can play the game, everything else determines if you'd make a good teammate.

Instead of smart enough and well liked, I'd pick sociable enough and very smart.

I'm sure you would.

 

[Crow King]

I'm sure you would.

🙄

 

[Rollo]

Not if you suck in person. Two standard deviations above the mean which puts you at 270 is really realy high and will get you interviews most everywhere but if you suck you still can not match.

2 standard deviation isn't at 270. It's more at 246.

To answer the original question, yes a very good Step score will net you interviews at lot of places. Matching is a different story because other variables such as clinical year grades, letter of recommendations, audition rotations, research, etc. are involved and can definitely help or hurt you.

Don't worry about that now. Focus on learning the basic sciences and master the material from first 2 years. Boards studying will be cakewalk then.

 

[235009]

Instead of smart enough and well liked, I'd pick sociable enough and very smart.

i'm guessing you've never had a job

 

[235009]

2 standard deviation isn't at 270. It's more at 246.

wrong. the average was 222 with a standard deviation of 24 so 2 SDs is actually exactly 270

 

[2012mdc]

2 standard deviation isn't at 270. It's more at 246.

To answer the original question, yes a very good Step score will net you interviews at lot of places. Matching is a different story because other variables such as clinical year grades, letter of recommendations, audition rotations, research, etc. are involved and can definitely help or hurt you.

Don't worry about that now. Focus on learning the basic sciences and master the material from first 2 years. Boards studying will be cakewalk then.

My score report from last year had the mean at 221 and one SD as 24. 2 SD's is 269.

 

[AlexMorph]

wrong. the average was 222 with a standard deviation of 24 so 2 SDs is actually exactly 270

this is accurate

 

[Funky]

I think it depends on the specialty. I saw an article from 2002 where ortho residency directors ranked what they thought was important in selecting residents. Step 1 was ranked 2nd most important but interestingly personal appearance was ranked 5th.

 

[Siverhideo1985]

Isn't there some official report that states exactly how important residency directors think certain things are? As in Step 1, Grades, Honors in Clerkships, etc? It even lists it by specialty. Reading that would make this discussion obsolete.

I'm too tired to find it now, but I am sure someone on SDN has that report in their favorites folder.

 

[drizzt3117]

Essentially post-interview selection is about a lot of things but who you know is very important. Furthermore, if one person, be they a secretary, resident, attending, has something negative to say about a candidate, they're eliminated from consideration, at least at a few places I'm familiar with.

So its like another filter, where this time they filter out the tools.

After that, would you suppose they go back to objective standards like Step score and start taking people from the top? I can't imagine, after filtering out the tools, they would start taking people based on likeability first, rather than start taking people based on something objective like Step scores... as in, start taking people with highest Step scores first.

 

[winkleweizen]

2 standard deviation isn't at 270. It's more at 246.

To answer the original question, yes a very good Step score will net you interviews at lot of places. Matching is a different story because other variables such as clinical year grades, letter of recommendations, audition rotations, research, etc. are involved and can definitely help or hurt you.

Don't worry about that now. Focus on learning the basic sciences and master the material from first 2 years. Boards studying will be cakewalk then.

NVM...

so yes, a high step 1 score will take you far, but if you suck (ie cant keep a conversation with an interviewer) dont expect good things.

 

[K31]

Isn't there some official report that states exactly how important residency directors think certain things are? As in Step 1, Grades, Honors in Clerkships, etc? It even lists it by specialty. Reading that would make this discussion obsolete.

I'm too tired to find it now, but I am sure someone on SDN has that report in their favorites folder.

2010 NRMP Program Director's Survey

Interpersonal interactions, both in the interview and at other times during your visit, are ranked as the most highly weighted aspect, followed by LORs, clerkship grades, Step scores, etc.

 

[Crow King]

i'm guessing you've never had a job

And I'm guessing you have a low or average Step score? 😛

I have a different opinion, you don't need to be a douche about it.

 

[Crow King]

btw much thanks for that link K31

 

[DrCoffeeBean]

I am under the impression that numbers get you the interview, and then you yourself get the job.

 

[Siverhideo1985]

2010 NRMP Program Director's Survey

Interpersonal interactions, both in the interview and at other times during your visit, are ranked as the most highly weighted aspect, followed by LORs, clerkship grades, Step scores, etc.

thank you for "digging" this up!

 

[2012mdc]

2010 NRMP Program Director's Survey

Interpersonal interactions, both in the interview and at other times during your visit, are ranked as the most highly weighted aspect, followed by LORs, clerkship grades, Step scores, etc.

Considering that in the competitive specialties many programs only offer IV's to ~10-15% of applicants having the numbers (step 1, 3rd year grades) is essential. You can't sit down at the table if they don't even let you in the door.

Although the interviewed applicants are still stratified by numbers and other pre-IV stuff (LOR's, dean's letter) this group is much more homogenous. Numbers still matter but matter less and fit becomes a big issue. Don't be a douche and show genuine interest and in theory you will find the right fit. Apply and interview with an open mind. 77% of US Seniors match into their top 3 (rises to 81% when considering only those who match)

http://www.nrmp.org/data/resultsanddata2011.pdf - look at figure 7 for stats I mentioned above and table 17 for belo

I'll use radiology as an example. Many programs say they interview 10-15% of their applicants which turns out to be between 60 and 100 usually. On average radiology programs had to rank 7 people per position to fill (table 17) Of course somewhere like MGH doesn't have to go that far but say they go down to 30 on their list. Getting the IV would still be by far the biggest hurdle.

 

[ZagDoc]

I am under the impression that numbers get you the interview, and then you yourself get the job.

Pretty accurate. You can pretty much close off entire fields if your scores arent up to snuff, but your scores will never get you the job. Sure there's anecdotes of people matching into hard-to-get fields with avg scores... but you dont want to be the anecdote, you want to be the sure thing.

Once you get to interview day, everyone is pretty much on even footing. Sure, aspects of you CV will come up during the ranking process, but its much more about "is this person going to work hard, not **** up, and be enjoyable to work with for 3/4/5/6/7 years?"

ECs for residency apps are basically something to talk about on your interview day after they've gotten their token "why butt surgery? whats on your 10 year butt surgery plan? do you have any questions about our butt surgery program?" schtick out of the way and have 10 minutes of awkward silence to fill. Whether this makes you more personable and memorable on interview day... hard to say. But programs really dont care about all those hours you spent setting up that diabetes clinic for puppy dogs. You're not going to have time for that in residency anyways.

Also second the comment that extremely high Step 1 scores make people wary more than impress for some reason (people will despair how this isn't "fair", but its true, its human instinct). You have to prove you're a normal human being more if you have a 270 than if you have a 250.

 

[ArcGurren]

Agreed with the comments regarding the obscenely high step 1 scores - I know someone with a 275 who was socially inept. Still matched well but he had a harder time than most.

 

[Law2Doc]

I am under the impression that numbers get you the interview, and then you yourself get the job.

Mostly this. A good audition rotation or phone calls from mentors in the field can also get you the interview and having the numbers will keep it from being a courtesy interview.

In general programs use ERAS to filter applicants that meet certain criteria, and from the group that passes the filter they more carefully read the applications to see who they want to bring in. But numbers are never the end of the game. Even if a residency program set their threshold numbers high, they are still going to have to make choices, there is no such thing as a shoo in. You also have to realize that every specialty looks at a range of numbers. So for one specialty, they might decide "we don't want to look at anyone with less than a 230". But that doesn't mean that someone with a 250 is regarded by them as better than a 230. They don't necessarily care once you meet their threshold -- if they needed you to have 240, they would have set their threshold there. The numbers no longer are a factor once they decide you were worthy of one of their scant interview slots. Your interview, your letters, your personality matters. The PD has to decide you will be a good, dependable employee who not only will score adequately on the inservice exams, but more importantly will be able to do the day to day job without causing him headaches. The residents (in many programs they get a voice regarding applicants) have to like you and think you will be a good teammate. So the guy with a good enough board score who comes across well in person does very well on the residency interview path. The bottom line for the OP is that you did okay but not great in terms of med school applicancy. You had high numbers, but didn't close the deal on as many places as your numbers would predict, so you came up short in some areas. The competition is fiercer for the competitive specialties, so you may need to put up even more than good board scores to close the deal the next time around. If your personality is lukewarm, you cant just rely on numbers, get some research under your belt.

 

[K31]

thank you for "digging" this up!

No problem; I seem to be turning into one of those people who obsessively bookmarks these kinds of things.

A Pubmed search can turn up specialty-specific data as well.

 

[2012mdc]

Pretty accurate. You can pretty much close off entire fields if your scores arent up to snuff, but your scores will never get you the job. Sure there's anecdotes of people matching into hard-to-get fields with avg scores... but you dont want to be the anecdote, you want to be the sure thing.

Once you get to interview day, everyone is pretty much on even footing. Sure, aspects of you CV will come up during the ranking process, but its much more about "is this person going to work hard, not **** up, and be enjoyable to work with for 3/4/5/6/7 years?"

ECs for residency apps are basically something to talk about on your interview day after they've gotten their token "why butt surgery? whats on your 10 year butt surgery plan? do you have any questions about our butt surgery program?" schtick out of the way and have 10 minutes of awkward silence to fill. Whether this makes you more personable and memorable on interview day... hard to say. But programs really dont care about all those hours you spent setting up that diabetes clinic for puppy dogs. You're not going to have time for that in residency anyways.

Also second the comment that extremely high Step 1 scores make people wary more than impress for some reason (people will despair how this isn't "fair", but its true, its human instinct). You have to prove you're a normal human being more if you have a 270 than if you have a 250.

What if you're right in the middle? 😛

Agreed with the comments regarding the obscenely high step 1 scores - I know someone with a 275 who was socially inept. Still matched well but he had a harder time than most.

What do you mean by harder time? Bad interview experiences? Fell out of his top 3?

 

[235009]

And I'm guessing you have a low or average Step score? 😛

I have a different opinion, you don't need to be a douche about it.

you'd be very wrong ...my score is above the avg score of all the specialties in charting outcomes....let's just leave it at that

this isn't about your opinion vs. mine ....people across the board prefer to work with someone they enjoy being around rather than a robot or a-hole they can't stand but is slightly more qualified. If you ever had a real job you'd know that and would agree.

 

[Siverhideo1985]

No problem; I seem to be turning into one of those people who obsessively bookmarks these kinds of things.

A Pubmed search can turn up specialty-specific data as well.

Ah, the joys of working with MD/PhDs 😀 you always have the answer to "where are your data?"

you'd be very wrong ...my score is above the avg score of all the specialties in charting outcomes....let's just leave it at that

this isn't about your opinion vs. mine ....people across the board prefer to work with someone they enjoy being around rather than a robot or a-hole they can't stand but is slightly more qualified. If you ever had a real job you'd know that and would agree.

You're right...it's about sneaking in a little bragging about your Step 1 score.

"Hmmm....tastes goooood"

 

[Crow King]

Thanks for all the input, it was very helpful! 🙂

 

[235009]

You're right...it's about sneaking in a little bragging about your Step 1 score.

if i wanted to brag i would just say my score and post about it in the scores thread like so many have done. just wanted to make sure he realized that my "opinion" wasn't being clouded by wishful thinking (like when people who went to low tier colleges swear up and down that where you went to undergrad plays no role whatsoever in med school admissions despite much evidence to the contrary)

 

[Crow King]

if i wanted to brag i would just say my score and post about it in the scores thread like so many have done. just wanted to make sure he realized that my "opinion" wasn't being clouded by wishful thinking (like when people who went to low tier colleges swear up and down that where you went to undergrad plays no role whatsoever in med school admissions despite much evidence to the contrary)

I take back what I said- you were right, I would prefer to work with someone who is more fun to be around than someone who is smarter.

I was thinking something else when I answered what you asked.

If you were the admissions committee at a school or some program, who would you rather take? The smart enough and well liked guy or the sociable enough and very smart guy?

 

[Ortho Guy]

If you were the admissions committee at a school or some program, who would you rather take? The smart enough and well liked guy or the sociable enough and very smart guy?

The qualified person that I like the most.

 

[2012mdc]

I take back what I said- you were right, I would prefer to work with someone who is more fun to be around than someone who is smarter.

I was thinking something else when I answered what you asked.

If you were the admissions committee at a school or some program, who would you rather take? The smart enough and well liked guy or the sociable enough and very smart guy?

Both people would have been deemed qualified enough to receive IV's so I would go with the well liked guy especially if it's a smaller program.

 

[Crow King]

The qualified person that I like the most.

Both people would have been deemed qualified enough to receive IV's so I would go with the well liked guy especially if it's a smaller program.

You guys are both assuming you have to work with this person, right?

 

[2012mdc]

You guys are both assuming you have to work with this person, right?

Yes.

But it would be the same way if I didn't have to work with that person. I don't want douches or a-holes in my program regardless if I run it vs just being on the committee and rarely interacting with residents vs being a resident.

The overwhelming majority of applicants who get interviews will be academically qualified.

Don't have any fears, you got accepted to half the places you interviewed at so you don't have a personality d/o.

 

[CaptainSSO]

I take back what I said- you were right, I would prefer to work with someone who is more fun to be around than someone who is smarter.

I was thinking something else when I answered what you asked.

If you were the admissions committee at a school or some program, who would you rather take? The smart enough and well liked guy or the sociable enough and very smart guy?

I think you're right, I think most people would pick the sociable enough and very smart guy.

At my last job, one of the most likable guys there, happened to be extremely lazy. He was a great guy, hilarious, fun to talk to--he just opted out of doing any actual work every chance he could get.

Another guy there had the personality of a rock, but he was an extremely hard worker. He did whatever was put in front of him, and he did it very well and very fast.

The guy who was the hard worker was respected immensely, even though his personality wasn't the best, and he worked more hours than anyone else there, because he was hands down the best.

Everyone wanted him around because they knew he was reliable and would get his work done.

I personally don't think hospitals are the bastions of charisma; the fact of the matter is, most people have very average personalities (myself and most of my friends included). So I think the other factors play a bigger role than perhaps they are being given credit for.

 

[Ortho Guy]

PDs will like applicants with enthusiasm, a strong work ethic, integrity, personality, class, and social skills. These don't show up on a paper application, they can only be assumed via ECs. Hence, we interview folks.

I wouldn't attempt to link social skills with laziness, it's a tenuous link at best.

 

[ArcGurren]

What if you're right in the middle? 😛



What do you mean by harder time? Bad interview experiences? Fell out of his top 3?

Yes to bad interviewing and also he was not ranked in some programs where he by all rights should have been.

 

[isoquin]

OP, it sounds like you are bitter, and that you have a false sense of entitlement based purely on your MCAT score. I'd guess skinMD is correct in that you've never held a job before, as you are not exhibiting good insight into how students are selected. MCATs hugely influence interviews, but red flags on an application, such as poor interpersonal skills, negative LORs, and a poorly written personal statement, are a good reason to reject an applicant.

Reading your interactions in this thread alone, you rub me the wrong way. I would not want you at my medical school. I don't see you as someone I'd want to call classmate. This is not said to be mean, but rather to provide feedback from someone who used to interview applicants.

What's worse, is that you are getting this feedback from multiple people in this thread, although not as explicit, and are erroneously attributing it to everyone else being wrong. You are showing a number of immature defense mechanisms, and instead of taking some advice and humble pie, you are pushing back because you believe you are just too awesome. Pointing fingers at other people and making blind accusations that they earned poor scores, or wild assumptions that they must not be as awesome as you, demonstrates your immaturity.

I would guess that your above average MCAT score compensated for your less than average interpersonal skills. You're going into medicine, so that's really not going to fly from here on out. It's one thing to overlook character flaws when adding someone to a class of 150. That won't work so well, regardless of your board scores, when attempting to enter a program that accepts 3 people per year.

So take a good look at your behavior in this thread and elsewhere. Is it that everyone else coming to the same conclusion about you is wrong? Or is it more likely that you are biased and having a difficult time being accurately introspective?