New Charting Outcomes 2014

[Raryn]

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http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf

Very interesting. Things have definitely changed a bit from the 2011 one. Need some time to chew through it before specific commentary, but the difference in step 1 scores is a big one.

 

[MEN2C]

Holy ****.

 

[MEN2C]

I'm glad I'm not applying in 2018. With 30% increase in US medical students, it's going to be absolutely BRUTAL then. Look at the stats. Step 1 averages in high 240s and step 2s in 250s for multiple specialties....

ENT. What. Look at the unmatched ENT....would have been considered superstars for most other specialties only a few years ago.


I also wouldn't want to be an IMG in a few years.

 

[NeedToStudy]

It's scary how 230 has become an average score. There was a time where getting more than 200 was considered competitive.

 

[JJMrK]

Seems mostly as expected to me, except maybe for the plummeting match rates for the most competitive specialties. Did not think the surgical subspecialties were quite on that level yet.

 

[calvnandhobbs68]

I'm glad I'm not applying in 2018. With 30% increase in US medical students, it's going to be absolutely BRUTAL then. Look at the stats. Step 1 averages in high 240s and step 2s in 250s for multiple specialties....

ENT. What. Look at the unmatched ENT....would have been considered superstars for most other specialties only a few years ago.


I also wouldn't want to be an IMG in a few years.

The overall match rates are interesting. Not quite what you would expect with respect to independent applicants. The overall match rate for independent applicants actually went UP from 44 to 53%.

 

[Raryn]

The overall match rates are interesting. Not quite what you would expect with respect to independent applicants. The overall match rate for independent applicants actually went UP from 44 to 53%.

My bet is it's because of the removal of prematches. All of the formerly successful independent applicants who would have prematched and left the stats are now captured in the match stats.

You can see it pretty easily in the >1000 spot increase in the number of IM spots, almost entirely going to independent applicants.

 

[BlondeDocteur]

I think they might have removed the people who apply but don't submit rank lists. Those people used to just try to find something in the scramble even if they received no interviews, but now they are barred from the SOAP so a lot of the bottom feeders have been excised.

 

[NeedToStudy]

I was just wondering why does everybody think the average usmle score is increasing so much? Is it because the study resources have become more efficient? For ex. rather than reading Robbins or even Goljan many people can just read Pathoma. Or is it because medical education has gotten better?

 

[BlondeDocteur]

It's because of commercial prep tools like USMLE World. Everyone uses it, everyone studies from the same bank of questions, and as a result scores are increasing-- much like the MCAT. The scores are awarded on a multi-year curve so current students' %age correct is being compared to past students' %age correct, hence the overall increase.

There is perennial talk of making Step 1 pass-fail precisely because of this issue, and because of the supposedly undue weight placed on it in the residency selection process.

 

[NeedToStudy]

There is perennial talk of making Step 1 pass-fail precisely because of this issue, and because of the supposedly undue weight placed on it in the residency selection process.

Honestly I think this would just disadvantage IMGs. How else would IMgs stand except without high step 1 scores?

 

[IMPD]

It's because of commercial prep tools like USMLE World. Everyone uses it, everyone studies from the same bank of questions, and as a result scores are increasing-- much like the MCAT. The scores are awarded on a multi-year curve so current students' %age correct is being compared to past students' %age correct, hence the overall increase.

There is perennial talk of making Step 1 pass-fail precisely because of this issue, and because of the supposedly undue weight placed on it in the residency selection process.

There is a great essay on "show me the rankings" from this month's GME journal. The essay is that since Med Schools are avoiding ranking students (even quartiles), PDs are relying more on the USMLEs. It's true. The pressures on schools and testing groups to be "pass/fail" is probably as intense as the pressure from GME groups to give ranking information. I don't see this as resolvable. Competition dictates that ranking with either be explicit, or implicit in code-words. PDs just want something to use with PDWS.

 

[Raryn]

The overall charts on the first few pages are quite illuminating.

Table 1: The only specialty with less total applicants than spots is child neurology. Followed closely by Radiology and Med/Peds.
Chart 2: Breaking that down into us grads/independent applicants, the vast majority of specialties still have a lot more spots than US applicants. The only exceptions are derm, neurosurg, ortho, ent, integrated plastics. Rad Onc is at parity.
Chart 3: Specialty with the highest match rate is Radiology. This is consistent with the data in table 1 and the fact that the last 3 years running radiology has had the highest number of unmatched slots every year. Lowest match rates are the same derm+surgical subspecialties that have the most applicants. Everyone else is in the low-mid 90s.
Table 2: No huge surprises. Of note, the mean number of contiguous ranks (a pretty good proxy for the # of interviews) for matched applicants has gone up to 11.5.
Chart 4: Breaks the contiguous ranks down by specialty. Everyone is in a pretty narrow range, with people applying to smaller subspecialties tending to rank more places. Going back to the above point regarding rads, people still seem to think it's more competitive than the data shows, so applicants to that are going on a lot of interviews (with an average of 14 being closer to the surgical subspecialties than anything else).
Chart 5: Shows the number of people applying to multiple specialties. No surprises, people applying derm, plastics, rad onc are more likely to have backup fields.
Chart 6: USMLE scores are all up 4-5 points from the prior charting outcomes, completely consistent with the increase in average scores. No big surprises.
Chart 7: Step 2 scores are way inflated, but this has been a chronic issue. No wonder the pass margin is almost 210 these days.

I won't comment on the research/volunteer/work experience graphs. That stuff is so subjective I think it's worthless data.

 

[Rothbard]

Why no charting outcomes 2013?

 

[Raryn]

Why no charting outcomes 2013?

Two possible explanations:

1) The people that would normally do charting outcomes were working on other projects (like the IM fellowship charting outcomes or the charting outcomes for FMGs)

2) NRMP and ERAS weren't playing nice so it took them a while to sort out the datagathering which delayed it.

We'll probably never know

 

[NeedToStudy]

Why no charting outcomes 2013?

They wanted us to get comfortable with the 2011 numbers so that they could suprise us with the 2014 numbers.

 

[IMPD]

The overall charts on the first few pages are quite illuminating.

Table 1: The only specialty with less total applicants than spots is child neurology. Followed closely by Radiology and Med/Peds.
Chart 2: Breaking that down into us grads/independent applicants, the vast majority of specialties still have a lot more spots than US applicants. The only exceptions are derm, neurosurg, ortho, ent, integrated plastics. Rad Onc is at parity.
Chart 3: Specialty with the highest match rate is Radiology. This is consistent with the data in table 1 and the fact that the last 3 years running radiology has had the highest number of unmatched slots every year. Lowest match rates are the same derm+surgical subspecialties that have the most applicants. Everyone else is in the low-mid 90s.
Table 2: No huge surprises. Of note, the mean number of contiguous ranks (a pretty good proxy for the # of interviews) for matched applicants has gone up to 11.5.
Chart 4: Breaks the contiguous ranks down by specialty. Everyone is in a pretty narrow range, with people applying to smaller subspecialties tending to rank more places. Going back to the above point regarding rads, people still seem to think it's more competitive than the data shows, so applicants to that are going on a lot of interviews (with an average of 14 being closer to the surgical subspecialties than anything else).
Chart 5: Shows the number of people applying to multiple specialties. No surprises, people applying derm, plastics, rad onc are more likely to have backup fields.
Chart 6: USMLE scores are all up 4-5 points from the prior charting outcomes, completely consistent with the increase in average scores. No big surprises.
Chart 7: Step 2 scores are way inflated, but this has been a chronic issue. No wonder the pass margin is almost 210 these days.

I won't comment on the research/volunteer/work experience graphs. That stuff is so subjective I think it's worthless data.

Thanks for the summary. I agree with the assessment. Radiology collapse is due to inflated spots? Lack of demand? Is it the only specialty that digital is going to eat?

 

[thesauce]

Interesting. I've been hearing how EM and anesthesia have become more competitive, but this suggests they have risen on par with other specialities and are still less competitive than IM.

No real surprises except the collapse of radiology. I didn't realize things had changed that much for them. Radonc competitiveness is down - looks to be a result of the increasing number of spots.

 

[mvenus929]

Two possible explanations:

1) The people that would normally do charting outcomes were working on other projects (like the IM fellowship charting outcomes or the charting outcomes for FMGs)

2) NRMP and ERAS weren't playing nice so it took them a while to sort out the datagathering which delayed it.

We'll probably never know

Not sure how it has worked in years past, but last year, they had us fill out a survey via NRMP... They did not gather data directly from ERAS.

 

[user3]

I wish they posted separate data for each type of independent applicant. As a DO student, it would be helpful to see DO specific match rates for the board score brackets, number of ranks, etc across the specialties.

 

[BoardingDoc]

Interesting. I've been hearing how EM and anesthesia have become more competitive, but this suggests they have risen on par with other specialities and are still less competitive than IM.

I don't agree with your read on EM and Anesthesia. The data clearly show that both of these fields have become more competitive over the past few years, and they are both certainly more competitive than IM. E.g. A step 1 score of 200 gets you a 90% chance of matching into IM, but only a 78% chance of matching EM or 75% chance of anesthesia. Other data such as number of programs needed to rank in order to have an X% chance of matching also indicates that anesthesia and em are more difficult than IM.

 

[UCLA2014]

Thanks for the summary. I agree with the assessment. Radiology collapse is due to inflated spots? Lack of demand? Is it the only specialty that digital is going to eat?

Just curious, what do you mean by collapse?

I'd also like to point out average step for diagnostic rads comes just behind dermatology, ortho, ENT, radonc, and plastics.

We are nowhere near (decades away even) from being close to having computer read imaging studies.

IM or primary care is closer to being replaced by computers

 

[thesauce]

I don't agree with your read on EM and Anesthesia. The data clearly show that both of these fields have become more competitive over the past few years, and they are both certainly more competitive than IM. E.g. A step 1 score of 200 gets you a 90% chance of matching into IM, but only a 78% chance of matching EM or 75% chance of anesthesia. Other data such as number of programs needed to rank in order to have an X% chance of matching also indicates that anesthesia and em are more difficult than IM.

You can't really look at the match rates (especially for a subgroup) alone because of self-selection. Successful IM applicants have higher step scores, more research, more of them are AOA, and more have PhDs.

Yes, Anesthesia and EM both had an increase in all of these factors from the last charting outcomes, but that increase is on par with the increase seen in IM over that same time period.

Both have stayed approximately the same in terms of competitiveness (relative to most other specialties) and they are certainly less competitive than internal medicine.

 

[BoardingDoc]

You can't really look at the match rates (especially for a subgroup) alone because of self-selection.

I don't understand your self selection argument. There are certainly self selecting fields out there. e.g. Ortho, derm, plastics, ENT. All of these fields absolutely have people who don't apply because they think they won't make the cut, and they still have acceptance rates below 80%. The fact of the matter is that 97% of us seniors who apply to IM match. If there is self-selection going on, it's going on across the board and the acceptance rates to IM programs remain the highest in medicine behind rads and path. Is it hard to get into a good IM program? Absolutely! But to say that it's harder to obtain a residency in IM than it is in EM/Gas just doesn't add up.

 

[thesauce]

I don't understand your self selection argument. There are certainly self selecting fields out there. e.g. Ortho, derm, plastics, ENT. All of these fields absolutely have people who don't apply because they think they won't make the cut, and they still have acceptance rates below 80%. The fact of the matter is that 97% of us seniors who apply to IM match. If there is self-selection going on, it's going on across the board and the acceptance rates to IM programs remain the highest in medicine behind rads and path.

This is exactly why you can't use the match rate to determine competitiveness. Rads has a higher match rate than IM, EM, or Anesthesia. As a result, you would say rads is less competitive even through successful rads applicants have higher stats across the board than all 3 of these specialties.

A self-selected group applies to all specialties. Someone who thinks they are a good anesthesia applicant applies anesthesia. EM to EM etc. This may be due to LORs, who they know, or any number of other factors.

Interestingly, Harvard med school has a higher acceptance rate than BU. Do you think that's because BU is more competitive?

Look, I was surprised by this too when it came out in the last charting outcomes, but the data is right there in front of you. You need to keep an open mind. Anesthesia and EM are not as competitive as everyone thought.

Is it hard to get into a good IM program? Absolutely! But to say that it's harder to obtain a residency in IM than it is in EM/Gas just doesn't add up.

So, I'm curious: how do you explain higher step scores, more research, higher % AOA, and higher % PhD's in successful IM applicants? You didn't address that part.

 

[NSAspy]

what's residency is Gas? or is it short for gasteroenterology (IM fellowshi[)?

 

[Raryn]

what's residency is Gas? or is it short for gasteroenterology (IM fellowshi[)?

Anesthesiology

 

[evilbooyaa]

Interesting. I've been hearing how EM and anesthesia have become more competitive, but this suggests they have risen on par with other specialities and are still less competitive than IM.

No real surprises except the collapse of radiology. I didn't realize things had changed that much for them. Radonc competitiveness is down - looks to be a result of the increasing number of spots.

I think that the top programs in IM are harder to get into than the top programs in EM. However, as there are so many IM programs across the country, the prospect of matching into ANY IM program is likely easier than matching into ANY EM program. I won't speak for anesthesia b/c in my gut it isn't getting more competitive.

There were ~3100 US Seniors who matched into IM. There were also ~3100 independent applicants who matched into IM. The US Seniors are better statistically than their independent counterparts, but for EM, it was 1,300 US Seniors and only 300 independent.

Collapse of radiology is again dictated by the explosion in their residency programs and that the lower-tier radiology programs aren't very competitive. The top radiology programs will still attract high-scoring candidates as is shown. The lower-tier programs are more likely to take the Independent applicants with averages of 235/240. Same story as IM.

Radonc competitiveness is down? In comparison to how everything else got more competitive and rad onc is essentially stable from 2011, then sure I see your point. The scores didn't inflate at the same rate as the others, but Step 1 and Step 2 are identical.

http://www.nrmp.org/wp-content/uploads/2013/08/chartingoutcomes2011.pdf - Page 265.

Same # of people applying for 15 more residency spots. Mean abstracts up by 4, AOA down by 8% in matched (that's significant I guess), but I look at the fate of those who didn't match as a sign of competitiveness for a field in general (as going to a residency program is better than not matching at all):
In 2011 Outcomes, 27 US Seniors who didn't match had average Step 1/Step 2 of 217/222.
In 2014, 20 US Seniors who didn't match had average of 237/240. That's among the highest out of the specialties I reviewed (besides ENT, which is just on plastics/urology levels of insane now)

For comparison:
ENT - 91 Seniors who didn't match, averaged 239/245.
Plastics - 52 Seniors who didn't match, averaged 236/241
Derm - 111 Seniors who didn't match, averaged 239/248.

Ok, in hindsight Rad Onc may be losing a tiny bit of ground in comparison to the other hypercompetitive fields, but it's way harder to match now than it was to match just 3 years ago, and is keeping up pretty well with the other fields. Rad Onc as a field (at least from what I've heard from advisers) has always been a field where Step scores are less important than they are for ENT/Plastics/Derm/Ortho/etc.

 

[kristofer]

Same # of people applying for 15 more residency spots. Mean abstracts up by 4, AOA down by 8% in matched (that's significant I guess), but I look at the fate of those who didn't match as a sign of competitiveness for a field in general (as going to a residency program is better than not matching at all):
In 2011 Outcomes, 27 US Seniors who didn't match had average Step 1/Step 2 of 217/222.
In 2014, 20 US Seniors who didn't match had average of 237/240. That's among the highest out of the specialties I reviewed (besides ENT, which is just on plastics/urology levels of insane now)

I think this is more indicative of the fact that step scores aren't as much of an absolute deal breaker in rad-onc as they are in other fields (speaking from my own experience in getting interviews with lower scores). PhDs with step scores in the 220s tend to fare pretty well in the rad onc match whereas they probably wouldn't in other competitive fields. I think it's probably unlikely that those with step 1 scores around the 237 unmatched average didn't match because of their step 1 score. I disagree that rad-onc is currently "way harder" to match into than it was 3 years ago. 3 years ago people were applying for the 2012 match, which was the most competitive in the history of the field I believe. My gut feeling is that this is going to be an uncompetitive year for rad-onc and that the next few years will be hypercompetitive like the 2012 match (following this data and the relatively uncompetitive 2013 match). Certainly a not insignificant number of 3rd/4th year med students see the results from the most recent data when deciding whether or not to apply to a field like rad-onc with very few spots causing these swings between more competitive and less competitive seasons.

Regarding radiology, I am under the impression that it has become less competitive because of a very poor job market and increasing necessity of doing one or more fellowships to be competitive in the job search. I.e., I don't think it's simply an oversupply of graduating residents from new/expanded programs generating this problem, but I could be wrong. Interestingly rad-onc appears to be suffering similar struggles in the job market (albeit not as bad), which does appear to be more driven by an increasing number of graduating residents, but does not appear to be affecting the competitiveness of the field. I would guess this has something to do with the very esoteric and specialized nature of the field which attracts people for reasons other than the ease of finding a high-paying job with geographic flexibility upon graduation.

 

[mercaptovizadeh]

The rising step scores are particularly damaging to MD PhD applicants, who have an extra 3-5 year lag on their score from their co-applicants. A 250 back in 2009 is a 260 today, but the PDs don't see that.

 

[user3]

Collapse of radiology is again dictated by the explosion in their residency programs and that the lower-tier radiology programs aren't very competitive.

# of PGY-1 rads increased only ~10% from 2002 to 2014 (source: GME data resouce book, NRMP).

 

[FutureInternist]

Isn't the USMLE supposed to come out with just 2 digit scoring soon

Going to make matching way harder

 

[Raryn]

Isn't the USMLE supposed to come out with just 2 digit scoring soon

Going to make matching way harder

Exact opposite. They completely nixed the 2 digit scoring last year. Three digit only now.

 

[FutureInternist]

Exact opposite. They completely nixed the 2 digit scoring last year. Three digit only now.

Oh...That's better then

I always felt bad about the people who got high 250s being lumped in with lower scores on the 2 digit score

 

[DermViser]

Oh...That's better then

I always felt bad about the people who got high 250s being lumped in with lower scores on the 2 digit score

You're kidding right? Before PDs saw the 2 digit score and the 3 digit score.

 

[thesauce]

You're kidding right? Before PDs saw the 2 digit score and the 3 digit score.

Right. And they completely ignored the 2-digit score.

 

[DermViser]

Right. And they completely ignored the 2-digit score.

Exactly. They only looked at the 3 digit. The only reason they removed the 2 digit score from score reports to residencies is bc they are still some fools who think it's a percentile after the NBME has said again and again that it isn't a percentile.

 

[thesauce]

Exactly. They only looked at the 3 digit. The only reason they removed the 2 digit score from score reports to residencies is bc they are still some fools who think it's a percentile after the NBME has said again and again that it isn't a percentile.

I still can't get over this. Not only does it explain it right on the score report, but who are these idiot PDs that think they're only getting applications from people with 75+ percentiles? Don't they think it's a little strange that they've never seen even one application that was below that?

 

[DermViser]

I still can't get over this. Not only does it explain it right on the score report, but who are these idiot PDs that think they're only getting applications from people with 75+ percentiles? Don't they think it's a little strange that they've never seen even one application that was below that?

They may have taken boards at a time when percentiles were given.

 

[Raryn]

I still can't get over this. Not only does it explain it right on the score report, but who are these idiot PDs that think they're only getting applications from people with 75+ percentiles? Don't they think it's a little strange that they've never seen even one application that was below that?

It was mostly IMGs who thought the two digit score meant something. Not program directors.

 

[gutonc]

I still vote for a P/F USMLE system.

 

[thesauce]

I still vote for a P/F USMLE system.

I think that would be a huge mistake. Right now, it's the only objective measure of performance that candidates have. Without it, you would have to go on letters of recommendation which are basically generic for everyone or clinical evaluations which are really no better.

 

[IMPD]

I still vote for a P/F USMLE system.

Interesting commentary in latest JGME about a wish that med schools showed more "ranking" in their grades. I think this is unlikely to happen for many reasons. So, we're left with USMLE and counting AOA and publication "points". Back in the day when recruitment happened by other means (word-of-mouth? entirely on med school rep? late-night phone calls from PDs to clerkship directors?) I'm sure they bemoaned the arbitrary nature of that as well. Basically, I have no idea what the ideal recruitment situation is and lots of good people get passed over for bad reasons. But that is also the way that life is in general.

 

[gutonc]

I think that would be a huge mistake. Right now, it's the only objective measure of performance that candidates have. Without it, you would have to go on letters of recommendation which are basically generic for everyone or clinical evaluations which are really no better.

It's an objective measure of a person's ability to take a standardized test. Nothing more. A reasonably smart person willing to spend 6 months doing nothing but Step 1 review could easily score a 240. Do you really want that to be your "objective measure of performance" for budding physicians? At the most, it should be a hurdle required to get past a particular level of training (M1/2 for Step 1, M3 for CK/CS). The way it's currently used is an abomination.

 

[thesauce]

It's an objective measure of a person's ability to take a standardized test. Nothing more. A reasonably smart person willing to spend 6 months doing nothing but Step 1 review could easily score a 240. Do you really want that to be your "objective measure of performance" for budding physicians? At the most, it should be a hurdle required to get past a particular level of training (M1/2 for Step 1, M3 for CK/CS). The way it's currently used is an abomination.

So what needs to be changed is the way it's used and not the test itself. Would you make the MCAT and SAT pass/fail as well? The same argument applies there.

I'm curious how you would select residents?

 

[gutonc]

So what needs to be changed is the way it's used and not the test itself. Would you make the MCAT and SAT pass/fail as well? The same argument applies there.

I'm curious how you would select residents?

SAT and MCAT were both designed as admission tests. I think they're both kind of ridiculous at this point given the arms race with the exam prep companies, but at least they're being used for their intended purpose.

The USMLE was designed as a test of the readiness of a medical student to obtain a license to practice medicine. Nothing more, nothing less. From the website:

The United States Medical Licensing Examination ® (USMLE®) is a three-step examination for medical licensure in the United States and is sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners® (NBME®).

The USMLE assesses a physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure.

Nowhere in there does it say anything about determining a students ability to do Derm vs FM based solely on the result of the exam. But that's how it's used. And that's bulls***.

One of the best, most published and awarded (at the med school, residency and fellowship level) people I've ever worked with (he was a med student when I was a resident and resident when I was a fellow), failed Step 1 once and CK twice. Somehow, he's managed to convince people (appropriately) that his exam performance and clinical skill and acumen are two different things (and was offered a pre-match fellowship position at Stanford). I honestly don't think it's that hard to judge residency applicants. When I review apps, I typically don't bother to even check the Step scores because I know it's not relevant.

 

[thesauce]

....From the website:

Nowhere in there does it say anything about determining a students ability to do Derm vs FM based solely on the result of the exam. But that's how it's used. And that's bulls***.

One of the best, most published and awarded (at the med school, residency and fellowship level) people I've ever worked with (he was a med student when I was a resident and resident when I was a fellow), failed Step 1 once and CK twice. Somehow, he's managed to convince people (appropriately) that his exam performance and clinical skill and acumen are two different things (and was offered a pre-match fellowship position at Stanford). I honestly don't think it's that hard to judge residency applicants. When I review apps, I typically don't bother to even check the Step scores because I know it's not relevant.

Just because it wasn't designed for that purpose, doesn't mean it can't be used for it. The exam does give a score, so clearly it feels it can differentiate candidates, which is exactly what is needed when you're filtering out tons of great candidates for limited spots. In any case, it isn't the NBME's place to tell the individual programs how to select their candidates.

I can say that I felt it was a fair exam and the smartest people that I know did very well on the exam. If you are one of those people that doesn't traditionally do well on standardized tests, you should know that and put more time and effort into it. If, as you say, a "reasonably smart person" can pull 240 with the appropriate preparation, what does that say about your friend that failed it twice? He either wasn't "reasonably smart" or wasn't willing to prepare appropriately. And anyway, there are always outliers.

 

[rokshana]

It was mostly IMGs who thought the two digit score meant something. Not program directors.

ahh…no.

 

[Raryn]

ahh…no.

*shrug* Maybe you knew a program director who cared about it. As far as everyone else, the only people I ever saw who gave a rip about the 2 digit score ("I scored double 99" and such) were foreign grads. They frequently would go on and on about it. No one else cared at all.

 

[DermViser]

SAT and MCAT were both designed as admission tests. I think they're both kind of ridiculous at this point given the arms race with the exam prep companies, but at least they're being used for their intended purpose.

The USMLE was designed as a test of the readiness of a medical student to obtain a license to practice medicine. Nothing more, nothing less. From the website:

Nowhere in there does it say anything about determining a students ability to do Derm vs FM based solely on the result of the exam. But that's how it's used. And that's bulls***.

One of the best, most published and awarded (at the med school, residency and fellowship level) people I've ever worked with (he was a med student when I was a resident and resident when I was a fellow), failed Step 1 once and CK twice. Somehow, he's managed to convince people (appropriately) that his exam performance and clinical skill and acumen are two different things (and was offered a pre-match fellowship position at Stanford). I honestly don't think it's that hard to judge residency applicants. When I review apps, I typically don't bother to even check the Step scores because I know it's not relevant.

Aren't USMLE scores more correlative with ability to pass specialty boards? Not making an assertion, but genuinely asking.