USMLE Scores through the eyes of residency program faculty

[drryan123]

Dear All:

Have been reading your posts today and wanted to share some thoughts. When I took Step 1 (1999) the average score was about 215 (my recollection). Above 220 was solid and above 230 was fantastic. Above 240 was out this world.

Average scores are now in the mid to high 220s as you may know. Probably you are all smarter than students of my era, or maybe its all the new resources and Qbanks. Whatever, the reason, higher scores are more common now.

This has important implications for your application to residency. I have been a US faculty member for almost 7 years, interviewing applicants to IM residency and cardiology fellowship. Until recently, I had NO IDEA average scores had climbed so high. I certainly noticed more high scoring applicants. But if I saw an applicant with a 220, I didn't know that was "low" or below average. Based on my generation, 220 was an above average score.

Aim for the best score you can achieve, but for those of you worrying about a below average score, there is lots of reason to hope (besides the fact that step 1 scores alone do not determine the match). There is a decent chance the person reviewing your application file will not know where you fall compared to mean. That person may even judge your score based on a prior era when scores were lower.

Best of luck,
Dr. Jason Ryan
www.boardsbeyond.com

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[SBR249]

So I have a question that pertains to USMLE scores and residencies. I get that how scores are viewed is often subjective and based on the experiences of the person doing the interviewing or reviewing the application. But I hear some programs utilize automatic score cutoffs to screen applications. Do you have any information about how those cutoffs are set and how often they are adjusted?

 

[drryan123]

It's true that some programs use an automatic cutoff. The ERAS application system allows program directors to screen for only applicants with scores > XXX. When programs receive hundreds of applications for just a few slots this is one way of quickly narrowing the field. They are set arbitrarily. A program director chooses a cutoff based on his/her experience and how likely that cutoff is to narrow the application list. Even within 1 specialty, different programs may employ different cutoffs.

Having said that, I know a few program directors who use this technique and they all make frequent exceptions. They will grant an interview to an applicant below the cutoff if they receive a personal phone call from a colleague, or if a current resident speaks highly of the applicant. This is particularly true for IMGs - if a current resident (who is good and well liked) tells the program director to interview an applicant, that means a lot. Many residencies also have medical schools with a strong track record for their program. An applicant from one of these can get around the cutoff. Program directors who use a cutoff are aware (in my experience) that the cutoff screens out many good people. They will make an exception if given good reason.

Once you get the interview, your scores matter much less. At the interview, they want to know you can communicate well, work with a team, get things done, a have a good bedside manner with patients. All of this comes through much more in how you carry yourself than in your board scores. Your evaluations from clinical rotations are key here. They show that you are "street smart" as opposed to just "book smart" with Step 1 scores.

Scores definitely matter and a good score helps a lot. But weak scores are not the end of the world, and good scores need to be matched by good clinical evals and communication skills. Many of you have probably heard this before, but I post for those who are interested.

 

[Transposony]

Thank you Dr. Ryan for the insight.
So IMGs are evaluated solely based on their Step scores and interviewing skills since they don't have evaluations from clinical rotations (if they don't have any "connections").

 

[BlueArc]

Dr. Ryan if one gets a good score on step 1 and 2 but is an old immigrant how much does that effect his chance of getting into a competitive program? Also when they ask the applicants whether they know any seniors working in their program currently, how much does that help the applicant?

 

[drryan123]

Keep in mind that all this is my opinion. There is no one single answer to the questions you ask.

Regarding Transpony's question: The IMGs I have interviewed come with some type of letter of recommendation or other assessment of their clinical skills. Even if there are no formal clinical evaluations, most have a letter of recommendation that attests to their clinical skills. These are very valuable.You want to get letters of rec that state you are a good team member, and good with patients. The interview is also very important for an IMG. They will picture you as a member of the team in a US hospital. They will be looking for good communication skills.

Regarding BlueArc's question: I don't think age is a big factor. If anything, an old applicant may appear more mature which is a plus. If you know someone currently at a program, that can be helpful. Program directors often ask current residents for their input on applicants.

Best of luck to all of you,
Dr. Ryan

 

[Prince090]

Keep in mind that all this is my opinion. There is no one single answer to the questions you ask.

Regarding Transpony's question: The IMGs I have interviewed come with some type of letter of recommendation or other assessment of their clinical skills. Even if there are no formal clinical evaluations, most have a letter of recommendation that attests to their clinical skills. These are very valuable.You want to get letters of rec that state you are a good team member, and good with patients. The interview is also very important for an IMG. They will picture you as a member of the team in a US hospital. They will be looking for good communication skills.

Regarding BlueArc's question: I don't think age is a big factor. If anything, an old applicant may appear more mature which is a plus. If you know someone currently at a program, that can be helpful. Program directors often ask current residents for their input on applicants.

Best of luck to all of you,
Dr. Ryan

Please , keep enlightening us with your informative posts.

 

[IMG_medstudent]

Hi everyone, I need some advice.

I have recently received my USMLE Step 1 score and I performed very poorly compared to what I was hoping to get. I scored 218, with the test average being 228. This is very unusual for me. I am studying at a medical school in Ireland and hoping to get a residency in General Surgery in the US. I am normally at the top of my med school class but did very poorly on this exam.

I am just wondering what my chances would be to get a residency. Any advice to improve my application and anything else that could help.

All advice is welcome. I would really appreciate it. Thanks a bunch!

 

[drryan123]

I do not believe that score precludes you from matching into a US residency program. At my hospital, we are currently interviewing candidates for our cardiology fellowship. Many are IMGs and all are completing their residencies in Internal Medicine at US programs. Many of them (I would say half) have step 1 scores below 220 yet they are current residents in a US program. This shows it can be done. Email me privately if you have more questions.

Dr. Jason Ryan