USMLE Step 1 Score ranges

[Dr. Whatever]

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Hi Everyone,

I'm preparing for Step 1 to take in June and I was just wondering if anyone knew what the averages were and what sort of scores people might need to be "competitive" for an IM residency in Boston or NYC (I'm not shooting for Harvard)? Thanks for your help.

 

[Kalel]

Most of the academic boston and NYC IM programs are actually quite competetive, mainly due to their desirable location. I'd aim for a step I of greater then 220-230 for the university programs. I had a step I of 230, but only received interview invites from Boston U and Albert Einstein out of the many schools that I applied to in the region. I had B's in preclinical years, A's and B's during clinical, and decent letters.

 

[souljah1]

Kalel,

From what I've heard, many things matter more for medicine residency directors. I'm not saying that one can bomb step1, but I am under the impression that step1 isn't as nearly important as your letters, clinical grades, and the rep of your school (for medicine).

 

[Kalel]

Originally posted by souljah1
Kalel,

From what I've heard, many things matter more for medicine residency directors. I'm not saying that one can bomb step1, but I am under the impression that step1 isn't as nearly important as your letters, clinical grades, and the rep of your school (for medicine).

Yup, I agree. Step I is mainly used as a cutoff. However, after seeing some of my classmates who I know had below avg step I scores but seemingly strong clinical skills not match where they wanted to go (but got interviews at), I wonder how much of a factor it really is used to evaluate your app in IM. In general, AOA and avg step I will probably get you farther in IM then 260 step I and poor clinical evals. In other fields such as derm, ENT, or rads though, if you don't make their step I cutoff, they won't even look at your app since they have so many qualified apps.

Oh, and regarding the avg, the national avg for first time US and Canadian med students is 216, with a standard deviation of ~20.

 

[avendesora]

Originally posted by souljah1
Kalel,

From what I've heard, many things matter more for medicine residency directors. I'm not saying that one can bomb step1, but I am under the impression that step1 isn't as nearly important as your letters, clinical grades, and the rep of your school (for medicine).

I got myself to believe this while I was interviewing because of all the great invites that I got. I had a 218 on Step I, but great clinical grades and great letters. However, I think in retrospect that at least at places that I wanted to go, Step I is indeed very important in the ranking process. It was hard for me to see classmates with higher scores, but whose a$$es I kicked on the wards match at places I wanted to go.

Wow, that comes off sounding way more bitter than I actually am, but I think illustrates my point

 

[irlandesa]

Originally posted by avendesora
I got myself to believe this while I was interviewing because of all the great invites that I got. I had a 218 on Step I, but great clinical grades and great letters. However, I think in retrospect that at least at places that I wanted to go, Step I is indeed very important in the ranking process. It was hard for me to see classmates with higher scores, but whose a$$es I kicked on the wards match at places I wanted to go.

Wow, that comes off sounding way more bitter than I actually am, but I think illustrates my point

I think this may be b/c Step 1 scores are considered more objective than clinical grades and could be used as a "tiebreaker" when ranking students with relatively similar qualifications. A grade of "Honors" is not necessarily the same from school to school or at different rotation sites in a school's curriculum. For example, one person on here from U of MD mentioned that an "A" at his school can mean either an Honors or High Pass at another school, depending on the course. At my school, the Surgery course director at one site is known to grade easier than the course directors at other sites b/c he gives his students so much work (i.e. some ppl carry up to 9 pts. at a time!). Hopefully, the Dean's Letter helps to objectify such matters, but there are probably still enough gaps that evaluation of clinical grades alone would be very tough.
Also, not to play devil's advocate or to be rude here, but how do you know for sure that you did a lot better than those students you mentioned on rotations? Just wondering, b/c I have found that sometimes I actually do better than students I'd expect to do better than me, and vice versa. Unless you have talked to people directly (which you may well have), it's hard to say how they did. Even if someone acts like a total ***** on the wards and manages to provoke the ire of several attendings along the way, they may get the same grade as you (not that I'm bitter or anything, stupid shelf exam). in any case, best of luck to all of you.

 

[avendesora]

Our clerkship grades are 50% based on the shelf -- you can't get the H unless you get at least 75th percentile on the NBME (or HP unless you get at least 50th). The other 50% of the grade is the arbitrary portion. The argument behind this was to make the grading more objective. I agree that step I is the most objective thing that ranking committees have. It's just too bad that the things it evaluates are your *basic science* abilities. For someone like me who didn't really get serious about school until 3rd year I don't think it gives a fair idea of how I'll turn out. I did about 20 points better on step II for comparison.

I did very well on all of the shelfs and in subjective grading. My problem was pre-clinical grades and step I -- there's just no other way to view it. I really could not have done much better during 3rd year.

One of my friends put it best -- we end up where we are destined to be. I truly believe that. True, my #1 was a much better program, but I'm not sure that I would have been happier there. If I wasn't worried about fellowships later on, my list would have been different.

 

[Jason26]

Avendsora, that is an awesome avatar; it's the guy from the movie Office Space, Lundberg, right? Where did you get it?

 

[Renovar]

I would have to say that looking at my experience and my classmates', the biggest break point for competitive IM, at least for interview purposes, is going to be:

1. AOA vs non AOA

and

2. The "eliteness" of your med school - top 10 vs Top25 or so vs the rest

Step 1 score is massively overrated for IM. I agree, higher is ALWAYS better, but there is a point where any higher wont do you any more good - and this point is surprisingly low. I'd boldly say that anything above mid-230's (mid-high 90's on 2 point) should keep all doors open, and it will be up to your other stats to get you interviews.

I ran into this dude on my interview trail from HMS, openly stated that he is below average in his class and got below average Step 1, and still got interviews at everywhere he applies (places like Stanford, UCSF, JHU, HMS hospitals, etc). That just goes about saying how much advantange an elite med school carries you in this process.

 

[avendesora]

Originally posted by Jason26
Avendsora, that is an awesome avatar; it's the guy from the movie Office Space, Lundberg, right? Where did you get it?

Yeah -- Office Space is one of my favorite movies. I blatantly ripped off the avatar from someone on another forum -- not SDN! I did have to resize it, though -- so some effort was involved.

Office Space is also a good one to watch after a day that makes you question medicine. Things can be a LOT worse

Thanks for the nod.

 

[Svetlana117]

Get more than 90 and you should be fine...with good academic track record of course...

 

[tiffin25]

just curious

where did some of you with below 230 match? was it in nyc? i guess my question is for avendosa (hope i spelled your handle right)... but as always, anyone is more than wleocme to answer

have a great day

 

[avendesora]

Originally posted by tiffin25
just curious

where did some of you with below 230 match? was it in nyc? i guess my question is for avendosa (hope i spelled your handle right)... but as always, anyone is more than wleocme to answer

have a great day

I matched at Wake Forest (in North Carolina). I stayed away from big cities when applying b/c that's not what I was looking for. From what it sounds like on here, for the NE programs it's MUCH more important where you're from than what your digits are. Could you match in NYC area with less than 230? I'm sure. But it's not going to be Columbia/Cornell/NYU etc.

 

[exjersey]

I know several people who matched at Columbia/Cornell/NYU with score under 230 (I'm from an east coast school, not in the top 10 - or even top 25 for that matter)

 

[avendesora]

Originally posted by exjersey
I know several people who matched at Columbia/Cornell/NYU with score under 230 (I'm from an east coast school, not in the top 10 - or even top 25 for that matter)

I stand corrected.

I'd assume these people were all at least above average though? It's been posted elsewhere that someone with a 241 didn't match at NYU.

Like I said, I didn't apply at any of these places b/c big cities turn me off.

 

[rajvosa]

I matched at NYU with step 1 <230.

 

[GO_MEDPEDS]

Your score on Step 1 is a strong predictor of your ability to pass the boards. Therefore, it is in the program's best interest to accept candidates who have strong Step 1 scores because this means they will likely pass certification boards and raise (or at least maintain) the residency's Board Pass Rate (something that can be quantified and thereby strengthen the reputation and funding of the program). Therefore, programs in NYC, which probably receive quite a few applicants, have the benefit of being able to pick and choose a little more and make sure they "stack the deck" with residents who have done well on Step 1, and therefore likely will pass their boards.

This being said, the overall thing programs are looking for is the "worth" of the resident. You become both an asset and a liability at the same time. Although board scores are certainly obejctive, they certainly do not indicate that the resident is multilingual, published, active in humanitarian efforts, compassionate, etc. I would venture to say that no program is going to completely ignore undesirable board score if the overall "worth" of the candidate is great, but certainly there are other things (and hopefully more important things) than board scores to determine your merit. Even at the competitive programs, there are certainly some who will match with "lower" board scores because they had other distinctions.

I guess what I am saying is that you will probably hear a wide variance of Step 1 scores that allowed people to match in NYC. Just do the best you can and see what happens!

Good Luck!

 

[rajvosa]

If you are a clinician, do you really need to know some obsecure detail shown on a histo slide on step 1??? If they really need more objective measure then PDs should require everybody to get a step 2 score before they consider you for an interview.

 

[GO_MEDPEDS]

I was told by my PD that the predictability goes Step 1>Step 2>MCAT. Although I agree that Step 2 would seem more applicable (due to the content), the fact that most programs put a greater emphasis on the Step 1 scores makes me think that this is a correct ranking... In any case, the tests in the past will more than likely reflect the outcome on your future boards (and it was no surprise to me that the people who got 35+ on the MCATs were the same ones who got 240+ on Step 1...)

 

[rajvosa]

Are you saying PDs are looking at MCAT score? Did you submit your MCAT score? How about SAT???

Listen, medicine is not about board scores. You should know that. Just to add that almost everybody passes IM boards from the first try.

 

[SoCalDreamin']

After experiencing the whole interview and Match process for myself, my conclusions are as follows:

1.) An outstanding Step I score and/or AOA is the ticket for the ultra-competitive specialties, and we all know what they are.

2.) For Medicine, two factors bear more weight that an outstanding Step I score and/or AOA; such factors include:

a.) Strength/rank/reputation of your medical school
b.) Getting letters of recommendation from nationally renowned physicians

However, these statements in no way imply that one should not try hard to obtain a good Step I score and a high class rank. These two factors might get you that top interview, even if your medical school's rank or the prestige of letter writers is not super-stellar. With this information in mind, let's consider the following 2 applicants:

On the one hand, we have med student X with the following statistics:

* Step 1 = 245
* AOA
* Attends a medical school that is not ranked in terms of NIH research funding or in US News & World Report
* Has letters of rec from 3 faculty members that are not well-published

On the other hand, we have med student Y with the following statistics:

* Step 1 = 225
* No AOA
* Attends a medical school that is ranked in terms of NIH research funding or in US News & World Report (e.g. Stanford, UCSF, HMS, UT Southwestern)
* Has a letter or rec from Dr. Topol of the Cleveland Clinic that is based on a cardiology elective he did there at the beginning of his fourth year

Of these two candidates, whom do you think will be more likely to land interviews at MGH and Brigham & Women's? If you said med student Y, then you are correct.

Luckily for me, I am not hung up on silly things such as rankings and academic reputation, so none of the above information mattered to me when it came down to deciding where I wanted to go for residency. Much larger factors weighed on my mind, such as work environment and house staff support, and most importantly, if I was going to be happy at a particular program. Things worked out just the way I wanted them to, and I couldn't be any happier. Just my 2 cents on this issue.

 

[SoCalDreamin']

One last thing to put this whole prestige / academic rank issue into perspective. One of the places I interviewed at is nationally renowned. I found it to be an outstanding institution with famous academicians, an awesome Chairman, and a top 5 rank in terms of NIH funding. Not only that, it is affiliated with a very good medical school, and as I was told on my interview day, ALL residents from this program who were interested in GI or Cards have matched successfully during the past two years. For this reason, I placed this school very high on my rank list...although it was not number one, it was in my top three.

Then, shortly before Match day, I read the following review on SDN, which was submitted by one of the program's PGY-3s:

"I would say the Achilles' heel in the program is the office of the program director. Many would use the term "unhelpful" in their relationships with her. With the caveat that I did not need a letter from her, I had several graduating seniors from last year complain to me that she did not know them and that their letters of support consisted of a few lines about their conference attendance records. Several of these people did not match and when they asked for her to call programs on their behalf, she did not do so. Recently, she sent an email out to the housestaff to discourage them from making schedule trades on call days because of the administrative burden it placed on her office. One outspoken resident emailed back that if we as housestaff are willing to cover for each other so that we can attend important personal events, secretarial time should be a secondary concern. I personally feel, for example, that my being maid of honor for my best friend's wedding should take precedent over a few hours of secretaries' time. There's also been some issue over a past intern who left from years ago whose confidential info was not so confidentially dealt with....... No inquiries, I'm afraid."

Needless to say, I was shell-shocked when I read this info., as I knew that there would be a chance that I could match into this program. For me, there is nothing in the world (e.g. most prestigious program, #1 ranked in this and that) that can make up for the things described in the review listed above. Having your program's support, honesty, and their being forthcoming, as well as your being happy at your particular program are the most important things when it comes time to commit yourself to a residency. If these vital things are missing, it will be a long three years, regardless of where you are.

 

[rajvosa]

From what I heard and saw during the interview process, a bellow average student from Harvard with bellow the national average step1 (<215) willl land most interviews at the most competitive programs in IM. That's a fact.

 

[Renovar]

Originally posted by avendesora

It's been posted elsewhere that someone with a 241 didn't match at NYU.

Sounds very familiar... in fact, this person is ME...

And the weirdest thing is, yesterday I got a post-match survey from NYU signed both by the PD and chairman saying it is regretful that I didn't match there but they would like my opinion, along with Columbia's encrypted message (last week) signed by their program coordinator saying something to the effect of we would have love to have you if you ranked us higher... or some $hit like that which I didn't really understand...

The more I look back in the process the more I feel it's a big political game, especially in IM. NYC programs just love to play that game. Both of those anonymous surveys were returned this am (without return addresses) where I just lambasted them for doing it to further confuse applicants. I have not been impressed especially with Columbia's etiquette throughout the process at all, and I honestly noted that on my reply to them.

 

[cbc]

I'd like to bring up another "factor" into this discussion.

You've all suggested the high step1, AOA, etc, that few ppl attain. What about the few ppl who have multiple pubs as 1st authors during med school? Does that earn them the right to "ultra-competitive" programs as you call it? How much does research pubs factor into this residency from experience of you or your classmates.

Also, if you do an away rotation and get someone to give you the phone call and such, but didnt make the cutoff, are you still definitely out?