Once you have your boards score the next obvious question is “how does this affect my chances at getting into the residency of my choice?”

Acceptance into a residency program depends not only on your score but also on the remainder of your application: references, essays, research, extracurricular activities, and interview.

If you are interested in getting a general idea as to which score ranges are typically associated with certain specialties, a document entitled Charting Outcomes in the Match is available through the NRMP and AAMC. It contains extensive data regarding each specialty and associated match statistics based on Step 1 scores, previous graduate degrees, AOA membership, and medical school affiliation (e.g. top 40 NIH school or not).

There is one highlight pertaining to USMLE Step 1 scores worth mentioning, located on a chart in the document above (page 16 of the pdf, page 11 in print) There appears to be 2-3 tiers of scores with the most competitive specialties falling under the highest tier. A potential breakdown is:

Tier 1 (Median USMLE Step 1 Scores of 233-243):

• Plastic Surgery
• Dermatology
• Otolaryngology
• Diagnostic Radiology
• Radiation Oncology
• Orthopaedic Surgery
• Transitional Year

Tier 2 (Median USMLE Step 1 Scores of 217-222):

• Internal Medicine
• Pathology
• General Surgery
• Emergency Medicine
• IM/Peds
• Anesthesiology
• Neurology
• Pediatrics

Tier 3 (Medan USMLE Step 1 Scores of 208-213):

• Ob/GYN
• Family Medicine
• PM&R
• Psychiatry

The above tiering is based on the Step 1 Scores for US Senior applicants. The data for independent applicants was much more variable and could not be stratified easily.

Also note that by no means is there any “rule” regarding residencies and board scores. Someone with a score well below the stated median can still get into a great program. In general though it is good to consider the top tier specialties to be excellent in nearly every aspect of their application while the rest of the programs can easily overcome a weak board score with strength in other parts of the application.

For more information about this data and/or specific information for your specialty of choice please browse the Charting Outcomes in the Match pdf.

First Aid Step 1 2009
Publication Date: December 29, 2008
Pre-order from McGraw-Hill or Amazon

First Aid Cases Step 1
First Aid Cases Step 2 CK
First Aid Q&A Step 1
Projected Publication: January, 2009

Whether you take the USMLE or the COMLEX you receive a 2 digit and a 3 digit score.

The 3 digit score is comparable across several different administrations of the exam. For example, a score of a 205 in the Summer of 2008 is comparable with someone who also received a 205 in the Summer of 2007. It is the score used by most residency directors when evaluating applicants.

The 2 digit score is not a percentile or a percentage. The 2 digit score is only relevant in the pool with which you took your exam. The NBME (group that administers the USMLE) reports that they are required by some licensing authorities to have a 2-digit score where the minimum passing score is a 75. Because of this the 2-digit score is not comparable between different test administrations. In other words a score of 81 in the Summer of 2008 is not necessarily the same as a score of 81 in the Summer of 2007. Also, on the USMLE, a 2-digit score of 99 correlated with a 234 or above. Certainly there is a difference between a 234 and a 244, but both received a 99 (further diminishing the usefulness of the 2-digit score).

USMLE (Step 1): more info about scores
The USMLE is the licensure exam administered for all medical students (required for allopathic students). It is administered by the NBME.

Most 3-digit scores fall between a 140 and 260. The minimum passing 3-digit score is a 185 and the average is between a 200 and a 220 (standard deviation of 20).

The 2-digit score is not a percentile. The minimum passing score is a 75.

The USMLE does not report percentiles (again the 2-digit score is not a percentile or a percentage).

You may also want to see the 2007 USMLE Performance Data for more interesting information.

COMLEX (Level 1): more info about scores
The COMLEX is the licensure exam required for all Osteopathic Medical Students and is administered by the NBOME. They also release a 3-digit and a 2-digit score.

The minimum passing 3-digit score is a 400 and the mean is a 500. The standard deviation varies between years but the most recent was a 79.

Similarly to the USMLE, the minimum passing 2-digit score is a 75. The most recent standard deviation was a 3.95. The 2-digit score is not a percentage or a percentile.

The COMLEX does not report a percentile.

A new version of the software used to deliver the computer-based USMLE Step examinations is scheduled to be introduced in mid-August 2008. Migration to the new version will occur first in the Step 2 Clinical Knowledge (CK) examination, and will be phased in over several weeks. If you plan to take the Step 2 CK examination in August 2008 or later, you should familiarize yourself with both the current test delivery software and the new version.

Orientation and practice materials using both the current and new versions of the software are available for downloading:
http://www.usmle.org/Orientation/2008/menu.html

The change to the test delivery software will be accounted for in scoring the examination results, so that scores will be comparable to those of exams using the older software. Because of this change, it will be necessary to delay the reporting of scores for some examinees. The normal turnaround time for reporting scores to Step 2 CK examinees is 3 to 4 weeks. However, during this transition, turnaround time may be as long as 6 to 8 weeks.

Note to Step 1 and Step 3 examinees: Migration of Step 1 and Step 3 to the new test delivery software will occur in 2009. Please monitor the USMLE website announcements section to check for changes in test delivery software, and to access orientation and practice materials.

The following is the official update list for the 1st Ed of the First Aid Q&A for the USMLE Step 2 CK Errata. This list does not include suggestions/additions submitted and accepted for the text.

Download the up-to-date list: PDF - 7/09/2008

1. Page 7
   1. Question 13: The patient’s sodium level should be 134 mEq/L, rather than 34 mEq/L.
   1. Question 14: The patient’s glucose level should be 133 mg/dL, rather than 33 mg/dL.
2. Page 17
   1. Question 50: The question should read, “What is the reasoning behind avoiding nonselective B-blockers in this patient?”
3. Page 41
   1. Question 50: The third sentence should start, “Nonselective B-adrenergic blockade…”
4. Page 139
   1. Question 36: The newborn is a boy, not a girl.
5. Page 169
   1. Question 14: The third sentence should read, “Pathologic examination reveals a population of atypical mononuclear cells infiltrating the dermis and epidermis.”
6. Page 179
   1. Question 51: the bleeding time should be 4 minutes, not 4 seconds.
7. Page 187
   1. Question 14: CTCL involves T (rather than B) lymphocytes.
8. Page 216
   1. Question 24: The next-to-last sentence should be deleted; image was deleted in press so no “physical examination findings are shown below.”
9. Page 236
   1. Answer 24: The correct explanation should not refer to an image.
10. Page 271
    1. Answer 10: The correct explanation should not refer to an image.
11. Page 301
    1. Answer 9: The last sentence should read,”… but the majority of cases of dementia are not reversible.”
12. Page 486
    1. Answers 45 and 46: The correct answers should be switched, K is correct for answer 45 and D is correct for answer 46.

The new errata for First Aid Q&A for the Step 1 are now available for download as a pdf and listed here.  For updates to previous editions, please visit the Q&A for the USMLE Step 1 Archives page.  The following pages received updates:

1. Page 28
2. Page 165
3. Page 176
4. Page 223
5. Page 322
6. Page 328
7. Page 430
8. Page 470
9. Page 548
10. Page 556
11. Page 571
12. Page 586
13. Page 591