The USMLE Step 2 CK exam recently began its migration to new test delivery software, which incidentally was designed to include a calculator function. The NBME has identified problems with this function and advises not to use it until further updates are posted.

The new software will be deployed at sites across the country throughout August and September, beginning August 14th. The Step 1 and 3 software transition will not occur until 2009.

The new orientation and practice materials are available here:
http://www.usmle.org/Orientation/2008/menu.html

It is strongly recommended that you familiarize yourself with the instructions and software in advance of the test date in order to save your energy for what matters most!

Also note that as a result of the software transition, scoring delays are expected. The score reporting target date for August-September Step 2 CK test-takers is October 8, 2008.

Finally, USMLE has decided to allow soft-foam earplugs during all exams (Step 1, 2CK and 3), so long as they are out of the package upon arrival (subject to inspection) and are left at the workstation during breaks. Great news!

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.

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.

So the Big Day has finally come. How can you maximize your chances of doing well? Here are some basic do’s and don’ts.

1. Double-check your paperwork. Do you have your driver’s license or another signed photo ID? And do you have your orange scheduling permit? Don’t leave home without it!
2. Leave your gizmos behind. The USMLE Bulletin of Information has a long list of electronic gadgets that you can’t bring with you into the testing area. These include cell phones, calculators, pagers, PDAs, radios, recording devices, and, as of the 2008 Bulletin, watches of any kind (both digital and analog). Other items you’ll have to live without - or store in a designated locker or cubicle - include books, notes, scratch paper, and, as of the latest Bulletin, earplugs.
3. Bundle up. Although you can’t bring outerwear such as coats and jackets into the testing area, you should wear warm, comfortable clothing to accommodate variable temperatures at the test site.
4. Show up early. Try to make sure you arrive at your designated testing center about 30 minutes before your scheduled appointment. If you get there any earlier than that, you’ll run the risk of stressing out. Whatever you do, however, don’t get to the testing center late, as you will likely have to reschedule.
5. Chill out! Bearing in mind how hard you’ve worked to prepare for this test, focus on being mentally alert. Focus and avoid panic.

Wondering if the USMLERx Qmax is really worth all that time and investment?

Trying to figure out how best to incorporate your First Aid text into your board preparation?  Check out this article to find out how one USMLERx subscriber prepared for his boards and ended up scoring a 260/99 on the USMLE Step 1!

Hoon Choi is a medical student at Auckland Medical School in New Zealand. He made choices just like you did, or will do, about how to prepare for his board exam. Initially, Hoon chose to use First Aid for the USMLE Step 1 as his primary resource for Step 1 preparation, assiduously underlining the information he felt was particularly high yield. “However, [I found it] difficult to retain the information just by reading and underlining,” says Hoon. So he purchased the USMLERx Step 1 Qmax to help him retain the information he had underscored in his First Aid for the USMLE Step 1 text.

Hoon began preparing for the Step 1 exam five months before he was scheduled to take it. His preparation actually began when he first entered medical school and started to attend his classes and lectures. He studied approximately five hours each day for those five months. And with the help of his classes, lectures, First Aid text, and Step 1 Qmax, Hoon walked into the exam feeling truly prepared.

“The exam was not easy by any means,” Hoon said. “However, the questions were definitely reasonable, and the level of difficulty was not unexpected. I finished the exam feeling like I gave it all I had.”

Here are some of Hoon Choi’s words of wisdom for those of you preparing for the Step 1 exam:

“Attend your lectures, and learn the school material well. Purchase your [First Aid] book six to nine months before your set exam date, and start annotating in your book. Make it your own! Do as many questions as you can get your hands on. When you feel like you’ve done enough questions, do some more. You won’t have time to work through questions when the clock is ticking. You should be familiar with the material enough to be able to ‘react’ when the clock is ticking.”

This announcement from USMLE.org

A small number of multiple-choice items with associated audio and/or video clips will be introduced into the USMLE Step 1 Examination beginning in mid- to late May 2008. No more than 5 items with associated media clips will appear in a single examination. The 2008 USMLE Orientation Materials include a small number of multiple-choice items that contain exhibits involving audio and/or video clips. Instructions for practicing with items with associated media clips on Step 1, Step 2 CK, and Step 3 are provided in the Tutorials for each Step examination in the orientation materials.

Items with associated media were introduced into Step 2 CK in 2007, and into Step 3 in March of 2008. As of May 2008 all three multiple-choice question components of the USMLE examination will include items with associated audio and/or video.

This update from USMLE.org

Starting on or around May 15, 2008, a transitin period will begin in which the number of items in current forms of the Step 1 examination will change from 350 items to 336 items. Although the transition will occur quickly at many test centers, there may also be some locations where the changes take slightly longer to complete. The overall transition period will likely last approximately 6 weeks. The length of the examination day will remain unchanged.

The decrease in the number of items per form will be accounted for in scoring the examination results, so that scores on new and old forms will be comparable. Because of these changes in timing, as well as modifications to the test item pool and the processing load caused by a heavy volume of test takers, there will be a delay in score reporting for most Step 1 examinations administered in the second half of May and June.

The target date for reporting Step 1 scores for most examinees testing from May 15 through late June will be Wednesday, July 16, 2008.

In the past week, there have been two notable items concerning the USMLE Step 1 and Step 3. On January 4th, Usmle.org made the following announcement:

A small number of multiple-choice items with associated audio and/or video clips will be introduced into the USMLE Step 3 Examination beginning in early March 2008. No more than 5 items with associated media clips will appear in a single examination. The 2008 USMLE Orientation Materials include a small number of multiple-choice items that contain exhibits involving audio and/or video clips. Instructions for practicing with items with associated media clips on Step 1, Step 2 CK, and Step 3 are provided in the Tutorials for each Step examination in the orientation materials.

Items with associated media were introduced into Step 2 CK in 2007, and will be introduced into Step 1 later in 2008. An announcement will be posted to the USMLE website approximately 2 months before any items with associated media clips appear on Step 1 examinations. Additional information will be posted to the USMLE website as it becomes available.

On January 9th, the American Physician Scientist Association released a survey asking those in medical education (students, residents and fellows) about proposed changes to the USMLE Step 1 and 2CK. These included:

1. USMLE Steps 1 and 2 will be combined into a single exam. However, this combination would involve the creation of a new set of questions that test BOTH basic science and clinical science.

2. A combination exam will necessitate that the exam be administered earlier in training than the current Step 2 in order for its use in residency applications.

3. Pass/fail could replace the current numerical score. This is separate and may be implemented even if a combined exam is not.

You can fill out their survey (med student) (resident/fellow) or read more about it.

The NBME has recently released data showing the relationship between students’ Comprehensive Basic Science Self-Assessment (CBSSA) Performance Profile Scores and their performance on the USMLE Step 1. This data is applicable to each of the four NBME forms.

Acad Med. 2004 Oct;79(10 Suppl):S55-7 (Abstract):

Problem Statement and Background. This study examined the extent to which performance on the NBME® Comprehensive Basic Science Self-Assessment (CBSSA) and NBME Comprehensive Clinical Science Self-Assessment (CCSSA) can be used to project performance on USMLE Step 1 and Step 2 examinations, respectively.

Method. Subjects were 1,156 U.S./Canadian medical students who took either (1) the CBSSA and Step 1, or (2) the CCSSA and Step 2, between April 2003 and January 2004. Regression analyses examined the relationship between each self-assessment and corresponding USMLE Step as a function of test administration conditions.

Results. The CBSSA explained 62% of the variation in Step 1 scores, while the CCSSA explained 56% of Step 2 score variation. In both samples, Standard-Paced conditions produced better estimates of future Step performance than Self-Paced ones.

Conclusions. Results indicate that self-assessment examinations provide an accurate basis for predicting performance on the associated Step with some variation in predictive accuracy across test administration conditions.