The residency application and the interview process is really a long job interview. It can feel like an interrogation as your whole medical career is put under the microscope. Without ever having met you, a residency program board will decide if they find you interesting enough to invite for an interview. Not only do you have to look good on paper, with strong academic performance, you also have to fit into the culture of the program. You need to be able to interact well with the administration, faculty and other residents of the program to which you’re applying. Program directors are tasked with the decision of determining if they should invest 3-5 years of their time, money and effort to train you. This decision will be made without having much interaction with you, the applicant, and thus your application has to speak for itself.

Strong applications are often accompanied with strong United States Medical Licensing Examination (USMLE) Step 1 scores, however Step 2 has recently been gaining in importance. During our research, we found that the criteria of multiple residency programs listed Step 2 as a requirement to be rank eligible. We decided to investigate if this was in fact becoming a trend in residency selection. Particularly since there is evidence to suggest that students are often misinformed about what components are most important to their residency application.

Comparing the residency application criteria of several programs however, we found that the actual criteria used for rank eligibility are not readily available. Luckily, we were able to find this wayward info in two recent surveys published in Academic Medicine. In the surveys published in 1999 and 2006 the authors respectively polled between 1200 and 2500 programs directors. They were asked to evaluate the variables used to select residents, and determined that the top five selection criteria were (1) grades in required clerkships, (2) USMLE Step 1 scores, (3) grades in senior electives in specialty, (4) number of honors grades, and (5) USMLE Step 2 Clinical Knowledge (CK) score.

It is important to note that with the exception of the USMLE Step 1 score all the other criteria are measures of clinical performance. Measures of clinical performance are valuable as they are the best indicator of how a candidate will perform in a program. In fact, one member of a residency selection committee told us during an interview that, “No matter how good a candidate’s application, if USMLE Step 2 scores were not available with the application the candidate would be wait listed”. While this may not be generalizable it is clear that an increasing number of programs are viewing Step 2 as an integral part of a residency application.

It is therefore in the best interest of candidates to have this exam done in time for the scores to be available with the residency application.  Taking the exam in June or July ensures that scores will be available for the Match period that begins in September. The more complete your application is in terms of required documents the more weight you give your application to make it through on the first selection of candidates.