Surviving Step 1: Setting Goals for Step 1

By Walter Wiggins

In my last post (“Preparing for the Boards”), we discussed several things you can and should be doing right now to get yourself ready for Step 1. Now that Step 1 is on your mind, you may have a number in mind for your ideal Step 1 score. Coming up with this number can be tough, as your Step 1 score is an important criterion by which you are evaluated by residency programs. More competitive residency programs will want to see higher Step 1 scores. Satisfaction with your performance requires planning, hard work, and knowing what your goals are before you’re too far along.

If you have an idea of which specialty you will likely choose, then I suggest you try to get an idea of what scores will make you competitive for that specialty and set your goals accordingly. To do this, consult the most recent “Charting Outcomes in the Match” released semi-annually by the NRMP and AAMC, then talk to the residency program director at your home institution. Discuss your medical school performance-to-date, extracurricular activities/interests, and aspirations for the months and years ahead to find out what your goal(s) should be for Step 1. You can do this even if you’re still undecided, in which case you might want to do this for a few different specialties.

Too many students get caught up in obtaining what they perceive to be a sufficient score to match into a certain specialty. While many competitive residencies do acknowledge considerable use of Step 1 scores in their evaluation process, there are always other factors in play. Thus, it is important that you do NOT put too much pressure on yourself, as you’ll likely end up burning out part-way through your studying or tank on test day. Remember…you need to relax.

Once you have an idea of what your goals are (and even if you don’t), I suggest setting three goals for Step 1: the minimum score for “success”, the score you’ll be happy with, and the “moon shot”. Once these are set, stick to them throughout the process. There’s no need to adjust them upwards, even if your studying is going particularly well.

1. Minimum score for “success”: For most people taking Step 1, their definition of success should be simply passing the test. That is, you need to score a 188 on the 3-digit scale. Note for you more competitive-minded folks, be careful not to set this bar too much higher than the passing line, as you don’t want to set yourself up for failure. If you really want to get an idea of where this bar should be, I suggest taking a practice test and subtract 20 points (approximately the lower limit of the confidence interval of score estimation for most practice tests) from the estimated 3-digit score to arrive at your minimum score. If this is below 188, then clearly you’ll want to bump up your minimum score to 188.

2. Score you can be happy with: This is where it starts to get a little more complicated. It is important to consider your performance in medical school thus far when you set this goal and the next. Someone who has struggled to pass any number of exams in medical school will want to keep this goal pretty close to the passing line. Those concerned with matching into a given specialty should look at the mean Step 1 score of matched applicants in “Charting Outcomes” and subtract 20 points (approximately one standard deviation). You should adjust this goal up from this point only if you’ve performed really well in medical school.

3. “Moon shot”: This is the score that will inspire you to propose to your significant other, take your spouse on a 2nd honeymoon, or get up the courage to ask out that guy or girl you’ve had a crush on since anatomy lab…it shouldn’t require any more explanation than that.

Check out these important links for more information:

USMLE Scoring page

Charting Outcomes in the Match

National Resident Matching Program (NRMP) website



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