For a moment, let’s imagine it’s a beautiful sunlit day somewhere very far from your computer screen. You decide to engage in a friendly game with a street vendor guessing where a stone is hidden in his cups. You play once, twice, three times, and every time it’s in the left cup. Fourth game, you guess the left cup because you’re no fool. But, alas! He noticed your leanings and switched it to the middle cup. He warns you your folly was in neglecting the middle cup. Now, imagine he’s the Federation of State Medical Boards (FSMB) and the stakes of the game are your future as a physician!
USMLE Step 1 Goes Pass/Fail
As you may know by now, the FSMB recognized the long time emphasis placed on Step 1 of the USMLE and the overemphasis placed on the USMLE as a whole; and in an attempt to make what they believe will be positive change, they voted to change Step 1 to pass/fail starting January 2022. This will presumably make your Step 2 score the golden-child of residence placement as it’s now the first one you can be numerically judged on, but that’s only speculation at this point. This was apparently part of the goal, as Step 1 had initially been planned to be pass/fail in hopes of placing greater emphasis on the more clinical-science-based testing of Step 2 CK.
The ultimate goal, however, is to move the residency admission process away from a nearly unifactorial decision in Step 1 towards a multivariate one. It’s likely in the first several cycles following this change that Step 2 scores will simply replace Step 1 scores in the weight they carry in residence-placement; but the hope is that other factors such as the inclusion of shelf examinations into application material or the requirement and standardized evaluation of sub-internships will gain greater importance. Ideally, these major shifts will catalyze changes in both the UME and GME cultures. If you’re a first year medical student starting this fall, residency applications might look very different for you than they have for many years.
Possible Outcomes of This Change
In this preliminary study to test what effects this scoring change may have, it was found that: “After the removal of USMLE step 1 points, 40% of all applicants decreased in rank, 35% remained the same, and 24% increased.” The conclusion from the study is that removing the Step 1 score allowed for room to judge based more on the core values of a residency program. This could even lead to limitations on the number of programs an applicant can apply to, presumably.
While the people making these changes hoped this shift would redirect some of the stress placed on the USMLE to the students’ academics as a whole, not everyone feels this will have the desired effect. The majority of orthopaedic and internal medicine program directors that responded to this study felt the decision lacked transparency and will negatively impact allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates to name a few.
Interpreting your Step 2 CK Score
All that being said, it’s still helpful to consider where you should aim based on your preferred specialty. The most competitive specialties have required higher Step 1 scores in the past, so it’s safe to assume those competitive specialties like Dermatology will now require high Step 2 scores where they cannot judge Step 1. You can find a list of more competitive specialities here. It’s important, however, to compare your score to data that’s no more than three years old, according to USMLE Interpretation guidelines. This is because the test, much like yourself, evolves overtime. You can see the “Norm Table” from the same interpretation guidelines below. Your score can range anywhere between 1 and 300.
The table below from the National Resident Matching Program (NRMP) can help you determine where you generally want to aim for Step 2 in your specialty to be as exceptional as we know you can be. According to the NRMP, “Overall, U.S. MD seniors who matched to their preferred specialty had mean USMLE Step 2 CK scores of 246.9 (s.d. = 14.2), well above the 2020 minimum passing score of 209.” You can see below how that compares to, say, Plastic Surgery, which averaged some of the highest scores for Matched students into the high 250s.
The Big Picture
At the end of the day, it’s important not to fixate so much on numbers. Of course, that’s easier said than done when it feels like your future as a physician now rides on just one 3-digit score. That’s not exactly the case, however. Your future is built on where you go to medical school; what research you get excited about and involved in; what extracurriculars you engage in; along with your letters of recommendation. It is built on how you choose to set yourself apart and not on how focused you were on one single exam for all of medical school. This is not a game of you v.s. USMLE. It’s the journey of becoming a physician who cares for humans when they are at their most vulnerable.
Med school student and Cram Fighter coach Danielle can attest to this. A friend of hers who had a goal of going into General Survey scored a 210 on Step 1, but he didn’t let this lower passing score stop him. He made a plan to do better on Step 2, but he also researched what programs were realistic options for him based on his scores. For him, becoming a surgeon was more important than the prestige of a residency program. So, he did away-rotations at a few of those realistic programs he found while using connections at his school to get interviews. He then dual-applied to family medicine in addition to surgery because becoming a surgeon was his main goal but if that wasn’t in the cards, he only wanted to be the best physician he could regardless of his specialty. He ultimately matched into a surgery program, and met his fiancé along the way. All this to say, prepare for the USMLE as best you can; but don’t conflate a number with your drive, determination, and value as a future physician.
If that wasn’t enough to encourage you, don’t forget that you will have had the enormous challenge of Step 1 under your belt before you will really be judged on Step 2; and by Step 2 you’ll already have some experience to make your exam more like recalling information and less like memorizing a textbook. And - of course - we’re here to help you plan your studies and stay on track! Check out our sample Step 2 CK study schedules in 4-week or 10-week durations. If you’re still preparing for Step 1 and want to plan ahead, you can use our Study Blocks feature to build a plan for both Step 1 and Step 2 CK into one customized, easily adjusted study schedule. To try Cram Fighter for yourself, sign up for a free 7-day trial.