The USMLE and Matching the Residency of Your Choice

Source: ScrubWars

The National Residency Matching Program (NRMP) surveyed directors of residency programs in 2008 and 2010, asking them what consideration was most important when deciding which applicants to interview, and the criteria most important to rank residency applicants. The program directors where asked to rank specific criteria that influenced their decision to rank the applicant after the interview, using a 1 to 5 scale, with 1 being “not at all important”, to 5, “very important.”

The survey also showed which percentage of program directors considered each factor important.

One of the most important factors appeared to be letters of reference in the specialty, considered as one of the primary factors in whom to interview. 71% of program directors considered letters of reference important, with the rating across specialties being 4.2. Since residency applicants participating in the NRMP can submit up to four letters of reference, it is important that at least two of the four letters be from an individual who is in the specialty to which the resident it applying.

The USMLE scores were considered important by 73% of program directors. The Step 1 score was ranked 4.1 in importance across all specialties, and Step 2 was ranked 4.0 in importance. 60% of programs have a target score which they use to screen applicants for interviews. 16% of programs will not consider applicants who have failed Step 1, and 29% won’t consider applicants won’t consider applicants who have failed Step 2 CK. Target scores for some of the more competitive specialties, including dermatology and orthopedics or ENT, range from 217 to 224. Some of the less competitive residencies, including family medicine and psychiatry, have target scores of 194 to 197. Some prestigious residency programs within the less competitive residencies have higher target scores, as would be expected.

Grades in basic science and core clerkship grades ranked 4.2 among residency directors, with the core clerkship grades considered most important. In summary, the USMLE Step 1 score, clerkship, and specialty elective rotation performance are the most important considerations when program directors decide whom to rank in the match.  For more information on other factors that are important to program directors as they rank their applicants for the match, try this link:

Kevin Pho’s blog mentions a couple of good resources for medical students applying for residency spots. He’s at He summarized a couple of publications. After required clerkship grades, the USMLE Step 1 was most important.  MedEdits, a Medical Admissions blog written by a consulting firm used by some students, reiterated that reference letters and USMLE Step 1 scores were the most important factors.

Sara Cohen, MD, answered an important question on Medscape: “How important is my Step 1 Score.” She noted that student usually have scores ranging from 140 to 260. The mean score from year to year usually ranges from 215 to 235. Step 1 scores must be strong to get into any competitive residency program. She notes that your can overcome a mediocre score with great letters of recommendation and good grades, and with research experience. By the same token, a good Step 1 score doesn’t help with poor grades and mediocre letters of recommendation. The entire article can be read at

The National Residency Matching Program lists characteristics of all candidates who matched, and the mean Step 1 score for those that matched was 226. The USMLE Step 1 scores of matched applicants were listed by specialties, with a mean of 240 for radiation oncology, and a mean of 250 for plastic surgery, the two highest-ranking specialties. Dermatology matched applicants had a mean of 248, and the distribution of scores in these specialties was tight. Diagnostic radiology and neurosurgery, orthopedics, and ENT had a tight range of high scores. Less competitive specialties include psychiatry and family medicine, but almost all matched applicants scored above 200 in 2013. The mean USMLE Step 1 score of matched applicants was 226, and unmatched applicants had a mean score of 203. Your probability of matching is close to 100% as you approach 240 on Step 1, but drops to 80% with a score of 200 in anesthesiology. In dermatology, a score of 260 gives you about a 93% chance of matching. You can find the link to all of this information and more at

The importance of preparing well for Step 1 of the USMLE cannot be overestimated. There are a variety of resources out there, including multiple question banks, which will help you narrow your focus. After clerkship grades, Step 1 of the USMLE appears to be the most important factor in obtaining a residency, according to another survey of program directors in 2009. Step 1 of the USMLE may determine your fate for the next few years, so be certain to use every resource available to prepare.

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