USMLE Step 1 Scores

Medical Residency Application & Interview Preparation Specialists

USMLE Step 1 scores have historically been enough to match a student onto their preferred residency. However, in recent years programs have worked to build on this as a foundation and include various other elements, including – but not limited to – strong letters of recommendation, having conducted clinical research whilst at medical school, having a strong CV that highlights both broader achievements and medical ability, and of course performance at interview. Per the NRMP themselves, we learn that despite ‘the fairly strong relationship between USMLE Step scores and matching to a preferred specialty, the distributions of scores show that program directors consider other qualifications.’ In other words, a high score alone won’t mean that you are guaranteed a match – and a low score could still result in a match. Additionally, this makes the Step 2 exam more important. Overall therefore you should focus on USMLE Step 1 as you would have done before and ensure that you score a strong grade, as it should still be seen as the basis of matching – but you must also be working to improve all other elements of your applicant in tandem with preparing for the exam.

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An Overview of USMLE Step 1 Scores

Let’s consider various USMLE Step 1 score brackets. A score of minimum pass to  215 would be considered low, yet still a pass. The lowest passing score possible is 194, which equates to just north of 55% correct of the 350 questions. This score means that you are likely to only be able to match the less competitive specialities.

A score of 215 to 230 would be considered as a weaker score, although working towards average. You should still consider yourself relatively limited in terms of which programs to apply to, although strong work in other areas – like research and the personal statement – might allow you to make some more competitive applications.

A score of 230 to 245 is a good score, and will now allow one to aim for more competitive specialities. If you are able to pair this raw score with strong clinical grades and Step 2 performances – and additionally with research undertaken – then you should see competitive programs as well within reach.

Scores from 245 to 250 are considered outstanding and will see you able to match all specialities, assuming the rest of your application is well-rounded.

A score of more than 250 will likely result in near-guaranteed matches across all specialties. This will unlock the most prestigious training roles in the country.

However, remember that you must have good grades, a well-written personal statement, great letters of recommendation, and ideally be able to evidence an interest in research if you are looking for these top places.

Remember that there will be a cutoff for the top programs, and your score will simply see you achieve that cutoff – beyond this you will need to excel at interview in order to be accepted. The USMLE score is therefore, as the name suggests, Step 1! It’s your foot in the door for the most competitive programs.

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Specialties and Scores

We can see from the average scores of US senior applicants how competitive the different fields are. Amongst the least competitive are family medicine, with a matched average score of 222, emergency medicine, with a matched average score of 231, child neurology, with a matched average score of 228, and physical medicine and rehabilitation or neurology, both with an average matched score of 230. Psychiatry, with a matched average score of 226, is also considered an easier route, as is paediatrics, also with an average matched score of 226. On the other hand, the most competitive fields include plastic surgery, with an average matched score of 251, otolaryngology, with an average matched score of 246, and neurological surgery, with an average matched score of 247, as well as the different branches of radiology.

The lowest average unmatched scores are for paediatrics, at 207, and radiation oncology, at 209. Meanwhile the highest average unmatched scores are dermatology at 242, otolaryngology at 241, and plastic surgery at 240.

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