1. While numerical USMLE Step 1 scores are no longer available to programs, anesthesiology programs will look to see that you have passed the exam. In the 2024 NRMP Program Director Survey, 82% of program directors cited "USMLE Step 1 Pass" as a factor used in selecting applicants for interviews. 

 

We now have several years of performance data on Step 1 scores following the shift to pass/fail scoring. Fail rates have significantly increased for all applicant types when we compare 2020 to 2024 data, from 2% to 11% for USMDs, from 4% to 14% for USDOs, and from 13% to 27% for IMGs. Factors that are contributing to these higher rates include changes in study habits and time devoted for Step 1 preparation.

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Applicants who have an attempt on the Step 1 exam face significant challenges in matching to the specialty. When the Department of Anesthesiology at Texas A&M University was asked "Would you ever take someone with a Step 1 failure", their response was very revealing. 

 

"It is possible, but not likely. A complete application with evidence of volunteer work, scholarly activity, and completion of a successful audition rotation, good grades in medical school, fantastic letters of recommendation, and a reasonable explanation of extenuating circumstances which lead to a poor test score can still overcome a single bad score."

 

 

2. In 2024, the mean USMLE Step 2 scores among matched USMD (252 vs 240), USDO (251 vs 239), US IMG (248 vs 237), and non-US IMG applicants (248 vs 245) were significantly higher than unmatched applicants.  In 2024, 31% of USMD applicants seniors with a USMLE Step 2 score of less than 240 failed to match into anesthesiology. If your Step 2 score will be of concern to programs, then a well-thought-out strategy for match success is crucial. Of chief importance is the assistance of a mentor or advisor to help you overcome the challenges of a low score. “A poor score...can be negated by...strong advocacy from faculty adviser” writes Dr. Peter Moore, Chair and Program Director of the University of California Davis Anesthesiology Residency Program. 

 

 

3. Osteopathic applicants should be aware that many anesthesiology residency programs require or prefer that you take both the USMLE and COMLEX exams. In the 2024 NRMP Program Director Survey, 76% of programs require a pass on both the COMLEX Level 1 and USMLE Step 1 exams. A similar percentage favored taking both the COMLEX Level 2 CE and USMLE Step 2 CK exams. Please check individual residency program websites for guidance on their specific policies. 

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4. In one study conducted by the Department of Anesthesiology at Wayne State University, the USMLE Step 1 and 2 CK scores were found to be significant predictors of the American Board of Anesthesiology written examination. The authors wrote that “our program has significantly increased its average written board examination performance while increasing the relative importance of USMLE in resident selection.”

 

 

5. In a survey of programs, 95% cited the USMLE Step 2 CK as a factor in selecting applicants to interview. When asked how important these scores are in inviting applicants for interview, program directors shed light on their relative importance. The Step 2 score was the top factor with a mean importance rating of 4.2 on a scale of 1 (not important) to 5 (very important).   

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6. Many programs will not consider your application unless you have a Step 2 score available at the time of application submission. "A numerical score on USMLE Step 2 or COMLEX Level 2 is required to apply," writes the Department of Anesthesiology at Case Western Reserve University School of Medicine.

 

Programs that do not require it will often indicate that it is preferred. "A United States Medical Licensing Examination (USMLE) Step 2 or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) 2 score is not required prior to applying to Mayo Clinic. However, with the transition to pass/fail scoring on USMLE/COMLEX 1, more emphasis may be placed on USMLE/COMLEX 2 examination performance."

 

Given the increasing competitiveness of anesthesiology as a specialty, we strongly encourage you to take these exams before you apply. Please heed the words of Association of Anesthesiology Core Program Directors: 

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"Anesthesiology applicants should ideally have both their Step 1 and Step 2 CK transcripts (or COMLEX Level 1 or Level 2-CE) available for programs to review by the application opening date. Many programs will not review applications that do not have a result reported on step 1 or step 2 (or COMLEX Level 1 or Level 2-CE)."

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7. Many anesthesiology residency programs have threshold or cut-off scores. Applicants below the threshold score may not receive any further consideration. "While we consider multiple aspects of each application, we do maintain exam score thresholds: a minimum USMLE Step 2 CK score of >240 and a COMLEX Level 2-CE score of >540," writes the Department of Anesthesiology at the University of Florida.

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8. “Program Directors know for sure there is a lot more to being a great anesthesiologist than test scores,” writes Dr. Alex Macario, Program Director of the Stanford University Anesthesiology Residency Program. “Attributes such as professionalism, communication, work ethic, interest in lifelong learning, working to improve our practice, and advocacy are all essential (and often considered for AOA status). Our very best residents also distinguish themselves by excelling in those areas, but since no objective measures exist for these attributes most residencies fall back on USMLE scores as one way to screen applicants for interviews.”

 

 

9. Applicants that are concerned about their chances of matching based on USMLE scores should realize that other factors are important to programs. “As I mentioned…the USMLE score is just one piece of the overall picture,” writes Dr. Alex Macario. “The selection committee looks at grades (especially in the 3rd year clinical core rotations), class rank if provided, medical school attended, commitment to the specialty of anesthesia (a very subjective assessment, but for example we would rather not hear that a person is switching to anesthesia from another specialty because anesthesia is easier or less demanding), research experience and potential for a future academic career, communication skills, compassion & humanism, and any other category that might include: exceptional achievements, their personal statement, or brilliant letters of recommendation.”

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10. According to the 2024 NRMP Program Director Survey, 90% cited "any failed attempt on the USMLE" as a factor used in making interview decisions with a mean importance rating of 4.6 on a scale of 1 (not important) to 5 (very important). Whether you have an attempt or a history of low scores, the road to match success is difficult for low-scoring applicants. At MD2B and The Successful Match, we have helped applicants overcome such obstacles, and you are welcome to contact us for more information.