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Importance of the USMLE

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USMLE Step 1 and 2 CK: 10 Important Points for the Anesthesiology Residency Applicant

1. In 2018, the mean USMLE Step 1 score among U.S. seniors who matched to anesthesiology was 232. Among unmatched U.S. seniors, the mean score was 212. 



2. In 2018, 10% of U.S. seniors with a USMLE Step 1 score of less than 220 failed to match into anesthesiology. If your Step 1 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. “We interview applicants in upper quartile of USMLE – Step 1 is important as basic sciences particularly physiology, biochemistry and pharmacology are the foundations of anesthesiology practice,” writes Dr. Peter Moore, Chair and Program Director of the University of California Davis Anesthesiology Residency Program.  “A poor score in Step 1 can be negated by improved USMLE step 2 or strong advocacy from faculty adviser.”



3. In a survey of 58 anesthesiology residency programs, 97% cited the USMLE as a factor in selecting applicants to interview. “As some residency programs are becoming more competitive because of either the reduction in the number of positions or the increase in the number of applicants, the USMLE scores are being used in various ways in making decisions on whom to select for interviews,” writes the University of Washington School of Medicine. “The following programs consistently use the scores in the screening process: Anesthesiology, Emergency Medicine, Neurosurgery, Obstetrics & Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Radiology, Surgery, and Urology.”



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 58 programs, 79% cited the USMLE Step 2 CK as a factor in selecting applicants to interview. Should you the take the USMLE Step 2 CK exam before applying to programs? “A step 2 score is not required prior to applying to Mayo,” writes the Department of Anesthesiology at the Mayo Clinic. “However, if your Step 1 score is less than stellar, a good score on Step 2 will definitely strengthen your application.” Note, however, that an increasing number of anesthesiology programs are requiring the USMLE Step 2 CK score either before applying or by the time the rank-order list needs to be submitted.



6. When the University of Minnesota Department of Anesthesiology was asked, “Should I take USMLE Step 2 before I interview,” how did the program respond? “Yes and no. Programs will definitely incorporate Step 2 scores if available. If you sense your current Step 1 score underrepresents your potential, you should plan an early effort at Step 2 so this new assessment is a part of your application packet. However, we have all seen the Step 2 score help – as well as occasionally hamper – a good application. As a benchmark, estimate that somewhere between 1/3 to 1/2 of applicants provide Step 2 scores before Match lists are finalized.”



7. Many anesthesiology residency programs have threshold or cut-off scores. Applicants below the threshold score may not receive any further consideration. “USMLE Part One is essential: Most programs have cut-off score of 210 - 230, but not absolute,” writes the Department of Anesthesiology at Duke University.  According to the NRMP, 86% of anesthesiology residency programs have a target score.



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.”


10. When anesthesiology residency program directors were asked, “Would your program consider applicants who fail their [Step 1] exam on the 1st attempt,” 39% of programs indicated that they never do and 57% reported that they seldom do. Only 4% of programs often consider applicants who have failed. As you can see, the road to match success is difficult for those who have failed the Step 1 exam. At MD2B and The Successful Match, we have helped applicants overcome such obstacles, and you are welcome to contact us for more information.

Your USMLE Step 1 exam score is a major factor used by anesthesiology residency programs in the selection process. "Although we consider each application in its entirety, USMLE scores are often one of the earliest components of your application that we receive," writes the Mayo Clinic Department of Anesthesiology. 

In 2018, 17% of U.S. medical school seniors with USMLE Step 1 scores of less than 210 failed to match. Applicants with lower USMLE scores need to strengthen their credentials in as many areas as possible, and work closely with an advisor to develop a strategy for match success.

Some applicants are concerned about their chances of matching in the specialty or securing a position in highly competitive residency programs.


If you have such concerns, consider our Strategy for Success Session with Dr. Samir Desai.


Dr. Desai will perform a comprehensive review of your credentials, assess your strengths and weaknesses, and provide you with a specific plan to implement tailored to your unique situation and school.


This plan will significantly improve your chances of a successful outcome.

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