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Importance of the USMLE

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

1. In 2018, 18% of U.S. medical school seniors with USMLE Step 1 scores of less than 220 failed to match.  If your Step 1 score will be of concern to programs, then a well-thought-out strategy for match success will be important. Of chief importance is the assistance of a mentor or advisor to help you overcome the challenges of a low Step 1 score.


2. In 2018, the mean USMLE Step 1 score among U.S. seniors who matched to emergency medicine was 233. Among unmatched U.S. seniors, the mean score was 220. 

3. In a survey of 87 emergency medicine 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. Why are scores so important to emergency medicine residency programs? “The USMLE provides an objective tool to compare medical students,” writes Dr. Shahram Lotfipour, Professor of Emergency Medicine and Associate Dean for Clinical Sciences Education at the University of California Irvine. “Performance helps determine the competitiveness of a candidate for EM residency programs. Each residency program is different in its emphasis on board scores and class rank vs. demonstrated clinical skills and letters of recommendation. In general, the goal for EM applicants is an above-average Step 1 score, as many EM program directors look positively at USMLE scores above the 90th percentile and negatively at those below the 50th. For those whose Step 1 score falls below the mean, it is recommended to take Step 2 before submitting the EM application.”

5. Among the other reasons for the importance of the USMLE in the selection process is the desire to select residents who will pass the American Board of Emergency Medicine certification examination. In one study, researchers evaluated the relationship between USMLE (Step 1 and 2 CK) and American Board of Emergency Medicine in-training examination scores (ITE).  A correlation was found with Step 2 scores showing a greater correlation. In their conclusion, the authors wrote that “scoring below 200 on either test is associated with significantly lower ABEM ITEs.”

6. Although programs differ in how USMLE Step 1 scores are used in the residency selection process, the score is an important factor used to make interview decisions. 62% percent of programs have established a target score while 32% look for evidence of a passing score. “Although there are no minimum scores required, candidates with above average scores (220 or more) will be more competitive for the residency,” writes the Department of Emergency Medicine at Duke University.

7. The USMLE Step 2 CK score is also a factor used by many emergency medicine residency programs in deciding whom to invite for interviews. 76% of programs use the Step 2 CK score in their decision-making process. 

8. Should you take the USMLE Step 2 CK exam before applying to emergency medicine? Dr. Todd Berger is the Program Director of the UT Southwestern – Austin Emergency Medicine Residency Program. He offers his thoughts on when applicants should take the Step 2 exam. “Some competitive programs want to see Step II scores when you apply. This is becoming more commonplace. If you got spanked on Step I, you will need to take Step II early to show residencies that you're really not academically pathetic. This assumes that you will study enough to redeem yourself. If you did ‘well’ (above the national average for candidates applying to your specialty), then you have the option of taking Step II later on and saving your summer for concentrating on your power rotations. Remember that you need to pass Step II in order to graduate (and start residency), so take them no later than December or early January.”

9. Dr. Kristen Herbert is a faculty member in the Department of Emergency Medicine at the Ochsner Clinic. She recalls the challenges of overcoming a low USMLE Step 1 score in securing an emergency medicine residency position. “I did horribly on Step so to redeem myself I decided to take Step 2 early and do much better. I took off July, studied, and made a 221 on Step 2. Some programs commented or asked about my Step 1 score during my interview, but they would then mention how well I did on Step 2. Point is, do your best, but if Step 1 isn't your best then know that programs DO look at Step 2 scores.”

10. When emergency medicine residency program directors were asked, “Would your program consider applicants who fail their [Step 1] exam on the 1st attempt,” 37% of programs indicated that they never do and 61% reported that they seldom do. Only 2% of programs often consider applicants who have failed. Failing the Step 2 CK exam is considered even more of a red flag with 46% of programs reporting that they never consider such applicants. 53% indicated that they seldom consider applicants who fail the Step 2 CK exam on their first attempt. “We prefer that you pass on your first attempt, but special circumstances are considered,” writes the Department of Emergency Medicine at Oregon Health Sciences University. As you can see, the road to match success is difficult for those who have failed either exam. At MD2B and The Successful Match, we have helped applicants overcome such obstacles, and you are welcome to contact us for more information.

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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