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Importance of the USMLE

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USMLE Step 1 and 2 CK:  11 Important Points for the Neurology Residency Applicant

1. In 2018, the mean USMLE Step 1 score among U.S. seniors who matched to neurology was 231. Among unmatched U.S. seniors, the mean score was 213. 



2. U.S. allopathic medical school seniors with lower USMLE Step 1 scores are generally able to match but may find it difficult to match into one of the more competitive neurology residency programs. If your USMLE Step 1 score will be of concern to coveted 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.



3. In a survey of 37 neurology residency programs, 89% 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. 

4. Why are scores so important to neurology residency programs? “It is important to the residency director that the student accepted into the program is capable of meeting licensure requirements,” writes the University of Washington School of Medicine. “If a resident is not successful in fulfilling the licensure examination requirement by the end of the first year of residency, the resident may not be able to continue in the program.”

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 Psychiatry and Neurology certification examination. Numerous studies have shown correlation between USMLE scores and specialty certification exam performance.

6. Although neurology 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% of programs have established a target score while 38% look for evidence of a passing score. “The Selection Committee generally looks for scores of 85 or higher, but reviews the entire application and does not base its decisions on USMLE scores,” writes the Department of Neurology at the University of Arizona. “There is a minimum USMLE Part 1 score of 200,” writes the Department of Neurology at the NYU Langone Medical Center.



7. The USMLE Step 2 CK score is also a factor used by many neurology residency programs in deciding whom to invite for interviews. 62% 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 neurology? The decision should be based on your Step 1 performance and the requirements of the programs you’re applying to. Traditionally, applicants have been told that if the Step 1 score is competitive for matching, then you can take the Step 2 CK later. However, an increasing number of programs are requiring the Step 2 CK score prior to the Match. “You must have taken and passed USMLE Step 1, Step 2 CK and Step 2 CS prior to the match,” writes the Department of Neurology at the Medical University of South CarolinaApplicants are urged to research programs of interest well in advance of application submission to make informed decisions regarding the timing of the Step 2 CK exam.



9. There are certainly other factors of importance in the residency selection process, and an average or even below average score can be overcome in a variety of ways. “An average USMLE performance does not necessarily have a negative impact if other components of the application are strong,” writes Dr. Helene Rubiez, Program Director of the Neurology Residency Program at the University of Chicago.



10. Matching into Neurology is not only about USMLE scores. The University of Cincinnati takes other factors into account. “The UC Neurology Department takes all information into account when considering resident candidates including medical school grades, USMLE scores, letters of recommendation, research performance, extracurricular activities etc.” Emory University also takes a holistic view of applicants. “In evaluating each resident candidate, we consider a wide variety of factors including evidence of academic excellence, participation in research and/or academic activities, the development of an area of interest in Neurology or the Neurosciences, evidence of excellent verbal and written communication skills, and leadership in forming or participating in academic or community organizations.”



11. When neurology residency program directors were asked, “Would your program consider applicants who fail their [Step 1] exam on the 1st attempt,” 27% of programs indicated that they never do and 59% reported that they seldom do. Only 14% of programs often consider applicants who have failed. Similar findings were found with respect to the USMLE Step 2 CK exam. “We will not invite candidates that have taken more than one attempt to pass any given section of the USMLE/COMLEX,” writes the Department of Neurology at the University of Florida. “If we receive notice that you have failed an attempt of any step of the USMLE after we have extended an invitation for interview, we reserve the right to rescind our invitation.” 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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