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Importance of the USMLE

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USMLE Step 1 and 2 CK:  9 Important Points for the Orthopedic Surgery Residency Applicant

1. In 2018, the mean USMLE Step 1 score among U.S. seniors who matched to orthopedic surgery was 248. Among unmatched U.S. seniors, the mean score was 240. 



2. In 2018, 36% of U.S. seniors with a USMLE Step 1 score of less than 230 failed to match into orthopedic surgery. 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.



3. In a survey of 47 orthopedic surgery residency programs, 91% 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. Among the reasons for the importance of the USMLE in the selection process is the desire to select residents who will pass the American Board of Orthopaedic Surgery certification examination. In one study, researchers evaluated the relationship between USMLE (Step 1 and 2 CK) and American Board of Orthopaedic Surgery examination scores.  The authors concluded that “USMLE Step 1 and 2 scores along with OITE (Orthopaedic In-Training Examination) scores are helpful in gauging an orthopaedic resident's performance on written boards.”

5. 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. 98% percent of programs have established a target score while 2% look for evidence of a passing score. “Unless there are extenuating circumstances, the minimum score on Step I of USMLE for our successful applicants is 210,” writes the Department of Orthopaedic Surgery at the Greenville Hospital System. “A Step I Board on the USMLE of approximately 235 is used as a general screening tool,” writes the Department of Orthopaedic Surgery at Loma Linda.


6. The USMLE Step 2 CK score is also a factor used by many neurosurgery residency programs in deciding whom to invite for interviews. 53% of programs use the Step 2 CK score in their decision-making process.

7. Should you take the USMLE Step 2 CK exam before applying to orthopedic surgery? Some programs want to see Step 2 scores when you apply. “Step II USMLE - score of at least 230 on the first attempt (may adversely affect applicant if Step II scores are not available),” writes the Department of Orthopaedic Surgery at the University of Tennessee.

8. Some programs want to see Step 2 scores before rank-order lists are due for submission in February “USMLE Step I & II results (Step II CK & CS must be completed in order to obtain a Massachusetts Limited License, therefore all results for Step II are needed to be ranked – USMLE results should be updated in ERAS)," writes the Department of Orthopaedic Surgery at Boston University Medical Center

9. When orthopedic surgery residency program directors were asked, “Would your program consider applicants who fail their [Step 1] exam on the 1st attempt,” 65% of programs indicated that they never do and 35% reported that they seldom do. 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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