Step 1 & The Residency Match

Posted by on Jul 30, 2010 10:16:32 AM

With August just around the corner, I got a bit nostalgic about the start of the academic year. A bunch of my friends are just about to start med school, even more friends have just started internships & fellowships, and all around the country M2's are starting to think about Step 1.

As a fresh M2 I was completely clueless as to the true nature of Step 1, and how important it was. At first, I (naively) assumed it was simply a licensing exam -- just a little something to ensure that doctors weren't completely bad. And in fact, that was the original purpose of the USMLE exams.

But for a number of reasons, Step 1 is now a key measure of competitiveness/achievement, and nowhere is it more obvious than during residency applications. Every year, the NRMP (National Resident Matching Program) publishes 2 highly informative documents: 1) the Results and Data of the main residency match and 2) the Characteristics of Applicants Who Matched to Their Preferred Specialty.

In 2009 & 2010, the number of overall PGY-1 (intern) positions per applicant hit an all time low: 0.75 spots per applicant. At the same time, the difference between the average Step 1 score for candidates who matched vs. the candidates who did not match remained small: 225 vs. 216 respectively. Think about that for a second. It might be tempting to think that a couple points in either direction won't make a big difference, but this data suggests otherwise. Nine points below 225, and you're into the "didn't match" zone.

The other side of the story is that average Step 1 scores for the most competitive specialties seem to be rising by the year: a whopping 247 in plastic surgery, 242 in dermatology, 241 in ENT, and 239 in orthopedic surgery. The message is clear: even a few points on the Step 1 exam can make or break you.

Step 1 scores certainly aren't the end-all of a residency application, and the NRMP provides plenty of other data points to look at (e.g. % of matched candidates with AOA, % of matched candidates with research experiences). But it's pretty clear that Step 1 scores remain a major and perhaps growing part of an application, and that competition for residency spots is going up.

The sooner you start studying/learning with Step 1 in mind, the fewer hurdles you'll have to securing the residency position of your choice.

I look forward to reading your comments.

Frank Lau, MD

Founder & Chief Medical Officer, Gunner Training
Resident, Harvard Combined Plastic Surgery Training Program
Clinical Research Fellow, Massachusetts General Hospital

Topics: USMLE, Medical Education, Residency

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