You Got a Poor USMLE Step 1 Score: Now What?

Marlene Busko


April 24, 2018

The stakes are high when medical students take the US Medical Licensing Exam (USMLE) Step 1, which tests their knowledge of basic science gleaned after 2 years of medical school. This is especially true if a student aims to be "matched" to a competitive residency program, such as surgery or dermatology, after his or her fourth year of medical school. Although students who fail Step 1 can make another five tries to pass, many residency programs will not accept a student who failed to pass this critical exam the first time.

Of equally pressing concern, in most US medical schools, students must pass this exam before they can enter the third year of medical school and/or graduate. Around 4% of students in American MD programs have failed the USMLE Step 1 exam in recent years. However, these students need not feel stigma (or shame) because they can still graduate from medical school if they work hard and subsequently pass Step 1 and make up for any shortcomings, says one expert contacted by Medscape.

The message to medical students who fail the USMLE Step 1 exam is, "continue to pursue one's dream and study diligently," Leon McDougle, MD, MPH, professor of family medicine and associate dean for diversity and inclusion at the Ohio State University College of Medicine in Columbus, told Medscape. "This test is important, but if failed on the first attempt, work with your faculty and education specialist to increase your likelihood to pass on the second attempt," and then focus on excelling in clinical work and on USMLE Step 2, he advises. "Be encouraged. Keep moving forward. The journey continues."

Scores Needed to "Match"

The current minimum passing score of the USMLE Step 1 exam, which is scored out of 300, is 194. In 2017, 96% of the 21,353 medical students from MD programs in Canada and the United States who took Step 1 for the first time passed.

"Failing" USMLE Step 1 actually means failing to get a sufficiently high score to be matched to a residency program of your choice, said Rishi Desai, MD, MPH, an instructor in pediatric infectious disease at Stanford University, in Palo Alto, California, and chief medical officer at Osmosis, a web- and mobile-based learning platform to help medical students pass USMLE Step1. In 2016, students in an MD degree program in the United States or Canada who took the Step 1 exam for the first time had a mean USMLE Step 1 score of 228 (with a standard deviation of 18).

Students who were matched into dermatology, neurosurgery, plastic surgery, orthopedic surgery, otolaryngology, and radiation oncology residency positions that year had a mean USMLE Step 1 score of 250. Those who were matched into residency positions in pediatrics or family practice had mean scores of 230 and 220, respectively. Thus, "if you want to go into orthopedic surgery or neurosurgery [residency positions], and you get a 210, technically you may not have failed [Step 1], but you didn't get a high enough score to get to where you wanted to go," Desai told Medscape. "Most of us think of it along the lines of, 'I want to get a 250 or 260,' so really... failure would be not getting a 250." On the other hand, "if you wanted to go into something like pediatrics or family practice, maybe a lower score would have allowed you in."


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