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

Marlene Busko


April 24, 2018

According to the National Resident Matching Program (NRMP), of the 18,818 seniors in their fourth year of an MD program who took part in this year's Residency Match (with results announced in March), 17,740 seniors (94.3%) were matched to first-year postgraduate residency positions. All US state licensure boards for physicians require that medical school graduates have at least 1 year of residency training, Mona M. Signer, MPH, NRMP President and CEO, told Medscape via email. Medical students who wish to become cardiologists or nephrologists, for example, have to do a residency in internal medicine before they do a fellowship in their specialty, she noted.

The "NRMP's Program Director Survey shows that many program directors are reluctant to rank applicants who fail USMLE examinations," Signer pointed out. Moreover, although students can re-enter the match as often as they wish, the more time that has elapsed since medical school graduation, the less likely the applicant is to match to a position. Signer believes that, "although the popularity and competitiveness of specialties ebbs and flows, the surgical specialties will remain competitive" in the coming years.

Stigma From a Poor Score?

"There is a big build-up, especially if you're taking [USMLE] Step 1, because it's so important," Kolin M. Meehan, a medical student at West Virginia University School of Medicine, in Morgantown, told Medscape. "When it comes to applying to the Match, there is certainly some stigma felt if you were to fail or even do poorly," added Meehan, who writes for the Differential blog at Medscape and is currently finishing a fellowship in pathology at Brigham and Women's Hospital in Boston, Massachusetts, between year 2 and 3 of medical school.

"It's not as though people are ostracized for failing or for scoring low," he noted, "but it certainly can shape your career of medicine." Medical students who fail USMLE Step 1, said McDougle, "should focus on...learning as much as they can to be the best provider of health that they can upon completion of their medical school education and also becoming a self-directed learner because the learning never ends."

"It's good to understand that Step 1 is a very important test in your medical training," Meehan echoed, "but it's important to keep perspective: You're in school to learn how to take care of other people. Any stress that you may feel about any individual test should be put in the context of your overall goal to become a physician and care for patients," he said.


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