A lot of different people will give you a lot of different advice about getting a residency position in the United States. Some will tell you that your USMLE Step 1 score is what makes all the difference. Others, that an externship in the U.S. makes all the difference. Still others will emphasize the virtues of recent medical school graduation, or the converse, work experience in a medical setting. In the face of myths and rumors it is nice to have some data to share that lets us put some of these opinions to the test.
About a month after the completion of the 2004 Residency Match, Kaplan surveyed a set of students who had taken USMLE preparation courses with us over the past year. Students were asked whether or not they had secured a residency position, and for some information about themselves, such as USMLE scores, USMLE failures, the date on which each USMLE Step was passed, the number of programs to which they had applied, their year of graduation from medical school, and whether they were permanent residents of the U.S. or not.
By far, the best predictor of getting a residency position was the USMLE Step 2 score! Good Step 1 scores were also positively related to getting a residency, but STEP 2 scores mattered MORE!
When both Step 1 and Step 2 scores are placed in a stepwise regression analysis to predict the chance of getting into a residency, once Step 2 is entered into the model, there is no predictive capacity left for Step 1. This means that adding a Step 1 score to the model does not give a better prediction. A Step 2 score, by itself, gives the best prediction. Using just Step 2 scores as a predictor, we are able to derive a model that correctly classified 75% of those who did and did not get a residency position.
The relationship between Step 2 scores and the chance of getting into a residency is displayed in the Figure below.
The chance of getting a residency position with scores in the range of 75 to 77 is 30%. With Step 2 scores in the 90's, the probability rises to 90%.
What does all of this mean? Students typically spend a lot of preparation time and effort while preparing for USMLE Step 1. This is time well spent. However, most students spend less time and energy preparing for USMLE Step 2. These data suggest that less effort on Step 2 is likely to be a strategic mistake. Because Step 2 matters most, the effort spent preparing for Step 2 should be at least as much as for Step 1.
* Preparing for and taking Step 1 before Step 2. A Step 1 knowledge base will help to raise your Step 2 score.
* Planning to put extra time, effort, and energy into Step 2 preparation. Don't listen to those who tell you that passing Step 2 is easier than passing Step 1. It is easier to pass Step 2, but passing is NOT your goal. Getting that higher Step 2 score is the key to finding yourself in the residency program that you want.