Applying - The Boards

Updated September 2016

By the time you get to your EM rotations and into the application process you will have already taken step 1 of your USMLE or COMLEX.  What you need to figure out is:
  1. What impact do board scores have on my application?
  2. When should I take step 2?
The boards are one of the more important parts of your application.  Therefore they are worth putting the time in to study.  They are important because your scores are one of the few objective measures available to contrast you with your fellow applicants.  Everything else is subjective.  So even though most Program Directors feel that board scores do not predict how good a physician you will be, they are still a heavily weighted part of your application.  


Are my scores good enough?

That, fortunately, is a difficult question to answer because each program puts different weight on board scores. A result that would ruin your application at one program will be of no concern elsewhere. Thus there is no magic number that will guarantee interviews everywhere you apply.

That being said, some programs do set a cut-off where they filter out applications with scores below X.  Each program that sets a cut-off has their own X. More sought after programs may set X higher. In general, a score less than 200, or failing a step of the boards, will seriously hurt your application. The average USMLE step 1 score for successful applicants has recently been in the 230's.  Anything in this vicinity puts you solidly in the middle of the pack, which for most programs, is just fine.


Are step 2 scores important?

In EM your Step 2 scores are both more and less important than Step 1 scores.  Step 2 covers more clinically relevant material so a really good Step 2 score will make many Program Director forget about a mediocre Step 1 score. But you need the Step 1 score to get past any filters that may be in place.  All programs want to see your step 2, and some will not rank you, or even interview you, unless they have those scores.  The only reason not to take step 2 by September is if you are concerned that you cannot do as well as you did on step 1. You must take Step 2 by then end of December so that it is available for rank list decisions by the program.

The best thing you can do for your chances in EM is to get as many eyes on your application as possible.  Even if you are not happy with your scores you are better off having them available for the initial review of you application.   

14 comments:

  1. Very informative blog. Can you tell me how step 2CS is viewed by PDs? I'm a U.S-IMG and I ended up failing my first attempt, but passed my second one and submitted it on Oct 12th. Otherwise, I had a 244 and 247, 2 SLORs + 2LORs, all As in my 3rd year clerkships, and an A and B+ on EM clerkships. I wondering how badly the CS screw up would affect me. Thanks

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  2. For the most part CS is not very important to your application. However, being in an applicant group, like US-IMG, where any "flaw" can weed your application out, I can see it being a bigger problem. There is not much you can do to mitigate this other than notify programs that you passed on your subsequent attempt.

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  3. For someone like me with a step 1 of 208 and step 2 of 245, how would the filters work? Let say they put step 1 <210 and step 2 <220, would I still be excluded even though I qualify on the step 2 portion? Thanks again for the blog post.

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    1. Filters are not commonly used for step 2 since many applicants don't have step 2 scores in mid-september, especially those who did well on step 1. Programs that use filters don't want to miss those students by screening them out for not having a step 2 score. A few programs will filter you out for a step 1 of 208. You can identify some of them using EMRA Match: https://webapps.emra.org/utils/spa/match#/search/map and save your application money for another program.

      Once reviewed, most would put the weight on your step 2 score, sort of replacing your step 1, since step 2 is the more clinically relevant exam.

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  4. What about if your step 2 is about the same as your step 1, (Step 1:221; Step 2 practices: 220) Is it worth putting off step 2 until later to obtain interviews? After all 221 is 9 points below the national average but 220 is 23 points below.

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    1. In general it is better to have your step 2 in, even if it is below average. Showing the ability to consistently pass these standardized tests will be adequately reassuring to most programs. Average scores are not benchmarks that must be cleared to have a chance.

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  5. i had a horrible outcome with a step 1 of 222 and a step 2 of 218. All my practice exmas were in the 240's and I am not sure how or why I performed so poorly. How will this affect my chances at my application being opened? I feel I am a stron applicant with a different and unique background.

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    1. Below average scores are not going to be the end of your application. The average step 1 of ~235 and step 2 of ~240 for those who match into EM. That means a substantial portion of those who match have scores below those levels. While some will filter you out as having less than a 220 on step 1, this is the minority of programs.

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  6. I am a third yr Osteopathic student interested in applying EM. My step 1 score was a 254. Should I take step 2 (I am concerned it may drop)? If you recommend I take it, when should be a good time? My school gives us approximately 3.5wks to study for it. Thank you in advance for any advice you may provide.

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    1. The general recommendation for osteopathic students pursuing EM is to take both USMLE step 1 and 2 to avoid any programs disqualifying you for consideration. It is hard to know how many programs that otherwise consider DO's actually require a USMLE step 2 at time of application review. There probably are not many. The need to take both COMLEX and USMLE will hopefully decrease over the next few years with the single accreditation system for EM residencies coming on line.

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  7. First, thank you very much for all your work on this site. As a DO student like the above, I get hardly no advising in terms of these topics so this is incredibly helpful.

    My question is similar in the Step 1/2 debate. My Step 1 score was 228. Studying for Step 2 right now, but my scores have been hanging low around 215-220 and am worried about how a poor performance/trend would affect my application. I'm pretty sure the strength of my application is going to be my SLOEs, and I'm trying to use that to my advantage for the cycle. Currently scheduled for a date that would return my Step 2 score Oct 10th or so. I'm just lost as to how Step 2 scores will affect me along the way. Any recommendations from a program standpoint on the best option? Was debating between:
    a) Study as much as I can for the next week and take it. Hope my average step 1 and letters are weighted higher in case of a poor performance to get some invites.
    b) Hold off a while so that programs can only use my SLOEs and Step 1 for initial review? Maybe take Step 2 so score comes back in early November?
    c) Not take it at all because of the risk of sinking application. It's not required of me as a DO student, but obviously encouraged in order to be better compared against my MD peers.

    I appreciate any advice you might have!

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    1. I think option B is your best bet if you are worried about doing worse on step 2. It is very rare for people to drop from step 1 to 2, so it could hurt you a little. Your SLOE's are the most important part of the application. Step scores can help, but SLOE's have a much greater impact.

      While you don't to take step 2 as a DO, there is the possibility of programs interviewing you but not ranking you if you don't have a USMLE 2 score. That seems unlikely as you would have a COMPLEX 2 score and they interviewed you in the first place.

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  8. Hi, so I'm a third year and got a pretty low Step 1 score of a 198. So I'm wondering if there is still a chance for me to match since I know <200 is going to instantly eliminate me from many programs. I do go to a US allopathic school, in a major city and my school does have an EM residency program and I've shadowed the Assistant program director multiple times in the ER as a 2nd year. So would my best bet be my own schools program? Also what would I need on Step 2 to have more of a chance? Thanks so much!!

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    1. There is no board score low enough to disqualify you from matching in EM. Lower scores will make it harder and should cause you to change your strategy from what would be considered "standard recommendations".

      1. invest time in prep for step 2 so that you do significantly better and take it early enough that results are back by September 15th of the year you apply.

      2. Use EMRA match and residency program websites to find out their philosophy on board scores. Less than half of programs filter out low step 1 scores, but some do. Your application dollars should not be wasted on those programs. With >200 programs you can find 30-40 programs to apply to that don't filter out low step 1.

      Board scores are generally agreed upon among program directors to predict the chances of passing future boards. They do not predict who will be the best emergency physicians. How you perform on your clinical rotations, particularly EM sub-internships is going to be much more important.

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