HealthFebruary 07, 2020

A guide to USMLE scores

By: Brian Wu, MD, PhD
For medical students getting ready to sit for boards, the pressure of getting good USMLE scores looms large. Here’s a guide to understanding the scores.

For medical students getting ready to sit for boards, the pressure of getting good USMLE scores can be overwhelming. One way to relieve the pressure may be to get a better idea of how the exams are evaluated so you can be better prepared. Here’s more information on how the scores are calculated and what to do if you don’t perform as well as you hoped.

How are USMLE scores calculated?

According to the USMLE Bulletin on Scoring and Score Reporting, the USMLE program provides a recommended pass/fail outcome for all Step examinations. These recommendations are based on a specified level of proficiency—there is no predetermined number of test-takers who will pass or fail. The recommended minimum passing levels are reviewed and adjusted periodically, and any changes are posted on the USMLE website.

For the multiple-choice examinations (Step 1, Step 2CK and Step 3), the percentage of correctly answered items required to pass varies from Step to Step, but generally, the test-taker must answer 60% of items correctly in order to pass. Step 1, Step 2CK and Step 3 scores are reported on a three-digit scale ranging from one to 300, according to the USMLE’s Score Interpretation Guidelines.

Step 2CS is a performance-based evaluation, so it’s scored in a different way than the other Step examinations. During Step 2CS, “standardized patients” (trained actors portraying patients with various medical conditions) interact with candidates and simulate 12 different patient encounters, then test-takers are scored on the following components:

  • Communication and Personal Skills (CIS)
  • Spoken English Proficiency (SEP)
  • Integrated Clinical Encounter (ICE)

A test-taker must receive passing scores on all three components in a single administration of the exam. Standardized patients assess CIS and SEP using a checklist of observed behaviors (CIS) and a global rating scale (SEP). Part of the ICE score comes from the standardized patients evaluating the test-taker’s performance on the physical examinations, and the rest comes from physicians rating the test-taker’s patient notes from the simulations.

The results of the Step 2CS are reported as pass or fail only; there is no numeric score.

What is a good score?

According to the USMLE’s Scores and Transcripts page, the minimum passing scores for the multiple-choice Step exams are currently:

  • Step 1: 194
  • Step 2CK: 209
  • Step 3: 198

However, you will need to achieve considerably more than the minimum for a competitive score. According to the most recent data from the USMLE Score Interpretation Guidelines, the average USMLE score for first-time takers of Step 1 was 230. (For Step 2CK, the average was 242, and for Step 3, it was 226.) Only 5% of first-time takers in the years 2016 to 2018 received scores lower than 195.

However, keep in mind that comparison of scores across Steps is not appropriate. For instance, a score of 230 on Step 1 does not represent the same level of proficiency as a score of 230 on Step 2CK.

How important are good USMLE scores?

The New England Journal of Medicine (NEJM) reports that competition for residency positions has become more intense in recent decades. On average, a program director receives about 1,000 applications for a handful of available slots, and the average number of slots available is 6.7. Since it’s not possible to go through that many applications in detail, directors rely on the USMLE as a means of screening prospective candidates for residency training.

Although it’s not the only factor program directors consider, the USMLE score looms larger than ever. The Step 1 score is particularly important to program directors because it’s available for almost all residency candidates.

What if I get a low score?

If your score isn’t all you hoped for, don’t despair. Getting a low score may limit some of your residency choices, but you can still find a match if you work hard on the other components of your residency application. You can also consider medical specialties that are more forgiving about low USMLE scores, such as psychiatry and family medicine.

It’s also important to keep in mind that the USMLE generally doesn’t allow retakes if you’ve already passed Steps, so go ahead and take the Step 2CK and 3 exams, aiming for a higher score. Progressing from a lower to a higher score will reflect well on you as a candidate, particularly if you can give a compelling explanation of how you faced challenges along the way.

How can I improve my score?

Though a less-than-stellar score on the USMLE Step 1 isn’t a career-ender, many people still want to know how they can improve those scores moving forward. One student, Omar Taha, provided a good guide for the American University of Antigua College of Medicine website, describing how he volunteered with an internal medicine physician to gain clinical experience after a disappointing Step 1 score. When he was studying for Step 2, he was more careful when selecting study materials and supports and kept his motivation levels high while studying so that he would be more successful with that exam.

What’s perhaps most important to understand about the scoring system is that it gives you an idea of what constitutes a poor, average and good score and thus allows you to set a more realistic goal for yourself. It also allows you to monitor your progress on practice exams in a concrete and meaningful way during the course of your studies. All this can increase your confidence when you actually sit for your boards.

Brian Wu, MD, PhD
Lippincott® Medicine
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