HealthJuly 30, 2010

Step 1 and the residency match

With August just around the corner, I got a bit nostalgic about the start of the academic year. A bunch of my friends are just about to start med school, even more friends have just started internships and fellowships, and all around the country M2s are starting to think about Step 1.

As a fresh M2 I was completely clueless as to the true nature of Step 1, and how important it was. At first, I (naively) assumed it was simply a licensing exam—just a little something to ensure that doctors weren’t completely bad. And in fact, that was the original purpose of the USMLE exams.

But for a number of reasons, Step 1 is now a key measure of competitiveness/achievement, and nowhere is it more obvious than during residency applications. Every year, the NRMP (National Resident Matching Program) publishes 2 highly informative documents: 1) the Results and Data of the main residency match and 2) the Characteristics of Applicants Who Matched to Their Preferred Specialty.

In 2009 and 2010, the number of overall PGY-1 (intern) positions per applicant hit an all-time low: 0.75 spots per applicant. At the same time, the difference between the average Step 1 score for candidates who matched vs. the candidates who did not match remained small: 225 vs. 216 respectively. Think about that for a second. It might be tempting to think that a couple points in either direction won’t make a big difference, but this data suggests otherwise. Nine points below 225, and you’re into the “didn’t match” zone.

The other side of the story is that average Step 1 scores for the most competitive specialties seem to be rising by the year: a whopping 247 in plastic surgery, 242 in dermatology, 241 in ENT, and 239 in orthopedic surgery. The message is clear: even a few points on the Step 1 exam can make or break you.

Step 1 scores certainly aren’t the end-all of a residency application, and the NRMP provides plenty of other data points to look at (e.g. % of matched candidates with AOA, % of matched candidates with research experiences). But it’s pretty clear that Step 1 scores remain a major and perhaps growing part of an application, and that competition for residency spots is going up.

The sooner you start studying/learning with Step 1 in mind, the fewer hurdles you’ll have to securing the residency position of your choice.

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