USMLE Importance of Board Scores

Passage of Step 1 and both components of Step 2 is a graduation requirement. Timeframes are set by which students must successfully complete the Steps in order to make progress in the medical school curriculum. The USMLE Step I scores are used in the Dean’s MSPE. The Dean’s MSPE  also includes a statement related to the student’s status in meeting this graduation requirement, i.e. Step 2 was taken in August, etc. If either of the Step 2 exams has not been scheduled within the timeframe required, this will be noted in the Dean’s MSPE since the residency directors expect our students to have completed these licensure applications prior to interviewing. It could also possibly delay participating in the Match and/or graduation on time.

Passage of the USMLE Steps 1, 2-CK, 2-CS, and 3 is now the single pathway for licensure. States may set a score level that needs to be met to be considered for a license. There is a seven (7) year limit between the date Step 1 was taken to when Step 3 is completed. If the timeframe exceeds 7 years, you may be required to retake Step 1.

Many residency program applications ask for information about licensure examinations. In most cases, program directors are interested in whether the student has passed Step 1 and Step 2 CK and CS and also prefer to have the scores prior to including the student in their residency rank order list. It is important to the residency director that the student accepted into the program is capable of meeting licensure requirements. If a resident is not successful in fulfilling the licensure examination requirement by the end of the first year of residency, the resident may not be able to continue in the program. In addition, the residency director may believe that successful performance on the USMLE is predictive of performance on specialty boards, which may be important to the evaluation of the residency program.

As some residency programs are becoming more competitive because of either the reduction in the number of positions or the increase in the number of applicants, the USMLE scores are being used in various ways in making decisions on whom to select for interviews. The following programs consistently use the scores in the screening process: Anesthesiology, Emergency Medicine, Neurosurgery, Obstetrics & Gynecology, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Radiology, Surgery, and Urology. Other specialties may request and use the scores, but this appears to be more dependent on the residency program than the specialty. With the implementation of ERAS, submission of USMLE official transcripts has become a routine part of the residency application process for all specialties.

The importance that you place on the level of the score you wish to achieve is your decision. The amount of study time may be important to your overall strategy. You must also be aware that, if you take Step 1 or Step 2-CK and receive a passing score, you cannot retake the examination to improve your score. The issue of the use of the USMLE scores, particularly Step 1, in the residency selection process is one about which you need to be aware so that you can make a decision on how you wish to approach this examination. Many programs want to also see the Step 2-CK scores as part of the residency application process. With the implementation of the ERAS noted earlier, most residency programs now expect to receive official transcripts for both Step 1 and Step 2-CK during the application timeframe.

The results of your performance sent to you by the National Board Office on Step 1 and Step 2-CK will be reported as a total numeric score and a pass/fail designation. In addition, you will receive a graph showing how you scored in the major content areas. You will receive more specific information on the scoring of the examination with your USMLE application materials. Step 2-CS is reported as a pass/fail designation only.

The USMLE transcript is released to residency directors by the student as part of the Electronic Residency Application Service (ERAS). Thus, the USMLE transcripts are a routine part of the residency application process, and the USMLE score may be used to screen candidates for interviews.

If a student needs to request an official copy (transcript) of performance on either Step 1 or Step 2, this will be provided through the NBME Office in accordance with USMLE policies for reporting scores to third parties, such as a residency program, but not to a medical licensing authority. This transcript will be provided only through ERAS or a written request by the examinee who has taken Step 1 and/or Step 2, has not yet taken Step 3, and who may have also taken but not passed an NBME Part examination. The transcript includes the entire examination history (pass and fail scores for all Steps taken to date).

The additional related information which is also noted includes an indicator of special circumstances (such as “did not complete”, “cancelled” or “irregular behavior”) and an indicator of prior history in taking NBME examinations. The examinee cannot choose which Step score will be shown on the transcript. For example, if both Steps 1 and 2 were taken, both will be reported, even if the request was for Step 1 only. (For additional information, see NBME Bulletin provided with your USMLE application.)