If you’re an IMG seeking a US residency, you know you have an uphill battle. The match rates are significantly lower for IMGs, either US or non-US. Program directors openly admit that it is harder to match as an IMG. So what constitutes a good USMLE score for IMGs? What are the average Step 1 and Step 2 CK scores for IMGs?
For context, before we dig into the average IMG Step 1 and Step 2 CK scores, let’s start with the passing rates for IMGs.
Table of Contents
Passing Rate for Step 1 and Step 2 CK for IMGs
Here are the passing rates for Step 1 for US MDs, DOs, and IMGs:
| Step 1 Passing Rates | 2019 | 2020 | 2021 | 2022 |
|---|---|---|---|---|
| MD Degree Examinations | 22,146 | 20,343 | 23,078 | 24,251 |
| MD Degree Passing % | 96% | 97% | 95% | 91% |
| MD Fails* | 886 | 610 | 1,154 | 2,183 |
| DO Degree Examinations | 4,837 | 5,274 | 5,365 | 4,722 |
| DO Degree Passing % | 96% | 95% | 94% | 89% |
| DO Fails* | 193 | 264 | 322 | 519 |
| IMGs Examinations | 16,065 | 13,117 | 19,210 | 24,956 |
| IMGs Passing % | 78% | 83% | 77% | 71% |
| IMG Fails* | 3,534 | 2,230 | 4,418 | 7,237 |
| Total Step 1 Exams | 43,048 | 38,734 | 47,653 | 53,929 |
| Overall Step 1 Pass Rate | 89% | 92% | 88% | 82% |
| Total Step 1 Fails | 4,614 | 3,104 | 5,894 | 9,939 |
And the data for Step 2 CK:
| Step 2 CK Passing Rates: | 2016-2017 | 2017-2018 | 2018-2019 | 2019-2020 |
|---|---|---|---|---|
| MD Degree Examinations | 21,071 | 22,367 | 21,721 | 18,574 |
| MD Degree Passing % | 95% | 96% | 97% | 98% |
| MD Fails* | 931 | 836 | 628 | 436 |
| DO Degree Examinations | 2,581 | 3,076 | 3,476 | 3,362 |
| DO Degree Passing % | 94% | 94% | 97% | 97% |
| DO Fails* | 34 | 38 | 31 | 21 |
| IMGs Examinations | 14,291 | 13,613 | 12,941 | 10,295 |
| IMGs Passing % | 76% | 78% | 82% | 87% |
| IMG Fails* | 2,342 | 2,144 | 1,859 | 1,172 |
| Total Step 2 CK Exams | 37,943 | 39,056 | 38,138 | 32,231 |
| Overall Step 2 CK Pass Rate | 88% | 90% | 92% | 94% |
| Total Step 2 CK Fails | 4,638 | 4,074 | 3,085 | 1,811 |
You’ll notice quickly that:
- IMGs have a substantially lower pass rate than US MDs and DOs, and
- The passing rate has been improving significantly over the years
What Step 1 and Step 2 CK Scores Do IMGs Need to Match?
So IMGs pass Step 1 and Step 2 CK at a lower rate overall. But what would constitute a good score for IMGs? In other words, what are the average Step 1 and Step 2 CK scores for successful (matched) US and non-US IMGs?
You can find the data here:
| US IMGs (Matched) | US IMGs (Unmatched) | Non-US IMGs (Matched) | Non-US IMGs (Unmatched) | |
|---|---|---|---|---|
| Mean Step 1 | 223 | 213 | 234 | 223 |
| Mean Step 2 CK | 234 | 223 | 240 | 230 |
As you’d imagine, the average Step 1 and Step 2 CK scores are higher for matched US and non-US IMGs. What’s interesting is that the difference between the means isn’t much – matched IMGs score ~10 points higher than their unmatched counterparts.
For comparison, this is the same for US MDs and DOs:
| DO (Matched) | DO (Unmatched) | US MD (Matched) | US MD (Unmatched) | |
|---|---|---|---|---|
| Mean Step 1 | 228 | 223 | 234 | 226 |
| Mean Step 2 CK | 240 | 233 | 247 | 238 |
What Are the Average Step 1 and Step 2 CK Score for IMGs Overall?
But what is the average Step 1 and Step 2 CK score for US and non-US IMGs? It is surprisingly difficult to find reliable data. However, using the above data for matched and unmatched IMGs, we can calculate the average Step 1 and Step 2 CK scores for IMGs who applied for the match.
| US IMGs | Non-US IMGs | DO | US MD | |
|---|---|---|---|---|
| Weighted Step 1 Mean (ALL Applicants) | 219 | 229 | 227 | 233 |
| Weighted Step 2 CK Mean (ALL Applicants) | 229 | 236 | 239 | 246 |
Observations
Non-US IMG Applicants Have Similar Step 1 Scores to DOs and US MDs
You’ll notice that for Step 1, the average scores for non-US IMGs, DOs, and US MDs are all similar. I found this surprising, given the disadvantages that IMGs face in preparing for Step 1. Note, though, that the many IMGs who don’t pass / have a low score may not apply to match at all, which would bring up the average significantly.
Non-US IMG Applicants Have Lower Step 2 CK Scores – Will Pass-Fail Step 1 Hurt?
Notice, too, that the average Step 2 CK scores for non-US IMGs are lower than the US MDs. (They are similar to the DOs). Since the Step 1 scores between non-US IMG applicants and US MDs were more similar, does this mean Step 1 moving to pass-fail will hurt non-US IMGs more than expected? Possibly.
However, I’m not convinced. In my work with IMGs, I find that they put disproportionate emphasis on Step 1. That is logical; because Step 1 has up until this point been so important for matching, it makes sense to spend more time on it. Now that Step 1 will be pass-fail, inevitably more of the emphasis will shift to Step 2 CK.
US IMGs Score Lower on Both Step 1 and Step 2 CK
Another observation is that US IMGs Step 1 and Step 2 CK scores lag those of non-US IMGs, DOs and US MDs. There are a variety of possible explanations for this. One is that the average US citizens/green card holder who trains outside the US has more difficulties with standardized tests. Low MCAT scores, for example, are one reason that someone may choose to pursue med school outside the US. Another possibility is that the schools/learning environments aren’t as conducive to scoring well on the USMLEs.
It’s impossible to know why based on these data. However, it is interesting to note that while non-US IMGs seem to have similar Step 1 scores to US MDs and DOs, the scores of US IMGs lag for both Step 1 and Step 2 CK.
Are You an IMG Who Wants to Train in the US?
For the IMGs who make it to the point of applying for a US residency, the USMLEs represent a huge hurdle they had to overcome. If you are an IMG interested in training in the US, check out:
The IMG’s Guide to Obtaining Residency in the United States
What do you think? Do the average Step 1 and Step 2 CK scores of IMGs surprise you? Let us know in the comments!
