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Step 1 + Step 2 CK Percentiles: What’s a Good Score for Each Specialty?

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by Alec Palmerton, MD in Residency
Step 1 US Seniors, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Have you ever wondered what a good Step 1 score was? What percentile is a 240 on Step 2 CK? Step 1 percentile cut-offs to get a residency interview? What score you need to match into any specialty? If so, you’ve come to the right place.

Here, we look at what exactly a “good” USMLE score is. Most med students have heard that a Step 1 score of 240 is “good.” A 250 is “really good.” While those are good starting points, the story is more nuanced than that.

Specifically, in this article, we’ll address:

  • Percentiles for Step 1, Step 2 CK, and Step 3
  • Minimum cut-offs for each NRMP specialty (get these scores if you don’t want to get screened out)
  • Scores needed to get interviews at most programs
  • Step 1 and Step 2 CK scores for matched applicants to each specialty

Percentiles for Step 1, Step 2 CK, and Step 3

The easiest way to answer what a “good” score is to look at the percentiles of all test-takers. Specifically, we can look at the percentiles for USMLE, as reported by the NBME. Here are the percentiles for Step 1, Step 2 CK, and Step 3:

ScoreStep 1 PercentileStep 2 CK PercentileStep 3 Percentile
280100100100
27510099100
27010097100
2659993100
260968699
255917698
250846595
245765490
240664282
235563272
230472360
225371647
220291134
21522723
21016415
2051138
200824
195512
190411
185200
180200
175100
170100
165000

Here are the same data represented visually:

And graphed as a distribution curve:

What do you notice?

First, Step 2 CK scores are significantly higher than Step 1 scores. So a 240 on Step 1 is the 66th percentile. However, it would be below the median for Step 2 CK (42nd percentile).

One reminder: med students are excellent test-takers. For example, the average MCAT score is roughly 500, with a standard deviation of 10.5. However, the average MCATs of matriculants is approximately one standard deviation higher! In other words, the average matriculant’s MCAT is in roughly the 80%ile of test-takers.

Translation: an “average” US med student scored higher than 80% of MCAT test-takers. Thus, to achieve the same percentile on Boards as you did on the MCAT, you have to do much better. (Not to mention the fact that you get to take each USMLE only once).

What Are Each Specialty’s USMLE Cut-Off Scores for Interviews?

Most people view USMLE scores not as an end in itself. Instead, they are a means to a particular aim, specifically residency applications.

Residencies use Boards scores as a significant criterion in selecting applicants. Often Step 1 is the most cited criteria used for extending residency interviews. In fact, many programs use it as a “screen” for applicants. It’s used so often, in fact, that many residencies have cut-off scores. For example, in the 2018 PD survey, 64% of respondents report a “target” Step 1 score. In contrast, only 39% reported having a “target” Step 2 CK score.

Here are each specialty’s cut-off scores from the most recent program director survey. These are the Step 1 Scores “Below Which Programs Generally Do Not Grant Interviews”:

Step 1 Scores (25%ile, Median and 75%ile) Below Which Programs Typically Do NOT Grant Interviews; 2018 Program Director Survey

Step 1 Scores (25%ile, Median and 75%ile) Below Which Programs Typically Do NOT Grant Interviews; 2018 Program Director Survey. *Median Cut-Off Scores Not Available for All Specialties.

And the Step 2 CK percentile cut-off scores for interviews:

Step 2 CK Scores (25%ile, Median and 75%ile) Below Which Programs Typically Do NOT Grant Interviews; 2018 Program Director Survey

Step 2 CK Scores (25%ile, Median and 75%ile) Below Which Programs Typically Do NOT Grant Interviews; 2018 Program Director Survey. *Median Cut-Off Scores Not Available for All Specialties.

What Score Will Virtually Guarantee an Interview?

Programs use USMLE scores as cut-offs for interviews. Similarly, they also may extend an interview based solely on high Boards scores.

Programs also reported scores above which they would “Almost Always Grant Interviews.” We went through and collected the 25%ile, median, and 75%ile scores. In other words, the median scores for Step 1 mean that 50% of programs with a target score would “almost always” grant you an interview. Similarly, the 75%ile score means that 75% of the programs would almost always grant you an interview based on your score alone.

Here are the Step 1 percentiles to maximize your interview chances:

Step 1 Scores (25%ile, Median and 75%ile) Above Which Programs Almost Always Grant Interviews; 2018 Program Director Survey

Step 1 Scores (25%ile, Median and 75%ile) Above Which Programs Almost Always Grant Interviews; 2018 Program Director Survey. *Median Cut-Off Scores Not Available for All Specialties.

And the Step 2 CK percentiles giving you the greatest chance at interviewing:

Step 2 CK Scores (25%ile, Median and 75%ile) Above Which Programs Almost Always Grant Interviews; 2018 Program Director Survey

Step 2 CK Scores (25%ile, Median and 75%ile) Above Which Programs Almost Always Grant Interviews; 2018 Program Director Survey. *Median Cut-Off Scores Not Available for All Specialties.

What do you notice? First, if you’re aiming for an interview, a 240 on Step 1 will get you in the door with programs that aren’t the most competitive. For the next tier up, you might want to aim for a Step 1 score of 250. And for dermatology, ENT, and plastic surgery? A 260 would get you an interview at most of the programs who grant interviews based on high USMLE scores.

How Many Residency Programs Have Step 1 and Step 2 CK Cut-Off Scores?

So how many programs have actual cut-off scores for granting residency interviews? 64% of the PD survey respondents reported having a “target score.” Only 34% of 2018 respondents claimed not to have a “target” Step 1 score. Discussions with admissions committee members would corroborate this.

Two (Small) Caveats to the Step Percentile Cut-Offs for Interviews

After looking at the data for interview cut-offs, there are two small caveats. First, with any surveys, you have to consider the response rate. The NRMP sent out 4,546 surveys, and 1,333 programs responded. (Response rate = 39.3%). A nearly 40% response rate seems pretty high for such a survey. However, it is not 100%.

Second, a small number of programs reported having a “target” score, but not all of them said what that score was. For example, of the 1,333 respondents, only 736 reported a cut-off Step 1 score. (~55% of all respondents, implying roughly 9% claimed to have a target score but didn’t specify it). Even fewer reported their Step 2 CK cut-off score: 394. (~30% of respondents, implying ~4% didn’t report their cut-off scores despite having one).

What about the “Scores Above Which Programs Almost Always Grant Interviews” question? 623 programs responded with a Step 1 score (~47%). And 342 respondents specified a Step 2 CK score (~26%).

The reported score cut-offs for getting interviews in each specialty is useful information. Like everything, however, take these scores with a grain of salt.

Step 1 and Step 2 CK Scores for Matched Applicants to Each Specialty

Boards scores are vital ingredients to getting an interview. As such, it’s no surprise that successful applicants have higher scores. Here are the 25%ile, median, and 75%ile Step 1 scores for matched applicants in each specialty.

(Note: unlike the program directors survey, these numbers come directly from the NRMP. In other words, as far as I can tell, the numbers encompass all programs.)

We’ll start with Step 1 percentiles for matched US Seniors:

Step 1 US Seniors, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 1 US Seniors, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Here are the Step 1 percentiles for matched US and Non-US IMGs. (Note: not all specialties had enough matched applicants to generate ranges).

Step 1 US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 1 US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 1 Non-US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 1 Non-US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Here are the 25%ile, median, and 75%ile Step 2 CK scores for matched applicants in each specialty.

Step 2 CK US Seniors, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 2 CK US Seniors, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

And the same Step 2 CK percentiles for US and Non-US IMGs:

Step 2 CK US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 2 CK US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 2 CK Non-US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Step 2 CK Non-US IMGs, 25%ile, Median and 75%ile for Matched Applicants 2018 Match

Matched IMG Scores May Be Lower Than You Expect

As discussed above, previously top students may struggle to achieve average USMLE scores. (Remember, this makes sense; roughly 50% of students will score below-average). This is doubly true for IMGs. It’s not uncommon to see non-US IMGs who were top students in their country struggle to get an average Step 1 score. Why?

There are several reasons non-US IMGs may achieve lower-than-expected USMLE percentiles. First, their home country curriculum may emphasize very different things. For example, most non-US medical schools teach little to no basic science. Things like biochemistry, microbiology, or immunology may get little emphasis.

Second, many non-US IMGs take Step 1 years after they’ve learned the material. Finally, most non-US IMGs have never taken exams like the USMLEs. Virtually every foreign graduate I’ve tutored describes national exams as memorization-heavy. They’ve never had to master a concept, then apply it to a clinical vignette.

IMG or not, if you struggle to master and apply key concepts, there is hope. It’s not easy, but you can learn mastery of these concepts. Read more about students who mastered the material to get their dream residencies:

High Scores Are Necessary But Not Sufficient for the Most Competitive Specialties

What do you notice from the scores of matched applicants? You might conclude good Boards scores are all you need. However, you’d be wrong.

Why? Because the scores of unmatched applicants in competitive specialties are often quite high. For example, for dermatology, the 25%ile of unmatched US seniors in 2018 was 233. 233 was higher than the median for six specialties!

Here are the 25%ile, median, and 75%ile for unmatched US seniors in the 2018 Match. In other words, these are the scores of applicants who did NOT match into each specialty.

Step 1 US Seniors, 25%ile, Median and 75%ile for Unmatched Applicants 2018 Match

Step 1 US Seniors, 25%ile, Median and 75%ile for Unmatched Applicants 2018 Match

Unmatched Applicants Have Similar Scores to Matched Applicants for the Most Competitive Specialties

We can also compare the median scores between matched and unmatched applicants. When we do so, a different picture emerges.

Here are the inter-median differences for US Seniors in the 2018 Match. Specifically, I subtracted the median for unmatched 2018 applicants from their matched cohorts. In other words:

  • The median Step 1 score for matched dermatology applicants in 2018 was 251.
  • The median for unmatched dermatology applicants was 243!
  • The difference between the two was only 8.

Here are the inter-median Step 1 scores for 2018 applicants by specialty for US seniors.

Step 1 Inter-Median Difference Difference (Median Matched - Median Unmatched) by Specialty, US Seniors, 2018 PD Survey

Step 1 Inter-Median Difference Difference (Median Matched – Median Unmatched) by Specialty, US Seniors, 2018 PD Survey

Here are the inter-median Step 2 CK scores by specialty for US seniors.

Step 2 CK Inter-Median Difference (Median Matched - Median Unmatched) by Specialty, US Seniors, 2018 PD Survey

Step 2 CK Inter-Median Difference (Median Matched – Median Unmatched) by Specialty, US Seniors, 2018 PD Survey

Competitive specialties clearly require high Boards scores. However, good Step scores aren’t sufficient. The difference between the median scores of matched and unmatched applicants in IR and radiation oncology was only five points! As we’ve discussed before, in addition to high scores, you also need other things. Successful applicants also need strong research and clinical performance.

(To read Get Into a Top Residency: 5 Things You Need to Know, click here).

Concluding Thoughts

A “good” USMLE score is a product of your goals. Want to get into a community program in a less competitive specialty? A Step 1 of 230 may be a fantastic score. Aiming for orthopedic surgery at a prestigious academic center? A 230 on Step 1 might get you screened out by nearly 75% of programs.

Many students studying for Step 1 want to keep as many doors open as possible. The median score of matched applicants in the most competitive specialties was roughly 245-250. Thus, to keep all doors open, you’d probably want to score in the high 240s at least.

That said, there are ranges in scores for a reason. Your USMLEs will be one (albeit important) part of your application. With enough hard work, connections, and ingenuity, few doors are truly closed. Knowing the kinds of scores programs look for is one piece of a larger puzzle.

What do you think? Were the various score percentiles what you expected? Anything about the statistics surprise you? Let us know in the comments!

Sources: National Resident Matching Program, Charting Outcomes in the Match: International Medical Graduates, 2018. National Resident Matching Program, Washington, DC 2018.

National Resident Matching Program, Charting Outcomes in the Match: U.S. Allopathic Seniors, 2018. National Resident Matching Program, Washington, DC 2018.

National Resident Matching Program, Data Release and Research Committee: Results of the 2018 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2018.

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored 270 on the USMLE Step 1 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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