Aim High or Just Pass USMLE Step 1 in 2021

Do You Still Need a High USMLE Step 1 Score in 2021?

Every year, medical students between second and fourth year will sit for the USMLE Step 1 and Step 2 CK. While the time at which each student will take these exams during medical school will vary based on program, the most common question we here is always the same: “What score should I be aiming for?” There are a multitude of factors which affect the answer to this question and the reality is that it is different for many types of students. In this blog, we will help you figure out which group you fall within.

Changes to the Exam Scoring

One of the largest changes to medical licensing in recent years was the decision by the NBME and FSMB to change USMLE Step 1 to Pass/Fail score reporting by January 1, 2022 (https://www.usmle.org/incus/). With this change, decades of tradition and advising for future residency applicants went out the window. Yes, this may mean reduced stress for medical students sitting for Step 1, but others view this decision as simply a deferment of this stress to Step 2 CK. 

What does this mean for you? Well if you are taking your exam after the date of this change, you no longer have to ask yourself the question, “How highly should I try to score on Step 1?” All you need is a passing score! While the passing score will change from year to year, it is typically within a small range that is preserved. According to the NBME/FSMB, the passing score for Step 1 in 2018 was 194, answering approximately 60% of all questions correctly (For more information, check out our EMP blog on interpreting your score and understanding your percentile).

Note: If you are taking Step 1 after the Pass/Fail system is implemented, you must similarly determine your target score while preparing for Step 2 CK . Given the Pass/Fail scoring, many residency programs may want to see your Step 2 CK score at the time your application is due and will use it as they previously used Step 1 scores to rank applicants.

Goal: Pass

While the USMLE Steps are a source of stress for nearly all medical students, for some the goal is simply to pass. Among students taking Step 1 prior to January 2022, and among all students taking Step 2 CK at any time, those aiming for “Pass” alone comprise a small subset. Some of these are students who have struggled on practice exams to answer more than 60% of the questions correctly (the approximate passing limit) or have failed previous attempts at Step 1 or Step 2 CK. For these students, failing to pass could preclude licensing and advancement in their clinical training. Another subset of students who aim only to pass these exams are those applying into specialties with more holistic application review approaches, such as some family medicine or psychiatry residency programs. Finally, the last group of students requiring only a “Pass” are those who may have only part-time clinical aspirations. Passing scores will allow these students to receive their medical license and practice medicine, whether it be after completing a residency or as “moonlighters” at clinical sites, while pursuing other career endeavors. 

Goal: High Score

For a majority of the students taking the USMLE, the goal is to score as highly as possible. Those lamenting that they will be taking Step 1 prior to January 2022 should see this not as misfortune, but as an opportunity. Step 1 is an opportunity to demonstrate your hard work and separate yourself from your peers, which is simply not possible in a Pass/Fail system. This is particularly relevant for students applying into competitive specialties and/or coming from international or lower-ranked medical schools. Many residents in competitive sub-specialty residency programs at top programs in the nation earned their spots by performing well on the USMLE Step 1 and Step 2 CK. 

While many students like to know the target score needed to be considered a strong applicant, the truth is that this will vary widely based on the student and the specialty to which you are applying. Rather than wasting time trying to figure out the exact minimum score needed to be “competitive,” do your best to score as highly as possible. Of all exams a medical student will have taken, the Step 1 score will the most accurate and predictive of scoring on Step 2 CK. Without a radical change in study techniques, one can expect to improve on Step 1 by approximately 5-10 points; for larger jumps, new approaches are needed, such as identifying a tutor (if you are looking for a tutor, check out the EMP roster of tutors available to help you). Once you have your first-available official USMLE score, decide if you feel that your application will make you a strong applicant – don’t forget that other elements of your CV, including research publications, awards and unique talents or life-experience, are also critical elements of the residency application process. 

There are a variety of resources available (some reliable, others questionable) which may allow an applicant to predict whether their score is “high enough” for a given field. Based on data from applicants matching into these fields in the past, those applying into family medicine should aim for a Step 1 score above 205 (add 5-10 points for Step 2 CK conversion), above 215 for pediatrics or psychiatry, above 220 for anesthesia, internal, or emergency medicine, above 230 for general surgery or radiology, and above 240 surgical subspecialties. Again, these are estimated minimum scores – remember the other important components of your application.

That’s all! We hope this post provided some clarity on whether you should aim for a passing score or a high score on the USMLE Steps. If you need additional help preparing for your USMLE exam or think that it may be time for you to get a USMLE tutor, please contact us here.