Douglas Olsen
The USMLE is a requirement for earning medical licensure in the United States and consists of three separate exams: Step 1, Step 2 CK (Clinical Knowledge), and Step 3. While the definition of a good score depends on one's preferred specialty and residency program, with more competitive specialties and programs requiring higher scores, a score of 240 is generally considered good and a score of 250 is considered really good. In this context, we will explore whether a score of 236 on Step 1 is a good score for international students.
| Characteristics | Values |
|---|---|
| Is a score of 236 good? | No clear answer, but one source says that a score of 240 is "good" and 250 is "really good". Another source says that the average score for US-IMGs who matched IM was 236. |
| What is Step 1? | The first of three separate USMLE exams, which are a requirement to earn medical licensure in the United States. |
| What is a good score for international students? | This depends on the residency program, as some are more competitive than others. |
| What is the scoring system? | Since January 26, 2022, Step 1 has been pass/fail. |
| How often can you take the exam? | Only once. |
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What You'll Learn
Residency program admissions
As a result of this change, residency programs have started developing alternative methods to assess applicants' qualifications. Factors such as shelf examinations, standardized evaluations of sub-internships, and away rotations are now playing a more significant role in the admissions process. That said, USMLE scores remain a significant criterion, with Step 1 scores often being the most cited criteria for extending residency interviews.
For international medical graduates (IMGs), comparing your score to data no older than three years is recommended, as the exam evolves over time. The competitiveness of the specialty you're applying for also matters; historically, the most competitive specialties have required higher Step 1 scores, so it's reasonable to assume they now require high Step 2 scores.
While a Step 1 score of 236 is below the "good" threshold of 240, it is still within the range of scores that have successfully matched into residency programs. For example, the average Step 1 score for IMGs who matched into Internal Medicine (IM) residencies was 236, while those who didn't match had an average score of 222. Additionally, US IMGs with a Step 1 score of 232 have successfully matched into General Surgery residencies.
Therefore, while a Step 1 score of 236 may not be considered "good" in isolation, it can still be sufficient for matching into residency programs, especially when combined with other competitive factors in your application.
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USMLE Step 2 CK scores
Since the USMLE Step 1 scoring system changed to a pass/fail outcome in 2022, Step 2 CK scores have become more heavily weighted in residency program admissions. A good USMLE Step 2 CK score depends on which residency program is your top choice, as some are more competitive than others. For example, the average USMLE Step 2 CK scores for US and non-US IMGs in their preferred residency specialties vary across the board: for anesthesiology, the score is 248 for both US and non-US IMGs; for internal medicine, it is 238 for US IMGs and 248 for non-US IMGs; and for neurology, it is 252 for US IMGs and 246 for non-US IMGs.
IMGs can take the Step 3 exam before applying for residency to improve their applications, but US medical students must wait until they have graduated from medical school. The USMLE consists of three separate exams: Step 1, Step 2 CK (Clinical Knowledge), and Step 3. Results are reported on a three-digit scale from 1 to 300, except for Step 1, which is pass/fail. Passing each step has its own benefits. For example, passing Step 1 allows you to begin third-year core clinical rotations, and passing Step 2 CK makes you a competitive candidate for residency programs and fellowships. Once you pass Step 3, you are eligible for a medical license.
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Competitive specialties
Since the USMLE Step 1 scoring system changed to pass/fail in 2022, a good score for an international student is simply a pass. However, a pass/fail result is unlikely to be a deciding factor in an application's success, and residency programs are now developing alternative methods to assess applicants' qualifications.
Previously, a good score for an IMG would depend on the competitiveness of the chosen residency specialty. For example, the top five specialties with the highest Step 1 scores in 2022 were plastic surgery, ENT, dermatology, neurosurgery, and orthopedic surgery. At the other end of the spectrum, the least competitive specialties were neurology, PM&R, pediatrics, psychiatry, and family medicine.
Now, with the shift to pass/fail, Step 2 CK scores have become more critical in residency applications. A high score not only showcases clinical knowledge but also helps make an applicant more competitive. For a competitive match, a Step 2 CK score of at least 245 is recommended, with scores closer to the 75th percentile (around 260) strengthening your application.
Other factors that residency programs consider include clinical performance, research experience, publications, presentations, work experience, and extracurricular activities.
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Core clinical rotations
As of January 26, 2022, the USMLE Step 1 scoring system transitioned to a pass/fail outcome, so a passing score of 236 is good enough to allow you to proceed to the next steps of becoming a doctor.
Most schools require core clinical rotations in internal medicine, general surgery, obstetrics and gynecology, pediatrics, family medicine, and neurology. These core rotations typically take place during the third year of medical school (MS3).
The internal medicine rotation is particularly important as it provides a foundation for the USMLE Step 2CK exam, which is heavily geared toward internal medicine. During this rotation, students learn a wide range of medical knowledge and practical skills, such as evaluating patient history, reading electrocardiograms and chest x-rays, and performing minor procedures.
Clinical rotations can also include both core and elective requirements. For example, a 12-week family medicine core rotation might include eight weeks in a hospital and four weeks in an affiliated clinic. Shifts during rotations are usually 8-12 hours long and can vary in timing, including days, nights, weekends, and possibly overnight call duties.
It is recommended to schedule your preferred specialty rotation towards the end of the program, as the experience gained from previous rotations can help you stand out and perform well, increasing your chances of receiving a strong recommendation for your residency application.
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USMLE Step 3
The USMLE is a requirement for earning medical licensure in the United States, consisting of three separate exams: Step 1, Step 2 CK (Clinical Knowledge), and Step 3. As of 2022, Step 1 has transitioned to a pass/fail outcome, and Step 2 CK scores have become more heavily weighted in residency program admissions.
Step 3 is the final exam in the USMLE sequence, which assesses the knowledge and skills of physicians who are assuming independent responsibility for providing general medical care to patients. The test items and cases reflect the clinical situations that a general physician might encounter in a specific setting. It is a two-day exam consisting of multiple-choice questions and computer-based case simulations. The first day, Foundations of Independent Practice (FIP), includes 232 multiple-choice items divided into 6 blocks of 38-39 items, with 60 minutes allotted for each block. The second day, Advanced Clinical Medicine (ACM), includes 13 clinical case scenarios (CCS), each lasting 10 to 20 minutes.
To prepare for Step 3, it is important to focus on statistics and interpretation and calculation topics such as positive and negative predictive value, sensitivity, specificity, likelihood ratio, and odds ratio. Familiarity with different study tactics and their strengths, weaknesses, and biases is also crucial. Time management is a critical skill, as most residents will have to study for Step 3 while working full days, nights, and weekends.
A good USMLE score for international medical graduates (IMGs) depends on the competitiveness of their preferred residency program. IMGs can take the Step 3 exam before applying for residency to improve their applications, while US medical students must wait until they have graduated from medical school.
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Frequently asked questions
Since January 26, 2022, Step 1 has transitioned to a pass/fail outcome, so there are no longer three-digit scores. However, before this change, a score of 240 was considered "good" and a score of 250 was considered "really good".
The USMLE is a requirement for earning medical licensure in the United States and consists of three separate exams: Step 1, Step 2 CK (Clinical Knowledge), and Step 3.
The passing standard for the USMLE Step 2 CK exam is 218 out of 300. A score of 255 is the 63th percentile, 245 is the 50th percentile, 235 is the 25th percentile, and 255+ is the 75th percentile.
Step 1 scores are still important for residency applications, especially for competitive specialties like Dermatology. However, with the transition to pass/fail, more focus is being placed on Step 2 CK scores and other factors such as shelf examinations and sub-internships.
