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The Practical Guide to Scores

This article serves as preliminary reference to the series of articles, “Match Season: 9-months to Your New Life”. It designed walk you through how your scores determine your path towards residency and help you better understand the application process discussed in the article series mentioned above.

We’ll start the discussion with minimum scoring requirements and then explain how mastery of questions at 3 different levels of difficulty translate into your eventual score. Upon completing this article and understanding what is required of you to achieve your target score, I invite you to move on to the, ‘Match Season’ series.

 

Let’s first take a look at the each of the USMLE’s current minimum required passing scores:

Step 1: 75 (185)

Step 2 CK: 75 (184)

Step 2 CS: Pass/Fail

Step 3: 75 (187)

As a general rule, you'll need to answer 60-70% of the questions  correctly achieve the minimum passing requirement.

 

Why is there a Two Digit  & Three Digit Score?

When you receive your USMLE score report, you will be assigned two scores - a 3-digit and 2-digit number.  These two scores are related to each other and residency training programs will use them to compare you to other candidates.

The 3-digit score is a direct reflection of your performance on the exam. The  creators of the exam - NBME - are the only ones that know the true calculation.  Passing scores in 3-digit, as you noticed above, are different for each of the Steps.  The highest possible score is presumed to be 300. Unlike the 2-digit, the 3-digit adjusts itself to maintain the following theory : the score you get should not be dependent on time or place.  This helps ensure that the value of your score is a true reflection of your medical knowledge.   It's similar to the theory of inflation in economics, where currency is adjusted to reflect trends in the current market.

The 2-digit score is NOT a percentile or percentage (the exam stopped % based scoring in 1999). Rather,  it is a number is derived from your 3-digit score .   The passing score is always equivalent to a 75 and 99 is the highest attainable score in 2-digit. Why does it exist?  From dealing with students, especially IMG's, it is simply easier to understand.  While it is not a percentage, we all know from grammar school to college/university that a 75 on an exam is almost failing and that getting a 99 rocks.

The 3-digit score, on the other hand,  exists on a scale you were never graded on in the past.  However, it becomes clear why it is necessary and helpful for both the programs and you when you think about the number of test-takers/candidates you will be competing against.

Imagine that you have 1000 potential candidates and out of that, you have 100 students with a 2-digit score of 99, but only have  50 spots available to award for interviews.  The best way to differentiate them even further is the more precise 3-digit scale.  The '99' is equivalent to any score around a 236 and above.  So you can have two candidates with, '99s', but one will have a 238 while the other one has a 268.  They're both awesome...its just that they are different levels of, 'awesomeness'.

For the sake of simplicity, we'll use the 2-digit scale throughout this article and for the rest of this series.

 

Difficulty Types: A USMLE’s Contents Explained in Three Parts.

There are many ways to look at the breakdown of the types of questions you'll see on the exam.  While there are universally accepted, 'High-Yield' subjects (for example physio, path, biochem, pharm on Step 1, Internal Medicine on Step 2CK), I prefer to approach it in more general terms.  We're going to examine the, 'Yields' (how common a question/topic is asked)....rather than point at specific subjects, I want you to accept that there are certain High-Yield questions on every subject covered in the exam.  In doing so, it is the hope that you do not make the mistake of overlooking subjects.

 

High-Yield:

These questions are made up of highly tested material, defined by the MINIMUM a student should know to safely practice medicine. You’ll need to get a high percentage of these questions correct to pass. Naturally, there are more of these questions on the exam than the other two types below. You cannot succeed on the next two levels without first mastering this one. High-Yield only students, for the most part, should expect to be around the passing minimum score, 70’s. If you’re not sure if something is high-yield, the easiest way to tell is to look at your USMLEworld (practice questions) results. If a relatively large percentage of other students are getting it right, its safe to assume its high-yield. As a general rule, the lower the percentage of students getting it right, the lower yield it becomes.

The importance of getting these questions right is THE reason why you need to carry your First Aid Step 1 Book or your Step 2 Secrets around with you ALL THE TIME.  Even in the bathroom.

Medium-Yield:

This level of question difficulty elaborates more on the material considered, ‘high-yield’. Difficulty is attributed to the fact that they require you to know more detail. An elementary way to put it is that if high-yield expects you to have a general understanding of an entire page of a subject, then medium asks if you have mastered a paragraph of that same page. There are less of these types than high-yield, but enough that in order to pass, you’ll want to get a decent number of these correct. If you master this, then you likely have a strong foundation made up of high-yield knowledge. High Yield + Medium Yield students can expect to be somewhere in the 80s.

Low-Yield:

If high-yield requires you to understand the concept of a page, and medium-yield asks you to specifically know a paragraph, then low-yield demands that you remember a SENTENCE. Even if you had a book open in front of you during your exam, you may struggle to find the answer, especially if your high & medium yield were weak, because you wouldn’t even know where to begin looking. To pass the exam, it helps to get lucky & get a few of these right, but someone at a barely passing level is NOT expected to get this right anyway.

Now that I’ve scared the crap out of you, I will tell you that if you make it your priority to understand the high & medium yield, your chances of getting these correct increase dramatically. You’ll be able to take that root knowledge, make some deductions, and narrow it down to at least 2 answers, and then make your best educated guess. Yes, a guess. While it would be great if you could answer it definitively, in all likelihood it will come down to 50/50. You might say, well 50% blows, but realize that it’s a whole lot better than having a 20% chance. If you’re sufficient at this level, then you’re strong with medium & high yield. Congratulations, you’re in the 90s.

 

To Rule the Questions, You Must Master The Ability To Teach

Goljan, Conrad, Barone, Mehta, Kudrath.  You may be familiar with these names if you've taken a prep course or somehow gotten your hands on the best pirated material (which is not only stealing, but its stealing from the professors that care the most about how you do...their material is good because there is passion behind it).  Whether or not you have seen them in action, understanding what makes their lectures so captivating is key to anyone aiming for a high score.

The 5 doctors/professors mentioned above have vastly different teaching styles.  The one thing that unites them is their ability to breakdown the most difficult subjects into its most basic parts and reassemble them in a way that is simple & memorable.  They'll use metaphors, tell seemingly meaningly stories or borderline off-color jokes, and in some cases, make you get up and do a dance or two.  And you remember it not only on the day they teach it, but it sticks with you through your exam day and beyond.

You have the power to do this and become your own best teacher.  Your goal should never to get past a practice question or topic without being able to ask yourself, 'could I teach this to a person that knew NOTHING about the topic'.  Once you've learned how to do that, the next level would be to do the opposite and ask yourself if you could teach the same topic to someone that knew the topic well and have them say to you, 'oh wow, that's a much easier way to explain it, why didn't I think of that?'.   Isnt that what most of us say to ourselves when a good teacher teaches us something well?  If you can learn how to break topics down and simplify it for someone else, when you run into a difficult question on the real exam, you'll be better equippied to break it down for yourself.

~ Dr Brian

 

*Quick Note for IMG's :

For a medical student or graduate of a medical school OUTSIDE of the United States (IMG), you must realize two things about minimum passing scores: 1) to compete with US medical students, you need to get as FAR above these scores as possible…as a general rule, 10 points (in two-digit) higher than the US grads competing for the same specialty positions*. That makes YOUR personal unofficial passing score an 85. 2) How well you build your foundation and master each level of question difficulty will determine how high above passing you’ll be able to get and how long it takes you to get there.