Step 1 vs. Step 2

I don't know how that is possible, considering that many if not most applicants haven't taken Step 2 (or at least haven't reported their score) by the time applications are sent in. While you may get asked about Step 2 in passing during interviews, it is not very likely to change your ranking by the program... and your score will probably be available too late to help you get an interview if you are a first time applicant.

The bottom line is this... programs like high Step 1/2 scores, A) because they can (given the large number of applicants to sort through) they are predictors of good standardized test-taking skills (and therefore predictors of higher OITE scores and higher passing rates on boards... both good for the programs)

If I heard that rumor, I would be willing to bet the person who told that rumor has a low step 1 and a high step 2. But I got to agree with Trigen. most of the people who go into Ortho have a high step 1 (230+) and wouldn't take step 2 until after the interviews because they are worried about getting a lower step 2 score. I just took it last week, and I was glad that I only had to pass and didn't put any effort into studying for it.

I was lucky to go on quite a few interviews (20) and not once was step 2 mentioned. I'm gonna take it in a few weeks.

Does anybody know if step 2 and step 3 scores are important for fellowships? I'm guessing not.

In talking to this year's chiefs from my program, there was one fellowship that asked for Step1/2/3 scores, but by and large, no one cares. It seems by the time fellowship rolls around who you know and how you have performed is the number one factor... from what I have heard, even OITE scores are not all that important to fellowships. Keep in mind, however, this is all 2nd hand info.

my experience was this:
I had a 99 on step 1 but took step 2 early b/c I have mediocre grades (mid third) and wanted to optimize my application.

I wound up getting 99 on step 2 also w/ slightly higher 3 digit score.

No-one ever mentioned either score except once or twice they might say "nice job on step 1/2" or "u have a nack for taking these tests"

so i dont think high step 2 is worth as much as AOA or anything (even though it should be!!). i have not been called and told i was ranked to match or anything and i know people that havent even taken step 2 yet and have been called by several places.
if i could do it again i would probably been better off using that time to rotate at another place i was serious about.
if ur step 1 is ok then i would suggest doing that and waiting on step 2.

Echoing all the above comments, no one gives a rats butt about step 2 really. Not one mention of why I hadn't taken it before Christmas and after Xmas when I like everyone else "previewed" my score, no one mentioned well nice 260 on step 2. With one or two exceptions to programs I obviously didn't apply to, NO ONE CARES ABOUT STEP II. If you messed up step I, try taking step II early if you want. Really, it is not going to make up for crap step I (

I would agree that it is true at the vast majority of places that Step II is not taken into much consideration. It is certainly not nearly as important as Step I, simply because everyone releases their Step I scores. However, I wouldn't go so far as to say that no one cares at all about a strong Step II score. I remember when I was interviewing, about 1/4 of the interviews mentioned my Step II. One or two mentioned that they thought that it was a better predictor than Step I for future performance and liked that I took it early and did well.

That being said, I reiterate that Step I is definitely more important for applications than Step II. Many programs are not interested in Step II at all. Most importantly, I would strongly suggest not taking Step II early if you have a strong Step I score (90.

I did well on step I (240ish), but took step II early to get it out of the way. I waited to submit my scores until I was sure that I had improved (or at least matched) my score. I did have three different program directors comment that they were impressed that I actually took it before interviews. Now that I have sat in on the rank meetings for three years, I can say that step II does matter. If you had akiller step I score >250, it doesn't seem to make much difference. For those that scored in the 225-240 range it can help solidify your score if you repeat on step II. For those that scored in the low 220's or lower, a great step II score can put you on similar ground with guys that scored 240+ on step I. It shows work ethic and determination to jump in on it early and improve your score if you had average scores.

Honestly, if I were doing it again, I would do it the same way. I took step II during the last week of third year when everything was fresh and I didn't have to think about peds or OB again until step III came around. By chooosing not to submit until my scores were in, I was able to make sure that I didn't get a score that would hurt me.

i have first hand knowledge regarding this topic, so i thought i'd share.

step 2 can make you more competitive and prove you are academically capable if you have a crappy step 1 and an otherwise solid package. programs generally do not care about it unless you have a crappy step 1, then they care a lot. even so, a stellar step 2 does not cancel out said crappy step 1 and even with a top step 2 score if a program has a step 1 cut off you will likely not be looked at.

for ortho2003's post, i agree it shows work ethic and determination, but it will not put you up there with the 240 step 1 guys. believe me.

cheers.
firegirl

Do tell...what kind of first hand knowledge do you have about it?

well, basically i have a family practice step 1 and an ortho step 2. i took it early to show i could do well (july) so my scores were released together. i applied geographically, and got interviews mostly at "total package" programs, and was uniformly shut out at programs rumored to have cut offs. even programs that more or less recruited me based on the extraneous X chromosome shut me out with the low step 1, even though my step 2 score was sitting right next to it. now, i'm no gunner, so there could very likely be a million other reasons not to take me. but, the step 1 score was most often cited when discussing my "weaknesses" as an applicant. point being, that stellar step 2 did NOT put me on the same level as someone with a 240 out of the gate.
again, universal disclaimer: i am not a perfect candidate, so who knows...

cheers.
firegirl

You have to be very careful when you take step 2. If you take it early and your scores come back before September 15 (the earliest to submit your ap via eras) or whenever after you submit they will get all scores for any steps that you have completed!!!!! You cannot prevent that by not transmitting.
If you want to take it early but are fearful of a worse score your best bet is to take it say mid August and beyond. That way your score is not back by the time you submit eras. There is a week or so play in there to remember because by the time you have it in the mail or at your deans office its everywhere already. But also if you don't transmit your scores and opt to see how you did first and then transmit later, you also run the risk of programs never seeing a good score even if you send it to them later. You would think a score is plastered all over your aplication. Not so, the scores are written very small and after they transmit you will be lucky if a secretary or program director will go back and put your new information with your file (I don't think they ever download again after the deadlines are past so they probably will never see it- don't believe all what eras has to say because ultimately its the individual programs that do what they want). I did well on one and two but no programs ever asked my about 2 (CK that is) even though the information was out there if they wanted it. I submitted without having a look first because I am the one guy who failed CS (took it way early because had time in my schedule and the thought of failing never remotly entered my mind) and had to show that the test is stupid by taking CK early. I ended up rocking CK but no one even saw it, I think because it never made it to my file. If you don't have to take it, don't take it. IE in my opinion anything over 235 on 1. Bottom line-- unless you take it way early and get your score in before they stop downloading, I doubt they will see it unless you bring it up (which at the majority of my interviews would have seemed weird). The majority of people who say their step 2 was mentioned, I bet had their score before they submited eras. Because I was asked at about 6/11 interviews what happended to CS, so if they have something to look at they will mention it, if they don't, they don't! Maybe will have sunk my chances but I guess I'll see in a few weeks. That's my change!

I took my CK at the end of Nov and my CS in October. I resubmitted my USMLE transcript at the end of December, when I was happy with my step 2 scores. I think most if not all of my Jan interviews had my Step 2 score. So I think most places do get the updated USMLE transcript contrary to what was posted earlier.

However, I think this was because I had already been granted an interview -- I doubt they redownload this stuff from all 400 people that had applied origionally.

Last comment for me on this one. PD at one school told me he would take candidate A with 235 on I/not taken II vs. candidate B with 217 on I/250 on II every time. His reasoning was that Step I was the only one that was
"high risk" (like MCAT for medschool). Everyone had to take Step I and knew/should have known that it was playing for keeps. His thoughts were that step II was totally controlled by candidates as they could take late/never seen or take early but screened by candidates before submitting. He knows candidates do this and acknowledged with good reasoning. His implications were that any school that has a step I cutoff - no matter what your step II score is will not make up for subpar step I performance.

Also, from personal experience no one me doing well on step II at any of interviews after Xmas yet multiple "nice step I." Also, no one mentioned "why have you not taken step II?" at before Xmas interviews while again "nice step I." Some programs may care about step II but none of the ones that I seemed to interview at (many top programs, some average programs). Not saying some had different experiences, just my own. Take home message: nail step I because ZERO gaurantees step II will help at most programs.

Don't shoot the messenger.

Firegirl, when you said you had firsthand knowledge about Step 1 vs. Step 2, I thought you were referring to having spoken with a program director about it or something like that. Didn't think you meant that you personally had struggled on Step 1. Sorry, I misunderstood and I didn't mean to call you out on the forum.

rwbrhp29

i think the origional question was "has Step II become more important recently?"
from my experience and most other peoples, it seems that Step I is still the more important score for most programs.

When I took Step 2 early i wanted to show
a. consistency
b. that i learned something on clinical rotations even though i wasnt
honoring most of them.
c. i'm not afraid to take a test

hopefully the PD's will read into the score a little and see this. If they don't i'm certainly no worse off for having a good Step II... if worst comes to worst it will help me during the scramble.

I think there are really two questions regarding Step II though...
1. the value in obtaining interviews
2. the value in ranking a canidate

Ortho2003... do u have any opinion on this??

There are a few other people on this forum who apparently are program coordinators or directors or something... maybe they will weigh in with their thoughts on the importance of Step II.

Here's one PD's perspective: Most programs do not take into consideration Step 2 scores. As I counsel students from our own program, if you did poorly on Step 1 it is definitely worthwhile to take Step 2 early to try and show that Step 1 was an anomaly. However, those programs that use Step 1 scores as a cut-off for consideration of review will not be swayed by a higher Step 2 score; and if you score poorly on Step 2 it obviously may raise a red flag for other programs that may have considered you.

Final analysis: Step 1 much more important than Step 2. Take Step 2 early if you're not happy with Step 1 but do everything in your power to score well!

Hope that helps -

William N. Levine, MD
Vice Chairman and Residency Director
Department of Orthopaedic Surgery
Columbia University Medical Center
New York, NY

I had a question about 3rd year, and wanted to know the PD's perspective. It seems 3rd year is very subjective, and you have attendings who never work with you evaluating you and some no matter how hard you work seem to rate you as average. I have Honors in Surgery and FM so far and High pass in all others. is that bad, since the first two years I have almost all Honors and did well on my step 1.

Does anyone else find it odd that so much importance is placed on doing well on a test that has almost nothing to do with orthopaedic surgery? I realize that it is the great equalizer, that it is a useful screening tool for selection, and that it shows that we are capable of scoring well on tests and therefore doing well on the OITE. But there are a lot of people out there that had a bad day when they took the test or they had circumstances that interfered with their ability to study effectively. I admit, I scored lower than I wanted to so my opinion is probably a little jaded, but I think that there is a lot more to an applicant than their scores. A person with a 210 has just as much ability as someone who scores a 260 to become a great surgeon. Scores do not coordinate well with technical ability, social skills, work ethic, and personality. There are a lot of good test takers who do not possess these attributes out there who will get more consideration from programs than the lower scorer who would really make the better fit for a residency program.

I realize that this is not a perfect process. I know that you have to be smart to do well in orthopaedic surgery. But there are also a lot of intangibles that go into making a successful surgeon and it is not just all test scores.

These are just my thoughts.

interesting discussion