Step 1 vs. Step 2

Dearest Chopper,

How come everyone that gets 250-260+ on step I has to be a four eyed wearing, socially incompetant, lazy, common sense lacking, asshole, sure fire nerd? Slamming others success seems pretty immature and insecure. By the way, I am certain those people have never had a few cold ones on weekends with friends or made out with a chick that wasn't tipping 315. Come on dude, you "bad day" folks are killing me. Dude, I went to middle and top tier places East/West Coast and all in between. Ortho candidates in general are a much different group than others. To be honest, >80% candidates I could probably have had a heck of a good time at any sportsbar over draft. Unlike interviewing for medschool where just talking to the rest of candidates on any day, you at least felt you were in the top 50% based on the "cool people (read total nerds)" at the interviews. Not so at ortho interviews. You tell me when you go on interviews who has the 215 vs. 260. This was at both top tier and average programs.

Your delusion that high scoring candidates are "freaks that wouldn't be as good a fit as me" and are not well rounded in the rest of their applications will not hinder programs from continuing to choose these applicants over you. If you are an outstanding candidate in multiple other areas then don't worry about the high scorers because you should easily rise to the top anyway. In short, the laughable stereotyping and whining by you and others is pathetic. I suggest you ground your claims in fact and reality but if you want to believe "all 250++ scorers suck and really aren't as cool as me" - please explain how that is going to help you in your quest to attain an ortho spot.

Hope you don't have a "bad day" for step II, interviews, OITE, Ortho Boards I/II (wait but smart people couldn't possibly pass the oral ortho boards - that might require being able to speak English audibly in a pressure situation).

My suggestion: stop stereotyping others and your own self pity.

The reason step I is stressed so heavily is simple. There are only two things that have been found to corelate well with passing written boards for orthopaedics. USMLE scores and OITE scores. Since MS3's and MS4's do not take the OITE, that leaves USMLE Step I as the one common factor to evaluate applicants. No program wants to take a chance on an applicant that may fail boards. While Step I may not show who is the best and brightest, it does show who tests well. In the end, passing boards is what a program wants and what the RRC wants. It is a tough fact of life.

As for my impression of step II. I didnt' mean to give the impression that I thought a great step II score would overcome a 190 Step I. However, I think someone who is a strong candidate otherwise with a 215-220 step I that rocks step II (245-260) can potentially bring themselves up with candidates in the 230's and 240's. I have seen it happen at rank meetings in my program.

Bottom line, you have to have a Step I score that will at least get the programs to download you applications. I know my coordinator sets ERAS server up to only download applications with scores >220 for non-rotators. That is the quickest way to drop 150-200 applications.

I agree that the test has little/nothing to do with ortho. So does MOST of the stuff you did in medshcool, which basically preps you for a career in primary care. It is used to screen, as already mentioned, and also as an equal denominator since grading is different at all the various schools (ie, one place may offer a lot more honors in surgery than another, etc,etc). Bottom line is that PD's/coordinators need a easy way to screen people (our ratio this year was something like 1 spot per 150 applicants) and have some way to choose people who wont flunk the written ortho boards.

I think its all about work ethic man. If you bust your ass what you want will come and thats what ortho programs want u to do. I only got a 26 on the MCAT and had like a 3.2 GPA and i barely got into medschool after the long 4 years of fraternity bashes. I turned it up "to 11" (Spinal Tap hahaha) and rocked medschool and popped a 260+. Now i know tons of shit and it shows on rotations. I am definitley not a nerd/geek/ or whatever. Dont be a hater man. If you dont have the scores for Ortho ...tough go do anesthesia or some crap. I know alot of er, anesthesia, and internals who hate on ortho and they admit that they wish they had the scores back then to get to ortho. Bottom line is when I match and have a say in who comes into programs I will choose the cool people with the high scores, because there are many of those. Why do you want to take the chance to dumb down your specialty.

Its just like getting into med school. Everyone can be a doctor and we need the MCAT to screen those people that can hang

Everyone can be an ortho pod but they only like to take the AOA studs.
SO if your not good enough just do something else and dont hate on the people who kick ass in life. You should just try harder.

Good luck to everyone in the match coming up.

I need to make a clarification, because it seems that I didn't make my point as clearly as I had meant. I do not by any means think that someone who has good scores is a nerd or social misfit and I did not mean to imply that. I do not think that someone who has good scores will not be a great surgeon and work hard. Some of my best friends killed Step 1 and they definitely aren't socially inept. They are some of the cooler people that I know. What I meant to say was that there are people out there with lower scores that have tremendous potential and I think that it is unfortunate that they are overlooked at times. Scoring a 210 does not mean that you are dumb. But scoring a 260 does not make you incredibly intelligent either. I respect the people who worked their ass off and did well. They will have an easier path into ortho. But there are very qualified people out there that didn't score as well. My sole point of posting was to make that point, not to attack anyone.

hey bmp,
a lot of us rocked the usmle so dont go falling in love w/ yourself.

yeah u have a nice score but it dosent give u the right to tear up someone else's post and call them out.

i'm sure dr. levine is already aware of your step I superiority and no one else here wants to have it thrown in our face, so f- u and try and keep your chest-thumping to a minimum between now and match day.
smarten up man

didnt mean to brag or call anyone out. I just get mad when people get all bent cuz ortho is so competitive. No drama. Good luck all once again

I'm just gonna post my personal experience here because I think it would be helpful for some MS-3's who didn't necessarily rock the exam and might be getting worried reading this post. I was in this 215-220 range for Step 1, but then bumped up to this 245-260 range for Step 2 which I took at the end of my third year.

Bottom line...I applied to 22 places and was offered 16 interviews, including places like Harvard, Duke, NYU/HJD, Yale, Brown, etc. Did I get shut out of a few places because I didn't meet their hard Step 1 cut-off? Sure, I probably did. But it goes to show that you can still be competitive without the 260+ on Step 1.

I had the same score scenario as anconeus. I'm sure I didn't get some interviews due to my step I score. But a few PD's did bring up my step II score and mention they like to see an increase like that. I think coupled with a good class rank and good letters, a good step II score will help a lower Step I score. I did have some PD's ask what happened on Step I, so be ready to talk about it. For this you can always fall back on explosive diarrhea... no further questions. Step I is crucial to get your foot in the door... no doubt. I don't know if my step II score will help me match, but it can't hurt. Good luck to everyone in the match.

Perhaps this will change some minds about the importance of Step 1 vs. Step 2 scores.... this is from the March 1 issue of JBJS

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Orthopaedic In-Training Examination Scores: A Correlation with USMLE Results
Kevin P. Black, MD1, Joshua M. Abzug, MD2 and Vernon M. Chinchilli, PhD1

1 Department of Orthopaedics and Rehabilitation (K.P.B.) and Department of Health Evaluation Sciences (V.M.C.), Penn State Milton S. Hershey Medical Center, P.O. Box 850, M.C. H089, Hershey, PA 17033. E-mail address for K.P. Black: [url=mailto][email protected][/url]
2 Department of Orthopaedics, Drexel University College of Medicine, Broad and Vine Streets, M.S. 420, Philadelphia, PA 19102

Investigation performed at the Departments of Orthopaedics and Rehabilitation and Health Evaluation Sciences, Penn State University College of Medicine, Hershey, Pennsylvania

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Both the United States Medical Licensing Examination and the Orthopaedic In-Training Examination measure factual recall as well as interpretative and problem-solving skills. The former examination is used to a variable degree by postgraduate programs in resident selection. Orthopaedic In-Training Examination scores are one measure of the medical knowledge of residents and are used by all American orthopaedic residency programs on a yearly basis. This investigation was performed to retrospectively review Orthopaedic In-Training Examination scores of orthopaedic residents who took the examination in our program. In addition, we sought to determine whether a relationship existed between performance on the Orthopaedic In-Training Examination and the United States Medical Licensing Examinations taken while in medical school.

Methods: The records of each orthopaedic resident who took the examination from November 1993 through November 2000 were reviewed. Correlation coefficients and 95% confidence intervals were calculated to assess the relationship, if any, between the Orthopaedic In-Training Examination percentiles and the three-digit scores on the Step-1 and Step-2 United States Medical Licensing Examination. In addition, examination scores were evaluated longitudinally from year-in-training 1 through 4.

Results: A significant moderate-sized correlation was found between United States Medical Licensing Examination Step-2 scores and Orthopaedic In-Training Examination score percentiles (p < 0.05); however, with the numbers available, no correlation was seen between United States Medical Licensing Examination Step-1 scores and Orthopaedic In-Training Examination scores. The mean Orthopaedic In-Training Examination scores were in the 66th percentile for year-in-training 1, the 53rd percentile for year 2, the 57th percentile for year 3, and the 50th percentile for year 4. Residents in the laboratory for one year scored in the 88th percentile while in the laboratory (year 0), in the 86th percentile in year 1, and in the 48th percentile in year 4.

Conclusion: Although Step-1 United States Medical Licensing Examination scores have been used by our department as a major factor in resident selection historically, our data failed to reveal a significant correlation with performance on the Orthopaedic In-Training Examination. The decrease in Orthopaedic In-Training Examination scores over time for our residents who worked in the laboratory is most likely attributable to multiple factors, including clinical workload hours.

similar findings have been demonstrated in the general surgery literature regarding step 2 performance and internship success.

Good post about step 2. I think the evidence might favor step 2, but based on what PDs wrote previously, I think the bottom line is do well on step 1.

If you bomb step 1, take step 2 early and ace it.

If you bomb step 1 AND step 2, ace the clinical rotations and get awesome letters.

If you bomb everything, take the year-off and do research and focus on reasonable "less-competitive" programs.

BOTTOM LINE: ACE STEP 1. IT WILL MAKE YOUR LIFE MUCH EASIER! Realistically, I don't think there is any debate that step 1 is more important than step 2.

Okay--so I did well on Step 1 (245+) and I'm struggling to decide when I should take Step 2? I originally thought I would take it right after clerkships so stuff would be fairly fresh and I could get it out of the way and just focus on electives. However, after reading through this thread I'm starting to think about taking it later on so it's not on my eras. Do I have anything to gain by taking Step 2 early or just everything to lose? Say I f'd up for some reason and got like a 200 on Step 2, would that matter? Any advice or "strategery" would be much appreciated.

also, Good luck to all those interviewing. Congrats!

I did pretty well on Step One. I didn't have to take step 2 when I did (July) but I took a chance for a couple reasons.
-Internal Med was my last rotation and I felt that my level of clinical knowledge was at its peak around that time
-My grades were so-so and I wanted to do everything possible to make myself look good.
-I just wanted the damn thing out of the way.

I would say most on this board would think I was dumb for doing this, but in the end I beat my step one by a significant amount so I didn't get hurt by it.

i did the same thing as pompacil, except it was my step 1 that was so-so ... and i also had just got off 3 months of IM.

i substantially improved from my step 1 score (something to do with not really studying for step 1 and then studying well for step 2 ...
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) and people have consistently mentioned it on the interview trail as something positive.

I did well on Step 1 and still took Step 2 early (August) because I was just coming off of internal medicine and I wanted it out of the way. I did exactly the same on Step 2.

People argue that with a good Step 1 score you can only hurt yourself if you take it early so there is a risk involved. I say if your score on Step 1 is good your clinical grades are solid, and you can take time off (I took 2 weeks off to study) then get it over with and enjoy 4th year.