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How to Achieve High Step 1 Scores

November 22, 2013

People ask me what to do to improve their application that has low step 1 scores. There really is very little one can do to overcome low step 1 scores. In general, the mean step 1 score is 225 with a standard deviation of 20. This means that if your score is 205 or below you are in the bottom 16% of all test takers. If your score is 225 you are in the bottom 50%. If you have a 245 you are in the top 16%. A score above 265 will place you in the top 2%. Remember that even high scores are not a guarantee of matching but in this matching climate, it is very hard to match with low step 1 scores.

I stumbled upon a very interesting presentation regarding how people are able to achieve high usmle step scores. A group from Albert Einstein College of Medicine in New York surveyed their own medical students to examine their study patterns relative to their step 1 scores. 96 of the 157 students completed surveys yielding a likely representative sample of this US medical school.

The results were interesting as it appears that the number of questions completed from question banks in addition to preclinical performance were robust indicators of step 1 score. What was interesting is that the number of hours of test prep study did not correlate with step 1 performance indicating that is not how hard you study for the exam but how smart you study. Answering questions activates learning as opposed to passive learning that occurs with reading or watching material without actively engaging with that material.

So my advice is to obtain and complete as many questions as possible. There are multiple online question banks that have thousands of questions. You should plan to do thousands (3000-4000) and plan to do them over time (1-2 years). The highest step 1 score I ever saw was from an IMG who did 10,000 questions over 18 months. In this match climate where you need strong scores, spend as much time as it takes to do as many questions as possible. Even if it means delaying your application by a year to get a higher score, do so. Programs would prefer an applicant with higher scores over an applicant with a more recent graduation date. Do your questions. Do more questions.

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of his employer Partners HealthCare, his hospital, department or division.

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