Does Your Step 1 Score Really Matter?

Taking Step 1 is a rite of passage for medical students. If you tell an upperclassman you are studying for this test, they will commiserate with you, remembering full well the stress and hours put into preparing for these 280 questions. Step 1 spits out a 3-digit number that reflects your fund of knowledge from your preclinical medical school years. This 3-digit number is a source of much anxiety and discussion within our community however research suggests Step 1 scores may not be the most important part of your application for getting a spot at an Emergency Medicine (EM) residency program

Matthew Negaard, MD, PGY-2 at University of Iowa Emergency Medicine Program, set out to learn how much Step 1 scores affected a student's likelihood in attaining an EM residency interview invitation. In the spring of 2016, Dr. Negaard sent a survey to the Council of Emergency Medicine Residency Directors (CORD) asking, "What is the minimum Step 1 score to offer an interview at your emergency medicine residency program?" This question, among others regarding the components of an application, received 112 responses from program directors throughout the country.

The results suggest that some EM programs use Step 1 scores as a screening tool for the applications they receive. Dr. Negaard found that scoring at the national average across all specialties, a score of 228 in 2016, was well within most screening cutoffs reported by program directors. Fifty-two respondents reported the minimum score for an interview was “Pass,” 20 respondents said their cutoff was between 200-210, 29 look for a score between 210-220, and 11 between 220-230. No respondents said they use 230 as a minimum Step 1 score to offer an interview at their programs. Dr. Negaard found no difference when comparing the data across the different regions in the United States as well as comparing the data between 3- and 4-year programs. Check out EMRA Match to see Step 1 screening scores for your dream EM residency programs!

Minimum Step 1 Scores

What does it take to get an interview offer at EM programs?

SCORE Pass 200-210 210-220 220-230 >230
# of RESPONSES 52 20 29 11 0

When respondents were asked to give value to the different components of an application when ranking an applicant, Step 1 scores were ranked in the bottom third. Of note, USMLE Step 2 CK was ranked higher in importance than Step 1. The survey indicated the most important factors when ranking applicants are the Standard Letters of Evaluation (SLOE), the interview day performance, and EM rotation grades. This reflects an emphasis on interpersonal relationships and performance in the ED during rotations.

Based on Dr. Negaard's research, follow these tips as you work toward preparing for Step 1 and matching in EM:


  1. Your Step 1 score will not make or break your chance to match at an EM residency. A strong score will not be the sole factor in obtaining interview offers from EM programs. An average or below-average Step 1 score may limit some interview offers. However, your Step 1 score appears to lose its importance in the overall final application.
  2. Plan and complete away rotations early in the year. Programs highly value your away SLOE when considering you for an interview invitation. Be proactive in obtaining this document early in the application season.
  3. Build relationships in EM. Find a mentor at your program's ED to get you connected to faculty. These relationships will go a long way in your SLOE and your preparedness for EM rotations.