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Now That Step 1 is Pass/Fail, Does Step 2 Matter More

  • by Sarah Godfrey
  • May 31, 2022
When USMLE announced that Step 1 was transitioning to a pass/fail grading system, medical students everywhere let out a sigh of relief. Gone were the days of memorizing every enzyme in every pathway! Unfortunately, while there is a push for Step 2 to also become pass/fail, this is not likely to happen any time soon. So, what does this mean for your residency applications?
Many residencies will focus more on your Step 2 score than in the past. 
Traditionally, your Step 1 score determined how many and what types of residencies you would apply to. Many medical students did not even take Step 2 prior to submitting their ERAS application. For those with a low Step 1 score, Step 2 offered the chance to show improvement prior to applying to residency. Without multiple exam scores to evaluate applicants, residencies may weigh the Step 2 score more heavily than they have in the past.
Medical schools often do not give as much dedicated study time for Step 2. 
While Step 2 will matter more in your residency application, many medical schools have not adjusted to provide more dedicated study time for Step 2. This will likely change over time, as students need less time for Step 1 to simply pass. To ensure your success, you should check with your medical school to see how much time you will be given and consider how to create a longitudinal study plan if you will not have sufficient time off to study.
For IMGs, this can put even more pressure on a single exam score. 
The USMLE exams have always been an opportunity for IMGs to demonstrate their clinical knowledge on standardized American exams. For IMGs with lower Step 2 scores or red flags in their application, you may want to consider taking Step 3 prior to applying in order to show improvement and readiness to start residency.
Residencies may place more weight on other aspects of the application.
This was the initial intent of transitioning to a pass/fail exam: to force residencies to consider applications holistically. While Step 2 may matter more, you should also consider the other aspects of your application. Do you have research experience? Volunteer activities? Enthusiastic letters of recommendation? An interesting personal statement? Each of these components may be weighted more heavily in the future, and they each provide an opportunity to make your application shine (especially for those who struggled with testing).
Investigate supplemental or additional residency applications required for your specialty.
Another trend in residency applications is the shift to supplementary or alternative applications to the traditional ERAS application. Last year, surgery, dermatology, and internal medicine offered an optional supplementary application to delve further into the experiences of applicants. Plastic surgery and OBGYN have started to offer their own applications as well. As you are starting to consider residency applications, research what the requirements might be for that specialty so that you are prepared.
In the end, Step 2 will likely matter more in residency applications for the near future, but so will other aspects of the application (outside of standardized testing). Give yourself plenty of time to study, while also working to optimize other parts of your application. If you have any questions about how to approach Step 2 or your residency applications, please reach out for help!
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