Importance of USMLE Step 2 CS score attempts in Program Interviews

Step 2 CS is an important exam for residency applicants. While American medical graduates do not have any issues passing this exam, many international and foreign medical applicants fail this exam for multiple reasons. Similar articles in the past have dealt with issues like which are the best programs for applicants with attempts in Step 1 and how Step 1 and Step 2 CK score affect interview invitations.

Reasons for failing and importance of Step 2 CS: 

Difficulty with accent, spoken English, customs, problems with comprehension of the standardized patient and unfamiliarity with the medical conduct and bedside manners in US, all contribute to high failure rate in IMGs. Step 2 CS is a pass/fail exam so it is important to clear this exam prior to applying for residency. It is one of the required examinations to get ECFMG certified which in turn is mandatory for residency application, matching and eventually state licensing to practice medicine in US. 

Using data analyzed from the program directors survey an NRMP publication (2012), program specialties were arranged in the order of importance they place on passing step 2 CS when considering applicants for interviews. The results, shown in figure 1, were indeed surprising. 

Fig 1: % of programs that consider step 2 CS result in inviting applicants for  residency interview, Source: NRMP

Results:

1. Highly competitive programs like dermatology, ENT (OTO), ortho, plastic etc did not place much importance on step 2 CS results 

2. Radiology which is competitive and a favorite for foreign trained radiologists was also at the bottom. 

3. Pathology, pediatrics and psychiatry programs (79, 82 and 83% respectively) used step 2 CS scores when considering applicants for interview 

4. Resounding majority of family medicine programs(91%) considered step 2 CS scores when inviting applicants for interviews. 

Discussion: 

The fact that highly competitive programs like Derm, Ortho, ENT etc do not stress much importance in USMLE step 2 CS pass/fail score may be as a result of a combination of factors. They are inherently very difficult residencies to get into with the bar for selection placed very high in other areas (AOA, research, contacts?, networking). All applicants are American graduates with almost 100% pass rates for USMLE step 2CS, which makes considering this exam a criterion less important.     

Radiology may not place much importance on this exam for the simple reason, this is a clinical skills exam and radiology is not a clinical skills field. The irrelevance of step 2 CS for radiology may reflect in its low importance as a factor to grant interviews. 

Looking at FM, IM, pediatrics and psychiatry, FM tends to place the most importance on step 2 CS scores. Thus if you have failed in this exam, it may not be a good idea to apply to FM as vast majority (91%) of programs are going to take your 2CS score into account. There may be other things in your resume, which may help you gain an interview mitigating the effect of a failed step 2 CS but a lot of FM programs seem to place importance on this result. 

Implication: 

Though the difference between IM, FM, Peds, psych, path and neuro are small, they may still be important enough to consider which programs you are going apply to if you have an attempt on your USMLE step 2 CS. 

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Reference:

National Resident Matching Program, Data Release and Research Committee: Results of the 2012 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2012.