If you’re starting a career in medicine, it is not an exaggeration to say that the USMLE Step 1 is one of the most important tests you will ever take. According to NRMP MATCH 2018 program director survey, 94% of program directors state USMLE Step 1 score as the most important factor they consider for selecting applicants to interview.
Editor’s Note: The USMLE Step 1 is pass/fail as of January 2022, so the scores below are no longer available to program directors. Instead, you should use this data as a reference to which programs are the most difficult to get into.
So with that in mind,
What’s a good USMLE Step 1 score? And..
What USMLE Step 1 score do I need to get into my target program?
You have probably already heard the advice of “260 or bust”. 260+ is an excellent score, but also incredibly difficult to achieve – the equivalent of getting a perfect 1600 on the SATs – and so that’s not really great advice. Sure, just get a top 1% score and I’ll be set – right? Right..
Good news is, there is plenty of room for success and great matches between passing and 260. Here’s our score breakdown, based on UMMS, AAMC, and NRMP MATCH data.
This is a lower passing score that isn’t going to help you get into any programs. The good news is that it is a passing grade and that’s the most important part, since schools look at your failed attempts in addition to your scores on passed attempts. If you have a score in this range, you still have two other critical Class A criteria where you can make up ground. Still, you’ll want to aim higher than this if you’re aiming to apply to the top programs.
Mean program scores in this range: None (all mean program scores are higher).
229 (the top of this range) was the average USMLE Step 1 score in 2018. A score in this range is good enough to get you into a number of different programs (see “Mean program scores in this range” right below). It is also an acceptable, if not great, score for the top programs. A score in this range is definitely not a death sentence if you’re trying to get into a top program – just focus on getting solid scores on the remaining exams.
Mean program scores in this range: Family Medicine (220), Psychiatry (226), Pediatrics (227), OBGY (230).
Now we’re getting somewhere. This score, followed up by good scores on the remaining steps, will form a good basis for an application to any program or specialty. The mean program scores for a large portion of programs are in this range, and a score in this range is considered acceptable to top programs if the rest of your resume is strong.
Mean program scores in this range: Anesthesiology (232), Emergency Medicine (233), Internal Medicine (233), Pathology (233), General Surgery (236).
This is the start of scores that are a positive on your resume with any program director. Follow this up with similar scores on the other sections and you’ll be a strong candidate anywhere. The remaining, most competitive programs have their mean scores in this range, which means that a score in this range is good enough for any program.
Mean program scores in this range: Diagnostic radiology (240), Orthopedic surgery (248), Otolaryngology (248), Dermatology (249), Plastic surgery (249).
This is an excellent score that will single handedly improve your chances to match with a top program. This score is above the mean program score for all programs, so you know you’re scoring above average no matter where you’re applying to.
Mean program scores in this range: None (all mean program scores are lower).
The fabled 260+ score is a ticket to any program you want, assuming you follow it up with comparable scores in the remaining two exams. Obviously no single thing will guarantee admission to your top choice program, but a 260+ shows program directors that you have an exceptional grasp of the material, the work ethic needed to prepare to this extent for the exam, and the endurance necessary to maintain attention to detail across an eight hour test.
Mean program scores in this range: None (all mean program scores are lower).
Things get even more interesting when you view all the mean USMLE Step 1 scores by program. Take a look and tell me if you notice anything:
| Program | USMLE Step 1 Score Mean |
|---|---|
| Plastic surgery | 249 |
| Dermatology | 249 |
| Otolaryngology | 248 |
| Orthopedic surgery | 248 |
| Diagnostic radiology | 240 |
| General Surgery | 236 |
| Pathology | 233 |
| Internal Medicine | 233 |
| Emergency Medicine | 233 |
| Anesthesiology | 232 |
| OBGY | 230 |
| Overall USMLE Step 1 | 229 |
| Pediatrics | 227 |
| Psychiatry | 226 |
| Family Medicine | 220 |
| Source: NRMP MATCH Data 2019 | |
As you can see from this data, there are two major clusters of mean scores. This is a big help for giving us a real target to look for. It’s also a good way to get a sense for the different specialties that you can pursue.
The first, between 226 and 233, contains the mean program score for 8 out of 14 major programs. The overall USMLE Step 1 average score is 229, falls right in the center of this range. There’s no shame in shooting for “average”: the USMLE is a very difficult test and your competition is a group of people (medical students) that have self-selected for hard work and rigorous academics. Eight out of fourteen program types have their mean scores fall into this range, so this is a great target to shoot for – especially if you’re not the best test taker. You will have a lot of options if you hit this range and it takes some of the pressure off to know that you’re in good company with this score.
This second cluster, between 248-249, contains the four most competitive programs. The people who score this highly are definitely top students and/or top test takers, and it is especially apparent because these are the highest mean scores for any program. If you reach the 248 milestone, you have the USMLE score to apply to any program, including the most selective.
We hope that this helps you determine what USMLE score you need to reach your target program. This is the first thing I recommend all my students do before starting their USMLE journey. Having a target score and holding yourself accountable to that target is one of the best things you can do to stay motivated during the months of studying to come.
This philosophy is at the heart of the new USMLE Step 1 course that we have developed at Achievable, a comprehensive course based on the official USMLE Content Outline. Achievable USMLE combines their author’s stellar experience in preparing US and international medical students for their USMLE exams with Achievable’s time-saving product approach. Our adaptive algorithm takes this a step further by scheduling your review flashcards for optimal memory retention, helping keep the large amount of material that is in the USMLE in your head with minimal study time.
Peek inside to view Chapter 1 of Achievable USMLE Step 1 for free to see it for yourself.
