Q &A: Should an ECFMG take Step 2 before applying for residency?

QuestionWhat's your question?: I am a recent IMG who is planning on giving Step 1 around the first week of July. I have completed my CS exam so far and passed. I plan to give my Step 2 CK immediately after completing Step 1 hopefully by the end of AUG. My question is: Is it beneficial to apply for the Match with a pending Step 2 CK score or wait until I am fully ECFMG certified? Do you have a study schedule for Step 2 CK, one that can be completed within 2 months? Thanks for your help.

Should an ECFMG take Step 2 before applying for residency?

Answer: This is a very good question and one that is often posed as students call our advising team. Since ECFMG applicants cannot begin residency without successfully completing both Step 1 and Step 2 CK and CS, it is highly recommended that you take them prior to applying for residency in the U.S.  Securing a residency position has become even more arduous in the past few years as the number of graduates has increased but the federal funding for training spots has not increased.

A residency program director would rather offer an interview to an applicant that has completed all the requirements to easily transition into residency. In addition, the residency selection committee will want to have all of the student’s important data in front of them so they can clearly see that the student is qualified. The selection committee has a very limited number of interview spots and their time is very valuable, so the applicant without the Step 2 score will be at a definite disadvantage getting the interview to present their qualifications. You will hear comments from the decision committee such as, “I am not sure he/she will be able to actually come to our program because they have not taken and passed Step 2 yet, so I need to give that interview slot to an applicant who I know will be able to show up on Day 1.”

According to the 2010 NRMP Program Director’s Survey, only 17% of programs surveyed in Internal Medicine will consider applicants without Step 2 CK scores. Of the 83% of IM programs requiring Step 2 scores, 54% required a minimum Step 2 score of applicants to earn an interview. The average Step 2 score cutoff by which applicants were generally not granted an interview in Internal Medicine was a 207.

A study schedule for Step 2 CK would depend on several factors, such as:

  1. Are you also doing clerkships while preparing? If so, how many hours per day do you have to devote to preparation?
  2. What are your goals for your Step 2 score? Is your goal to pass? Is your objective to make up for a weak Step 1 score? Is your goal to keep up with a very strong Step 1 score?
  3. Have you just completed your training?
  4. Did you take shelf exams as part of your training?
  5. Have you taken an NBME self-assessment to determine your baseline level of mastery?

This data will help us determine whether a student can prepare in 2 months or will need longer. The typical student, one who has had no breaks in training and has just completed their first year of clerkships or their last year of medical school, will need only 3 to 4 weeks of preparation time in a typical accredited curriculum.

A highly suggested preparation schedule for an excellent Step 2 CK score would include completing USMLE World question bank and the DIT Step 2 course. An alternative would be to use 2 or 3 review book choices along with the question bank. Books that have been highly used according to student surveys include USMLE Secrets (or Crush the Boards), Prescription for Boards, Step Up, Case Files, or Boards and Wards. You do not need to do all of these.

Thank you again for the great question and good luck in your preparations.


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