The test computer will send your answers to the National Board of Medical Examiners for scoring. The system will render your correct answers into a three digit score and a two digit score.

The mean score for US MDs is 210-230, the standard deviation being 20. On the three digit scale the passing score is 188, and on the two digit scale it is 75. A score of 99 on the two digit scale corresponds to 247 on the three digit scale.

If you are an IMG, you must score at least 220 to stand a chance. Your aim should be a score of 240 or above, which puts you in a strong position, and then you can be sure of getting interview letters.

If you have a high score, you could get an interview invitation. And if they like you, you will get matched into a program. The interview is very important. They will want to know how well you will fit into the system, and whether you can learn the ins and outs of the system quickly. If you know someone in that program who can put in a good word for you, that will go a long way.  Any research background , where you have achieved something meaningful (which excludes 99% of 'research' activities in third world countries) will help you to impress the program director. If you have any new research ideas you would like to do during the residency, that will get them excited. Be prepared to discuss study design and statistical stuff intelligently. And again, NEVER try to bluff your way through, it will never never work.

Once you get into a residency program, remember that your job is to survive. Forget about inventing a cure for cancer or the problems of the world. Learn as much as possible, take notes of everything, learn practical management skills, and be on good terms with EVERYBODY, from the CEO to the janitor. Do not make any enemies, do not get anyone mad at you.

The American medical system will impose great responsibilities on you if you manage to get into it. As a resident you have every imaginable responsibility on your shoulders, but zero authority of any kind. The key is to be tactful, smile at every dolt. No matter what happens, convince everyone how much you are enjoying three years of torture. You WILL be the whipping boy as first year resident, take it with a smile, and ask for more and they will love you. You are not going to win any Nobel prizes for medicine as a lowly resident, your first job and your second job and your third job is to survive at any cost, without getting ANYONE mad at you, not any patients, not any nurses, certainly not any attendings, and not even the janitor. If three guys badmouth you, that could shut down your career effectively.

At the interview in addition to testing your grasp of practical medicine, they will also try to find out if you are able to speak English properly and communicate properly, and also if you can get along with others. You must convince them that you are in love with whatever speciality you are are pursuing. If you have done any kind of research, and you are capable of intelligently discussing it, try to throw that into the discussion. The American scientific field is driven by innovation , while in your country probably it is driven by googling and re-inventing things that have already been invented or discovered in the US.

At this time in your life, your primary goal should be to get a USMLE score of 240. If you pass with a low score of 188, your USMLE dreams are nuked for good, never to be seen again. But if you fail the USMLE with a laughable score of 187, you are ok, because you can try again next year.

The three digit score is more important, because it remains the same regardless of the year you are tested in, whereas the two digit score is a bit tricky, its relevance changes with the year and the testing levels of other candidates. 

One important point to remember is that many program directors give more importance to the step 1 score than the step 2 score, for the simple reason that students who have a strong grounding in basic sciences are the one most likely to contribute to advances in medical science, they are considered the future of the profession.

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