Many medical students wonder why residency programs look so carefully at the Step 1 scores of applicants when deciding who they will invite for interviews and in rank ordering them during the National Residency Matching Program (NRMP) process. This is a good question and deserves a thoughtful answer.

The majority of residency programs in the US receive applications from far more people than they can possibly find time to interview. Residency interviewers are busy clinicians who must set aside time during the whole span of the program's interviewing process. This effectively limits the number of interviewing slots at any given program. Residency program directors must therefore find ways to sort these applications and reduce the number of applications they recieve to match the number of slots available for interviews.

At this stage, the programs only have the information made available through the ERAS application system (application, personal statement, curriculum vita, transcripts, Dean's letters and recommendation letters). The Step 1 score thus becomes a relatively easy to spot indicator of applicants' relative competitiveness that can be used to reduce the number under consideration.

It is not true that all programs use a cut-off score below which an applicant is eliminated from further consideration. Some very competitive programs only consider applicants with scores above a certain number, but most programs make a genuine effort to look over all the information available about an applicant before deciding who they will invite for interviews. The bottom line is simply this — a higher score keeps more doors open and increases your chances of being asked to interview at programs you really want.

Step 2 scores also play a role, but may not be available for all applicants to a specific program since some students take Step 2 too late in their fourth year to have their scores reported before the interview season begins. Once you reach the interview, the focus shifts to less objective factors such as your goals, personal style, and the match between the type of training experience you are seeking and what that program has to offer.