Being an International Medical Graduate (IMG), you often think whether your medical school grades will affect your way into residency or not. This is an important question especially if you are studying for USMLE along with your high demanding medical school curriculum in your home country. Even though there is much overlap in the content, the expectation, approach, exam pattern, extent of evidence based medicine practice, insurance, ethics etc vary and it can be challenging to manage both USMLE and medical school curriculum at the same time. If you are an IMG with average medical school performance, you may wonder if that matters as you no longer can do anything about it.
Take a Look at NRMP Data: To answer this question, you have to look at the Program director’s (PDs) survey. This survey is conducted every year by NRMP or National Resident Matching program. It provides the authentic insights whether a certain factor is important or not to get the candidates matched.
In 2020’s survey, for selecting applicants to interview, “class ranking/quartile” was cited by a total of 65% PDs giving it an average rating of 4.0 and “consistency of Grades” cited by 48% PDs, with an average rating of 4. The most important factor was USMLE step1 score, cited by 90% of program directors with an average rating of 4.0 (this may change when step 1 becomes pass/fail). Letters of recommendation in the particular specialty came second in this list, cited by 84% with an average rating of 4.3. Third important factor was Step 2 CK score, cited by 78%, an average rating 4.0. After that was Personal Statement cited by again 78% but with an average rating 3.9. While Medical Student Performance Evaluation (MSPE) occupied fifth place in the list, cited by 76% of PDs having an average rating of 4.0.
For ranking applicants,”class ranking/quartile” and “Consistency of Grades” cited by only 50% and 34% of PDs respectively, both having an average rating of 4.0. While USMLE step scores, Letters of recommendation and MSPE stayed much higher in the list.
Let us look at Individual specialties: If you are aiming for competitive specialties like plastic surgery, orthopedic surgery, dermatology, their data is presented below:
For Orthopedic Surgery, in selecting applicants to interview, “class ranking/quartile” cited by 75%, average rating 4.0. Top of the list occupied by USMLE Step 1 score, letters of recommendation on the 2nd and Step 2 CK on third position.Then came Personal Statement and then MSPE.
For Plastic Surgery, “class ranking/quartile” cited by only 67% with an average rating of 3.8 only for selecting applicants to interview. Still, Step 1 score, letters of recommendation and Step 2 CK score stayed on the top of list.MSPE fifth on the list.
Looking at the data for Dermatology, 83% of PDs rated “class ranking/quartile” 4.4. Here, USMLE Step1 score was cited by 100% with an average rating 4.3. Again, 2nd on the list was Letters of recommendation and then came Step 2 CK score.4th on the list was Personal Statement and after that MSPE.
Even for specialties like Family Medicine (FM) and Internal Medicine (IM), top factors were USMLE Steps scores, LORs, personal ptatement and MSPE. While “class ranking/quartile” only cited by 49% and 80% of PDs respectively, got an average rating of 3.7 in FM and 4.1 in IM.
What does this data mean? Looking at all of this data, you can say that grades matter to some extent but they are not as important as your Step exam scores. As long as you manage to get a good letter from your School Dean, you have a good chance to get matched into ACGME programs.
What To Do Now?
Medical Students: If you are in a first or second year medical school, and you have decided to further your career in the United States
Balance between your school exam preparation and preparation for USMLE. For example: Suppose you are studying for the respiratory system in school, you can try to think how its physiology, pathology, and pharmacology shows up in clinical vignettes.
Understand the high yield materials with application using practice questions.
Learning patho-physiology and mechanisms more than just satisfying the medical school curriculum.
If you are learning for your medical school using online materials, look for materials which are geared for USMLE as well.
Focus on overlapping topics between USMLE requirements and your medical school curriculum (green in overlap). For example: heart failure!
Medical Graduate: If you have done excellent or at least above average in your medical school, do not forget to mention it in your application (MSPE, CV, personal statements, interview etc). That will help.
If you have failed one or two of your medical school tests or have scored below average
Aim to score high in your USMLE. Your application will still be great with high USMLE scores.
Focus on developing your clinical skills. That way you can do good during USCE and get a great letter of recommendation.
Develop your interpersonal skills as 95% of PDs gave “interpersonal skills” an average rating of 4.8 for ranking an applicant.
Finally, Do not let your medical school performance down in your path towards residency in the United States.
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