There are 3 board exams required for licensing. USMLE Step 1 is the first. This is taken after the second year of medical school and covers all the knowledge acquired during the first two years. Neuroscience, genetics, pathology, pharmacology, physiology, epidemiology, and microbiology are some of the subjects included. It's the hardest of the 3 exams, and the score counts the most. The average score is roughly 220. That's the three digit scores. Then there's the two digit score, a mysterious number that isn't a percentage or a percentile. 75 is passing. I have a 230, which correlates to a 98. I'm not sure how one relates to the other.
Some residency programs have "cut off's" and supposedly won't even consider lower scoring applicants. These tend to be the more competitive programs- the ones on the "ROAD" to happiness (Radiology, Ophthalmology, Anesthesiology, Dermatology) as well as Ear Nose and Throat, and Neurosurgery. I'm really not sure how hard and fast these cut-offs are, but I do know that when our Step 1 scores were released, one of my classmates sadly decided that Neurosurgery wasn't in the cards for him. Another was convinced he would never be an a Radiologist. The former chose another field, the latter is a second year Radiology resident.
Step 2 is taken after third year of medical school, the clinical year. It comes in two parts, CK, or Clinical Knowledge, and CS, or Clinical Skills. It's a little easier, and covers mostly clinical medicine. The score for Clinical Knowledge is also given out as a three digit, and the mysterious two digit, score. It's mostly important for those who feel they didn't do well enough on step 1. My score was again, a 230, and this time, my two digit score was a 95. Step 2 Clinical Skills tests students on their patient interactions. Each student must pay over a thousand dollars to interview, and perform physical exams on, actors.
Step 3 is the final test, usually taken during, or after, intern year. It's supposedly the easiest of the three steps, and supposedly, the score counts the least.
Anyway, I'm studying for CS right now. The patients are actors so in many cases they don't have actual physical findings. So, they act. If a patient is supposed to have a heart murmur, he or she will say "hush hush hush" when you put the stethoscope over the chest. No air going into the left lung? The patient holds his breath while moving his shoulders up and down as you hold your stethoscope over the left lung.
And, if you laugh, this means you lack empathy. Laughing puts you in danger of failing, in which case you will have to pay over a thousand dollars to take the test again.
I hope I don't laugh.