If my Step 1 Score Isn’t as High as I Hoped, Can I Still Apply to Orthopaedics?


Amiethab Aiyer, MD | Jonathan Kaplan, MD | Matthew Varacallo, MD

July 8, 2020


Regardless of what you may hear from your colleagues and medical students who have gone before you, there is no magic formula with respect to the ideal application profile for getting into orthopedics.   If your step 1 score is lower than average, it is important to augment additional areas of your application and demonstrate mature personal insight when it comes to addressing a step 1 score that could serve as the ‘elephant in the room’.

While the average score for applicants accepted into orthopedic residency positions continues to increase year after year, there are a few key points to remember when it comes to assessing your own unique position as a future orthopedic residency applicant:

1This is a critical time to call on mentorship guidance

We have discussed these concepts in prior posts, but this would be a time to reiterate that a cultivated relationship with an attending/faculty member, residents, or even more senior medical students is critical.   Having a mentorship foundation consisting of (ideally) multiple individuals at various stages in their careers is imperative to give you the best and most realistic feedback during this process.

As a student, it is important to take an active role in soliciting the true, genuine insight from your mentors about your competitiveness. Additionally, it will be highly beneficial to program networking, choosing which programs are more realistic to apply to, and building a logical algorithm when it comes to interview selection and regional/geographical considerations

2Additional options

If orthopedics is your one true love, then stay true to your gut, but know that there is always an option for having a backup plan in terms of residency specialty programs.  Even if your backup plan does not consist of applying to a different specialty, be prepared to answer the question, “What would you do next year if you do not match into orthopedics?” 

Demonstrating mature insight in answering this question can potentially mitigate the glaring risk of a lower step 1 score.  However, with USMLE Step1 going to pass-fail, it is possible that more weight may be placed on USMLE Step 2 in years to come.  

3How low can you go? 

There is no magic number in terms of what specific step 1 score is the ultimate low threshold cutoff from an accepted applicant versus a rejected applicant. 

Remember, with the recent change of step 1 becoming pass/fail, programs are on the cusp if utilizing additional metrics and objective measures to substitute for the step 1 score.  Strategically augmenting the other elements of your application (job experiences, research, step 2 scores, letters of recommendation, leadership positions, volunteer work etc) will go a long way regardless of your step 1 score!


DISCLOSURES: Dr. Aiyer American Orthopaedic Foot and Ankle Society: Board or committee member, Delee & Drez Orthopaedic Sports Medicine (Elsevier): Publishing royalties, financial or material support, Medline: Paid consultant, Medshape: Paid consultant, Miller’s Review of Orthopaedics (Elsevier): Publishing royalties, financial or material support Dr. Kaplan Medline: Paid consultant, Wright Medical Technology, Inc.: Paid consultant Dr. Varacallo This individual reported nothing to disclose.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.


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