Getting an internship
Securing an internship or residency is a "tough" business. "The Match," as it is called, works like this: Around the start of the fourth year of medical school, a student will look at internship/residency programs and send applications to their favored choices. On the other side of the equation, administrators of each institution, review all their applications and select the candidates whom they are interested in and wish to interview. Interviews are held between the following 10th and 2nd month of the year.
Following attendance of various interviews, the student creates a "rank order list" (a list, ordered by preference, of all the places they would like to intern/resident). This list is then submitted to the National Residency Matching Program (NRMP). Similarly, residency program administrators produce a list of their preferred applicants, put them in rank order, and submit this list to the same service. Neither the applicant nor program administrators will ever see each other's lists.
Entering the Match system means that applicants are contractually committed to go to the residency program to which they get matched. The same applies to the programs - they must take whatever applicants they get matched with. The two parties' lists are united by an NRMP computer that creates optimal matches of the residents to all the programs. On the third Thursday of March each year (Match Day) these results are announced in medical schools nationwide. On the Monday prior to Match Day, candidates find out from the NRMP if (not where) they matched. If they have matched, they must wait until Match Day (the third Thursday of March) to find out where.
If the applicant has not secured a position through the Match, then the following day they receive a list which details the remaining residency positions which are yet to be filled. All unmatched applicants then have the opportunity to contact each programs on the list about the open positions. Perhaps unsurprisingly, this process is known as "The scramble." The scramble is regarded by many as an unfavorable and highly stressful process. Occasionally, students even have to choose new specialties in order to move their career forward.
Matched students may also receive relatively unwelcome news - they may be matched to programs very low on their rank list, especially in the competitive specialties like dermatology, oncology, ophthalmology, orthopedics, otolaryngology, radiation, radiology, and urology. An alternative match body for osteopathic physicians announces its results ahead of the NRMP. Osteopathic physicians may participate in either match, filling either traditional Medical Doctor positions, or Doctor of Osteopathic Medicine positions.
A candidate's USMLE score is one of the many factors considered by residency program administrators when selecting interviewees, and when compiling their preference lists. A chart of USMLE Step 1 scores for graduates and their frequency at various residencies are charted in Table 2 on page 5 of "Charting Outcomes in the Match".