While students frequently understand the importance of Step 1 for their residency application, many Caribbean students do not realize yet another unfair advantage that US students have in regards to Step 2. Many residency programs will allow a US student to apply for their program and will conditionally match that student prior to receiving their Step 2 scores. This is not the case for Caribbean students. A Caribbean medical student must pass Step 1, Step 2 CS and Step 2 CK prior to match day, meaning that potential residency programs will have access to all their scores prior to making a match decision.

According to NRMP data, Caribbean medical school graduates who score below 220 on Step 1 and Step 2 have less than a 50% chance of matching into their preferred specialty. Many students neglect the importance of Step 2 as they enter the match, too often with disastrous consequences. Because there are so many well qualified applicants for such a limited number of positions, these positions often go to applicants with the higher scores.