USMLE Step 2 CK: What You Need to Know

How different is it to prepare for the USMLE^® Step 2 Clinical Knowledge (CK) exam from Step 1?

The short answer: very.

Let’s consider the basis of each. Step 1 tests your ability to recall important information related to the Basic Sciences. Meanwhile, Step 2 CK tests your ability to apply that same information in the clinic.

Now, the joke goes that you study for two months for Step 1, for two weeks for Step 2 CK and you bring a #2 pencil for Step 2 CS (or at least it did before Step 2 CS was canceled!). But, if there’s even a kernel of truth to that, how, then, should you prepare for Step 2? Does that mean Step 2 matters less than Step 1 in the grand scheme of things?

By reviewing past reports and analyses on Step 2 performance, we’ll get to answering those questions and more so that you’ll know exactly what to expect on exam day.

What to know about the USMLE Step 2 CK exam

Here’s the official word on the USMLE Step 2 CK exam: “Step 2 Clinical Knowledge (CK) assesses whether the examinee can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes [an] emphasis on health promotion and disease prevention. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.”

Exam scores go from 1 to 300 with 209 as passing and, over the past few years, student scores have hovered around a mean of 240 with a standard deviation of 18.

How high do I need to score on the Step 2 CK?

It should be noted that by the time you take Step 2 CK, you’ve likely already gone through all your clerkships, meaning you've already worked in the clinic and taken every Shelf exam necessary. With that in mind, many of the question scenarios you’ll face on exam day will probably feel familiar to some extent.

Having said that, many students do expect Step 2 to be less challenging than Step 1 and will adjust their approach to the exam accordingly. Either of the following two strategies tend to be popular: score high on Step 2 to “make up” for a poor Step 1 score or maintain your record and keep from dipping down “below” your Step 1 score. Which specialty you’d like to break into and where you’d like to apply for residency will also influence your prep plans; a high Step 2 score could be the tie-breaker between you and an equally qualified competing candidate.

What would be considered an “ideal” score falls into a few different ranges with 240-250 considered good, 250-260 very good, and 260 and above excellent. These ranges are particularly evident when we check out the National Residency Matching Program’s (NRMP) yearly Charting Outcomes in the Match report which correlates average Step 2 scores of students who matched with a variety of residency programs. In their 2020 report, we see that the mean Step 2 CK for students (US MD/DO Seniors) who matched to their first-choice specialty was 246—quite the jump from Step 1’s 236. Breaking scores down further by a select few specialties further demonstrates score ranges:

Plastic surgery: 256

Dermatology: 255

Otolaryngology: 254

Interventional Radiology: 253

Meanwhile, scores reported for Internal Medicine and General Surgery were 244 and 246, respectively.

If you’d like to know more about the average match scores for each specialty, check out these handy tables with a breakdown of the Step 2 match scores. 

So, how should I prep for Step 2?

In the months leading up to the Step 2 CK, you will likely be both getting through rotations and studying for and taking Shelf exams. However, despite the tight schedule, it’s those very activities that will offer you the exact kind of preparation you need for exam day: rotations and Shelf exams will put your knowledge to the test, placing you in real clinical scenarios that require you to go through differential diagnoses and determine the next steps in patient management.

The trickiest part of studying for Step 2 is finding the time and energy to do it. Rotations usually start early and end late, putting not just your knowledge to the test, but your stamina, too. The trick is to persevere and make the most of your downtime. 

When you’re home, commuting to and from the clinic, or at any other moment you have some downtime, go through as many Qbank questions as you can—which is easy with a handy app like the AMBOSS Qbank. If you feel you’re struggling with any particular question, rely on the study aids available to lead you through the stem, or jump into the medical Library to get the bigger picture on the topic at hand. And when you’re really short on time, take advantage of your personal analysis and get an overview of your progress as well as personalized study recommendations specific to your weaknesses.

So, feeling confident to tackle Step 2 now that you know what to expect? Remember, a bit of determination and a solid resource can help you get the score you’re aiming for — maybe even 10 points higher than the national average. Good luck!

Be prepared with the AMBOSS Step 2 CK study plan