Comparing Step 1 and Step 2 CK: What Changes to Expect

What is the Difference Between USMLE Step 1 and Step 2?

USMLE Step 1 and Step 2 are compulsory licensure exams for medical students before residency in the US. Scores on these exams are also used by residency programs to evaluate each individual student’s didactic knowledge and capabilities. However, ever since Step 1 became pass/fail in 2023 and Step 2 CS was discontinued, there has been a significant shift in focus towards Step 2 CK scores. It is essentially the only tangible metric that residency programs have to compare students against each other. 

USMLE Step 1 and Step 2 share a similar structure and content, but with key differences we’ll explore.

Difficulty level

Students often wonder which exam is more difficult, Step 1 or Step 2, to mentally prepare for their dedicated period. However, this really depends on your knowledge base and commitment during your dedicated period. Most medical school curriculums cover the bulk of didactic knowledge for Step 1 during the preclinical years, so inevitably you will be preparing for Step 1 during this time. Similarly, if you take NBME Shelf exams during your third year of medical school, you will be preparing for Step 2 since the material is extremely similar. However, in clinical years, patient management reinforces concepts learned from textbooks and UWorld.

For those reasons, many students believe that Step 1 is harder, accompanied by the fact that it is the first long licensing exam students are taking. 

Content coverage 

USMLE exams test the same material but at different levels. For example, if faced with a question about pernicious anemia, Step 1 and Step 2 will test your knowledge differently. On Step 1, you will likely be asked about B12 deficiency and the biochemistry behind the condition. On Step 2, you will likely be asked about B12 deficiency and the clinical management of this condition.

Step 1 is largely didactic, with focuses on physiology, anatomy, embryology, microbiology, biochemistry and pathology. Step 2 is more clinical-based, with focuses on pathology, physiology and clinical management of diseases. 

Types of questions

As outlined above, Step 1 has more didactic questions whereas Step 2 has more clinical-based scenarios. However, the structure of the questions differ as well. For example, Step 1 questions force students to rely on rote memorization and recall. A vignette could therefore explain the clinical presentation and lab values of a patient presenting with a sickle cell crisis, and the question would ask what the gene mutation is for this condition. Therefore, students must have those small factoids memorized and applied quickly to a patient. 

Conversely, Step 2 questions are largely rooted in critical clinical thinking. For example, the same vignette as above could describe a patient in a sickle cell crisis. Still, the question would likely ask about the next steps in clinical management, disposition, or other clinically related items. The preparation for these types of questions remains the same. The Uworld question bank will adequately prepare you to assess, evaluate, and answer these types of questions quickly and accurately. 

Scoring 

At this point, USMLE Step 1 has transitioned to being pass/fail with the minimum passing score increasing to 196 in 2022. Although Step 1 is now pass/fail, we do not recommend that you study less for the exam in hopes of just barely passing the test! Giving strong Step 1 effort sets you up for success in clinical rotations, NBME shelf exams, and Step 2. Step 2 CK is scored out of 300 with a passing score of 214. 

Length of exam 

The length of Step 1 and Step 2 CK are quite similar. Step 1 is 280 questions with a total test day time of 8 hours, while Step 2 CK is 318 questions with a total test day time of 9 hours. Step 2 CK has one more 60-minute question block than Step 1 does. 

Studying Tips for Both Step 1 and Step 2

Managing study time

When studying for both Step 1 and Step 2, you’ll have a dedicated period to focus on each exam. In terms of time allocation, there’s no significant difference between the two. However, there’s a twist. Since you’ve likely been studying for Step 2 while preparing for NBME shelf exams, you may find the stress of managing your study time is lower compared to your Step 1 dedicated period.

On the other hand, during your Step 2 dedicated period, you may be juggling other commitments like research, community service, or preparing your residency applications. This could include writing your personal statement, researching programs, or coordinating with mentors for letters of recommendation. As a result, your study time for Step 2 CK might get interrupted. To stay organized, check out our Step 2 CK study planner and Step 1 study planner, which provide a concrete timetable for using your resources.

Ultimately, effective study time management comes down to creating a reasonable checklist and sticking to it throughout your dedicated period. Since Step 1 is your first board exam in medical school, you may find that managing all the tasks is a bit more challenging and requires more intention to complete.

Resources

There are a few resources that are shared between Step 1 and Step 2. Those are Anki and UWorld. The differences in resources are centered around content consumption. For example, for Step 1 you may find yourself watching videos from Sketchy and Boards and Beyond, and reading the First Aid for the USMLE Step 1 exam book religiously. However, there is no “gold standard” resource for a textbook or video resource. You can read this article to review the best resources for USMLE Step 2 CK that we recommend here at EMP. Generally, we find that the best resources for each student differ, but we definitely recommend Anki and UWorld as a baseline requirement for resources used! 

Transitioning from Step 1 studying to Step 2 studying

If you’ve been studying for and taking NBME shelf exams, transitioning to Step 2 studying can be smooth. The main difference is that you’ll use a different UWorld question bank and resources. Many students find Step 2 easier due to their clinical experience and prior shelf exam prep. However, Step 2 material is more in-depth and clinically focused, which can be a challenge for didactic learners. Plus, Step 2 is a longer exam, so it’s crucial to build endurance and incorporate strategy time into your studying.

Is Step 2 Going to Become Pass/Fail?

With Step 2 CS being dissolved and Step 1 going pass/fail, there is no clear indication that Step 2 CK will become pass/fail any time soon. As mentioned above, it is the only comparable metric that residency programs can use to evaluate candidates without any bias. For the foreseeable future, Step 1 will remain pass/fail while Step 2 CK and Step 3 will remain graded. Since the minimum passing scores have recently increased for both Step 1 and Step 2 CK, it is improbable that the passing score will increase further for some time. 

Takeaways

While both USMLE Step 1 and Step 2 are crucial exams for medical students, they serve different purposes. Although they share similar structures and content coverage, they differ in question types, length, and preparation strategies. Step 1 focuses on rote memorization of facts in subjects like physiology, microbiology, and anatomy, whereas Step 2 applies those facts to clinical approaches and disease management. While there’s some overlap, the exams have distinct goals: Step 1 tests basic medical knowledge, while Step 2 assesses clinical knowledge.

By understanding the differences between these exams, you can tailor your study approach to succeed on both. If you’re struggling to develop an effective study plan or need personalized guidance, consider consulting with an expert who can help you achieve your goals. With the right approach and support, you can conquer both Step 1 and Step 2 and set yourself up for success in your medical career. Book a consultation to learn more about how we can help you succeed!