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Which USMLE Step Exam is the Hardest?

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A frustrated medical school student studying for the USMLE in front of a pile of textbooks.

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The USMLE Step exams are one of the most important and anxiety-inducing aspects of medical training. Step 1 is an exam that most medical students take in their second or third year of school, which tests basic science knowledge relevant to the practice of medicine. Students generally take Step 2 during the third or fourth year of medical school. Step 2 focuses more on clinical science applicants. Step 3 is the final exam of the USMLE series. It is usually taken during residency training and tests an examinee’s application of clinical knowledge for the unsupervised practice of medicine. Each of these exams is important; ultimately, you must pass all three to become a licensed physician. A common question for many medical students is which of these three exams is the hardest. Unfortunately, the answer to this question may be different depending on whom you ask. 

 

Is USMLE Step 1 the Hardest Even Though it is Pass/Fail?

 

Traditionally, Step 1 has been thought of as both the most difficult and most important USMLE Step exam. There are several reasons for this. Firstly, this exam is the first in the series, and students taking it will have had less experience with the types of questions that the USMLE asks. They also may have less test-taking stamina, which is important for the 8-hour examination. Another reason is that this exam tests basic science knowledge, including subjects like biochemistry which many students struggle with. Scoring well on Step 1 also previously held great importance for many students, as it was a significant consideration of residency programs when evaluating applicants. Achieving a top score on Step 1 was one way to distinguish your application for competitive residency spots.

However, this is no longer the case with Step 1 becoming pass/fail in January 2022. Step 2 may become more important in the residency application process with this shift. (see our article “How Will the USMLE Step 1 Pass Fail System Affect your Step 2 Score?” for more on this topic). It is important to keep in mind that this switch to pass/fail could be a double-edged sword. On the one hand, it has taken the pressure off young medical school students to achieve a high score on their first pass of USMLE Step 1 so early in their medical careers. On the other hand, it may have led to a more lax attitude around Step 1 studying, which may put more students in danger of failing the exam.

 

USMLE Step 2 and Step 3

 

Many students think of Step 2 as an easier exam than Step 1. This may be because they have already had experience with USMLE testing. Maybe they have identified successful study methods and know how to create an ideal study schedule for their dedicated study time. It could also be that this exam tests clinical knowledge, which doctors often learn through experiences on the wards and thus may be easier to recall during the stress of test day. While Step 3 also tests clinical knowledge, the majority of doctors take it during residency training. Examinees often do not have the same kind of dedicated time for preparation that they have for Step 1 and Step 2. This can lead to this exam being perceived as more difficult. Additionally, USMLE Step 3 is a two-day exam, meaning it is almost twice as long as both Step 1 and 2. Test-taking fatigue can be a huge factor in an examinee’s performance. 

 

Which USMLE Exam is Hardest?

 

So which USMLE step exam is hardest? While many factors might influence the answer to this question, we can look to the data to give us some insight. According to the 2021 Performance Data from the USMLE, Step 1 had the lowest passing rate, with 95% of US/Canadian students passing and 77% of examinees from non-US/Canadian schools passing. Step 3 had a slightly better pass rate, with 97% of US/Canadian examinees and 87% of non-US/Canadian examinees passing. Step 2 had the highest passing rates for both US/Canadian students (98%) and non-US/Canadian test takers (88%). This data suggests that Step 1 was the hardest exam to pass.

 

No matter which step you are preparing for, the USMLE exams are challenging. It is important to plan your study schedule, start early, and do lots of practice questions and exams. If you are struggling with any aspect of your preparation, a tutor can help get you on track to succeed. Contact Elite Medical Prep to schedule a complimentary consultation today!

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About the Author

Kathleen Oakes

Katie has extensive experience tutoring at all levels in various subjects throughout college and medical school, as well as experience helping students with standardized test…

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