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Navigating the Transition from Step 1 to Step 2 CK

11 min


A medical student studying for his USMLE Step 2 CK exam at home in front of a laptop.


Navigating the USMLE Step 1 to Step 2 CK transition is a pivotal moment for many medical students, demanding a thorough grasp of the similarities and differences between these two exams. In this blog, we’ll explore essential facets of each exam, from their structure and content to strategic insights for scheduling and preparation. Understanding these dynamics is crucial for mastering the transition and maximizing your readiness for both exams.



The Similarities Between Step 1 and Step 2


  • Both exams are multiple choice and are taken in 60-minute blocks that contain roughly 40 questions. 
  • Both exams will assess the presentation, diagnosis, and pharmacotherapy of disease processes. 



The Differences Between Step 1 and Step 2


  • Step 2 is a longer exam with eight, 60-minute blocks while Step 1 has seven, 60-minute blocks. 
  • Step 1 is now pass/fail, while Step 2 is scored. 
  • Step 1 will focus largely on the basic science of medicine and ask questions such as: 
    • What is the diagnosis of this patient with these findings? 
    • Which physiologic/pathologic process is responsible for this patient’s symptoms? 
    • What is the mechanism of action and side effects of pharmacologic therapy?
    • Which anatomical location is affected by this patient’s condition? 
    • What is the histopathologic finding associated with this patient’s condition? 
  • Step 2 will emphasize the management of diseases and ask questions such as: 
    • What is the next appropriate step in the evaluation/management of this condition?
    • What are the risk factors associated with this patient’s condition?
    • What is the best test to order to establish the diagnosis? 
    • What is the most likely diagnosis or causative organism? 
    • Which tests are best to monitor the progress of this patient’s condition or treatment? 
    • What are the complications of this disease/medication? 
    • Which screening tests are indicated for this patient?



When to Schedule USMLE Step 1 and 2 Exams


Many students will schedule their Step exams in line with their medical school curriculum and will take Step 1 first followed by Step 2. Before making plans to schedule either exam, learn about your schools curriculum requirements and when students typically take the exam. While the transition time between Step 1 and Step 2 CK may vary by school, students should have completed basic clinical rotations and taken most NBME shelf exams before taking Step 2. If your school allows Step 1 and 2 after clinical rotations, consider viewing this blog post for considerations about taking the exams simultaneously or sequentially (back-to-back). We recommend taking at least 2-4 weeks between Step 1 and Step 2 exams if taking them sequentially.


Additional resources for scheduling your exams:

  1. Step 1 10-week study schedule
  2. Step 1 6-week study schedule
  3. Step 2 study schedule



Is USMLE Step 1 or USMLE Step 2 Harder?


Step 1 has been thought of as traditionally more difficult because it is the first exam in the series and students often struggle with some of the basic science concepts which are tested in detail. Additionally, many students may find that Step 2 concepts are learned easier through clinical rotations as opposed to book learning which is typically emphasized before Step 1.


According to public USMLE data, in 2023, students from US and Canadian medical schools had a 90% pass rate on Step 1 compared to 97% on Step 2. While Step 1 is now pass/fail, a passing score on the three-digit score is 196. A passing three-digit score for Step 2 is 214.


Regardless, each exam is difficult and requires a significant amount of studying and dedication.



Shifting Your Mindset


Because Step 1 is no longer scored, more emphasis is being placed on Step 2 as the only scored metric residency programs have to compare applicants from different medical schools. While planning to take the exam, it is important to reflect on your goals and how well you want to do on the exam. Additionally, it is worth considering your career interests and average Step 2 scores of matched applicants into your field of interest.


Additionally, transitioning from questions centered on basic science to clinical management can be tricky for students. In addition to asking “what caused this disease”, you should also begin asking “what is the best test to screen for or diagnose this condition”, “what are the treatment options for this condition, and risks and benefits of each?”, and  “what are the complications of this disease patient need to be monitored for?”. Thinking about these questions during clinical rotations and while studying will help you prepare well for Step 2.



Study Strategies and Resources


USMLE Step 2 and Shelf QBanks


Similar to Step 1, the best study resource for Step 2 is generally the UWorld Qbank. Students should aim to complete, or nearly complete their Step 2 Qbank before taking the exam. Many of the Step 2 Qbank questions overlap with Shelf subject exam Qbank questions. One helpful way to prepare for Step 2 is to learn shelf exam material well. A significant amount of this information will reappear on Step 2.


If you complete the UWorld Qbank studying for Shelf exams, that does not necessarily mean you need to complete it again before the exam, but you should aim to have completed it one time total before taking the exam. You can reset the Qbank if you have finished it in preparation for shelf exams and want to use it to study during a Step 2 dedicated period. Personally, I completed all the “shelf” section UWorld questions for each rotation during the rotation and then reset the Qbank and completed the “Step 2” section questions for a 1-month dedicated period before taking the Step 2 exam. 


Spaced Repetition


Some students may also use spaced-repetition tools such as Anki. Anki can be a valuable study resource for Step 2, especially if studying over a long period (ex: during clinical rotations). If you used Anki while studying for Step 1, you may choose to continue reviewing the cards you learned during Step 2 studying. Either way, you should make sure that all of the new cards you view are Step 2 related material. If you are unsure about how to format this, how to use Anki, or which decks to use, check out this blog post. I did not rely on Anki much while studying for Step 1, but did rely heavily on it while preparing for Step 2. Consistency with Anki cards (especially reviews) was instrumental in my success on Step 2.


Mastering the transition from USMLE Step 1 to Step 2 CK is essential for every medical student’s journey. We’ve explored the nuances of each exam, from their formats to study strategies, to help you navigate this critical phase with confidence. For personalized guidance and tailored support in your exam preparation, consider Elite Medical Prep’s 1-on-1 tutoring services. Our expert tutors are dedicated to helping you excel on your USMLE journey. Schedule a free consultation today and take the first step towards achieving your goals.

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