Step 2 CK Minimum Score is Increasing

As of July 1, 2022 the minimum score required to pass the USMLE Step 2 CK exam has increased by 5 points from 209 to 214.

Anytime a USMLE exam, including USMLE Step 2 CK, receives a minimum score increase it sends a wave of anxiety out into the medical student world. For some, the change may feel as insignificant as a small ripple because they have their sights on the upper echelon of test scores. But for those who find themselves flirting with the minimum score threshold, this change can be as intimidating as a tidal wave.

Why Change the Step 2 CK Minimum Score?

Every three to four years the USMLE Management Committee will review each of the exams they administer. They evaluate the content as well as the minimum passing standard. The USMLE exams are criterion-referenced exams. This means that an examinee’s performance is compared to a predetermined standard.

This standard represents an acceptable level of competence.

A passing score on the exam communicates to interested parties (state medical licensing bodies, residency programs) that the examinee will be able to fulfill their duties.

When the USMLE sets the score cut-off, they envision a candidate who possesses the minimum (or borderline) level of necessary knowledge and skills and then they set the passing score to just below this level. Every three to four years they make sure the minimum threshold still adequately accomplishes this purpose.

The USMLE wants to be sure that their test “reflects the current expectations concerning knowledge and skills needed to support effective medical practice and patient care”. In other words, they want a passing score to mean something, and they don’t want to pass those who are not ready to participate in patient care.

How Does the Committee Decide on a New Step 2 Pass Rate?

So how does the USMLE program conjure up this theoretical “standard candidate” to whom they compare our exam performance?

They collect data, opinions, and recommendations from multiple sources. These sources include expert panels, stakeholder surveys, examinee performance data, and score precision data.

Examiners…assemble!

The main method of determining the score cutoff is via a process that puts the “standard” in “standardized-test”. It is based on the Angoff method of test creation. It is slightly modified because they don’t solely rely on expert review for their decision.

This process involves assembling a committee of non-USMLE affiliated physicians who are experts in the subject matter of the exam and have enough exposure to medical education to be able to establish the “standard level of proficiency”. And thus, the standard candidate is born.

I like to picture the Avengers only older and whiter. This committee met in February of 2022 to discuss Step 2 CK and their recommendations were considered by the USMLE in adjusting the minimum score.

And the survey says…

Residency program directors, medical school faculty, state licensing representatives, and examinees are surveyed by the USMLE program in order to review minimum passing scores as well.

I haven’t seen the exact survey, but I know that the content centers on determining whether the respondent feels that the minimum score in question is too high, too low, or “just right”. As an examinee myself only a few years ago, I am certain I would’ve had no idea what the standard candidate should know in order to practice medicine. But, it does give us a voice, so, right on.

What the numbers say

Now, the USMLE Management Committee’s goal is to create a criterion-referenced exam. Therefore, according to them:

“Recommended performance standards for the USMLE are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination.”

This would suggest that they don’t care about the percentage of candidates that pass. But apparently, they kind of care…at least a little. They use previous years’ exam performance to decide if a minimum passing score should be increased. This may have more to do with testing industry business strategy and less to do with their mission to identify those who are prepared for the next phase of their training. At any rate, it has resulted in a 5 point minimum score increase to Step 2 CK, which is what we care about.

You can see that the pass rate of first-time MD test takers of USMLE Step 2 has steadily been climbing since 2017 with the most recent percentage reaching 99% in 2021. You can find this here. The last score change to Step 2 CK occurred back in 2014. Perhaps with the added emphasis on Step 2 CK the USMLE program is being proactive and anticipating even higher scores and pass rate as students dedicate more energy to preparing.

Pursuit of Precision

The USMLE program also objectively monitors whether or not they have a good test. A good test is one where the competent students pass and those who are not yet competent do not. I would be interested to see exactly how this is assessed, but I have not yet been granted access to the inner sanctum. All we know is that they collect data on this and that this is also something they evaluate prior to making score adjustments. They call it “score precision” and apparently sometimes it requires increasing the minimum passing score for exams such as USMLE Step 2 CK.

Should This Effect How I Study for Step 2 CK?

At the end of the day, Step 2 CK is still the same test and it can be overcome. I feel for those of you who feel like the rug has been pulled out from under you. As of July 1st, you will be held to a slightly higher standard. As your test date draws nearer, I hope you feel an increased drive to continue working hard so you can give your best effort come test day. Try to resist the temptation to feel discouraged.

Realize that Step 2 CK is still an imperfect exam and it does not determine who will be a good doctor. The intern year learning curve is rough for everyone. No matter what their board scores are. There are intangible qualities that set excellent physicians apart and they aren’t assessed on the boards.

The good news is that you can prepare to beat the test.

So the Step 2 CK Minimum Score Has Increased. What Should You Do Now?

We already knew that with Step 1 going pass/fail there would be more emphasis placed on Step 2 CK. With the minimum score increase, we now have yet more motivation to roll up our sleeves and get after it. If you find yourself still in your third year of medical school, then I would encourage you to start preparing for Step 2 now. I’ve written some specific advice on how to balance clerkships and Step 2 CK studying in a separate discussion here if you are interested.

If you are already approaching your dedicated study period, then this new information will help you strategize appropriately. Maybe you extend your study period if you suddenly see that your scores put you in danger of not passing.

If you are concerned, have questions, or just need some help figuring out where to go next, please reach out! Step 2 tutoring is a great way to get some practical advice tailored to your unique situation. Strategizing with someone who has recently been through the process to help you gain those few extra points may end up making all the difference.

Chances are, you are not alone. Meet up with a classmate or two and work together to prepare for Step 2 CK. Study groups are an underutilized resource in the clinical years of medical school. I covered the essentials of effective group study for USMLE exams here. Studying with other people in a similar situation offers a wide range of benefits. Having someone to commiserate with can help you take road bumps, like rising cutoff scores, in stride. It also breaks up the monotony of solo studying when you’re putting in lots of hours so you don’t burn out.

The minimum score is going up. That blows. But whether the score change feels like a ripple or a tsunami depends on what you do next.

Happy studying.