Step 2 CK Percentiles and Placing in the Top
According to the USMLE, Step 2 CK asks test takers to “apply medical knowledge, skills, and understanding of clinical sciences essential for the provision of patient care under supervision”. They are testing whether you are ready to move on to your next step of training, meaning residency! Placing high on the Step 2 CK percentiles is likely to become very important for keeping your residency options open.
USMLE Step 2 CK Percentiles: Shift to Pass/Fail for Step 1 and Effects on Residency Applications
Given the NBME/FSMB decision to change Step 1 to pass/fail, the changing significance of Step 2 CK is still unclear. Previously, Step 2 CK was thought to carry much less weight. However, even then, average Step 2 CK scores for matched applicants were 9 points higher than average scores for unmatched applicants. Without data on application cycles sans Step 1 scores, there remains some uncertainty about how the importance of Step 2 CK may evolve over time.
Regardless, there are still different ways to stand out as a residency applicant. One thing years of applications to residency tell us is that a higher score is better. We will have much more data after charting outcomes are released for the 2023 match cycle, where many applicants had no Step 1 score. However, we do have some important data from prior cycles. See the charting outcomes from prior cycles o get a better understanding of how scores were previously weighted.
As of 2023, a passing score on Step 2 CK is 214. This is much higher than the passing score for Step 1. That being said, the percentiles for failing Step 1 and 2 CK are about the same. The mean score for Step 2 CK was 247 with a standard deviation of 15. This means that in recent years, the majority of test takers have scored between 232 and 262. The standard deviation is 4 points smaller than the SD for Step 1. This means there is less variation in common scores for Step 2 CK.
Setting Your Step 2 CK Percentile Goal Based on Preferred Residency Specialty
The key for interpreting Step 2 CK scoring is making specific goals for yourself based on a few factors. The first (and most important) factor to determine is your field of interest. The average scores of applicants vary significantly across different specialties. According to USMLE, the average score for matched applicants in plastic surgery is higher than the score for family medicine. This also applies to the SD and you can see that the scores are far more narrowly distributed in orthopedic surgery than in psychiatry. This means that there is less variation in the range of scores that would be considered reasonable for an applicant. It would not be surprising if these scores trended upward now that Step 1 has transitioned to pass/fail.
The next factor nearly as important as the first is an honest evaluation of your scoring potential. Although test-taking skill levels can improve, you should have a reasonable goal of what you may be able to achieve. Speaking in broad terms, the average test taker does not commonly jump from the 5th percentile to the 95th percentile without extraordinary measures.
Other factors to consider in setting your personal goal are the strength of your application as a whole and your requirements as an applicant. Applicants with very meaningful extracurricular activities, research, and awards may be able to compensate (somewhat) for a slightly lower score. Alternatively, applicants who are very particular about the location of their residency or those applying from international programs may want to fall higher on the distribution of scores of applicants within their field.
Scoring in the Top Percentiles for USMLE Step 2 CK
So how can you score within the range you are hoping for and what is the best way to prepare for Step 2 CK? Like any test, there is no one magic trick that can lead to a high score. If this existed, scores would be meaningless. Here are a few tips on setting up a really strong study plan:
Don’t sleep on your clerkships
I don’t mean this in the literal sense (you should definitely sleep). I mean that you shouldn’t overlook the importance of your clinical rotations. The USMLE said it themselves. They are testing your application of the knowledge you are expected to acquire during these rotations!
As much as the 45-minute discussion of the sodium shift on Internal Medicine rounds may make you yearn for a triple shot of espresso, this will be important knowledge for test day and you are far more likely to retain this information if you are associating it with a patient that you are caring for. This also applies to those required journal clubs. You are expected to interpret medical literature on this exam! As a rule of thumb, if you are putting energy into caring for your patients, playing an active role on your team, and performing well on your shelf exams, you are also preparing yourself for Step 2 CK.
Practice makes perfect when it comes to Step 2 CK
You simply cannot prepare for this exam without dedicating a good chunk of time to practice questions. You should subscribe to UWorld at the beginning of your clerkship year and work through questions in preparation for your shelf exams. Ideally, you will be through a pretty significant chunk of UWorld by the time you have arrived at your dedicated Step 2 CK study time. While doing practice questions, you should simulate real life as much as possible. That means putting your blocks on timed mode and turning off tutored mode. You should be doing questions in a quiet, distraction-free environment as much as possible. As always, make sure you review your blocks afterward and grow from the questions you answered incorrectly!
Wait until you are ready to take your Step 2 CK exam
Some students have less flexibility here, but when deciding how long to prepare for Step 2 CK, I always recommend against taking exams until you are scoring your target on practice exams. You should not expect your score to be magically higher on test day! If you are not reaching your target, you should consider delaying the test until you are ready. This leads me to my last tip, which is…
This process is challenging and there are a whole slew of issues that might come up. Ultimately, your success in this career will be dependent on your resilience and your ability to seek help when you need it. When you start struggling to understand a topic, ask one of the residents on your rotation (most residents love teaching). If you are struggling to navigate the crazy logistics of being a medical student, ask one of your colleagues who is the year ahead of you. If you are concerned about your schedule and considering pushing your exam, reach out to one of your advisors (do this early!!).
As always, there are many tutors who specialize in assisting students with their Step preparations. You can set up an initial session to help to determine ways that you may be able to improve your score. Schedule a complimentary consultation to learn more about Step 2 CK tutoring and whether it is right for you.
This is a long and stressful process but you are not alone! Countless medical students have been in your shoes before and have come out as wonderful, happy physicians. Trust the process and whenever possible, enjoy the process!