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Taking USMLE Step 1 and Step 2 CK Back to Back After Rotations

8 min


Medical school student studying for the USMLE Step 1 and USMLE Step 2 with multiple study books open in front of her.


Traditionally, the USMLE Step 1 exam has been taken after the first 2 years of medical school. In the past, taking this exam marked the transition from preclinical years to the wards. Then, after finishing the core clerkships, students would take the USMLE Step 2 CK exam. Although this is still the structure in the majority of medical schools, there has been a wave of change and restructuring of medical school curriculum that is enabling some students to take Step 1 after clinical rotations. Such students typically take USMLE Step 1 either simultaneously or back-to-back with Step 2CK. In this post, we will tackle the pros and cons of this approach. We hope this helps you make an educated decision regarding whether to postpone your Step 1 exam.



Pros of Taking USMLE Step 1 and Step 2 CK Back to Back:


Higher Likelihood of Passing Step 1


On average, schools have noticed that their students’ Step 1 performance is better when the test is taken after clinical rotations.


Enhanced Understanding


Students’ understanding of Step 1 material is strengthened after being able to see related topics in real life on the wards. Treating patients with certain diagnoses and ordering specific medications will allow students to become more familiar with the terminology that will inevitably be on their Step 1 exam.


Step 1 as Direct Preparation for Step 2


It’s no secret that there is a lot of crossover between Step 1 and Step 2. In fact, Step 1 success is a great indicator for passing Step 2. Studying for Step 1 and 2 back to back will help students retain the information learned for Step 1, and carry it over to their Step 2 preparation directly afterward.



Cons of Taking USMLE Step 1 and Step 2 CK Back to Back:


Less Time to Explore Residency Options


Although Step 1 isn’t the most important part of your application, a failure is a red flag for residency programs. Additionally, Step 2 scores are a major factor for residency programs in deciding which applicants to interview. If students don’t get their scores until the summer, this leaves less room for exploring realistic residency specialties. Applications for away rotations can be submitted in early Spring. So if students are not sure what their scores or what specialty they want to pursue, this can also complicate their away rotation plans.


Needing to Re-learn Basic Science Coursework


Although students will get more exposure to clinical medicine, which will be invaluable when studying for Step 1, they will also inevitably start to forget some of the basics. Biochem, pharmacokinetics, and other basic sciences are all major components of Step 1. Students will essentially have to re-learn this material when their Step 1 study period comes around. This does have some positive effects, as mentioned earlier. Having basic sciences fresh in your mind can help support your Step 2 preparation.


Needing to Map Out Your Test Dates in Advance


Students may not know how many weeks they’d like to dedicate to studying for each exam. But they will have to make a ballpark estimate so that they can secure test dates in Prometric for both exams. See our updates Step 1 and Step 2 exam dates to help you plan ahead.



How to Study for Step 2 CK and Step 1 Simultaneously or Back to Back:


It’s important to remember that dedicated study time is required for each USMLE exam. USMLE Step 1 includes more basic science content whereas Step 2 CK includes more clinical content. There is definitely a lot of overlap between the two (which is very helpful). But each exam has distinct differences. Due to these differences, it is important that students set aside ample time to study for each exam, either simultaneously or sequentially.


The length of time students should take to study for each exam is very individualized and depends on different factors. These factors include the students’ score goals, the progress they’ve made in their studying, and their level of comfort with the material.


In terms of a study plan, as mentioned previously, there are two main options:

  1. Studying for both exams simultaneously (~6-10 weeks).
  2. Studying for them sequentially.


Studying for Step 1 and 2 Back to Back (Sequentially)


We suggest to study for Step 1 first for a minimum of 4-6 weeks. See our 6-week Step 1 study calendar to help you get started. Then, take a much-needed, although preferably short break, and then spend another 2-4 weeks studying for Step 2CK.


Studying for the exams sequentially can facilitate going through the UWorld quest banks for each exam, which is the gold standard resource for both exams. Although taking Step 1 first seems to be the more popular option, USMLE does allow students to take Step 2CK prior to taking Step 1 if that is their preference.


Regardless of when you take your USMLE Step 1 or Step 2CK exam, it’s important to keep in mind that there is no “cookie cutter” approach. If you’d like to speak with one of our tutors to discuss an individualized study plan based on your specific score goal and career aspirations, please don’t hesitate to reach out–we are happy to help!

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About the Author

Alexandra R., MD

Alexandra earned her Neuroscience degree from the University of Michigan, graduating with Summa Cum Laude recognition in 2014. She continued her education at the University…

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