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Taking USMLE Step 1 with Step 2CK After Rotations

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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 2CK 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.

Interestingly, this approach may gain more popularity as a direct effect of the COVID-19 pandemic, with limited availability at Prometric sites due to social distancing restrictions and a back-log of previously cancelled test dates. Since students may not have much of a choice but to further postpone their Step 1 date in order to start clinical rotations on time, many medical students are finding themselves asking about the pros and cons of taking Step 1 and Step 2CK within a short time frame– as well as how to set up a study schedule. As such, here is our opinion based off our work with students who have chosen this testing option.


Pros of Taking USMLE Step 1 with Step 2CK:

– Higher Step 1 scores: On average, schools have noticed that their student’s Step 1 scores are higher when the test was 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.

Ability to freely explore career options: Students often feel limited by their Step 1 score when entering clinical rotations; they close the doors on specific “competitive” specialties without even giving them a chance. By taking Step 1 after clinical rotations, students will be able to openly explore different specialties and feel less restraint.


Cons of Taking USMLE Step 1 with Step 2CK:

Less time to explore residency options: Although Step 1 isn’t the most important part of your application, it is arguably the most important exam you’ll take in medical school. Thus, the score does play a role in what specialty and residency programs a student should consider applying to. If students don’t get their score until the summer, this leaves less room for exploring the specialty that the student may ultimately want to pursue. 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 biochem, pharmacokinetics, and other Step 1 subjects. Students will essentially have to re-learn this material when their Step 1 study period comes around.

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.


How to Study for Step 2CK:

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 2CK 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: studying for both exams simultaneously (~6-10 weeks), or studying for them sequentially. If students chose the latter, a suggestion is to study for Step 1 first for a minimum of 4-6 weeks, take a much needed, although preferably short break, and then spend another 2-4 weeks to study 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 the 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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