Does USMLE Step 2 CK Matter if I Aced Step 1?

  • /Reviewed by: Amy Rontal, MD
  • Congratulations! You did it! You ACED Step 1 and you are finally done with the basic sciences. You can finally let your hair down, relax, and just enjoy clinicals; it’s all easy coasting from here right?


    You are really only halfway done with medical school and you have all those pesky Shelf Exams coming up (see Third year: It’s Awful Now, But It Gets Better). Once that’s done, you have the ever-exciting Step 2 CS exam then the dreaded Step 2 CK exam.

    You may be thinking “Leila, not only have I heard that CK is wayyyy easier than Step 1, I heard it doesn’t really even matter what your score is if you killed Step 1.”  I’m sure many people have perpetuated this rumor, and I hate to burst your bubble, but they were wrong.

    Let’s look at the stats:

    In the 2014 NRMP Program Directors Survey, the number 1 cited factor in deciding whether to interview a residency candidate was their USMLE Step 1 score, whereas their Step 2 Score was # 4 on the list (after Letters of Recommendation and Dean’s Letter). This statistic is slightly misleading, however. The mean ratings of “perceived importance” for both the Step 1 and Step 2 were BOTH 4.1/5. The only difference between these two statistics is that 94% of Program Directors cited Step 1 as being important, whereas only 80% cited Step 2 as a factor. 

    In simple terms: while less Program Directors cited the Step 2 as important, of those that did (80% of all PDs), they essentially said it is of the same importance as Step 1! 

    What does this mean?

    It means Program Directors do care about Step 2 CK.

    Now you are thinking “Leila, you can throw numbers around all you want but I have many friends that did worse on Step 2 and they still matched.” You may be absolutely right, but this leads me to my second point. In the 2016 Match, there were a total of 27,860 positions to be filled with 53,642 total applicants. That’s nearly twice as many applicants as positions, and that’s not even getting into specific specialties. 

    Basically, the Match is more competitive than ever. It’s essentially a “buyer’s market” for Program Directors, and they are now looking at everything from your Step scores to your professional photo to help them decide whether or not to rank you highly. (Fun fact: Programs cannot see your photo until they choose to interview you, at which point I guarantee they are taking it into consideration asking, “Does she look friendly?” “Is he dressed professionally?”  “Would she think the dress is black/blue or white/gold?” (Kidding on that one.))

    I personally experienced both of these examples firsthand on the interview trail. One program actually showed me their scoring system for how they would rank their applicants, and guess what wasn’t in their algorithm? You got it: STEP 1! The Step 2CK, however, was weighted about 25% in their decision. Crazy, right?!

    I also actually had a program director tell me that my professional photo was one of the best he has seen (thank you Goodrich Orthodontics and JC Penney Photography). My point?  They are literally looking at EVERYTHING. And with the match being more competitive than ever, you can’t afford for any part of your application to be weak.

    So how well do you have to do on Step 2 CK?

    Since we can all agree that it IS important, let’s examine exactly how well you have to do. This is a very complex question that takes into consideration specialty, Program Director preference, Step 1 Score, and overall application strength. Sheesh. So what’s my general advice to students?

    If you did poorly or average on Step 1: 

    Step 2CK is your opportunity for redemption. If you can show programs that you are capable of improvement and furthermore that your clinical skills are even better than your basic science skills, this is invaluable. I suggest at the very least aiming for 10 points higher on your Step 2 CK. Remember, the average is about 10 points higher on this exam, as well.

    If you knocked Step 1 out of the park:

    Your focus is to at least make sure that you maintain your score! If you got a 240 on Step 1, try for a 250! But at least try to get that 240 again.

    What if I go down in my Step 2 CK score?

    Relax!  It isn’t the end of the world. After the test is over, you can’t go back and change anything, so your main focus is to make sure that every other aspect of your application is on point. Fluff your CV, get amazing letters, and get that celebrity style JC Penney professional photo (I swear I am not getting paid by JC Penney).  There are many other components of the application that you can improve even in the “eleventh hour”, whatever that expression means. Your first priority is to GET THAT INTERVIEW, then show the interviewers what an amazing applicant you are and that you would make an incredible addition to their team.

    The moral of the story:

    Step 2 CK does matter, no matter how well you did on Step 1. But have no fear!  I can tell you firsthand that while Step 2 CK is a very challenging exam, the return on investment for studying is much higher. It is possible to get really high scores much more easily than for Step 1. I studied about 10 weeks for Step 1, about 14 hours a day, lost friends, hair and sanity and got a 249. I studied about 5 weeks (dedicated time) about 6 hours a day, kept my hair and still had friends and got a 258. It was tough though, don’t underestimate this exam!

    The point is: you can do it. I know it’s the end of third year and you are weary and grumpy, (and lets face it, a little bit lazy) but suck it up and put in your 110% for this test and make an impression on Program Directors that they aren’t likely to forget! Godspeed!


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