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Step 2 CK Percentiles: How to Understand & Interpret Your Score

With USMLE Step 1 becoming pass/fail, and no matter your personal opinion of that move, it all ends up with one overarching consequence: the importance of Step 2 CK has just increased dramatically. As such, it is natural to have a lot of questions about how Step 2 CK is similar to—and different from—Step 1. First, let’s review the numbers so we can explain and demystify them.

Step 2 CK Percentiles: Side-by-Side Comparison with Step 1, Step 2 CK, and Step 3

Score Step 1 Percentile Step 2 CK Percentile Step 3 Percentile
300 100 100 100
295 100 100 100
290 100 100 100
285 100 100 100
280 100 100 100
275 100 99 100
270 100 96 100
265 98 91 100
260 95 82 99
255 90 71 98
250 82 59 95
245 72 46 89
240 62 35 81
235 52 25 71
230 43 17 58
225 34 12 45
220 26 7 32
215 19 4 22
210 14 3 13
205 10 1 8
200 7 1 4
195 4 0 2
190 3 0 1
185 2 0 0
180 1 0 0
175 1 0 0
170 1 0 0
165 and below 0 0 0

Data based on Step 2 CK scores from July 1, 2017 to June 30, 2020; Step 1 and Step 3 scores based on data from January 1, 2017 to December 31, 2019. Sourced from USMLE.org.

 

As you can see above, Step 2 CK is right-shifted from Step 1 and even Step 3, meaning you need a higher Step 2 CK score to pass and a higher score to be competitive.

For Step 1, the concepts are difficult but often much more abstract, and students have usually not been exposed to a wide variety of pathology yet.

For Step 3, most matched residents not attempting to apply to fellowship are riding the ‘P=MD’ or ‘70=DO’ train pretty hard and there is little incentive to do more than pass.

Step 2 CK tends to be the highest-scoring exam because students are never more competent in clinical knowledge for a wide variety of specialties than they will be at the end of their third year of medical school. Additionally, students have been sharpened by shelf exams digging deeper into the details for each speciality than the preclinical years.

Classically, one likes to do ‘slightly better’ on Step 2 CK than they do Step 1, but for those who have not gotten the score they wanted on Step 1, Step 2 CK provides a major opportunity to make a statement right before applications go out.

I have several friends who had mental or physical ailments provide a roadblock on Step 1 only to absolutely kill it on Step 2 CK and match into some very good specialties in some very competitive places.

What is the Step 2 CK Passing Score?

The current passing score for Step 2 CK is 209. For those familiar with Step 1, just barely passing comes with problems of its own. If you find your practice scores are scraping along the pass/fail line, consider if you have additional time or resources you can access.

What Qualifies as a “Good” Step 2 CK Score?

The 50th percentile corresponds to around 248, and all but those trying to compete for very competitive specialities or very competitive locations can feel generally happy with a score around the top of the bell curve. The 75th percentile corresponds to around 258 and at this point, anything above that is gravy.

The 25th percentile corresponds to around the score 235. Most students should aim to have this as their floor, if possible, especially international medical graduate students.

A ‘good’ score depends on your individual profile, what specialty you want to apply to, where you want to apply, and what school you attend.

For example, consider the somewhat exaggerated case of two similar students trying to match into a general surgery residency. Student #1 is in a US MD school trying to apply to rural residencies in the Midwest and Southeast. Student #2 is in an IMG school trying to apply to residencies in his home state of California. The former student has inherent advantages in his school profile and is attempting to apply to an area that is traditionally less competitive. The latter student has a higher ladder to climb as an IMG and is attempting to match into a very competitive environment. The former student likely only needs to approach the top of the bell curve to feel fairly comfortable moving forward, while the latter has a lower risk tolerance because a score below their desired range may prove to be difficult to overcome.

 

Are you thinking about whether you may need to postpone your test? Check out our guide which expands on whether you should push your test date back.

What Step 2 CK Score Do I Need to Secure Residency Interviews?

The mean Step 2 CK score for United States MD seniors who matched into residency in their preferred specialty in 2020 was 246.9, so you can consider this number a general ballpark for your target score. But remember that this is the mean score and not a minimum! We discuss this in greater detail below.

According to the 2020 NRMP Program Director Survey, the mid-230s was the mean score which nearly guarantees an interview. Additionally, 78% of program directors stated that they would consider applicants’ Step 2 CK scores.

As mentioned above, there are several factors involved in what your Step 2 CK score should be: your goal, your stretch goal, and your floor score where you do not proceed to take the exam.

The NRMP offers Step 2 CK score data by specialty for matched and unmatched applicants. These tables are great guides but not all encompassing. Applicants with scores below the average match score match all the time (otherwise it would be the minimum matching score not the average match score). And those with strong scores do occasionally get dealt an unlucky hand come application time. Use these as a guide and in concert with an advisor from your school, a mentor from your specialty, or one of the tutors working with you here.

To take a ten thousand foot view, one would love to have a score around the 66th percentile for their specialty and situation. For all Step 2 CK test takers in general, the 66th percentile corresponds to around 250.

If I Got a High Step 1 Score, Should I Care About Step 2 CK?

In a word, YES!

One of the most common things I hear about Step 2 CK is, “If you have a good Step 1 score, you should slow walk Step 2 CK until after you finish the application process.” Besides the obvious fact that this scenario is going to be obsolete in the near future, it is old dogma in a new world.

In days where specialties were much less competitive and Step 2 CK was often an afterthought, this was traditionally decent advice and was fairly simple: Good Step 1 score? Delay Step 2 CK. Poor Step 1 Score? Take Step 2 CK and try to use it to your advantage. This is an ethos of the past.

The world we live in today is very different, and Step 2 CK is used by program directors as an additional stratification point. Even with a good Step 1 score, failure to send in a Step 2 CK score may make program directors believe you are trying to hide a poor score.

Best of luck with your Step 2 CK preparation!