What’s Next After USMLE Step 1?

  • /Reviewed by: Amy Rontal, MD
  • Here’s how the next big exam for M3s, Step 2 CK, differs from the USMLE Step 1.

    So, you’ve made your way through the USMLE Step 1, and now it’s on to your Step 2 CK exam. The Step 2 Clinical Knowledge (CK) exam naturally follows Step 1 and tests your knowledge of the additional material covered in your upcoming coursework and clinical rotations. In this article, we’ll dive into how the material tested on Step 2 CK evolves from the fundamentals of Step 1, and how to leverage these for Step 2.

    As you know, the USMLE Step 1 exam gauges students’ knowledge and comprehension of basic science. Step 1 measures scientific problem-solving abilities. Many questions involve interpreting microscopic and gross specimens in addition to graphical and tabulated values. The content from Step 1 is listed below, categorized by discipline.

    • Pathology
    • Physiology
    • Pharmacology
    • Biochemistry & Nutrition
    • Microbiology
    • Immunology
    • Gross Anatomy & Embryology
    • Histology & Cell Biology
    • Behavioral Sciences
    • Genetics

    Building upon the science basics covered in Step 1, the USMLE Step 2 CK shifts focus toward questions that reflect clinical science and medical practice. Elements of patient care and discipline-specific competencies encompassing medicine, surgery, pediatrics, obstetrics and gynecology, and psychiatry are all incorporated into Step 2 CK. It’s important to remember when preparing for Step 2 CK that this next assessment incorporates the fundamentals from Step 1. A vast majority of the topics require med students to recall the essentials from Step 1 materials. Therefore, you should actively maintain an understanding of the underlying principles rooted in basic science. These are the subjects covered by Step 2 CK:

    • General Principles
    • Immune System
    • Blood & Lymphoreticular System
    • Behavioral Health
    • Nervous System & Special Senses
    • Musculoskeletal System/Skin & Subcutaneous Tissue
    • Cardiovascular System
    • Respiratory System
    • Gastrointestinal System
    • Renal & Urinary System & Male Reproductive
    • Pregnancy, Childbirth & the Puerperium
    • Female Reproductive System & Breast
    • Endocrine System
    • Multisystem Processes & Disorders
    • Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature
    • Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety

    In the time after Step 1, before you take Step 2 CK, you will also tackle NBME Shelf exams and clinical rotations. These may just sound like further distractions from preparing for Step 2 CK, but the key takeaway when looking at topics from Steps 1 and 2 is that scientific concepts are interconnected.

    While you’re going through your clinical rotations, in addition to keeping up with fundamental material from Step 1, do what you can to tie the principles from your shelf exams to the subject areas on Step 2 CK. In all likelihood, there will be a substantial amount of overlap between the two. Although the exam questions will differ between the Shelf exams and the step exams, the same analytic understanding of basic and clinical sciences will be invaluable, nevertheless. Furthermore, the clinical emphasis present on many of the Shelf exams will prepare you for the types of questions that may be on Step 2 CK.

    During rotations, use the opportunity to deepen your clinical knowledge while connecting basic science principles to your observations from patient cases. Review the patients’ progress in relation to their medications, laboratory values, and imaging results while also tracing things back to the fundamental mechanisms of disease progress.

    In summary, take the opportunities that come after Step 1 to build an interwoven network of knowledge. The fundamentals from Step 1, your Shelf exam preparations, and your experiences on rotations all provide knowledge and skills that you can leverage for success in Step 2 CK and beyond.

    About the Author

    Erica Forrette is the former Director of Marketing at Cram Fighter.