The Step 2CK is the second part of the USMLE board exam and is used to assess a medical student’s clinical knowledge. Despite comprising a third of the entire USMLE board exam, the Step 2CK is often regarded as less important than the Step 1, requiring significantly less effort and preparation.
I spoke with a residency director who told me that while a strong Step 1 score is important for matching with top-tier residency programs, the need for strong Step 2CK scores is evident. Rising Step 1 scores, combined with ever-increasing competition for a limited number of residency berths, are making the Step 2CK more important for all medical students.
Each year there is a significant increase in average Step 1 scores, leading to more emphasis on students’ Step 2 scores to differentiate themselves in front of residency directors for the specialties of their choice. The National Resident Matching Program (NRMP) reported that average Step 1 scores in the U.S increased from 225.2 to 230.4 and average Step 2CK scores increased from 234.3 to 242 during the 2011-2014 period. Additionally, last year the USMLE Management Committee raised the minimum passing score on the Step 2CK 6 points from 203 to 209. This adjustment was made after examining data on trends of examinee performance. Rising Step 2 scores place pressure on overall outcomes and increase the competition for residency placement.
According to the Tulane University residency director I spoke to, achieving a higher Step 2 than Step 1 score is just as important as scoring well on your Step 1. Residency directors look for consistency and improvement in board exam performances. A student scoring well on the Step 1 but poorly or even slightly worse on the Step 2 often indicates laziness and places a student’s responsibility in question, both of which are frowned upon by those ranking residency candidates. The fact that there are fewer residency positions available than there are candidates—the National Residency Matching Program reports that there were 41,334 registrants vying for 30,212 residency positions in 2015—highlights the importance of solid performances on both USMLE Step exams to be competitive.
Time management and study habits become important factors in Step 2 preparation adding several dimensions to the importance of diligent preparation for the exam. Schools often provide time off of class for first year students preparing for their Step 1, but the Step 2 usually takes place after M3 year while students are in the midst of their busy clinical rotations schedule. Success on the Step 2 often necessitates a strategic study plan that fits around the busy schedule of M3 and M4 students. Students taking the Step 1 benefit from exam content overlapping with their class material, but Step 2 content is characterized as more ambiguous and requiring independent preparation. During this period, students cannot rely on classroom participation or school resources to help them prepare, often causing feelings of vulnerability. All of these things may contribute to affecting student’s overall learning process and outcomes on the exam.
The Step 1 is crucial to achieving a successful match, but the importance of continued success throughout the USMLE Step exams is not often highlighted. From an administrative perspective, it is important to ensure that your students are aware of the exam’s importance and resources available to them so that they may succeed. As USMLE Step scores and the number of residency candidates continue to rise, the Step 2 is becoming a crucial determining factor for match success so it’s important to treat it as such.
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