Doctor of Medicine (M.D.)
Tbilisi State Medical University
What’s the Main Difference Between Step 1 and Step 2 CK?
As the name implies, Step 2 CK is an exam used to test a medical student’s clinical knowledge. While this description is accurate, it really gives you no information about just how different the two exams are. If I had to describe it in my own words, Step 1 was all about “How?”-s and “Why”-s, while Step 2 CK is all about “What do you do?”-s. To put it simply, Step 2 CK is an exam which tests your knowledge about diagnosis and management while Step 1 tests your knowledge about how the body works and why diseases develop.
Step 2 CK took a lot of endurance! At a full 9 hours, it is only an hour longer than Step 1, but that difference was enough for me to feel considerably more tired afterwards. The question stems also seemed longer to me, even though this might have been a quirk of my particular exam.
Step 2 vs. Step 1: Is Step 2 Easier?
Everyone seems to like pitting Step 2 CK against Step 1 in a contest of difficulty. While I dislike comparing two completely different exams, I need to note this right away – do not believe anyone who tells you it’s easy; it is not! I made that mistake in believing that I had covered most of the important topics in Step 1 and could definitely get a better score on Step 2. While a lot of knowledge can be inferred from your basic science subjects, if you don’t know the diagnosis and management guidelines, you simply don’t know them!
To my own personal shame, I did not prepare for Step 2 CK as intensely as for Step 1. I took too much time, over 6 months specifically, studying in a non-organized manner and my score reflects this! My Step 2 CK score lags considerably behind my Step 1 score, meaning that I overall did worse on this so-called “easier” exam.
Questions on Step 2 CK seemed to be more hard knowledge-based than Step 1 questions. Using logic to figure out the results was more difficult because I could narrow it down to two possible answers, but beyond that choosing the correct one required prerequisite knowledge. My advice here would be to really learn diagnosis and management methods to the fullest.
Does Step 2 CK Matter for Residency?
The answer to this question is a resounding yes! And since score reporting for the USMLE® Step 1 is changing to pass/fail, it will only become more important with time. A lot of residency program directors like seeing what they call “score progression” – meaning that the applying student’s Step 2 score is even better than their Step 1 score. Well, my score did have progression… sadly, it was in the opposite direction!
Going through the 2020-2021 residency Match was tough. Interviewers for competitive residency programs really do not hold back on asking you questions you don’t really know how to answer. I found myself explaining and excusing myself for why I had a lower Step 2 CK score compared to my Step 1 score. I’m completely sure it had a huge impact on my Match results. Luckily, I still managed to Match, and into one of my top picks as well!
Can a Good Step 2 Score Make Up for Step 1?
The entire USMLE® experience tends to dehumanize us sometimes. We start thinking of ourselves in terms of our scores, whereas we should be paying more attention to our overall application. While many residency programs have so-called “filters” for Step 1 and 2 scores, getting past those does not require an unattainable score for most students. Beyond that barrier, each application is unique and judged on its overall merits. So, the answer to this question would be yes, if you have a low Step 1 score you could aim higher with Step 2 to make up for it.
Personally, I felt the weight of the matching process very heavily. I called all the doctors I’ve worked with in the United States for letters of recommendation, I had to decide how I would write my personal statement. We forget that all of these other aspects of the application process are no less important than our scores. After all, those scores don’t really determine whether we’ll be good or bad doctors!
What Should My Goal Be for Step 2 CK?
I believe the goal for everyone going through the USMLE® process is doing their absolute best. I ended up having regrets about not doing so for my Step 2 CK. Remember, this is an important part of your overall residency application; programs are not going to turn a blind eye if they see results which they don’t like. “Why is your Step 2 score lower than your Step 1 score?” is a very valid question which does not really have a good answer. Make sure you don’t need to answer it!