[Dr. David Delnegro and Paige Mauriello contributed to this post]
For a moment, let’s imagine it’s a beautiful sunlit day somewhere very far from your computer screen. You decide to engage in a friendly game with a street vendor guessing where a stone is hidden in his cups. You play once, twice, three times, and every time it’s in the left cup. Fourth game, you guess the left cup because you’re no fool. But, alas! He noticed your leanings and switched it to the middle cup. He warns you your folly was in neglecting the middle cup. Now, imagine he’s the Federation of State Medical Boards (FSMB) and the stakes of the game are your future as a physician!
As you may know by now, the FSMB recognized the long time emphasis placed on Step 1 of the USMLE and the overemphasis placed on the USMLE as a whole; and in an attempt to make what they believe will be positive change, they voted to change Step 1 to pass/fail starting January 2022. This will presumably make your Step 2 score the golden-child of residence placement as it’s now the first one you can be numerically judged on, but that’s only speculation at this point. This was apparently part of the goal, as Step 1 had initially been planned to be pass/fail in hopes of placing greater emphasis on the more clinical-science-based testing of Step 2 CK.
The ultimate goal, however, is to move the residency admission process away from a nearly unifactorial decision in Step 1 towards a multivariate one. It’s likely in the first several cycles following this change that Step 2 scores will simply replace Step 1 scores in the weight they carry in residence-placement; but the hope is that other factors such as the inclusion of shelf examinations into application material or the requirement and standardized evaluation of sub-internships will gain greater importance. Ideally, these major shifts will catalyze changes in both the UME and GME cultures. If you’re a first year medical student starting this fall, residency applications might look very different for you than they have for many years.
Possible Outcomes of This Change
In this preliminary study to test what effects this scoring change may have, it was found that: “After the removal of USMLE step 1 points, 40% of all applicants decreased in rank, 35% remained the same, and 24% increased.” The conclusion from the study is that removing the Step 1 score allowed for room to judge based more on the core values of a residency program. This could even lead to limitations on the number of programs an applicant can apply to, presumably.
While the people making these changes hoped this shift would redirect some of the stress placed on the USMLE to the students’ academics as a whole, not everyone feels this will have the desired effect. The majority of orthopedic and internal medicine program directors that responded to this study felt the decision lacked transparency and will negatively impact allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates to name a few.
Interpreting Your Step 2 CK Score
All that being said, it’s still helpful to consider where you should aim based on your preferred specialty. The most competitive specialties have required higher Step 1 scores in the past, so it’s safe to assume those competitive specialties like Dermatology will now require high Step 2 scores where they cannot judge Step 1. You can find a list of more competitive specialities here. It’s important, however, to compare your score to data that’s no more than three years old, according to USMLE Interpretation guidelines. This is because the test, much like yourself, evolves overtime. You can see the “Norm Table” from the same interpretation guidelines below. Your score can range anywhere between 1 and 300.
The table below from the National Resident Matching Program (NRMP) can help you determine where you generally want to aim for Step 2 in your specialty to be as exceptional as we know you can be. According to the NRMP, “Overall, U.S. MD seniors who matched to their preferred specialty had mean USMLE Step 2 CK scores of 246.9 (s.d. = 14.2), well above the 2020 minimum passing score of 209.” You can see below how that compares to, say, Plastic Surgery, which averaged some of the highest scores for Matched students into the high 250s.
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 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|
|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 fromUSMLE.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 we 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.
The Big Picture
At the end of the day, it’s important not to fixate so much on numbers. Of course, that’s easier said than done when it feels like your future as a physician now rides on just one 3-digit score. That’s not exactly the case, however. Your future is built on where you go to medical school; what research you get excited about and involved in; what extracurriculars you engage in; along with your letters of recommendation. It is built on how you choose to set yourself apart and not on how focused you were on one single exam for all of medical school. This is not a game of you v.s. USMLE. It’s the journey of becoming a physician who cares for humans when they are at their most vulnerable.
Med school student and Cram Fighter coach Danielle can attest to this. A friend of hers who had a goal of going into General Surgery scored a 210 on Step 1, but he didn’t let this lower passing score stop him. He made a plan to do better on Step 2, but he also researched what programs were realistic options for him based on his scores. For him, becoming a surgeon was more important than the prestige of a residency program. So, he did away-rotations at a few of those realistic programs he found while using connections at his school to get interviews. He then dual-applied to family medicine in addition to surgery because becoming a surgeon was his main goal but if that wasn’t in the cards, he only wanted to be the best physician he could regardless of his specialty. He ultimately matched into a surgery program, and met his fiancé along the way. All this to say, prepare for the USMLE as best you can; but don’t conflate a number with your drive, determination, and value as a future physician.
If that wasn’t enough to encourage you, don’t forget that you will have had the enormous challenge of Step 1 under your belt before you will really be judged on Step 2; and by Step 2 you’ll already have some experience to make your exam more like recalling information and less like memorizing a textbook. And – of course – we’re here to help you plan your studies and stay on track!
Data provided by the National Board of Medical Examiners, which administers the USMLE, indicate that the average score for Step 2 CK for U.S. medical graduates hovers just above 240. Generally, it's been 242 to 243 over the past few years. The 25th percentile is around 232, while the 75th percentile is near 256.How do you interpret the percentile of a test score? ›
A student's percentile rank indicates that the student scored as well as, or better than, the percent of students in the norm group. For example, a student scoring at the 35th percentile scored as well as, or better than, 35 percent of students in the norm group.What percentile is a 250 on Step 2 CK? ›
|Score||Step 1 Percentile||Step 2 CK Percentile|
|Score||Step 1 Percentile||Step 2 CK Percentile|