USMLE Step 1 vs. Step 2 CK: Which Matters More, and How Are They Different?

I’ve heard it many, many times: “Study the most for USMLE Step 1, it is the most important exam of your life.” Reading through forums, blogs, and listening to advisors, I came to the early conclusion that Step 2 CK was easier and less important than Step 1.

That is, until the program director of my surgery rotation called all the medical students in for a talk.

Amongst the life lessons, he made sure to mention that when picking an applicant, it was Step 2 CK that mattered most, and he doesn’t care much for Step 1.

Going home in shock, I bought a book on residency matching, and there it was: while Step 1 was said to be more important overall, when it comes to specific residencies (IM, EM, surgery) Step 2CK was weighted higher. The reason being, out of every USMLE exam it has the strongest correlation with likelihood of passing your eventual board exam, an important mark for the quality of a residency program’s education.

While it is true that many of these surveys are not answered by a significant number of program directors, and preferences change from program to program, the fact that both my own surgery program director and a book on residency match showed a preference for Step 2 CK meant I’d have to rethink my old thought process. Essentially, they are both important and it cannot be said with certainty that one is more so than the other.

So how are they different exams? Well, beyond the obvious (one is basic sciences and one is clinical medicine) they are different exams and therefore the approach to them must be different.

While USMLE Step 1 tests a broad range of basic science knowledge requiring a mix of understanding and memorizing facts, CK focuses on a smaller range of content that requires more in-depth understanding to be able answer questions. This is why fact-based books such as First Aid are said to be essential for Step 1 but much less so for CK.

When approaching Step 1, ensure you learn that broad range of facts, and then focus your attention on the question bank to see how much depth you need to go into on certain sections. You may notice your score to be directly correlated with the amount of information you know.

With CK, you should shift your focus from how broad your knowledge base is to how much depth you have in high-yield concepts. You may find that unlike Step 1, your score goes up in a stepwise fashion because once an entire concept clicks, multiple questions will now be answerable. Focus on understanding treatment and work-up algorithms and why you do certain things in certain situations rather than a fact based approach of this disease = this work-up.

As a final caveat I should state that overall, Step 1 and Step 2 CK are much more similar than they are different. Both are medical exams that require BOTH broad knowledge and depth of understanding. It is simply the balance that is different in each, and therefore you should guide your learning accordingly.