USMLE Step 1 vs. Step 2 CK: Understanding the Differences and Similarities

The USMLE or the United States Medical Licensing Examination is a three-step examination that medical students require to pass in order to practice medicine in the U.S. The program is owned by two entities i.e., the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). The USMLE assesses your ability to apply the skills and concepts learned in medical school to patient care, diagnosis, and treatment. Scoring high on the USMLE is important as it brings you closer to your dream residency program. The higher the score, the higher the chances of being matched.

As described earlier, the USMLE is divided into three steps i.e., step 1, step 2 CK, and step 3. Although these steps are a part of USMLE, they are different from each other. However, all the USMLE steps complement each other. In this article, we will discuss the similarities and differences between the USMLE steps 1 and 2 CK.

How is the USMLE Step 1 different from the Step 2 CK?

USMLE Step 1

Skills tested on the USMLE Step 1

The USMLE step 1 evaluates your ability to apply basic science concepts learned in medical school to patient care. It primarily focuses on health, disease, and mode of treatment. The exam content includes fundamental concepts revolving around various systems and processes occurring in living organisms. Questions included in this USMLE step test a wide range of basic science knowledge and are based on the topics like anatomy, pathology, physiology, pharmacology, microbiology, biochemistry, and so on.

When do I take USMLE step 1?

The medical students take USMLE step 1 at the end of the second year of medical school. The best time to take any test is when you are fully prepared for it. We recommend that the best time to take step 1 is as soon as possible after completing the basic science subject reports when the difficult topics are still fresh in your mind. The time required for studying for the USMLE step 1 is 3-6 months.

What is on the USMLE Step 1 exam?

Step 1 is a one-day exam divided into seven blocks. Each block must be completed within 60 minutes. The total time allocated for the test is 8 hours with 45 minutes of break and 15 minutes of optional tutorial.

The total number of questions in the USMLE Step 1 exam is 280 with each block having around 40 questions.

USMLE Step 1 Scoring

The Association of American Medical Colleges (AAMC) transitioned USMLE step 1 scoring from a numeric score and pass/fail outcome to pass/fail only. The standard passing score for this step is 196. The USMLE step 1 results are released on or after 26th January according to AAMC.

You should mainly emphasize learning important principles, grasping basic science concepts, and memorizing facts to achieve high scores while preparing for the USMLE step 1. In addition, the test takers should enhance their abilities to adequately answer the test question and acquire comprehensive knowledge of the content.


The USMLE step 2 CK focuses on a smaller range of content that is specially designed to assess the applicants’ clinical science knowledge and skills. The USMLE step 2 is divided into two parts i.e., step 2 CS (clinical skills) and step 2 CK (clinical knowledge).

Skills tested on Step 2 CK

The USMLE Step 2 CK tests the medical students’ understanding of clinical science that is requisite for patient care and disease prevention. Content areas in the USMLE step 2 include internal medicine, preventive medicine, psychiatry, surgery, obstetrics and gynecology, and so on. The test items revolve around clinical medicine, disease diagnosis, prognosis, and underlying disease mechanisms. 

When do I take USMLE Step 2 CK?

Most medical students take USMLE step 2 CK at the end of the fourth year of medical school. The best time to take the USMLE step 2 exam is when the knowledge from clinical rotations is still fresh in your mind. The time required for studying for the USMLE step 2 is at least 4 weeks.

What is on the USMLE Step 2 CK?

Just like Step 1, the USMLE Step 2 CK is also a one-day exam divided into eight blocks. Each block must be completed within 1 hour. The total time allocated to the USMLE steps is 9 hours including 45 minutes of break and 15 minutes of optional tutorial.

The number of questions per block on the USMLE Step 2 CK varies, but each block in this USMLE step also has around 40 questions. The total number of questions is 318.

USMLE Step 2 CK Scoring

The USMLE step 2 CK grading is based on a competitive numeric score and the minimum score required to pass the exam is 209. The USMLE step 2 CK results are declared within 3-4 weeks after the exam day. The results for the applicants who take the test in June-July are declared in August.

While preparing for step 2 CK, the medical students should spend more time grasping important concepts and learning the principles of clinical science that lay the foundation for the safe and competent practice of medicine.

NBME Shelf Exams and the USMLE Steps

Shelf exams are subject-based exams taken by medical students in the third year of their med school (MS3). These exams are organized by NBME to assess the applicants’ skills to practically apply their medical knowledge within an actual clinical setting. The NBME shelf exams are usually taken after a medicine clerkship and core rotations in fields like internal medicine, obstetrics and gynecology, surgery, neurology, pediatrics, psychiatry, and family medicine. Thus, the questions included in these exams are based on the practical application of clinical science concepts learned in these subjects.

Shelf exams are named so because they comprise questions expired from the USMLE step 1 and step 2 CK that have been “shelved” by the NBME. Therefore, preparing well for shelf exams actually prepares you for the USMLE Step 2 CK.

Strategies to ace the USMLE Steps

The USMLE is one of the hardest yet most significant exams to get into your dream residency program. Keeping the above-mentioned facts in view, employ the following strategies to give your ultimate best in the USMLE steps 1 and 2 CK.

1.   Prepare well for the shelf exams.

The experts suggest that your performance on the NBME shelf exams shows a high correlation with your success in the USMLE Step 2 CK exam due to the underlying reasons.

·        The test items on the USMLE Step 2 CK are similar to those in the shelf examinations.

·        The same resources are used to prepare for both USMLE Step 2 CK and the shelf exams.

In other words, when you are preparing for the shelf exams you are also preparing for the USMLE step 2. A good performance during your core clerkship ensures your chance to succeed on the USMLE Step 2 CK. Therefore, work hard to excel in the shelf exams as well as the USMLE.

2.   Use the right resources to prepare for USMLE.

While studying for the USMLEs, choosing the right resources can be quite helpful. Use resources like textbooks, video lectures, and qbanks to prepare for the USMLEs. Some popular resources used by the test-takers to prepare for the exam include:

BoardVitals USMLE Qbank

BoardVitals is an important online tool for USMLE preparation. Its qbank has over 3000 questions for steps 1 and 2 CK and elaborate explanations of the questions.

Kaplan USMLE Prep Courses

Kaplan is also a popular USMLE resource that provides med students with online video lectures and subject-wise textbooks for the USMLE steps 1 and 2 CK preparation. Its qbank also has thousands of questions with well-articulated explanations of the test questions for the preparation.

UWorld USMLE Qbanks

UWorld’s qbank contains 30600 test questions with detailed explanations, diagrams, and flowcharts only for Step 1. In addition, UWorld offers various self-assessments and practice tests that mimic the actual USMLE test pattern. Solve these practice tests to prepare yourself for the test day.

Other resources include the First Aid textbook for step 1, pathoma for pathology lectures, and USMLE Rx Qbank.

3.   Make a study schedule.

A great way to prepare for the USMLEs is to make a study schedule. A study schedule provides you with an accountability framework and an agenda to rely on. The USMLE is not a piece of cake and you need to take out at least 10 hours of dedicated study time at least 5 days a week to prepare for your USMLE exam. Keeping this in view, make a USMLE study schedule and strictly follow it to conquer the USMLEs.


1. How hard is step 1 compared to 2 CK?

Apparently, step 2 CK seems easier as compared to step 1 as most test-takers perform much better on the step 2 CK exam than the step 1 exam. Step 1 focuses on high-yield concepts and requires more studying as compared to step 2 CK which emphasizes patient presentation and includes questions based on diagnosis and treatment. Step 2 CK requires less studying than step 1.

2. Which USMLE step is more important: step 1 or 2 CK?

Although step 1 is considered more important overall, yet when it comes to specific residencies (Internal Medicine, surgery, etc.), step 2 CK has more weightage. However, all the USMLE steps complement each other and you need to score high on both steps 1 and 2 CK to succeed.

James Edge

James Edge

James is on a mission to uncover the greatest study guides and prep courses to ensure you pass your exam on your first attempt. He has personally assessed hundreds of study materials and developed courses himself.

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