What’s a Good Step 2 Score and How to Improve Fast

by Alec Palmerton, MD in Plan, Step 2 CK/Shelf

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What is a good Step 2 CK score? Is your predicted Step 2 CK score not where you want it to be? Are you performing much lower than you hoped? Are you wondering when – or even whether – you should take your Step 2 CK exam?

For many students, Step 2 CK represents their last best hope. Some of us have poor prior test scores (e.g., not passing Step 1, low Shelf scores, etc.) that we want to make up for. Others wish for a high score to stand out in the crowded residency application process. Whatever the reason, it is (very) common for students to panic in the weeks leading up to their Step 2 CK because of their predicted scores.

In this article, you will learn:

• What is a good Step 2 CK score,
• How Step 2 CK scores have changed over time,
• The fastest way to improve your Step 2 CK score if you only have a few weeks (or less),
• How to weigh whether to delay your Step 2 CK exam date,
• What happens when your Step 2 CK score comes back after you submit your ERAS application, and
• Much more

What is a Good Step 2 CK Score?

Here are the percentiles for Step 2 CK. Note that there are two periods, July 1, 2014 – June 30, 2017 and July 1, 2019 – June 30, 2022.

How Have Good Step 2 CK Scores Changed Over Time?

As you can see above, a “good” Step 2 CK score has changed over time. We can graph the percentiles over these two periods to see clearly that Step 2 CK scores have increased significantly over the years.

Step 2 CK: July 2014-June 2017 vs. July 2019-June 2022

Note that the Step 2 CK scores from the latter period include some time after Step 1 became pass-fail. As Step 2 CK will take on added importance, we would expect Step 2 CK scores to continue to increase in the future.

What Can We Do When Our Step 2 CK Performance is Below Our Goals?

What can we do if we want a good Step 2 CK score, but our predicted scores are lagging? Here are four things you can do.

Improve Question Interpretation

You may be wondering: what is the fastest way to improve my Step 2 CK score? In most cases, question interpretation (QI) is the quickest way to improve your score on any USMLE – particularly Step 2 CK.

What is question interpretation? QI is learning how to analyze the meaning behind every sentence in a vignette – knowing what it means and why the question writer put it there.

QI is easiest to understand when you consider what it is not. Interpreting a question is NOT scanning for buzzwords or reading the last sentence/question first. Instead, it is looking at the 56-year-old man with crushing chest pain and recognizing that his smoking is likely a coronary artery disease risk factor. QI would also mean knowing that smoking in a different context – a 36-year-old woman on OCPs with sudden onset chest pain – likely means a DVT risk factor.

To read more about question interpretation, read this article.

How Much of an Effect Can QI Have?

So, if so much of Step 2 CK is based on our interpretation ability, what effect might we see on our final scores? Potentially a significant impact.

Here is a student who just took his Step 2 CK, who was in Never Forget. Note that these practice exams were all within a week of each other.

• Form 10 (7/16): 223 (65%)
• Form 9 (7/19): 220 (63%)
• Form 11 (7/23): 242 (73%)
• Step 2 CK Score (7/28): 245

Note that within 12 days, he improved by 22 points (and 19 points on his NBME). That is a remarkable improvement. This jump would be much less likely for someone studying for Step 1. Note: some students may see a considerable improvement in their Step 1 score if they’ve done few/no practice questions, simply due to familiarity with the test. However, it is rare to see such a significant short-term jump for students who have already done lots of practice questions.

For Step 2 CK? Such a considerable score improvement is more common, which in my opinion, is because we can improve question interpretation in a much shorter period.

Assess Your Step 2 CK Goal in Context of Your Larger Goals

Another task when considering what to do is to figure out your goal with Step 2 CK. For example, do you need your score to make up for another area of perceived weakness on your residency application? Are you looking just to pass? The answers to these questions will dramatically impact your options and actions.

Consider Delaying Your Test

One thing to consider is possibly delaying your exam. Most people studying for Step 2 CK have a short timeline. Specifically, they may want/need to:

Get a score back before they submit their ERAS (Electronic Residency Application Service) residency application and/or
Re-enter clerkships/do a sub-I/etc.

If you’re in the above situation, you may feel pressed against the wall. If that is true, know there are often options for delaying clerkships to give you more time. In addition, it may even benefit you to delay your test, so results come AFTER ERAS submission.

Let me explain.

Consider Taking Your Test So Results Come Out After You Submit Your ERAS Application

If your practice Step 2 CK scores are well your goals, you may consider delaying your exam until after submitting your residency application. Wait, what?

Many people are hoping for high Step 2 CK scores because they want to either:

• Stand out more and/or
• Make up for other perceived deficiencies in their residency applications (e.g., not attending a prestigious med school, low shelf scores, insufficient research, etc.)

So, you want a high Step 2 CK score to impress those evaluating applicants for residencies. Then why would you like your results to come in AFTER you’ve submitted your application?

Step 2 CK Scores Received After ERAS Submission: Choice to Send to Residencies or Not

Because by receiving your results after ERAS submission, you have a CHOICE of whether to submit the scores or not.

From the ERAS® Fellowships Documents Office (EFDO):

If you receive a new or updated score after submitting your MyERAS application, you will need to return to the Documents | Additional Documents section and click on “Resend My Scores” to have your updated USMLE transcript retransmitted to your programs.

In other words, if your Step 2 CK score comes out AFTER you’ve sent your residency application, you must manually submit it to programs. However, because submission is manual and not automatic, it means you have a CHOICE of whether to submit it or not.

This choice translates into a more favorable risk/reward equation for many:

• If you have a high score? Great! Submit it immediately to all programs.
• Have a low score? Depending on the rest of your application, you may consider not submitting it – or submitting it to select programs.
• Fail Step 2 CK? Probably best to hold off on submitting it while you work on your re-take.

But What About Step 1 Pass-Fail?

This strategy of receiving your test after ERAS submission works best if:

• You have other strengths in your application (e.g., solid LORs/connections with programs of interest, lots of research, etc.) and
• You’re worried about the effects a low Step 2 CK may have

On the off-chance you have a high(er) Step 1 score to fall back on, delaying your Step 2 CK would be a relatively easy call. (This possibility is only relevant for the small number of people who took Step 1 when it was still scored; most will have a “pass”). That said, the more likely scenario is that you don’t have a Step 1 score – or at least one you can bank on.

In that case, delaying is less to give you a choice on whether to submit or not. Instead, delaying your exam would give you the best chance to maximize your Step 2 CK prep (and score).

DO Students May Benefit Even More From Delaying Step 2 CK So Results Come In ERAS Submission

DO students, in particular, may benefit from delaying their exams, so results come out after ERAS submission. Why? Because DO students still do not necessarily need a USMLE score to match. Of course, it would be preferable to have a Step 2 CK score – particularly a higher one. But if there is a reasonable chance of not passing Step 2 CK? DO students, in particular, may consider taking their test later. In the worst-case scenario that they don’t pass, their report wouldn’t automatically go to the programs they apply to.

Concluding Thoughts: Asymmetric Bets in Your Favor Can Help Keep You Calm

So, what should you do? You may feel anxious about your Step 2 CK performance like most normal human beings. Stress and anxiety are typical around exams, especially the USMLEs.

That said, remember that you have options when you take your test. For example, you may feel tremendous pressure to do well on Step 2 CK by a particular date. In particular, you may feel stressed about delaying your test so your results come in a few weeks after residency programs can view ERAS applications. However, it likely won’t be the end of the world.

Yes, residencies look at applications and grant interviews on a rolling basis. However, the choice is less evident if given a choice between an application with a delayed – but possibly higher – Step 2 CK score vs. a lower Step 2 CK score. Many programs have filters based on USMLE scores, given the many applicants. As a result, programs screen out roughly 50% of applicants without getting a careful look. With Step 1 pass-fail, the most logical filter is Step 2 CK.

Plus, with interviews moving remote – and likely staying there – the benefit of being in the first wave of invites wanes. Now, there is less of an advantage to doing all of your interviews in a particular location simultaneously. If you don’t need to fly back and forth between locales, it matters much less that your two Boston-area interviews aren’t in the same week.

Remember, it can be comforting – and stress-relieving – to take your test knowing that it can only help you and has less chance of hurting you. If that means delaying your exam a bit to get more time – even if it doesn’t fit your ideal timeline – that can still be ok.

Want Help With Question Interpretation?

Want to improve your question interpretation so Step 2 CK questions are easier? In the Yousmle Never Forget Course, question interpretation is at the core of what we do. We will teach you how to identify what you’re missing and study it so vignettes become more automatic and easier. Schedule a free consultation to learn more.

What do you think? Is delaying your exam a viable option for Step 2 CK if you want to apply this year? How much of a score improvement are you looking for? Let us know in the comments!