USMLE Step 1 or Step 2 CK – Which Exam should I take first?

By askdoc / May 2, 2011
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People preparing for the USMLE have been asking this question since as far as I can remember. Way back in 2004, when sitting for the USMLE was just a thought for me, there were very sound arguments for taking either one of this exam first.

If you are an AMG you may be wondering what the debate is all about, since you are required to take the USMLE Step 1 first. But for an IMG, who can take either exam first, this is a big questions which can have an impact in their performance in the exams. This is especially true for the Old IMG.

My recommendation for IMGs is to take USMLE Step 1 first before taking USMLE Step 2 CK as this can help you perform better overall in the Steps. If you want to know the reason why, then read on.

Why Take USMLE Step 1 First?

The reason you take USMLE Step 1 first before taking Step 2 CK is the fact that 20 to 25% of Step 2 CK is composed of topics covered in Step 1. This includes pathophysiology which are listed as mechanisms of disease in Step 2 CK. Both pharmacology and microbiology as well as immunology are also included in Step 2 CK.
If you take USMLE Step 2 CK first, you still need to study those topics in Step 1. By studying Step 1 first, you make sure you have covered those topics before you take Step 2 CK. It’s just more efficient that way. It is also important to note that all three topics are also covered in Step 3. Therefore it makes sense to make sure you study all of them very well during your Step 1 prep.

What About Clinical Vignettes?

Now what about clinical vignettes, you may ask. Isn’t it better to start with Step 2CK so it will be easier for me to diagnose clinical vignettes?

The clinical cases in Step 2CK is slightly different from the clinical vignettes in Step 1. Clinical vignettes in Step 1 are usually classical in presentation. In Step 2CK be prepared for cases with atypical presentations.

Whereas cases in Step 2CK are mostly common cases albeit with both common  and atypical presenthttps://blogs.askdoc-usmle.com/wp-admin/post.php?post=546&action=editation, Step 1 cases can be common or rare albeit with classical presentation most of the time. The determining factor in Step 1 is if the case illustrates an important basic science concept. For example, Prader Willi and Angelman syndrome are very rare. Therefore, it’s less likely to appear in Step 2CK although it will in Step 1 because it illustrates the concept of imprinting in Genetics.

So, in conclusion, it is highly recommended that you take Step 1 first before Step 2 CK for the reasons cited above.

 

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