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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About the author

    askdoc

  • bekka says:

    hello
    im old img and take my usmle CK in may but failed with 73/188
    and i can’t undertand , i work more than 2years i have 3 kids and wife, i x
    work in hospital in emergency department
    i study koalan note and do UW with 70%
    i uwsa with 199
    do u think ist better to change and switch to usmle1 and after usmle ck or to continu with ck thank
    for yu advice

  • zaina says:

    Hi doc..

    Thanks for all the insightful posts! Please know your help is highly appreciated by all fellow FMGs! I recently graduated med school in June, 2011. And moved to the States recently and planning to prep for my usmles. However, I am considering of doing step 2 CK first since its still fresh in my head cuz I did my final MBBS exam this june. Hence, Im sorta “clinically oriented” at this point and I am weak in the basic sciences. So knowing all this do u still recommend doing step 1 first?

    Many thanks!

  • askdoc says:

    Hi Zaina,

    Please understand that 20% of Step 2 CK is basically Step 1. If you do not study that well, you lose 20% of the total score even if you do well on the clinical parts. Therefore, you need to study pathology, pharmacology and micro/immuno very well if you want to take Step 2 CK and do well as well as study the clinical subjects. And those 3 subjects is 65% of Step 1. So if you study for Step 2 first, you have to study 65% of Step 1 plus the clinical subjects of Step 2 CK. Still its your choice.

    Askdoc

  • askdoc says:

    Hi bekka,

    Suggest you start with Step 1. But more importantly understand whether you are studying correctly for this exam. Just knowing the materials is not enough to pass this exam. USMLE expects you to know the materials. The questions focus on whether you understand the materials and can apply them in particular situations presented in the exam.

    Askdoc

  • asad says:

    im a final year mbbs student…i wanted to know ur opinion if it is better for me to give usmle part 2 first or part one…cuz the subjects i am studying right now are the same that would be in part 2.

  • Mehru says:

    If i want to become a cardiologist, and i do my a-levels from pakistan, what do i have to do next to be qualified for giving the USMLE exams. & can you please tell me what benefits do you get after passing your USMLE?

  • askdoc says:

    HI Mehru,

    To be able to take the USMLE as foreign grad, you need to be a graduate of a medical school recognized by the ECFMG. Go to the ECFMG website at http://ecfmg.org. If you want to practice medicine in the US, i.e. get into a residency program or fellowship, then you need to pass the USMLE to be able to do so.

    Askdoc

  • fish says:

    can an IMG give the usmle step 1 from usa?

  • Dango says:

    Hi Askdoc,
    It seems you are emphasizing that step 2 ck is more important than step 1. As I read, PDs use step 1 to assess your performance on usmle. So I have a strategy of doing usmle step 2 first, so that if I dont get good score in step 2 , I still have chance to excel in step 1 which is way more important.It is as if I am using step 2 ck to excel step 1. How about this strategy? please give me your advice on this.

  • askdoc says:

    Hi Dango,

    All AMG have only Step 1 when they go for their interviews. Therefore that is the only basis that PD’s have to evaluate among them. For IMG’s Step 2 CK is important in that having two results for evaluation, PD’s will use it. Also with Step 2 CK finished, PD’s are assured that the one they chose won’t suddenly be disqualified because they failed Step 2 CK. And lastly. your main competition are your fellow IMGs not AMGs so concentrate on beating other IMGs. And there is no guarantee with that strategy you will excel in Step 1 or even that that strategy can help you excel in Step 1. So I don’t see the point of your argument. Or why doing in that way will be an advantage.

    Askdoc

  • askdoc says:

    Hi fish,

    You can take it anywhere you like. A lot of IMGs take their Step 1 there. Of course they are mostly residents in the US.

    Askdoc

  • Mina says:

    Can somebody please tell me for what is PD abbreviation?

  • askdoc says:

    Hi Mina,

    PD means Program Director.

    Askdoc

  • Minghia says:

    Dear askdoc,

    Thank you for your article.

    So if, say, somebody has to take step 2 ck before step 1. That someone can’t take step 1 (hypothethical). How would you suggest that the student covers for this while prepping for step 2 ck? Just reading FA Step 1 would be enough? Doesn’t doing a lot of question banks make up for the lack of step 1 knowledge, or not?

    I am looking forward to your knowledgeable answer.

  • askdoc says:

    Hi Minghia,

    First, First Aid Step 1 will not teach you Pathology. It presumes you know Pathology and Pathophysiology. It will give you a short high yield review so you remember the most important topics on exam day. If you do not understand those topics or study them in detail, you will be in the familiar situation a lot of people find themselves in. They recognize all the topics in the exam but cannot answer the question. That is probably the most common complaint of people who fail the exam. And that is the effect of studying just FA and the online qbanks. If you are third year medical student, using FA and qbank alone can work because you still remember all your basic medical science stuff in detail. In all other situations, you have forgotten enough of it that you can’t rely on it unless you actually study it again.

    Askdoc


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