What Are Common FAQ About USMLE® Step 2 CK and COMLEX® Step 2?

Consensus opinion provided by Steve Leslie, MD; Ali Tariq, MD; and Nick Lorenzo, MD

• When do you take the USMLE® or COMLEX® Step 2?
  • Most students take the USMLE® Step 2 or COMLEX® Step 2 in July - September after completing their third year of medical school.
  • In 2022, with the emphasis on the USMLE® Step 1 score being decreased due to making it a pass-fail exam, the USMLE® Step 2 exam will quickly become the single most important test for students interested in matching in highly competitive specialties. 

• How many questions are in the USMLE® Step 2 CK?
  • The USMLE® STEP 2 Clinical Knowledge (CK) is a nine-hour exam broken into eight one-hour sections, with 40-45 questions each, with 355 questions. 

• What is the pass rate on USMLE® Step 2?
  • The USMLE® Step 2 CK pass rate is usually 96% for first-time test takers from the USA. For international students, approximately 71% pass on the first attempt.

• What happens if you fail the USMLE® Step 2?
  • Failing either Step 1 or Step 2 CK once decreases your chance of matching by approximately 20 to 25%. An examinee may not take the same USMLE® Step 2 CK examination more than six times, including incomplete attempts. All attempts are counted toward the limit, regardless of when the examinations were taken.

• What order should I study subjects in for USMLE® Step 2 CK or COMLEX® Step 2?
• • Based on the emphasis of USMLE® Step 2 CK and COMLEX® Step 2, start with internal medicine, then surgery, pediatrics, obstetrics and gynecology, and psychiatry. Flag questions missed, and as the examination nears, reverse the order so that review of the highest tested items that were missed in pediatrics, surgery, and medicine are covered just prior to the exam. 

• What is the best method to prepare for the USMLE® Step 2 CK or COMLEX®  Step 2?
  • Study techniques vary from student to student. Some students are “oral learners” and should focus their study time on reviewing lectures. Many students learn and increase recall by doing as many questions as possible and then reviewing explanations and articles based on the questions. Whatever approach the student takes, it is clear that those who start early and practice questions often will achieve the highest scores on USMLE® Step 2 or COMLEX® Step 2. It is strongly recommended that students develop a habit of spending at least 30 minutes twice a day doing practice questions throughout their 3rd year of medical school, repeating questions missed until consistently answered correctly with an understanding of the concept.

• How long does it take to get your USMLE® Step 2  or COMLEX® Step 2 score?
  • Scores of USMLE® and COMLEX® Steps 1, 2, and 3 are normally available within three to four weeks from the test date.

• What is a good USMLE® Step 2 CK Score?
  • A “good score” is somewhat dependent on the training program being considered. Some specialties require much higher scores than others to be considered a “strong applicant.” The following ranges of USMLE® Step 2 CK scores are arbitrary but should assist in setting a goal to match in a selected specialty area. The average score varies from year to year but tends to be approximately 233. Candidates should remember that academic performance, letters of recommendation, and experience in a field are also important factors. A high USMLE® Step 2 CK score alone is not sufficient to ensure a match in most specialties. Students must have other favorable accomplishments in addition to strong Step 2 CK scores.
  • 209-219: The minimum passing score is 209. Scores in the range of 209-219 are considered low, and as a result, it may be more difficult to match. Match data suggests that scores below 219 on Step 2 CK will likely limit a student’s match possibilities. Students in this range should strongly consider applying to a broad range of less competitive training programs.
  • 220-232: This range is just below average. Students with scores at the lower end may face more challenges to match, particularly in competitive specialties.
  • 233-250: This range is considered above average. Students with scores in this range will be able to match in most specialties.
  • 251 and above: Scores of better than 251 are considered excellent. Scores above 251 typically indicate that all specialties may be considered for potential matching; those with a 251 or higher are likely to have multiple choices of training programs.

• What USMLE® Step 2 score is necessary to get into a competitive residency program?

• From year to year, the average USMLE® Step 2 CK for acceptance into each specialty varies. The following provides the average score achieved for the NRMP match for the last five years.
• Average - 246
• Anesthesiology - 243
• Child neurology - 245
• Dermatology - 255
• Diagnostic radiology - 250
• Emergency medicine -246
• Family medicine - 238
• General surgery - 249
• Internal medicine - 247
• Internal medicine/pediatrics 249
• Interventional radiology - 254
• Neurosurgery - 250
• Neurology - 243
• Obstetrics and gynecology - 248
• Orthopedic surgery - 254
• Otolaryngology - 253
• Pathology - 243
• Pediatrics - 242
• Physical medicine - 240
• Plastic surgery - 255
• Psychiatry - 240
• Radiation oncology - 254
• Vascular surgery - 245