USMLE Step 1 vs. Step 2 Comparison

USMLE Step 1 or USMLE Step 2, that’s the question. When you’re preparing to take the USMLE, many questions come up. You may want to know what exactly each test entails, how each test is designed and how they are scored.

Both the USMLE Step 1 and USMLE Step 2 are important in their own way. That’s why in the coming paragraphs, we’ll dissect both tests, their importance, and the differences in difficulty, knowledge and scoring.

Let’s get to it!

Knowledge: Step 1 vs. Step 2

There are different kinds of medical knowledge needed for Step 1 and Step 2.

First, Step 1 focuses on the basic knowledge of medicine. Here you should have access to a wide range of facts, and knowledge, about several areas like anatomy, physiology, biochemistry, pathology, pharmacology, microbiology and more.

The knowledge you need here is purely theoretical because of the nature of the tests. So when you’re preparing, you should be able to memorize a wide range of facts with ease.

However, Step 2 is designed to test your clinical knowledge. What this exam tries to find out is not the basics of medicine but, instead, if you’ll be able to accurately diagnose patients, treat them, and perform the right tests on them.

The exam is normally split into two

  • Step 2
  • Step 2 Clinical Knowledge (CK)

This is unlike Step 1, which isn’t split. Ultimately, Step 2 makes sure as medical personnel, you’re ready to interact with a patient and apply standard evidence-based management practices.

Note that the Step 2 CS exam has been cancelled permanently as of January 2021.

Scoring differences: Step 1 vs. Step 2

Obviously, the scoring between the USMLE Step 1 and USMLE Step 2 is a tad different.

USMLE Step 1 and Step are both scored differently. While the USMLE program doesn’t disclose its scoring system, it’s important to look closer at the minimum and average scores for each step to prepare well for the exams.

Scoring well on the USMLE exams is crucial because they play a significant role in determining residency matches. Typically, higher scores are associated with better chances of being matched. The minimum passing score for Step 1 is 194, but the average scores for Step 1 and Step 2 vary by specialty.

For instance, neurology residents had an average Step 1 score of 229.5 with a standard deviation of 17.1 in the 2020-21 school year. The minimum passing score for Step 2 CK is 209, and neurology residents scored an average of 239.4 with a standard deviation of 15.4 in the same year. However, it’s important to note that scores can vary significantly depending on the specialty and resident.

Thus, if you’re planning to become a neurologist, it’s advisable to aim for a score close to or above 230 for Step 1 and 240 for Step 2 CK to stay competitive with your peers. So, keep this in mind as you prepare for the exams. Be sure to use CanadaQBank to prepare.

Difficulty: Step 1 vs. Step 2

The level of difficulty for USMLE Step 1 and Step 2 is dependent on individual knowledge and skills, so it’s difficult to determine how hard one is compared to the other.

Step 1 assesses a broad range of fundamental scientific knowledge, while Step 2 covers a narrower range of medical concepts directly applicable to clinical practice. So, the time required to pass each step may vary from person to person.

USMLE Step 1 is an eight-hour exam with seven one-hour blocks with breaks. It may have up to 280 multiple-choice questions with a maximum of 40 questions per section. Refer to the USMLE’s official content outline for further information.

USMLE Step 2 CK, on the other hand, focuses on high-yield concepts that are essential for safe medical practice under supervision. The exam is nine hours long and comprises eight one-hour blocks with breaks. It may include up to 318 questions, with 40 questions per block. You can visit the USMLE’s official content outline for Step 2 to learn more about the test.

You can also learn more about the test at CanadaQBank.

Which exam matters more: Step 1 or Step 2

People often say that USMLE Step 1 is the most crucial exam of one’s life and should be studied extensively. However, for certain residencies, such as Emergency Medicine, Internal Medical,  and Surgery, Step 2 CK holds more weight than Step 1. This is because it has the strongest correlation with the likelihood of passing the board exam, which is a crucial marker for a residency program’s education quality.

While the importance of each exam may vary depending on the residency program, it is safe to say that both exams hold significant value.

To prepare for each exam, one must take a different approach.

For USMLE Step 1, a broad range of basic science knowledge must be acquired, and memorization of facts is essential.

On the other hand, Step 2 CK focuses on a smaller range of content, requiring a more in-depth understanding to answer questions. Therefore, learning high-yield concepts and understanding the treatment styles are crucial for success in CK. So, it is essential to adjust your approach to the exam accordingly to maximize success.

Should you take USMLE Step 2 CK or Step 1 first

So you may be wondering, “Which exam should I take first, Step 1 or Step 2”. Well, the answer is not as simple.

Students must now decide whether to take Step 1 or Step 2 CK first because of the recent change to pass-fail for Step 1. Thus, the order of taking the USMLE tests has become an even more significant concern. The USMLE Step 2 CK is now the only scored USMLE test, which means it will receive more attention from residency programs.

While most students take Step 1 first, a few students have opted for Step 2 CK first, and they have done well. Taking Step 1 first allows you to solidify key concepts fundamental to clinical medicine, build a foundation for Step 2 CK, and maximize study time. Additionally, taking Step 1 first gives you more time to practice and get used to the USMLE format. On the other hand, taking Step 2 CK first allows you to focus on the more important test (Step 2 CK) first, particularly with Step 1 being pass-fail now.

Ultimately, the choice lies with you and only you.


Both USMLE Step 1 and Step 2 are very important exams in their own right. While Step 1 tests your fundamental understanding of basic concepts of medicine, such as anatomy, microbiology, physiology and biochemistry, Step 2 takes a more clinical approach. Thus, both exams should be taken seriously.

Take advantage of our QBank, study guides, and access to our vast education resources at CanadaQBank. Whether USMLE Step  1 or USMLE Step 2, you are covered!