How is USMLE Step 2 different from USMLE Step 1?

In the US, medical practice is regulated through state laws and requires a license that is obtained after clearing the USMLE exam. This is also commonly known as the boards and is crucial for all med school graduates as it has a decisive impact on their careers. To clear USMLE one must put in a lot of effort. Completion of medical school, post-graduate training as a resident doctor, and passing a challenging medical license exam are the prerequisites that prepare anyone for entering the healthcare profession as a doctor. The USMLE exam tests the prospective doctor’s knowledge of critical topics for efficient patient care, disease management, and health promotion. 

The licensure exam is divided into three steps namely Steps 1,2, and 3. As per the format any applicant can take Step 1 and 2 in any sequence but can attempt Step 3 only when they clear both Step 1 and 2. Each Step differs from the other in many aspects. There is a common belief that Step 2 is easier than 1 but that has been busted off-late by many students who talked or wrote about their experience. The time and seriousness allocated to study USMLE step 2 should be equal and similar to other levels of the exam.

Here are some commonalities and differences between Step 1 and Step 2 that can help a person:

• Core knowledge

The knowledge base between Step 1 and Step 2 is different from a skills perspective and various areas of a student’s clinical science and medical applications knowledge are tested to gauge their competence. 

Successful doctors who have passed the exam feel that the Step 1 part is critical as it is based on basic sciences. In a way it makes an exam taker go through whatever they learned in their bachelor program as a refresher and apply that in a clinical setting. It requires in-depth knowledge of science topics like life sciences including pathology, physiology, pharmacology, and more. 

A person taking Step 1 has to prepare for a broad range of science topics. Many resources will help a person prepare for these topics. It is essential to be consistent in efforts when preparing for these topics as few people have reported that they get confused as they crammed their preparation towards the last few days. 

Step 2 is based on clinical medicine. It is the appropriate application of clinical medicine that you have learned. Often there are more than one correct answer and the apt fit in the given circumstances is the best course of action. 

• Scoring pattern

Recently the exam format of USMLE underwent a few changes. A significant one among that is that there is no score for Step 1. It is either pass or fail that determines the successful attempt of an applicant.

This leaves Step 2 in USMLE an important aspect in terms of the score as this stage will be the first measure that can differentiate between two applicants of similar stature when being screened by the residency program director for a hospital. 

The minimum score to pass Step 2 is 214. However, passing the exam alone cannot be the objective of students who have come this far to choose the specialization of medicine they would like to pursue. Hence the student needs to score above the median score that has acted as a barrier for different disciplines. 

The maximum score in Step 2 is 300. Many people have achieved between 240-280 for winning a position as a resident in a program of their choice. 

How to prepare for USMLE?

1. Start early

It is essential to strategize your journey for USMLE while in the first year of medical school. Early starters will always have the advantage of time on their side and they can learn from other’s mistakes and not repeat them from their end. 

2. An appropriate time for an exam

Step 1 is based on basic science concepts. It is ideal to complete this step when the science topics from your bachelor program are still fresh in your mind. You can attempt it either in the first or second year of the medical program.

Step 2 has a lot of questions based on how a doctor handles patient care in a clinical situation. It is ideal to complete this step soon after a med school student has finished clinical rotations. In this manner, the concepts are fresh in your mind and the questions can be mapped easily with practical exposure to what you might have learned. 

It is recommended to prepare for Step 2 by being attentive in clinical rounds and trying to absorb everything that goes around. You can also come up with alternative paths and ask the instructor if that might work. In this manner, you can clear the elimination process during the preparation time itself. 

3. Preparation

Whether one is appearing for Step 1 or 2, a few common things are the preparation pattern. Both exams are intensive and one is not easier than the other. If ever it is a consolation, the applicant is more confident by the time they appear for their second level. And for a student to feel relaxed about an exam, there has to be a considerable amount of time spent preparing for the paper. 

It is good to refer to resource material and online prep courses that can help streamline the exhaustive preparation through easy-to-understand 3D videos that are immersive with simulated animations. An enacted animated picture is retained for a longer duration and helps in the overall planning for the exam.

Conclusion:

The Step 1 and 2 exams are equally challenging and open the doors for the final step of the USMLE exam. Although the exam is exhaustive, competitive, and tests the nerves of the applicants, with a sequential and organized study pattern, one can score well in the exam. A student who fails can reapply. However, it does bear on the outcome when one is applying for the residency program of their choice.