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Taking Step 1 After Rotations: Pros and Cons


The traditional structure for taking the USMLE Step 1 exam has been after the first two years of medical school followed by Step 2 CK after core clerkships. However, some medical schools are allowing students to take Step 1 after clinical rotations. This approach may become more popular due to the COVID-19 pandemic and limited availability at Prometric test sites.

Taking Step 1 after clinical rotations has been found to result in higher scores, enhanced understanding, and the ability to explore career options. However, there are also cons to this approach such as less time to explore residency options and having to re-learn basic science coursework. 

When studying for Step 2 CK, students should set aside ample time and can choose to study for both exams simultaneously or sequentially. It is important to remember that there is no one-size-fits-all approach and an individualized study plan can be helpful.

In this article, we will explore the advantages of taking the USMLE step 1 and step 2 ck exams after completing rotations. We will also discuss the importance of determining the timing of these exams.

Pros of taking USMLE Step 1 after clinical rotations

Achieving better scores in Step 1: On average, students who take USMLE Step 1 after clinical rotations score higher than those who take it before.

Increased comprehension: Being able to see related topics in real life on the wards strengthens students' understanding of Step 1 material.

Having the capability to explore any career options without any restrictions: By taking Step 1 after clinical rotations, students have the opportunity to explore different specialties without feeling limited by their score.

Cons of taking USMLE Step 1 with Step 2 CK After Rotations:

There is a limited amount of time available to consider and evaluate different residency choices: While Step 1 may not be the most crucial component of your application, it is arguably the most pivotal test you will undertake during medical school. As a result, the score does factor into which specialty and residency programs a student should contemplate applying for. Not getting their score until summer can limit a student's time to explore their desired specialty. Since applications for rotations are due in spring, uncertainty about scores and specialty can make planning for rotations more difficult.

Having a requirement to refresh one's understanding of fundamental scientific subjects: Even though students will gain valuable experience in clinical medicine, which will be very useful while preparing for Step 1, they will also unavoidably begin to lose some knowledge related to biochemistry, pharmacokinetics, and other subjects that are important for Step 1. Therefore, when it is time to study for Step 1, students will have to effectively start learning this material over again.

Requiring the need to plan and schedule test dates beforehand: Students need to estimate how long they want to study for each exam and secure Prometric test dates in advance.

Importance of dedicated study time for each exam

The USMLE Step 1 exam focuses on fundamental science topics, while Step 2 CK is more centered around clinical matters. Although there are similarities between the two, they also have notable distinctions. Consequently, it is crucial for students to allocate enough study time for both exams, whether concurrently or consecutively.

The period of time required for students to prepare for each exam varies based on various aspects that are unique to each individual. These factors comprise their targeted score, the extent of progress they have achieved in their studies, and how familiar they are with the subject matter.

There are two primary study plan options, as discussed earlier. The first is to prepare for both exams concurrently, which typically takes around 6 to 10 weeks. Alternatively, students can opt to study for each exam one after the other. In this case, it is recommended that they focus on Step 1 for at least 4 to 6 weeks before taking a brief break and then investing another 2 to 4 weeks in preparing for Step 2 CK.

It is recommended to prioritize studying for Step 1 due to the foundational concepts covered in the exam, but ultimately it is up to the student to decide which exam they want to take first. Regardless of the order, a sequential approach can help in tackling UWorld question banks effectively for both exams.

Individual factors to consider for study plan

Timeframe: Students need to consider their timeline for taking both exams and plan accordingly. Some students may choose to study simultaneously, while others may prefer to take them sequentially.

Goals: Students should have clear score goals for both exams and tailor their study plan accordingly.

Comfort level with material: Depending on the student’s past performance and level of comfort with the material, they may need more or less study time for each exam.

Strengths and weaknesses: Identifying personal strengths and weaknesses in each topic area can help students structure their study plan and focus on areas that need more attention.

Resource availability: Students should consider the availability of resources, such as study materials and practice exams, when planning their study schedule.

Career aspirations: Students should consider how their Step 1 and 2CK scores may impact their choice of specialty and residency programs, and plan accordingly.

Reminder that there is no one-size-fits-all approach to USMLE exams. Encouragement to seek individualized help from tutors if needed.

Frequently Asked Questions About Taking Step 1 After Rotations 

Do you need to pass Step 1 rotations? 

In order to begin your second rotation, it is necessary for you to successfully complete Step 1. It should be noted that the process could vary in an osteopathic school. It will be quite challenging to prepare for test taking during your rotations. 

How many months to prepare for Step 1? 

Drawing on our background of working with medical graduates from around the world, we have found that it typically takes 6 to 12 months to prepare for the Step 1 exam and 4 to 7 months for Step 2 CK, which tests clinical knowledge.

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