How Is USMLE Step 2 Graded and What Score Should You Aim For

When Step 1 transitioned to pass/fail, USMLE Step 2 CK became the main academic differentiator for residency programs. If you’ve ever wondered how is USMLE Step 2 graded or what score actually counts as competitive, this post will break it all down — from the grading system itself to realistic target scores for top specialties.

How USMLE Step 2 Scoring Works

Unlike Step 1’s former numeric score, Step 2 CK continues to use a three-digit scoring system, typically ranging from 1 to 300. Your score represents your performance relative to a national reference group of first-time test-takers from accredited U.S. and Canadian medical schools.

The average score hovers around 245, with the standard deviation around 15 points. That means most students fall between 230 and 260 — but what matters most is how that score translates into a percentile compared to other examinees.

The NBME uses a process called equating to ensure fairness across different test versions. This statistical adjustment accounts for slight variations in difficulty so that a score of 250 on one form reflects the same performance level as a 250 on another.

What Does “Passing” Mean on Step 2 CK?

The current passing score (as of 2025) for Step 2 CK is 214. That’s the baseline every student must reach to officially pass the exam.
However, with Step 1 now being pass/fail, most program directors expect scores significantly higher than that to demonstrate academic strength.

In other words, passing isn’t enough if you’re aiming for a competitive residency. The higher your Step 2 score, the more leverage you have — especially in specialties where Step 1 used to play a major role.

Understanding Step 2 Percentiles

Percentiles show how you performed relative to other test-takers. For instance:

• 50th percentile: Around 245
  
• 75th percentile: Around 255
  
• 90th percentile: Around 265
  

A percentile doesn’t change based on a single year’s cohort—it’s recalculated annually as new data emerges. So, a 250 today might represent a slightly different percentile next year, depending on how the overall pool performs.

Percentiles matter because residency directors use them to compare applicants objectively. Even if they don’t fixate on your raw score, your percentile ranking speaks volumes about where you stand academically.

What Score You Should Aim For by Specialty

Your target Step 2 score should depend on your specialty goals and the competitiveness of those programs. Here’s a general guide:

Highly Competitive Specialties

The most competitive specialties typically demand scores in the top percentile. Dermatology is considered one of the most competitive, requiring scores in the 255–270+ range. Similarly, Orthopedic Surgery requires applicants to be in the 250–265+ range, with a top percentile score often being required for a match. General Surgery is also highly competitive, with a score range of 245–260+, placing a high emphasis on the Step 2 CK score for success.

Mid-Range Competitive Specialties

Specialties in the middle of the competitiveness scale balance strong scores with other application components. Internal Medicine is considered a mid-range competitiveness specialty, with a required score range of 230–250. Emergency Medicine applicants should aim for 240–255, as this field balances the need for strong clinical skills with academic performance.

Other Specialties

The remaining specialties require solid scores while often relying on a more holistic review of the applicant. Pediatrics and Psychiatry share a similar competitive score range of 225–245. For Pediatrics, there is a focus on consistency across the application, while Psychiatry still emphasizes a holistic review beyond just scores. Finally, Family Medicine is among the least score-dependent, with a competitive range of 220–240, and places a strong emphasis on well-rounded performance and fit within the program.

Of course, numbers aren’t everything — but they help you gauge what programs expect and how much effort to allocate to Step 2 prep.

Why Step 2 CK Matters More Than Ever

Since Step 1 became pass/fail, Step 2 CK has taken on greater importance. It’s now viewed as the most objective academic metric available to residency directors.

In fact, a 2024 NRMP survey showed that Step 2 CK score ranked as the #2 factor in residency selection — right behind letters of recommendation.

That means your Step 2 performance could determine whether your application gets a serious look in competitive specialties.

How to Improve Your Step 2 Score

If you want to score higher, your focus should shift from memorization to clinical reasoning. Here’s how to maximize your prep:

1. Start early with a structured plan.
   Give yourself at least 3–4 months of dedicated study time and create a schedule that integrates UWorld, NBME practice exams, and review blocks.
   
2. Use UWorld effectively.
   Don’t just memorize answers—understand the “why” behind each explanation. Review your wrong answers daily.
   
3. Incorporate active recall.
   Use Anki or flashcards to solidify key concepts. Passive reading wastes valuable time.
   
4. Simulate test conditions.
   Take full-length NBMEs under timed conditions. This helps you manage pacing and stamina.
   
5. Track your progress.
   Regularly assess your percent-correct and NBME predictions to ensure you’re trending toward your goal score.
   

Final Thoughts

So, how is USMLE Step 2 graded? It’s a carefully standardized process designed to evaluate your clinical reasoning and application of medical knowledge. But beyond just “passing,” your score tells residency programs how well-prepared you are for the next phase of training.

If you want to boost your Step 2 CK performance, use MedSchoolBro’s USMLE Prep Bundles — designed by top scorers to help you master high-yield concepts, build test stamina, and stay organized through every study phase. Study smarter, score higher, and match with confidence.