When should I take USMLE Step II: Early, Mid-Year, or Late? (Louis Binder, MD)

Again, this is an individualized consideration for each student, and there are no right or wrong answers. Below are some of the salient considerations:

Will you have completed all of your core junior year clerkships (Medicine, Surgery, Pediatrics, Psychiatry, Ob/Gyn, Family Practice) by August? If not, plan on deferring Step II until prerequisite clinical experiences are completed.

Is passing USMLE II a requirement for graduation at your school? If so, this mitigates toward taking USMLE II earlier, in order to preserve time for a second attempt at the exam if unsuccessful.

What is your level of standardized test taking skill? If you are not a proficient standardized test taker, consider taking the exam in August to preserve time for an additional attempt prior to graduation.

Preparing for the Step II exam will cause a certain amount of extra distraction in conjunction with other priorities. What is your preference - to have this distraction occur in early fall amidst specialty choice decision making and residency applications, in late fall during important rotations, or in the winter with interviews and rank order lists? There is no "right" answer; each student is able to pick the point in the senior year when the least parallel distraction is anticipated, allowing the best focus on the examination. Whether you choose (or not) to plan unscheduled time for these periods, or for USMLE II preparation, may influence this consideration.

The final consideration on when to schedule USMLE Step II is whether you would desire for USMLE II to be a consideration in the residency application process (take early) or not (take late). To explain the thinking here, use the analogy of the "NFL Draft". At the scouting events, top draft prospects will often skip these sessions, while weaker prospects want to attend to show scouts what they can do, and enhance their chances of getting drafted. Why? The top prospects have nothing to gain by a good workout, but have a lot to lose with a sub-par workout performance, including draft position and money. The weaker prospects have little to lose from a poor workout, but have much to gain from a strong one. The analogy carries over with Step II timing from a residency application viewpoint. If you achieved a Step I score of 240, you have little competitiveness to gain in taking Step II early, but much to lose with a sub-par performance. From a competitiveness standpoint alone, you might consider deferring the exam (although if it is better to take it early for other timing reasons, then do so). Conversely, if you achieved a Step I score that is marginally competitive in your intended specialty, then take Step II early. You have little to lose from a poor score (correlates with the lower score for Step I anyway, doesn't change programs thinking about your candidacy), but everything to gain in raising your competitiveness with a good score. This is a golden opportunity to improve your application if you can prepare well and perform superbly.