With Step 1 now pass/fail, residency programs rely heavily on Step 2 CK scores to differentiate applicants. While no single test defines an application, Step 2 has become one of the most critical objective metrics available to program directors.
A score above 270 places a student in the top 6% of test takers nationwide (>94th percentile). That’s impressive, but it’s essential to recognize that a 270 is not required for residency success.
For most specialties, a score in the 250s is already highly competitive. This guide outlines the strategies used by high scorers (including those who have broken the 270 barrier) to achieve their impressive results—strategies you can replicate to do the same.
This guide was written by Aditya Belamkar, M.D., who earned a Step 2 CK score of 274 (99th percentile).
How to Score 270+ on USMLE Step 2
Step 1: Build a Strong Foundation with Core Rotations
The content on Step 2 CK is not evenly distributed. Internal medicine, surgery, and pediatrics together account for roughly 75% of the exam. Performing well on these rotations is the single best way to position yourself for success on Step 2. Think of them as the foundation of the exam—if you know them cold, everything else becomes easier to handle.
During clerkships, UWorld should be treated as the primary study tool. Completing all questions, carefully reviewing explanations, and redoing incorrect answers before each Shelf exam builds the foundation that will carry into dedicated Step 2 prep. This method does two things at once.
First, it prepares you for your Shelf exams, which often overlap heavily with Step 2 content. Second, it builds a framework for dedicated study. By the time dedicated rolls around, high scorers don’t have to start from scratch; they already have a solid grasp of the most heavily tested material.
Another overlooked benefit is that UWorld teaches you how to think like the exam writers. Each question forces you to pull together key details, recognize the illness script, and apply first-line management or treatment decisions. Over time, this trains you to cut through long vignettes quickly and zero in on what matters.
Step 2: Master UWorld and Review Misses Aggressively
UWorld is the single most important resource for Step 2 CK. Other tools, such as First Aid, Divine Intervention podcasts, or clerkship review books, can add supplementary value, but they should never displace question-based practice.
Step 2 is, at its core, an exam of pattern recognition and clinical reasoning. The only way to train those muscles is by consistently engaging with questions written in the same style as the real test.
High scorers don’t just “get through” UWorld—they master it. That typically means completing the entire bank once during clerkships, then redoing a significant portion during the dedicated study block. The repetition is not about memorization; it’s about refining thought processes and stress-testing knowledge until weak points are eliminated.
What truly differentiates top performers is the review method. Every missed question is an opportunity, but only if handled correctly. Instead of transcribing explanations or copying entire paragraphs, high scorers condense each error into a single, targeted learning point: the precise concept that was missed. For example:
- Wrong: writing a page about all causes of chest pain.
- Right: “Acute pericarditis = positional/non-anginal chest pain, diffuse STE and/or electrical alternans, friction rub”
This forces clarity, prevents wasted time, and makes review sustainable over hundreds of questions.
The second layer of mastery comes from reframing wrong answers. Every incorrect choice is correct in a different clinical context. Asking, “How would this vignette need to change for that answer to be right?” transforms one question into five mini-lessons and builds the kind of flexible knowledge Step 2 relentlessly tests.
By test day, the error log should be lean, high-yield, and fully reviewed—with every previously missed concept checked off. The end goal is simple but powerful: never miss the same mistake twice.
This philosophy of error correction and efficiency is what separates good scores from truly exceptional ones. It’s not about knowing everything; it’s about ensuring nothing slips through the cracks twice.
Step 3: Integrate AMBOSS and Anki for Reinforcement
While UWorld forms the backbone of preparation, AMBOSS and Anki provide crucial reinforcement. AMBOSS exposes students to alternative question styles and explanations, while daily Anki reviews, specifically the widely available AnKing deck, ensure that key details remain fresh.
AMBOSS introduces students to alternative question styles, in-depth explanations, and an expansive medical library. Its questions are often slightly more detail-oriented than UWorld’s, which challenges test-takers to recognize subtler distinctions between similar clinical presentations.
This exposure makes UWorld, and ultimately the real exam, feel more approachable. A highly effective strategy is to work steadily through AMBOSS during the winter and spring of third year, targeting 10–20 questions per day on lighter rotations. This creates a slow but steady second pass through high-yield concepts and trains flexibility in question interpretation without overwhelming daily schedules.
Anki, specifically the widely used AnKing deck, serves a different but equally essential purpose: retention.
Step 2 is as much about keeping information accessible under pressure as it is about acquiring it in the first place. By committing to daily Anki reviews and steadily graduating cards throughout clerkships, students leverage spaced repetition and active recall to combat the forgetting curve.
By the time dedicated study begins, this habit ensures that high-yield details are not just vaguely remembered, but immediately retrievable.
Together, this two-pronged reinforcement strategy creates a powerful safety net. AMBOSS expands understanding and offers fresh practice, while Anki guarantees that nothing slips away.
This is the essence of the “slow and steady wins the race” approach: small, consistent effort applied across months builds a deeper and more durable foundation than any single resource used in isolation. When layered onto UWorld mastery, this combination maximizes both comprehension and recall—the exact skills Step 2 demands.
Step 4: Develop Illness Scripts
Scoring highly requires more than memorizing facts. One differentiator is learning to recognize illness scripts—the core clinical patterns that define how diseases present and how they should be managed. Step 2 questions are long by design, but buried within each vignette are just a few critical features that point directly to the answer.
Most diagnoses can be identified by two to four key features. For example, Beck’s triad (hypotension, muffled heart sounds, jugular venous distension) immediately signals cardiac tamponade.
Once that anchor is recognized, the rest of the vignette becomes noise. Applying this method across disease processes allows students to quickly group conditions by their defining clinical patterns—effectively creating mental “shortcuts” through even the most verbose question stems.
But illness scripts are not just about recognition; they’re also about anticipation. Step 2 rarely stops at diagnosis—the test is designed to probe the next logical step in clinical reasoning. Effective illness scripting means expecting questions in the following high-yield domains:
- First-line management or treatment
- Exceptions to standard rules
- Common or high-yield side effects
- Classic “Step 2 factoids” related to pathophysiology
When approached this way, each vignette is no longer a wall of text but a pattern-recognition exercise. The test becomes less about grinding through details and more about instantly recognizing the defining features, predicting the angle of the question, and selecting the correct answer with confidence.
This skill—turning long, complex cases into recognizable and testable illness scripts—is one of the most powerful strategies for moving from a solid score into the 270s. It combines speed, accuracy, and exam-specific reasoning, which are the three qualities Step 2 is truly built to assess.
Step 5: Dedicated Study and Practice Exams
During the dedicated study block, the emphasis should be on questions and review:
- Reset UWorld and complete as much as possible.
- Take all NBME and UWorld practice exams under timed conditions.
- Review missed concepts daily using a streamlined error log.
The review process is what makes or breaks Step 2 performance. High scorers don’t just read the correct explanation and move on—they break down every part of the question.
- Educational Objective: Focus first on what UWorld or NBME identifies as the key learning point. This is often the exact type of fact the exam expects.
- Wrong Answer Choices: Don’t skip them. Each incorrect option is correct in a different clinical scenario. Ask, “How would this vignette need to change for this answer to be right?” This transforms one question into three to five learning opportunities.
- Illness Script Integration: Add the missed point to a running document, condensed into a single line. Keep it specific, not broad. For example: “Tamponade = hypotension + JVD + muffled heart sounds.” The goal is to capture only what was missed, not to rewrite a textbook.
- Error Correction: Once a concept is truly mastered, cross it out. By test day, the error log should be thoroughly reviewed with no concept left unchecked. The goal is simple—never miss the same mistake twice.
This process does more than reinforce knowledge—it rewires thinking. By reframing wrong answers into illness scripts and repeatedly revisiting missed material, students train themselves to anticipate testable variations of the same concept.
Over time, long vignettes stop feeling overwhelming and instead become pattern-recognition exercises. Each stem can be stripped down to its defining features, and the answer can be predicted with confidence.
In short, dedicated study is not just about the volume of questions completed. It’s about extracting maximum value from every question, turning errors into scripts, and arriving at test day with no blind spots and no repeated mistakes.
Step 6: Treat Test Day Like Game Day
Scoring well on Step 2 CK is not just about months of preparation—it is equally about executing on test day. High performers approach the exam like athletes preparing for competition: every detail is rehearsed, and nothing is left to chance.
Key Elements of a Test-Day Strategy:
- Fuel: Eat the same breakfast you practiced with during full-length exams. Familiar foods reduce the risk of stomach issues and help maintain steady energy. Test day is not the time to try something new.
- Breaks: Plan your breaks in advance. A common strategy is a short walk or stretch every two blocks, using the time to decompress, hydrate, and reset.
- Snacks & Caffeine: Bring what has worked consistently during practice exams. Stick to familiar options that provide sustained energy without spikes or crashes.
- Mental Resets: Between blocks, take 30–60 seconds to close your eyes, breathe deeply, and clear your head. This brief pause prevents stress from accumulating across the day.
- Visualization: Many elite performers, including athletes and musicians, rehearse success mentally before competition. The same principle applies to Step 2. In the days leading up to the exam, walk yourself through the entire test day—from waking up, to your commute, to sitting down for the first block. Visualizing the sequence in detail builds confidence, reduces uncertainty, and primes the brain to perform under pressure.
A carefully planned test-day routine ensures that all the preparation translates into peak performance. Fatigue, nerves, and distractions are minimized, leaving space for focus, recall, and clinical reasoning to take center stage.
Common Step 2 Mistakes
These are the most common pitfalls students fall into when preparing for and taking the USMLE Step 2.
- Overloading on Resources: Students chase every new book, deck, or podcast instead of mastering core materials like UWorld. This creates the illusion of productivity but dilutes focus when Step 2 rewards depth and precise application, not breadth of resources.
- Writing Long, Unfocused Notes: Students respond to missed questions by transcribing entire explanations, filling pages of notes they never revisit. This feels productive but fails to create concise, memorable takeaways that actually improve recall and application.
- Repeating the Same Mistakes: Students miss the same question types multiple times because they move on quickly instead of properly analyzing and correcting errors. This prevents turning mistakes into permanent strengths when Step 2 recycles the same patterns repeatedly.
- Ignoring Test-Day Strategy: Students neglect preparing for the 8-hour endurance challenge, treating it like another study session. Poor execution on test day—including fatigue, untimed breaks, or untested routines—can prevent knowledge from translating into points despite adequate preparation.
Frequently Asked Step 2 Score Questions
What Percentile Is 270 on Step 2?
A score of 270+ typically corresponds to the 94th percentile.
Find our comprehensive breakdown in our guide to Step 2 percentiles.
Can You Retake Step 2 for a Higher Score?
No. Step 2 CK can only be retaken if it is failed.
Learn what happens and what to do if you fail USMLE Step 2.
Is a 270 a Good Enough Score on Step 2?
Absolutely—but it’s worth emphasizing that scoring above 270 is by no means necessary for residency success. Any score above 260 typically places an applicant above the threshold for securing interviews, even in highly competitive specialties.
Higher scores may look good, but they generally do not provide a significant additional advantage, especially if other aspects of your residency application are lacking.
What Step 2 Score Do I Need for Residency?
It depends on the specialty:
- Internal Medicine: 230–240+
- General Surgery: 240–250+
- Dermatology, Neurosurgery, Plastic Surgery: 250+ often expected
- Family Medicine: 220+ typically sufficient
However, Step 2 is only one part of the equation. Program directors also weigh clinical evaluations, research, leadership, extracurricular activities, and letters of recommendation. To get a clearer sense of overall competitiveness, use the Residency Predictor Tool.
Final Thoughts
Scoring 270+ on Step 2 requires more than hard work—it requires focused, efficient strategies. The formula is consistent: prioritize UWorld, review mistakes systematically, reinforce with AMBOSS and Anki, master illness scripts, and execute with a game-day plan.
Achieving a competitive Step 2 CK score requires a strategic, personalized approach that addresses your specific weaknesses. Med School Insiders USMLE Step 2 tutoring provides a customized study plan tailored to your needs, 260+ scoring tutors who have passed rigorous screening processes, recorded sessions for review, and detailed feedback after each session.
Our flexible online platform adapts to your learning style and schedule constraints, allowing you to access it from anywhere, regardless of your rotation obligations.
Most importantly, we stand behind our methods with a score increase guarantee. Whether you’re preparing for your first attempt or recovering from a setback, our tutoring program provides the strategic guidance needed to achieve competitive scores that open doors to your desired specialty.
These methods have worked for students who achieved some of the highest scores on the exam. But remember: Step 2 is just one part of the residency application. While aiming high is admirable, residency programs value a well-rounded application above any single number.
