Which is the Hardest Test a Medical Doctor Has to Take? Is it the MCAT, USMLE Step 1, Step 2, etc.?

This question was originally posted on Quora.com and was answered by Paul Bolin, M.D. (physician)



Step 1.

The MCAT has a fairly limited amount of information in disciplines that are objectively easier (elementary chemistry, general biology, etc.). Admittedly, I took the MCAT prior to the changes made in 2015, so my perspective might be outdated.

Steps 2 and 3 are limited to commonly-encountered diseases and situations. That’s not to say it’s a small amount of information, as there are many commonly-encountered diseases and situations. It is also more judgment based. In other words, there may be multiple “correct” choices on a Step 2 or 3 question, but you’re expected to choose the “best” correct choice.

Step 1 is almost purely a memorization test. It tests molecular biology and biochemical processes and detailed microbiology that you will never encounter in real life. The unique thing about Step 1 is that you could administer the exam to 100 practicing physicians and it’s quite likely that the majority of them would fail, and fail by a lot. That’s not the case for Steps 2 and 3.

Personally, I found that I could reason my way through Step 2 and 3 questions. I could rule out wrong answers and make an educated guess, and more often than not I’d be right. With Step 1, there are a large number of questions where you either know it or you don’t. If you know it, it’s easy. If you don’t, you’ll have to make a wild guess. That’s the nature of a memorization test. And, for me, memorization tests are harder than judgment tests.

Does this look like something your friendly doctor would need to know? (Step 1)


Or rather this? (Step 3)


Obviously one you see — tangibly and practically. The other is pure trivia.

An honorable mention for Step 2 CS (which tests your clinical interview and exam skills, judged by model patients and real physicians). While well over 90% of examinees pass the exam, I found it difficult because it was almost impossible to “study” for it. You also have to satisfy a checklist, which just isn’t practical in real life. That is, in real life, you’re not going to ask a patient with an obvious migraine about their sexual activity. But on Step 2 CS you may be docked points if you fail to gather a full history. You have to get used to doing things in a way that you just don’t do in real life, as it’s simply not practical or time efficient.

The old adage for Steps 1, 2, and 3 — when it comes to what you need to prepare is “Two months, two weeks, and a number two pencil.” I think that’s pretty accurate.

Dr. Paul

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