A Step 2 CK score of 250 or above is generally considered competitive for internal medicine residency, placing you near the 50th percentile among US and Canadian medical school test-takers. But “good” depends heavily on who you are, where you trained, and what type of program you’re targeting. A US MD senior applying to a community program faces a very different bar than an international medical graduate aiming for a university-based program.
Why Step 2 CK Matters More Now
When USMLE Step 1 shifted to pass/fail scoring, residency programs lost the numerical filter they had relied on for decades. Application volumes didn’t shrink. They grew. Programs needed a new sortable metric, and Step 2 CK filled that gap. For internal medicine specifically, Step 2 CK now ranks as roughly the second most important factor program directors consider when deciding who gets an interview, sitting alongside clerkship grades, class rank, letters of recommendation, and medical school reputation.
Before the change, Step 2 CK was a secondary academic marker. Now it functions as the primary numeric screen for many programs. That doesn’t mean it’s the only thing that matters, but it does mean a strong score carries more weight than it used to, and a weak score is harder to offset.
Score Percentiles to Know
The USMLE publishes percentile data based on first-time test-takers from US and Canadian medical schools. For the current testing window (July 2022 through June 2025), the breakdown looks like this:
- 240: 24th percentile
- 245: 34th percentile
- 250: 47th percentile
- 255: 60th percentile
- 260: 74th percentile
- 265: 85th percentile
- 270: 94th percentile
These percentiles are normed to US and Canadian graduates only, so international medical graduates scoring in these ranges are compared against that same reference group. The minimum passing score is currently 214, though it rises to 218 for anyone testing on or after July 1, 2025.
What Different Applicants Need
Your target score depends on your applicant category. Internal medicine is one of the largest specialties in the Match, and it draws applicants from every background, but the expectations vary.
US MD Seniors
US allopathic seniors have the most flexibility. A score in the 245 to 255 range is solid for most community and mid-tier university programs. If you’re aiming for a top-20 academic program or positioning yourself for a competitive fellowship later (cardiology, gastroenterology, hematology/oncology), scores above 260 make your application noticeably stronger. Below 240, you’re in the bottom quarter of test-takers, and while you can still match, other parts of your application need to do more heavy lifting.
DO Seniors
DO applicants generally benefit from scoring at or above the averages for MD applicants, since some programs still carry implicit bias toward allopathic graduates. A Step 2 CK score above 250 helps level the playing field. Strong clinical rotations at ACGME-accredited sites and solid letters from internal medicine attendings can complement a good score.
International Medical Graduates
IMGs face the highest score expectations. Data from the American Medical Association shows that US citizen IMGs who matched into internal medicine averaged a Step 2 CK score of 238, while non-US citizen IMGs averaged 244. Those are averages for matched applicants, meaning plenty of people who matched scored below those numbers and plenty who didn’t match scored above them. But as a practical target, IMGs should aim for 245 or higher to stay competitive, and scores above 250 significantly improve interview odds. Internal medicine absorbs roughly 40% of US citizen IMGs and about half of non-US citizen IMGs who match in any specialty, making it the most common landing spot for international graduates.
Academic Programs vs. Community Programs
University-based internal medicine programs, especially those affiliated with major medical centers, tend to receive far more applications per spot. These programs can afford to set higher score filters, often screening out applicants below 240 or even 250 before a human ever reads the file. If a program uses an algorithm to sort thousands of applications, your Step 2 CK score is likely the first number it sees.
Community-based programs are typically less score-driven. Many prioritize interview performance, clinical experience, and compatibility with the program’s patient population and training style. A score in the 230s that would get filtered out at an academic center may be perfectly acceptable at a well-regarded community program. That said, the overall trend since Step 1 went pass/fail has pushed even community programs to pay more attention to Step 2 CK than they once did.
How Programs Actually Use the Score
Most internal medicine programs use Step 2 CK scores in two distinct phases. First, as a screening cutoff to reduce a massive applicant pool down to a manageable interview list. Second, as one data point in a holistic review of your entire application. Clearing the first filter is the more important function. Once you have an interview, your score matters less than how you perform in person, what your letters say, and whether you seem like a good fit.
This means there’s a practical ceiling to the return on a higher score. Going from 235 to 255 can dramatically increase your interview invitations. Going from 260 to 275 is less likely to change your outcome in a meaningful way, because at that point you’ve already cleared every filter and the rest of your application takes over. If you’re deciding whether to delay your exam for a few more points versus submitting your application on time, the calculus depends on where you currently stand. Crossing a threshold like 240 or 250 is worth the effort. Pushing from 265 to 270 probably isn’t.
If You’re Planning a Fellowship
Internal medicine is a three-year residency, but many applicants choose it specifically because they plan to subspecialize. Competitive fellowships in cardiology, gastroenterology, and pulmonary/critical care look at Step 2 CK scores again during fellowship applications, sometimes years after you first took the exam. If subspecialty training is part of your plan, aiming higher now saves you from having a number that becomes a liability later. Scores above 255 keep most fellowship doors open. Scores above 260 give you a meaningful edge for the most competitive subspecialties.