I'll chime in on this because I had a terrible day on step 1 for some reason and barely scored in the 200's. I knew that I was screwed without boosting step 2, but I also knew that my strengths were on rotations, working hard and working with people. So, I took July off and studied for three weeks, took step two and scored in the mid 240's. I did an ortho month at my home place in aug. and aways in oct and nov. I only got 13 interview invites and could only make it to 9, but I matched. I am not sure where yet, but I am quite confident I won't go below my top 3 (the three places I rotated). So, you know yourself best. For me, I knew that without a decent step 2 I would get screened out of every place except where I rotated, so my focus early was step 2. After that, I knew that my overall best chance of matching somewhere good was by rotating there. For some people with great numbers but not the greatest personal skills, rotating can hurt them. You know yourself best. So as long as your application has other things that make you stand out, step 2 probably isn't the deal maker, but otherwise I'd take it early. As the previous post said, do you think you can improve? If you do better with clinically oriented topics then you'll probably improved on step 2 since it is a clinically oriented test. However, no doubt the sure way to earn a spot is by rotating with a program and getting the residents and attendings that you work with to like you and to see that you are going to work hard and do a good job. They'll go to bat for you. Hope this helps.