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All about USMLE Step 2 CK

  • USMLE Step 2 CK assesses an examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes an emphasis on health promotion and disease prevention.
  • USMLE Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine under supervision.
  • USMLE Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.
  • The examination also includes a minimum allotment of 45 minutes of break time and a 15-minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.
  • USMLE Step 2 CK examinations will include an increased number of questions that assess knowledge of Professionalism, systems-based practice, patient safety, legal/ethical issues, and professionalism (Beginning in November 2020).
  • You can see representative items in these categories: Step 2 CK Patient Safety and Step 2 CK Professionalism.
  • All USMLE examinations are constructed from an integrated content outline. Content is organized according to general principles and individual organ systems. Test questions are classified into one of 18 major categories, depending on whether they focus on concepts and principles that are applicable across organ systems or within individual organ systems.
  • The tables below provide information on the content weighting for Step 2 CK examinations administered before and after November 2020.

USMLE Step 2 CK Question Distribution

  • Sections focusing on individual organ systems are subdivided into normal and abnormal processes, including principles of therapy.
  • In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology.
  • While not all topics listed in the content outline are included in every USMLE examination, overall content coverage is comparable among the various examinations that will be administered to different examinees for each Step.

USMLE Step 2 CK System Specifications

Before November 11, 2020 On or After November 11, 2020
System Range, % Range, %
General Principles of Foundational Science 1–3 2–4
Immune System 4–6 3–5
Blood & Lymphoreticular System 4–7 4–6
Behavioral Health 6–10 6–8
Nervous System & Special Senses 6–10 6–8
Musculoskeletal System/Skin & Subcutaneous Tissue 6–10 6–10
Cardiovascular System 8–12 8–10
Respiratory System 7–11 7–9
Gastrointestinal System 7–11 7–9
Renal & Urinary System & Male Reproductive 4–8 4–6
Pregnancy, Childbirth & the Puerperium 4–8 4–6
Female Reproductive System & Breast 4–8 4–6
Endocrine System 4–8 4–6
Multisystem Processes & Disorders 5–9 4–6
Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature 1–5 3–5
Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety 3–7 10–15
  • NB:
    • Percentages are subject to change at any time.
    • The General Principles category for the Step 2 CK examination includes test items concerning those normal and abnormal processes that are not limited to specific organ systems.
    • Categories for individual organ systems include test items concerning those normal and abnormal processes that are system-specific.

Physician Tasks/Competencies

 USMLE Step 2 CK Physician Task/Competencies Specifications*

Before November 11, 2020 On or After November 11, 2020
Competency Range, % Range, %
Medical Knowledge: Applying Foundational Science Concepts 12–16 0**
Patient Care: History and Physical Exam 40–50 0***
Patient Care: Laboratory/Diagnostic Studies 13–17
Patient Care: Diagnosis 16–20
Patient Care: Prognosis/Outcome 5–9
Patient Care: Health Maintenance/Disease Prevention 7–11 8–12
Patient Care: Pharmacotherapy 22–27 8–12
Patient Care: Clinical Interventions 6–10
Patient Care: Mixed Management 12–16
Practice-based Learning & Improvement 3–7 3–5
Professionalism 5–7
Systems-based Practice & Patient Safety 5–7
  • NB:
    • *Percentages are subject to change at any time.
    • **Test items that assess patient care competencies may also assess knowledge of underlying foundational science concepts.
    • *** Test items that assess the history and physical exam competencies will be covered in Step 1 and Step 3 examinations.

Each Step 2 CK examination covers content related to the traditionally defined disciplines as listed below.

Step 2 CK Discipline Specifications

Competency Range, %
Medicine 50-60
Surgery 25-30
Paediatrics 20-25
Obstetrics & Gynecology 10-20
Psychiatry 10-15

Design of USMLE Step 2 CK

  • USMLE Step 2 CK consists of multiple-choice questions (MCQs) prepared by examination committees composed of prominent faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields make up the USMLE Test Material Development Committees.
  •  They are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.
  • Test questions focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training.
  • The content description is not intended as a curriculum development or study guide, but rather models the range of challenges that will be met in the actual practice of medicine.
    • It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis.
    • The categorizations and content coverage are subject to change.
  • The best preparation for the examination is broad-based learning that establishes a strong general understanding of concepts and principles in the basic and clinical sciences.


  • Read each question carefully.
    • It is important to understand what is being asked.
  • Try to generate an answer and then look for it in the response option list.
    • Alternatively, read each option carefully, eliminating those that are clearly incorrect.
    • Of the remaining options, select the one that is most correct.
    • If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.

Sample USMLE Step 2 CK Questions

Patient Scenario Formats

  • Patient scenarios for any Single Item or Sequential Item Set may be provided in either Vignette (paragraph) format, or in Chart/Tabular format.
  • Test items using the chart/tabular format are designed to resemble patient charts but are not intended to be an exact representation of a patient chart.
  • Questions written in chart/tabular format will contain relevant patient information in list form, organized in clearly marked sections for ease of review.
  • Familiar medical abbreviations may be used within chart/tabular format questions.

1. Single-Item Questions

    • This is the traditional, most frequently used multiple-choice format.
    • It consists of a single patient-centered vignette is associated with one question followed by four or more response options that are in an alphabetical or logical order.
    • The response options in this format are lettered (eg, A, B, C, D, E).
    • A portion of the questions involves interpretation of graphic or pictorial materials.
    • You are required to select the one best answer to the question.
    • Other options may be partially correct, but there is only ONE BEST answer.

2. Sequential Item Sets

    • A single patient-centered vignette may be associated with two or three consecutive questions about the information presented.
    • Each question is associated with the initial patient vignette but is testing a different point.
    • You are required to select the ONE BEST answer to each question.
    • Questions are designed to be answered in sequential order.
    • You must click “Proceed to Next Item” to view the next item in the set; once you click on this button, the next question will be displayed, and you will not be able to change the answer to the previous question.

3. Abstract Format

    • The abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician (eg, as an abstract that accompanies a research report in a medical journal).
    • Examinees must interpret the abstract in order to answer questions on various topics, including
      1. Decisions about care of an individual patient
      2. Biostatistics/epidemiology
      3. Pharmacology/therapeutics
      4. Use of diagnostic studies
    • See Example Abstract Item.

USMLE Step 2 CK Practice Materials

USMLE Computer-based Testing (CBT) Practice Session

  • Practice Sessions are available, for a fee, for registered examinees who want the opportunity to become familiar with the Prometric test center environment.
  • Register for a CBT Practice Session

Also read:

  1. Eligibility for USMLE
  2. USMLE Application
  3. USMLE Test Day
  4. USMLE Results and Score
  5. All about USMLE Step 1
  6. All about USMLE Step 2 CS
  7. All about USMLE Step 3
  8. Visit the official USMLE page

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