Step 2 CK


The Step 2 Clinical Knowledge (Step 2 CK) portion of the Step 2 exam consists of multiple-choice questions that reflect the broad representation of academics, clinical practice, and licensing communities across the United States and Canada. The clinical science material of the Step 2 CK is organized along two dimensions:

  • Normal conditions and diseases (normal growth and development, basic concepts, and general principles) and
  • Physician tasks (preventive medicine and health maintenance, understanding mechanisms of disease, establishing a diagnosis, and patient management).

Examination Content

Step 2 CK includes test items in the following content areas:

  • Internal Medicine
  • Obstetrics and Gynecology
  • Pediatrics
  • Preventive Medicine
  • Psychiatry
  • Surgery
  • Other areas relevant to provision of care under supervision

Most Step 2 CK test items describe clinical situations and require that you provide one or more of the following:

  • a diagnosis,
  • a prognosis,
  • an indication of underlying mechanisms of disease,
  • the next step in medical care, including preventive measures.

Normal Conditions and Disease Categories

  • Normal growth and development and general principles of care
  • Individual organ systems or types of disorders
    • Immunologic disorders
    • Diseases of the blood and blood-forming organs
    • Mental disorders
    • Diseases of the nervous system and special senses
    • Cardiovascular disorders
    • Diseases of the respiratory system
    • Nutritional and digestive disorders
    • Gynecologic disorders
    • Renal, urinary, and male reproductive systems
    • Disorders of pregnancy, childbirth, and the puerperium
    • Disorders of the skin and subcutaneous tissue
    • Diseases of the musculoskeletal system and connective tissue
    • Endocrine and metabolic disorders

Physician Task

15%–20% Promoting preventive medicine and health maintenance
20%–35% Understanding mechanisms of disease
25%–40% Establishing a diagnosis
15%–25% Applying principles of management

  • Percentages are subject to change at any time. See the USMLE website for the most up-to-date information.

Test Length and Format

Step 2 CK has approximately 370 multiple-choice test items. It is divided into eight sixty minute blocks and administered in one nine hour testing session. For Step 2 CK, during the defined time to complete the items in each block, you may answer the items in any order, review your responses, and change answers. After you exit the block or when time expires, you can no longer review test items or change answers.

Eligibility Criteria

To be eligible for Step 2 CK, you must be in one of the following categories at the time of application and on the test day:

  • a medical student officially enrolled in, or a graduate of, a US or Canadian medical school;
  • program leading to the MD degree that is accredited by the Liaison Committee on Medical Education (LCME);
  • a medical student officially enrolled in, or a graduate of, a US medical school leading to the DO degree that is accredited by the American Osteopathic Association (AOA); or
  • a medical student officially enrolled in, or a graduate of, a medical school outside the United States and Canada and eligible for examination by the ECFMG.




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