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How does USMLE Step 2 differ from USMLE Step 1?

The USMLE Step 2 Clinical Knowledge (Step 2 CK) is a part of the USMLE Step 2 exams, the other part being Clinical Skills (Step 2 CS). While Step 1 focuses on basic sciences, the Step 2 exam focuses on physiologic conditions and diseases, and important physician tasks. Another big difference is that Step 2 consists of two parts while the Step 1 exam is a one-part examination.

How much does the USMLE Step 2 cost?

The Step 2 CK exam fee depends on whether you are taking the test in the United States and Canada, or abroad. In the United States or Canada the fee is $610 (2018). If you choose to take the test in the Middle East, Latin America, Africa, Asia, or Australia, you will be charged an additional $170 as international test delivery surcharge. If you take the test in Europe, the surcharge would be $210.

The Step 2 CS exam can only be taken in the United States and costs $1,285 (2018).

2018 Fees Effective Dates for 2018 Fees
Step 1 $610 Three month eligibility periods beginning November 1, 2017 - January 31, 2018 and ending October 1, 2018 - December 31, 2018
Step 2 CK $610
Step 1 and 2CK $70 Eligibility Period Extension (requests received starting January 1, 2018)
Step 2 CS $1,285 For completed applications received starting January 1, 2018.


How many sections are in Step 2 CK? How is the USMLE Step 2 structured?

The Step 2 CK part of the exam consists of eight 60-minute blocks and has to be completed in one-day 9-hour testing session. You will be able to answer the questions in each block in any order or your preference, and you will also have the option to change your answers until you exit the block, or the allocated block time runs out. Once you exit the block, they get locked and you will not be able to review test items or change answers.

The Step 2 CS exam includes a day’s testing session where you will have twelve patient encounters. The time allocated for each encounter is fifteen and ten minutes to complete each patient note which should be typed on a computer. If you do not use the entire fifteen minutes for the patient encounter, the remaining time will be added to the ten minutes that you normally have for typing the patient note.

How many USMLE questions are on Step 2 CK?

The Step 2 CK has a maximum of 318 multiple-choice test items. The test is divided into eight 60-minute blocks. The number of questions per block does not exceed 40 items.

What is covered by the exam?

The Step 2 CK exam covers the contents from clinical specialties like internal medicine, obstetrics and gynecology, pediatrics, preventive medicine, psychiatry, surgery, and other areas relevant to provision of care under supervision. You are requested to provide one or more of the following while answering the questions: a diagnosis, prognosis, use basic science knowledge in different clinical situations, and the next step in patient management. Up to 3% of the exam focuses on foundational science, 90% covers individual organ system, and the remainder 7% addresses biostatistics and epidemiology.

The Step 2 CS cases cover common clinical presentations that you as a physician are likely to encounter in everyday medical practice. They may include cases that you are likely to see in outpatient clinics, emergency departments, or in the floors. You are expected to collect information from the patient by taking a detailed history, performing a focused physical examination, documenting your findings, giving a diagnostic impression, and writing down the initial patient workup.

Who is eligible to take the USMLE Step 2?

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

  • A medical student who is officially enrolled in or a graduate of a US or Canadian medical school
  • A medical student in a program that leads to an MD degree and that is accredited by the Liaison Committee on Medical Education (LCME)
  • A medical student officially enrolled or a graduate of a US medical school that leads to the DO degree and is accredited by the American Osteopathic Association
  • A medical student who is officially enrolled in or a graduate of a medical school outside the United States and Canada and is eligible for examination by the criteria set by the ECFMG

The same eligibility criteria apply for the Step 2 CS.

How many times can I retake Step 2 CK?

You may take the Step 2 CK exam no more than three times within a 12-month period. Your fourth and subsequent attempts must be at least 12 months after your first attempt and at least six months after your most recent attempt.

How do I apply for USMLE Step 2?

To complete your USMLE Step 2 application, you will need the following:

  • a computer to access the website
  • an e-mail address
  • a USMLE or ECFMG identification number and an online service password
  • A credit card such as Visa, MasterCard, Discover, or American Express to pay your exam fees, or a checking account in a US bank. You can also pay in advance by sending a payment to ECFMG using Form 900.

You must complete your application for the ECFMG certification before you apply for the Step 2 exam. You will then receive a USMLE or ECFMG identification number that you need to apply for the test.

What should I remember before arriving at the prometric center on exam day and what am I allowed to bring with me?

You should arrive at the test center approximately 45 minutes prior to your scheduled appointment time. You will be asked to present your scheduling permit and valid form of identification, which can be your passport, driver’s license with your photograph, national identity card, or any other forms of dated and unexpired government-issued identity card. Your name on the scheduling permit must match the name on your form of identification. If you fail to provide this, you will NOT be admitted to the test.

You can take with you only soft-foam earplugs (subjected to inspection) without strings. All other personal belongings should be stored outside the testing room. You can store your personal belongings in a small locker outside the secure testing area. You will not be allowed to write on anything except the laminated note boards provided by the prometric center during the exam and a scrap paper in Step 2 CS exams. You will also be provided with a marker pen at the center.

What is the passing score for Step 2 CK?

The current minimum passing score for the Step 2 CK is 209 (2018). The passing rate for examinees from US or Canadian medical schools for the Step 2 CK is 95%. The passing rate for examinees from outside the US and Canada is 71%. The passing rate for the Step 2 CS for examinees from the United States and Canada is 97%, whereas the passing rate from examinees outside the US and Canada is 78%.

If you do not know the answer to a question in the Step 2 CK, try to make a best guess. Wrong answers do not deduct extra points from your score.

How much is my performance on the USMLE Step 2 exams affected by the medical school I attend?

The relationship between medical schools and the ability of a student or a graduate to perform in the Step 2 exams is complicated. Larger medical schools where students score above average in the Step 1 positively correlates with higher Step 2 scores. Smaller medical schools are more likely to be associated with lower scores on the Step 2 most likely because they have a narrow curricular focus and a less diverse patient population.

How long does it take to get USMLE Step 2 results?

It takes around three to four weeks to get your score and transcript after taking the Step 2 CK exam. The reason is the fact that the USMLE’s scoring and processing are done in a secure and accurate fashion where several quality assurance steps need to be followed. You will need to wait more than four weeks to get the score of your Step 2 CS exam.

Can I retake the USMLE Step 2 CK to raise my score?

You can retake the Step 2 CK to raise your score only if you comply with certain state board requirements that have been previously approved by USMLE governance. You are not allowed to retake a USMLE Step that you have previously passed except in the following situations:

  • If you are currently enrolled in a US or Canadian medical school that is accredited by the LCME or AOE and leads to an MD or DO degree.
  • You have previously passed Step 2 and/or Step 2 but have not passed Step 3.
  • You are expected to graduate from the medical school program six or more years after the date of passing the exam you intend to retake.

What is the Step 2 exam format? What is the difference between USMLE Step 2 CK and CS

The Step 2 CK uses multiple-choice question (MCQ) format. You are asked to choose the best answer to each question.

Step 2 CS assesses clinical skills. It examines whether one can demonstrate the fundamental clinical skills needed for safe and effective care of patients under supervision. It focuses on three main components: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP). The Step 2 CS consists of twelve clinical cases. You will need to perform the following tasks to complete each case: data gathering and documentation using a clear spoken English. You should have good questioning and information-sharing skills, professional manner and rapport. Each case consists of two parts: the patient encounter and the typing in patient notes.