All About the USMLE® Step 2 Exam

Everything you need to know about Step 2 CK and Step 2 CS

USMLE Step 2 at a glance

The USMLE Step 2 is the next in the series of standardized exams required for earning medical licensure in the United States. Step 2 is divided into two parts: Clinical Knowledge (CK) and Clinical Skills (CS). While Step 1 focuses on basic sciences, Step 2 focuses on important physician tasks, physiological conditions, and diseases. Step 2 CK and Step 2 CS can be taken in any order, but you must receive passing scores on Step 1 and both parts of Step 2 in order to be eligible to take Step 3.

What is the difference between Step 2 CK and Step 2 CS?

The main difference between Step 2 CK and Step 2 CS is the format of the test. Step 2 CK consists of eight 60-minute blocks and has to be completed in a one-day, 9-hour testing session. You will be able to answer the questions in each block in any order, 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. There are a maximum of 40 questions per block.

Step 2 CS is also a day-long testing session, in which you will have twelve patient encounters. The time allocated for each encounter is fifteen minutes, with an additional ten minutes to complete each patient note (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. All data gathering and documentation must be completed in English.

Who can take the USMLE Step 2?

At the time of application and testing for Step 2, you must be: 

  • a current MD student or graduate of a LCME-accredited medical school in the US or Canada, OR
  • a current DO student or graduate of an AOA-accredited medical school in the US, OR
  • a medical student or graduate of a medical school outside the US listed in the World Directory of Medical Schools who meets the eligibility criteria of the ECFMG. 

For more detailed information about USMLE Step eligibility, please see the latest NBME bulletin. 

When and where can I take the USMLE Step 2?

Many students in the US choose to take Step 2 following their 4th year of medical school, after rotations.

When you apply to take Step 2 CK, you will choose a 3-month eligibility period, during which you can take your exam. Step 2 CK can be taken at Prometric testing centers worldwide, but keep in mind that not every test center offers every exam.

When you apply to take Step 2 CS, you will be assigned a 12-month eligibility period, during which you can take your exam. You must register for a specific date as schedules at all test centers fill up rather quickly (often 3-4 months in advance). There are only six test centers for Step 2 CS, and all are located in the United States. There is no option to take the exam outside of the US.

What topics are on the USMLE Step 2? 

Step 2 CK

Step 2 CK includes content from the following clinical specialties: 

  • Internal medicine
  • Obstetrics and gynecology
  • Pediatrics
  • Preventive medicine
  • Psychiatry
  • Surgery

On the exam, you will be requested to do one or more of the following while answering the questions: provide a diagnosis and prognosis, use basic science knowledge in different clinical situations, and determine the next step in patient management. Up to 3% of the exam focuses on foundational science, 90% covers individual organ systems, and the remaining 7% addresses biostatistics and epidemiology.

Step 2 CS

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 on 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. This exam determines whether you 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).

Taking the USMLE Step 2 exam 

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 form of dated and unexpired government-issued identity card. Your name on the scheduling permit must exactly match the name on your form of identification. If you fail to provide this, you will NOT be admitted to the test.

You are also allowed to bring soft-foam earplugs (subject to inspection) without strings. All other personal belongings must be stored 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 exam. You will be provided with a marker pen at the center.

What is the minimum passing score for USMLE Step 2? 

Step 2 CK

The current minimum passing score for Step 2 CK is 209. 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%.

Step 2 CS

The Step 2 CS exam is pass/fail only. 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%.

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