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USMLE Step 2 CK: best time, format, topics, minimum score

After passing the USMLE Step 1 and demonstrating that you understand the basic sciences, the USMLE Step 2 CK is next, which tests the clinical knowledge you have acquired.

Now that the USMLE Step 1 has become a pass/ fail exam, Step 2 scores are more important to be accepted into your first-choice residency program. However, before preparing for the exam, you should first understand it. This article discusses the USMLE Step 2 Exam and answers all your questions about it.

Overview of USMLE Step 2 CK:

The USMLE Step 2 CK (Clinical Knowledge) is the second of the three tests you must take to get your medical license to practice as a physician in the USA. The test's primary objective is to assess your ability to apply medical knowledge, skills, and understanding of clinical sciences to provide patient care under supervision.

Earlier, along with USMLE Step 2 CK, you would also have to pass an in-person Clinical Skills (CS) assessment exam known as Step 2 CS before being allowed to take Step 3. However, the COVID-19 pandemic caused NMBE to suspend USMLE Step 2 CS in 2020, and it was discontinued in early 2021.

When should you take the USMLE Step 2 CK?

As Step 2 CK aims to test your clinical knowledge, it is best to take it shortly after you finish your clinical rotations. Because you will be able to answer the test questions much more efficiently since all the information learned during rotations will be fresh in your mind.

Suppose you are done with your clinical rotations at the end of your third year of med school, then you can take the exam shortly after that. Or, if you feel you need more work to enhance your knowledge, you may take a bit more time. Once you apply for the Step 2 exam, you will need to choose a 3 month eligibility period in which you will take the exam.

Format of USMLE Step 2 Ck:

The USMLE Step 2 CK is a one-day exam. It is a 9-hour exam divided into 8 blocks of 60 minutes each and the break period. Each block will contain varying numbers of questions but will not exceed 40 questions. Also, the total number of questions in the exam will not exceed 318.

The exam consists of 45 minutes break and a 15 minutes optional tutorial. You can take a 1-hour break if you skip the optional tutorial by familiarizing yourself with the exam interface and instructions before sitting for the test. Additionally, you can increase your break time by finishing the questions allotted in a block before the time limit and adding the remaining time into your break.

Topics to study for the USMLE Step 2 CK:

The content outline of Step 2 can be organized in three ways.

  1. According to system specifications: This has 16 major categories depending on the focus on concepts and principles applicable across or within organ systems.
Some Systems that you have to study in USMLE Step 2 CK.
1.General Principles of Foundational Science2–4
2.Immune System3–5
3.Blood & Lymphoreticular System4-6
4.Behavioural Health6-8
5.Nervous System & Special Senses6-8
6.Musculoskeletal System/Skin & Subcutaneous Tissue6–10
7.Cardiovascular System8–10
8.Respiratory System7-9
9.Gastrointestinal System7-9
10.Renal & Urinary System & Male Reproductive4-6
11.Pregnancy, Childbirth & the Puerperium4-6
12.Female Reproductive System & Breast4-6
13.Endocrine System4-6
14.Multisystem Processes & Disorders4-6
15.Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature3-5
16.Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety10-15

2. According to the Physician Task/ Competencies Specifications:

1.Patient Care: Laboratory/Diagnostic Studies13-17
2.Patient Care: Diagnosis16-20
3.Patient Care: Prognosis/Outcome5-9
4.Patient Care: Health Maintenance/Disease Prevention8-12
5.Patient Care: Pharmacotherapy8-12
6.Patient Care: Clinical Interventions6-10
7.Patient Care: Mixed Management12-16
8.Practice-based Learning & Improvement3-5
10.Systems-based Practice & Patient Safety5-7

3. According to Discipline Specifications:

4.Obstetrics and Gynaecology10-20

Types of questions to expect in the USMLE Step 2 CK:

In Step 2 CK, you can expect to face three types of questions that are-

  1. Single-Item Questions:

Typically, this type of question involves a patient-centric scenario with a question and four or more options for an answer. You will choose the best answer for each question. Other options may also be partially correct, but there is only one right answer for each question.

2. Sequential Item Sets:

Here a patient-centric scenario may be associated with two or three consecutive questions about the information presented. You are expected to give the best answer for each question. Questions are designed to be answered in sequential order. Click on "Proceed to Next Item" to see the next item in the set. Be aware that once you click on this button, the next question will appear, and you will not be able to change your answer.

3. Abstract Format:

Abstracts present a summary of an experiment or clinical investigation in a format commonly encountered by physicians, e.g., an abstract that accompanies a research report in a medical journal. You must interpret the abstract to answer questions on various topics, including

  • Individual patient care decisions
  • Biostatistics/epidemiology
  • Pharmacology/therapeutics
  • Use of diagnostic studies

How much is the minimum passing score for USMLE Step 2 CK?

Since the USMLE Step 1 now only shows pass/ fail in the results, Step 2 CK is the first numerically scored exam in all three tests. You must score at least 209 to pass the exam. Though some residency programs may use higher cut-offs to decide whether or not to interview you. To do well in the exam, you must know the cut-off score for the specialty you intend to study.

The exam scores will be released in about 3 to 4 works after your exam date and will be available for 120 days.

What if you fail the USMLE Step 2 Ck?

In one year you can give the exam at most 3 times. So even if you fail in your first attempt, you can make 2 more attempts within the same year. But your fourth attempt must be at least 12 months after your first attempt and at least 6 months after your most recent exam attempt.


Now that you understand the USMLE Step 2, you are one step closer to passing the exam. But If you want to ace the exam, you will need to take many practice tests to ensure that you know the material.

Archer Review doctors teaching USMLE step 2 CK aspirants

But worry not, we have made the preparation super easy for you! Our USMLE Step 2 CK course will provide you with proper guidance and a high-yield question bank that will help you master the exam content in no time.

It is time to make a study plan and prepare for the exam. If you want to know about the best study techniques that you can use to ace your exams, then you can check out our article on that topic.


  1. https://www.usmle.org/step-exams/step-2-ck