USMLE Step 2 Clinical Knowledge


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The USMLE-Step 2-CK ("Clinical Knowledge") is the nine-hour-long multiple-choice portion of the second part of the United States Medical Licensure Examination.[1] It assesses clinical knowledge through a traditional, multiple-choice examination. In contrast to the USMLE Step 1, the focus is much more on clinical application of medical knowledge. It assesses the ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision.[2] The USMLE Step 2 is generally taken during the 4th year of medical school by medical students.[1] From January 2010, to take the exam in North America the registration fee is $645 (as of December 2016) for students attending medical colleges in the United States and $850 for medical students from other countries. There are additional charges for applicants who choose a testing region outside the United States or Canada.[3]


The exam is administered in a 9-hour single-day computer-based session.[4] The session is divided into eight one-hour blocks of questions, a 15 minute tutorial and a 45 minute break.[4][2][5] The 15-minute tutorial at the beginning of the exam is optional. The 45 minutes allowed for breaks can only be taken between sections at the discretion of the test taker. Both the unused tutorial time and time saved from finishing a test block early is added to the break time.[6] The test is administered at the Prometric testing sites. [7]


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.[8]

Most Step 2 CK test items describe clinical situations and require that you provide one or more of the following: diagnosis, a prognosis, an indication of underlying mechanisms of disease, the next step in medical care, including preventive measures.[8]

Step 2 CK is an integrated examination that frequently requires the interpretation of tables and laboratory data, imaging studies, photographs of gross and microscopic pathologic specimens, and results of other diagnostic studies.[8] Step 2 CK tests the aspiring physician's knowledge of medicine putting special emphasis on the principles and mechanisms underlying disease, and the therapies needed to address them.[9]


The Step 2CK scores are reported in a 3 digit format with a range between 1 and 300. The passing score is 209.[10] As of academic year 2019-2020, the mean CK score was 245 with a standard deviation of 15 for first-time takers from accredited medical schools in the United States and Canada.[11] Every three to four years the Step Committees are asked to complete an in-depth review of standards, and they may schedule more frequent reviews.[12] At its May 2014 meeting, the Step 2 Committee conducted a review for USMLE Step 2 Clinical Knowledge (CK). As a result of its review, the Step 2 Committee decided to raise the Step 2 recommended minimum passing score to 209 for students taking the test after July 1, 2014. A more recent review in May 2018 maintained the passing score of 209.[13] USMLE provides each test taker with a score report that includes information on their performance on various physician tasks, disciplines and systems.[14]

Effect on Residency Matching

The USMLE Step 2 CK score is one of many factors considered by residency programs in selecting applicants.[10][15][16][17][18][19] Along with the USMLE Step 1, this test is a standardized measure of all applicants. The median USMLE Step 2 scores for graduates of U.S. Medical Schools for various residencies is published periodically by the NRMP in their "Charting Outcomes in the Match" documents[20]

USMLE Step 1’s pass/fail status in 2022 is likely to enhance the effect of USMLE Step 2 CK on residency matching, since it will remain as the sole standardized factor in the residency application process.[21]

See also


  1. ^ a b "USMLE Prep Handbook" (PDF). University of Texas Rio Grande Valley. Retrieved 31 May 2021.
  2. ^ a b "Step 2 CK (Clinical Knowledge)". Retrieved 31 May 2021.
  3. ^ The ECFMG(r) Reporter. Issue 148 - December 10, 2009
  4. ^ a b "USMLE Step 2". Thomas Jefferson University. Retrieved 31 May 2021.
  5. ^ "Stage Four: Career Preparation". New York University. Retrieved 31 May 2021.
  6. ^ "Content Description and General Information" (PDF). Retrieved 31 May 2021.
  7. ^ "USMLE Information". University of Tennessee Health Science Center. Retrieved 31 May 2021.
  8. ^ a b c "Step 2 Clinical Knowledge and Clinical Skills". Virginia Tech Carilion School of Medicine. Retrieved 31 May 2021.
  9. ^ Ganti L, Rosario J, Lebowitz D, Vera A. Step-Up to USMLE Step 2 CK (5th ed.). Preface.
  10. ^ a b "A guide to USMLE scores". Retrieved 31 May 2021.
  11. ^ "USMLE Step Examination Score Interpretation Guidelines" (PDF). Retrieved 31 May 2021.
  12. ^ "United States Medical Licensing Examination | Frequently Asked Questions (FAQs)". Retrieved 31 May 2021.
  13. ^ "No Change to Minimum Passing Score for Step 2 CK". Educational Commission for Foreign Medical Graduates. 25 May 2018.
  14. ^ "Step 2 CK Score Report" (PDF). Retrieved 31 May 2021.
  15. ^ Ryan, Michael S.; Levine, Leonard J.; Colbert-Getz, Jorie M.; Spector, Nancy D.; Fromme, H. Barrett (2015). "Advising Medical Students for the Match: A National Survey of Pediatrics Clerkship Directors". Academic Pediatrics. 15 (4): 374–379. doi:10.1016/j.acap.2015.03.009. PMID 25922334.
  16. ^ Jayakumar, Kishore L.; Lipoff, Jules B. (2017). "US Medical Licensing Examination Step 2 Clinical Knowledge Score in Dermatology Resident Selection". JAMA Dermatology. 153 (11): 1193–1194. doi:10.1001/jamadermatol.2017.2924. PMC 5817479. PMID 28832874.
  17. ^ Janis, Jeffrey E.; Hatef, Daniel A. (2008). "Resident Selection Protocols in Plastic Surgery: A National Survey of Plastic Surgery Program Directors". Plastic and Reconstructive Surgery. 122 (6): 1929–1939. doi:10.1097/PRS.0b013e31818d20ae. PMID 19050546.
  18. ^ Nallasamy, Sudha; Uhler, Tara; Nallasamy, Nambi; Tapino, Paul J.; Volpe, Nicholas J. (2010). "Ophthalmology Resident Selection: Current Trends in Selection Criteria and Improving the Process". Ophthalmology. 117 (5): 1041–1047. doi:10.1016/j.ophtha.2009.07.034. PMID 20110128.
  19. ^ "Results from the 2020 NRMP PD Survey". National Resident Matching Program. Retrieved 31 May 2021.
  20. ^ "Main Residency Match Data and Reports". National Resident Matching Program. Retrieved 31 May 2021.
  21. ^ Rajesh, Aashish; Asaad, Malke; Sridhar, Monica (2021). "Binary Reporting of USMLE Step 1 Scores: Resident Perspectives". Journal of Surgical Education. 78 (1): 304–307. doi:10.1016/j.jsurg.2020.06.013. PMID 32600888.

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