What to Know About Step 2 CK

The United States Medical Licensing Examination tests medical students and graduates in three separate exams in order to ensure preparedness for medical licensure. Step 2 CK (clinical knowledge) is the second exam administered, assessing the clinical application of medical knowledge. Step 2 CK emphasizes health promotion and disease prevention, and the goal is to guarantee devotion to clinical sciences and patient-centered skills that are key to practicing medicine safely and efficiently.

When should I take Step 2 CK?

Whereas Step 1 is generally taken after the second year of medical school, Step 2 CK is taken most often during the 4th year. Many US and Foreign Medical Schools now require a passing Step 2 CK Score before graduating. It can also be more beneficial to take Step 2 CK before applying to the NRMP (National Resident Matching Program) Match, because some program directors will not consider applicants that do not have a score or are not ECFMG certified. However, some applicants with higher Step 1 scores might delay taking Step 2 CK in fear of scoring lower and making their application less competitive.

What subjects does the test cover?

The subject areas for Step 2 CK cover Internal Medicine, Obstetrics and Gynecology, Pediatrics, Preventive Medicine, Psychiatry, and Surgery.

USMLE Step 2 CK organizes clinical science subject matter along two categories: normal conditions and diseases, and physician tasks. See table A below regarding the test specifications:

Table A: USMLE Step 2 CK Test Specifications

                                                                                                                     *Source: www.usmle.org

Step 2 CK is also organized to test on the ACGME Six Core Competencies:

  • Patient Care
  • Interpersonal Skills and Communication
  • Medical Knowledge
  • Systems-Based Practice
  • Practice-Based Learning and Improvement
  • Professionalism

See Table B below for an outline of the physician competency testing items.

Table B: USMLE Step 2 CK Physician Task/ Competency Specifications

                                                                                                                               *Source: www.usmle.org

What is the test format?

Like Step 1, USMLE Step 2 CK is only a one-day examination. Test items are distributed into blocks with various formats within each block. The number of items per block will not exceed 45 items. Only 60 minutes are given for the completion of each block, regardless of the total number of items in the block. There is a minimum of 45 minutes of break time and students have the option for a 15-minute tutorial before the exam. Finishing a block of test items before the 60 minutes expires would allow for more break time.

Test questions are multiple choice and include single-item questions, sequential item sets and matching item sets. For more helpful information on test question formats click here

Who is eligible to take Step 2 CK?

To apply and take Step 2 CK, one must fall under one of these categories:

  • A medical student officially enrolled in, or a graduate of, a US or Canadian medical school
  • A medical student in a 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)
  • A medical student officially enrolled in, or a graduate of, a medical school outside the United States and eligible for examination by the ECFMG

What is a passing score for Step 2 CK and how important is my score for Matching?

As of July 1st, 2014 the passing score for USMLE Step 2 CK raised from 203 to 209.

During the NRMP Match 2014, the average Step 2 CK score for US Seniors applying to the Match was 242. The average score for those US Seniors who actually matched into a residency program was 243. For International Medical Graduates, the average score for applicants was 227 and for those who matched was 234. Scores are becoming higher and higher in order to be competitive for residency, especially for IMG’s.

*Source: 2014 NRMP Charting Outcomes in the Match

It is important to many programs to get a good score on Step 2 CK. In the 2014 NRMP Program Director Survey, 80% of program directors cited Step 2 CK scores as important when choosing who to interview. However, the survey determined that the USMLE Step 1 score was the most frequently cited factor when choosing who to interview at 94%. Out of the program directors that consider Step 2 CK scores when choosing applicants to interview, 50% required a target score, 31% required only a passing score, and 19% did not require scores.

*Source: 2014 NRMP Program Director Survey


1.       Step 2 CK. (2015) Retrieved December 16, 2015, from http://www.usmle.org/step-2-ck/

2.       USMLE Step 2 CK Exam- Overview. (2015). Retrieved December 16, 2015, from http://www.uworld.com/Step2CK/step2ck.aspx

3.       Results of the 2014 NRMP Program Director Survey, Retrieved December 16, 2015 from http://www.nrmp.org/match-data/main-residency-match-data/

4.       Charting Outcomes in the Match 2014, Retrieved December 16, 2015 from http://www.nrmp.org/new-charting-outcomes-match/