ULTIMATE GUIDE

TO THE

USMLE STEP 2 CK
®
ALL YOUR QUESTIONS ANSWERED
The Osmosis Ultimate Guide
to USMLE® Step 2 CK
Version 1.3 - Updated December 22, 2022

The United States Medical Licensing Examination (USMLE®) is a joint program of the Federation of State Medical Boards (FSMB®)
and the National Board of Medical Examiners (NBME®). Osmosis is not affiliated with NBME or FSMB.
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The Osmosis Ultimate Guide

to USMLE® Step 2 CK
Contents

2 Introduction

2 What is USMLE Step 2 CK?

3 What topics appear on the USMLE Step 2 CK exam, and how are they weighted?

6 What types of questions appear on USMLE Step 2 CK?

7 How long does the USMLE Step 2 CK exam take?

8 What are the best USMLE Step 2 CK study resources?

9 What should I do to prepare for USMLE Step 2 CK before exam day?

14 How do I register for USMLE Step 2 CK?

15 When do I take USMLE Step 2 CK?

15 What should I expect on USMLE Step 2 CK test day?

17 What should I bring to the USMLE Step 2 CK exam?

20 How long do I have to wait for my USMLE Step 2 CK exam results?

20 What USMLE Step 2 CK score do I need to match?

21 How will USMLE Step 1 being pass/fail impact the importance of Step 2 CK?

22 What happens if I fail USMLE Step 2 CK?

24 How has COVID-19 impacted USMLE Step 2 CK?

24 How can Osmosis help me study for USMLE Step 2 CK?

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Introduction
The medical education journey often seems like it revolves around board exams! Though they
can be intimidating and challenging, they’re also important milestones on your path to
becoming a doctor. USMLE® Step 2 CK (full name USMLE Step 2 Clinical Knowledge) is one
such medical licensing examination. Luckily, you’re in the right place to learn everything there
is to know about it!

Ready to learn how to crush this exam? Let’s dive in!

What is USMLE Step 2 CK?

USMLE Step 2 CK is the board exam that follows USMLE Step 1. USMLE Step 2 CK evaluates
clinical knowledge through a computer-based multiple-choice exam.

According to USMLE, “Step 2 CK assesses an examinee’s ability to apply medical knowledge,

skills, and understanding of clinical science essential for the provision of patient care under
supervision and includes emphasis on health promotion and disease prevention.” Most
questions describe clinical scenarios, and examinees are asked to determine the diagnosis,
prognosis, mechanism of disease, or next steps.
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What topics appear on the USMLE Step 2 CK exam, and how

are they weighted?
USMLE Step 2 CK tests a broad range of topics. Not all topics will necessarily be tested, but it’s
important to cover your bases and make sure you’re adequately prepared to address any topic
on USMLE’s content outline.

You can expect to be assessed on physiologic and pathologic processes of individual organ
systems, including principles of therapy, biostatistics, and social sciences. See the
comprehensive list in Table 1.

Table 1: Step 2 Test Specifications*

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Table 2: Step 2 CK Physician Task/Competency Specifications*

As Step 2 CK is centered on clinical knowledge, physician tasks and competencies will also be
tested!
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Table 3: Step 2 CK Discipline Specifications*

Though the knowledge you’ve accumulated from your clinical rotations will undoubtedly come
in handy for every section of Step 2 CK, it’ll be particularly useful for answering questions
related to the five traditionally defined disciplines in Table 3.

* Note that percentages are subject to change at any time.

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What types of questions appear on USMLE Step 2 CK?

During the USMLE Step 2 Clinical Knowledge exam, you will encounter three different types of
questions:

1. Single-item questions

Single-item questions will ask you to choose the best answer from between three to 26
options (on average, you’ll be presented with five options). Some answer choices are partially
correct, but don't let these throw you off: only choose the answer you are certain is 100%
correct.

2. Sequential-item sets

Sequential item sets use ordered questions attached to a single clinical vignette. Answering
one question in the sequence will bring you to the next one; once you've moved forward in the
set, there's no way to go back to change your previous answers.

3. Abstract-based questions

With this type of question, you will be provided with an abstract of a research experiment or
clinical investigation and asked to answer questions about it. With these questions, you want
to be careful to balance your time between scrutinizing the abstract and determining your
answer. These questions are designed to test your ability to synthesize information presented
in an abstract to make clinical decisions.
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How long does the USMLE Step 2 CK exam take?

Step 2 CK is a one-day examination that lasts roughly 9 hours. It’s divided into eight 60-minute
blocks. There are at most 40 questions per block and 318 questions per exam; the actual
number of questions may vary.

You have, at minimum, 45 minutes of break time and an optional 15-minute tutorial at the start
of the exam. You can choose when to take your break time, but you cannot interrupt a block for
a break. It’s wise to plan out in advance when you’ll take breaks.

For example, you can choose to take a 10-minute break after block 2 and block 4 and an
extended break (20 minutes) after block 6 to gear up for the final sprint. Note that if you finish
a block before the allotted time expires, you can use the extra time to extend your breaks.
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What are the best USMLE Step 2 CK study resources?

Tackling Step 2 CK may be intimidating at first. The key to success is to get organized and
create a comprehensive plan. First, take stock of resources you should invest in. The following
materials will put you on the road to success:

Online Resources

● Osmosis: Check out our Clinical Practice library (with brand new learn pages coming
soon!), in addition to our Microbiology, Biostatistics and Epidemiology, Anatomy Clinical
Correlates, and Pharmacology series to prepare for Step 2. We also have an enormous
Step 2 Question Bank, described in more detail below.
● UWorld: UWorld is a non-negotiable resource. If you’ve taken and passed Step 1,
you’re likely already familiar with it. Take advantage of its extensive question bank and
self-assessments.

While you don’t necessarily have to use a physical book, given all the fantastic online
resources listed above, you may want a text to refer to. Remember not to spread yourself thin
across resources—stick to one book! The following are some of the most common textbook
options.

Textbooks

● First Aid for the USMLE Step 2 CK comes packed with mnemonics and illustrations.
(656 pages)
● USMLE Step 2 Secrets is relatively short and has information arranged in
question-and-answer format. (424 pages)
● Master the Boards Step 2 CK is well-organized and longer than other resources, but a
common complaint is that it lacks finer details. (784 pages)
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● Step-Up to USMLE Step 2 CK: As you can tell by the page count, Step-Up is a concise,
short book, probably best used paired with another resource. (384 pages)

What should I do to prepare for USMLE Step 2 CK before

exam day?
Having Step 2 CK on the horizon can be daunting, but it need not be as long as you stick to a
schedule and take good care of yourself.

Make your clerkships count

You will learn valuable clinical medicine from your clerkships. Pay attention, familiarize yourself
with new information, listen closely, ask questions, and study hard for your shelf exams. Aim to
excel!

Many students take Step 2 CK soon after rotations, so quality learning on the ground definitely
pays off. The stronger your foundation, the easier it will be to jump into studying for Step 2 CK!
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Create a plan

It’s essential to create a study schedule. As you’ve studied for Step 1 and built robust study
habits throughout medical school, you should have a good idea of what techniques work for
you. First, select the resources you’re going to be using. Some are non-negotiable (like
UWorld), but others (like textbooks) you can take or leave.

Next, map out the time you have until exam day. Be realistic about how many hours of effective
studying you can put in each day, and make sure to account for break time and rest days.

Finally, list out your weekly goals, and create a plan. Consider using the time-blocking
technique. Treat your to-do list as the skeleton of your plan, and carve out specific hours to
complete tasks. The more detailed your plan, the better! Research shows that single-tasking
(the foundation of time-blocking) significantly boosts productivity. Also, take stock of your
current habits: when during the day are you usually most productive? Plan to complete your
most intensive tasks during that “block” of time.

For example, spend your mornings watching Osmosis videos about topics you struggled with
the day before. In the afternoon, work through a set of UWorld questions. In the evening,
review your daily allotment of Anki cards. At the end of the week, take an assessment and
gauge your weaknesses. Rinse and repeat!
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Cultivate a healthy lifestyle

Don’t make the mistake of sacrificing a healthy lifestyle to squeeze in more study time. Your
health should remain a priority. While good health is valuable for more than just achieving a
great Step 2 CK score, note that you’ll study more effectively (and retain more information) as a
well-rested, well-fed student than as a lethargic, unhealthy one.

Here are some healthy lifestyle tips to put into practice:

● Sleep and wake up at the same time every day, and aim for 7-8 hours of rest. Regularity
makes for more restorative sleep.

● Eat a healthy diet. Plan out meal times and take some time over weekends to prepare
your food for the week. Having meals that are ready to go will help you avoid impulsive,
unhealthy snacking.

● Exercise daily. Exercise is great for your brain! Try this student’s no-equipment, at-home
workout routine, or go for a brisk, 15-minute walk around the block.

● Practice mindfulness. Meditative practices can boost self-esteem and alleviate anxiety.
Try this 10-minute meditation once a day.
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Take breaks as needed

Break time can be just as important as study time. Time off allows you to recharge, which is
why scheduling breaks is so important. A great schedule will enable you to focus on relaxing
because you’ll know that every task has been incorporated into your plan.

Don’t spend your break fretting over the work you have left to do; give yourself permission not
to think about studying.

This is also a good time to examine your journey with perspective: getting to take Step 2 CK
means you’re firmly on the path to living out your dream of becoming a doctor!
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How do I register for USMLE Step 2 CK?

You’ve taken and passed Step 1, and you’re ready to move on to Step 2. Congratulations! It’s
time to register. You will be assigned an eligibility period during which you can schedule your
exam. Note that if you decide to reschedule, your new test date must fall within your assigned
eligibility period.

If you’re a medical student or graduate in the United States or Canada, you must apply to take
Step 2 CK through the NBME and pay a $645 registration fee. You may be subject to additional
fees to reschedule your test date depending on proximity to the date.

However, if you’re a medical student or graduate outside the United States or Canada, you
must apply to take Step 2 CK through the ECFMG and pay a $965 registration fee.
Rescheduling fees depend on your testing region.
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When do I take USMLE Step 2 CK?

Allopathic medical students (i.e., MD students) in the United States take USMLE Step 2 CK in
the fourth year of their medical education journey after completing their core clinical rotations
and shelf exams.

Some may choose to complete the exam soon after rotations while their clinical knowledge is
fresh, while others might delay to maximize study time and focus on residency interviews.
Medical students must pass both the USMLE Step 1 and Step 2 CK to graduate.

In contrast, international medical students hoping to match in the United States must pass
both the USMLE Step 1 and Step 2 CK to qualify for ECFMG (Educational Commission for
Foreign Medical Graduates) certification. ECFMG assesses whether international medical
graduates (IMGs) are prepared to enter residency or fellowship programs in the US.

To participate in the Match, IMGs must be eligible for ECFMG certification, so they may
structure their board exam schedule around achieving certification in time to apply to residency.

What should I expect on USMLE Step 2 CK test day?

Though your priority before test day has, of course, been to master the material, it’s important
to consider logistics as well to maximize your performance on Step 2 CK.

Two days before test day

A couple of days before test day, map your route to the testing center. How long will it take
you? When should you leave to arrive 30 minutes early (which is recommended by USMLE)? If
you’re taking public transportation, triple-check the schedule. Confirm the plan with your driver
if someone else will be taking you to the testing center.

Review the USMLE’s Rules of Conduct. You don’t want to inadvertently break the rules and be
directed to leave the testing center or have your score canceled.

Also, plan out and purchase your test day snacks. Don’t scramble to do a grocery run the night
before the exam! You should also purchase foam earplugs if you plan to use them.

Finally, prepare a comfortable outfit. Figuring out these details in advance frees up your final
day before the exam for relaxation.
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Test day

On test day, arrive at the testing center 30 minutes early with your snacks, valid photo
identification, and scheduling permit. Expect to undergo security procedures. You will be:

● Scanned with a device designed to detect prohibited items

● Asked to empty your pockets

● Asked to show your photo identification

● Required to have your fingerprint captured using biometric technology (only available at
some locations)

● Required to write your unique Candidate Identification Number (CIN) on a laminated

note board provided to you

Note that you will likely have to repeat this process every time you return to the testing room
after a break. You can access your phone and snacks during breaks outside the testing station.
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When you sit at your computer in the testing station for the first time, test your headphones.
You can choose to complete an optional 15-minute tutorial, after which you will begin the first
block. Stay calm, and don’t forget to take a deep breath!

What should I bring to the USMLE Step 2 CK exam?

Since Step 2 CK is computer-based, there’s no need to bring a number 2 pencil! Check out the
following lists of things to bring.

Mandatory

1. Valid, unexpired identification with your photo, name, and signature. You will NOT be
allowed to take the exam without this.

2. Your USMLE scheduling permit usually sent in an email. Make sure the name on your
scheduling permit exactly matches the one on your ID. Note that you can bring a
physical or electronic copy, so a screenshot of it on your phone may suffice.
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Strongly recommended

1. Beverages. It’s important to stay hydrated during such a long exam. Avoid anything
sugary or caffeinated – you don’t want to feel jittery or crash.

2. Snacks. You’ll get hungry at some point. Pack healthy snacks. Try fruit, a sandwich, trail
mix, or whole grains. Don’t overeat, lest you get lethargic!

Optional

1. Foam earplugs. You can bring these into the testing center to reduce distracting noises.

2. Personal item exceptions. Here is an official list of personal items that you can bring
into the testing station WITHOUT making a request or submitting documentation.

Only foam earplugs and personal item exceptions (refer to the list) are permitted in the testing
room. You can only access your other possessions during breaks outside the testing room. You
will be provided with a personal locker to store your belongings in.

Remember: when in doubt, it’s best to avoid bringing an item with you. If you feel the need to
bring something into the testing room that isn’t explicitly listed as a personal item exception,
submit a request to the USMLE in advance.
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How long do I have to wait for my USMLE Step 2 CK exam

results?
Congratulations on taking Step 2 CK! Results are usually available in 3-4 weeks, but delays
occur. The USMLE says to allow at least eight weeks for notification that your score is
available. You can find announcements about any potential delays here.

What USMLE Step 2 CK score do I need to match?

Of course, Step 2 CK is a major part of your application for residency. A passing score is 214,
but the data shows that you need a score well above 214 to match in your preferred specialty.
What score should you aim for?

According to the NRMP’s 2022 report, Charting Outcomes in the Match, U.S allopathic seniors
who matched to their preferred specialty had a mean Step 2 CK score of 248.

Of course, depending on your chosen specialty, you may need to aim higher. Find your
preferred specialty in the table below.

USMLE Step 2 Scores by Student Type & Desired Specialty

* n/a = data not shown due to small sample size.

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How will USMLE Step 1 being pass/fail impact the importance

of Step 2 CK?
Effective January 26, 2022, USMLE changed score reporting for Step 1 from numeric scoring to
pass/fail only. Though this decision had long been rumored, the announcement sent
shockwaves throughout the pre-medical and medical community. Of course, the foremost
question on everyone’s mind remains: how will this impact residency and fellowship
applications? Will other components of applications be weighted differently, given Step 1’s
historical importance?

With this recent change, some outcomes seem likely. According to the 2018 NRMP, the vast
majority of residency programs cited Step 1 as one of the most important factors in ranking
applicants. Now that Step 1 is pass/fail, it’s likely that greater importance will be placed on
Step 2 CK performance.

Some hypothesize that medical school reputation will matter more in the absence of Step 1
scores, but NRMP data indicates that less than half of residency programs cited “graduate of
highly regarded U.S. medical school” as a factor in ranking applicants. It’s best to focus on what
you can control: your board scores. That’s why you’re here!
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What happens if I fail USMLE Step 2 CK?

Despite intensive preparation for Step 2 CK, students do fail. If you find yourself in this
position, first take a deep breath: this isn’t the end of your journey, and it will be okay. Take
time to examine and accept your feelings, and then look ahead to the future.

As mentioned earlier, Step 2 CK is required for graduation from medical school for U.S. seniors
and ECFMG certification for IMGs. With that in mind, here’s what you should do next:

Reach out to your academic advisor

Your school likely has resources for students who fail board exams. Reach out to your academic
advisor immediately and discuss a plan for retaking Step 2 CK. This might necessitate
rescheduling a rotation to make time for additional studying. Depending on timing, IMGs may
have to postpone participating in the Match, as Step 2 CK is a prerequisite for ECFMG
certification.

Assess your mistakes

Don’t dive back into studying without reflecting deeply on why you failed. Did you cram? Was
your understanding of a particular organ system shallow? Were you feeling ill on test day?
Take honest stock of what went wrong. Don’t beat yourself up! Approach this exercise with an
optimistic attitude: diagnosing the problem will help you succeed on your next attempt.

Seek support

In such a challenging moment, it’s important to lean on your social network for support. Ask to
talk to a close friend or family member. Express your feelings honestly, and reach out when you
need to hear words of encouragement.

Refine your study plan

Gather your resources and create a new plan. Make sure you’re directly tackling the problems
you experienced on your first attempt.

Reassess your specialty choice

Painful though it may be, it’s important to be honest with yourself. Many residency programs
seldom or never consider applicants who fail Step 2 CK on the first attempt. If you were hoping
to apply to a competitive specialty, you might have to change your plan based on the likelihood
of matching into that particular specialty.
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Strengthen other aspects of your application

Though board scores are important, they aren’t the only important components of a residency
application. Among other things, program directors also consider the following:

● Letters of recommendation in the specialty

● Personal statement

● Clerkship grades

● Class ranking

● Professionalism, ethics, and leadership qualities

Despite this setback, your application can still shine. Make sure to ask your recommenders for
strong letters. Refine your personal statement until it clearly expresses why you’re a great fit
for the program. Highlight other academic achievements.

You can do it!

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How has COVID-19 impacted USMLE Step 2 CK?

As COVID-19 unraveled in early 2020, plans for the year had to evolve accordingly. Prometric,
the U.S.-based test administration company, temporarily closed some testing centers, but the
majority of testing centers have reopened now. Be sure to check out Prometric’s COVID-19
Update page to read about any updates or safety regulations for the testing center. Although
rescheduling fees were temporarily waived, you will once more be charged a fee for changing
testing appointments within 45 days of the scheduled test.

When examinees apply to take Step 2 CK, they are assigned a three-month eligibility period
during which they can schedule (and reschedule) their exam. To find a testing center near you,
visit Prometric’s site.

Many examinees are understandably frustrated about this turn of events, as COVID-19 has
disrupted careful planning. Examinees should be vocal about their concerns and issues as they
arise. Remember to practice self-care: here are some tips for overcoming anxiety during the
pandemic.

You can check the USMLE Announcements page for any new updates regarding Step 2 CK.

How can Osmosis help me study for USMLE Step 2 CK?

Resource selection is one of the most important parts of preparing for Step 2 CK. Luckily,
you’re in the right place! Osmosis is well-equipped to help you prepare effectively for Step 2
CK.

Check out our Clinical Practice library, which will help you acquire the clinical reasoning skills
necessary to treat various conditions. Apply this knowledge throughout your rotations.
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Remember: making the most of your learning experience on the wards is one important way to
conquer Step 2 CK.

Also, see the Clinician’s Corner, where you’ll learn essential professional skills directly from the
source: current and future clinicians!

Of course, no study schedule is complete without practice. Osmosis has over 1,300 case
questions for Step 2 CK, complete with detailed answer explanations. Apply your knowledge
here.

Best of luck preparing for Step 2 CK. We’re rooting for you!

The United States Medical Licensing Examination (USMLE®) is a joint program of the Federation of State Medical Boards (FSMB®) and the
National Board of Medical Examiners (NBME®). Osmosis is not affiliated with NBME or FSMB.