USMLE Step 2 Information

Clinical Knowledge

Step 2 assesses whether you can 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. Step 2 ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine.

Step 2 CK is constructed according to an integrated content outline that organizes clinical science material along two dimensions: physician task and disease category.

Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks, administered in one 9-hour testing session. Test item formats may vary within each block.

The number of items in a block will be displayed at the beginning of each block. This number will vary among blocks, but will not exceed 40 items. The total number of items on the overall examination form will not exceed 318 items. Regardless of the number of items, 60 minutes are allotted for the completion of each block.

On the test day, examinees have a minimum of 45 minutes of break time and a 15- minute optional tutorial. The amount of time available for breaks may be increased by finishing a block of test items or the optional tutorial before the allotted time expires.

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

Most Step 2 CK test items describe clinical situations and require that you provide one or more of the following:

  • A diagnosis
  • A prognosis
  • Apply basic science knowledge to clinical problems
  • The next step in medical care, including preventive measures

Normal Conditions and Disease Categories:

  • 1%–3% General principles of Foundational Science
  • 85%–90% Individual organ systems
  • 1%-5% Biostatistics & Epidemiology/Population Health Interpretation of the Medical Literature

Individual organ systems or types of disorders:

  • Immune System
  • Blood & Lymphoreticular Systems
  • Behavioral Health
  • Nervous System & Special Senses
  • Skin & Subcutaneous Tissue
  • Musculoskeletal System
  • Cardiovascular System
  • Respiratory System
  • Gastrointestinal System
  • Renal & Urinary Systems
  • Pregnancy, Childbirth, & the Puerperium
  • Female Reproductive System & Breast
  • Male Reproductive System
  • Endocrine System
  • Multisystem Processes & Disorders

Physician Task:

  • 10%–15% Medical Knowledge/Scientific Concepts
  • 40%–50% Patient Care: Diagnosis, History/Physical Examination, Laboratory/Diagnostic Studies, Prognosis/Outcome
  • 30%–35% Patient Care: Management, Health Maintenance/Disease Prevention, Pharmacotherapy, Clinical Interventions, Mixed Management, Surveillance for Disease Recurrence
  • 3%–7% Communication, Professionalism, Systems-based Practice/Patient Safety, Practice-based Learning

Clinical Skills

The USMLE Step 2 CS exam consists of a series of patient encounters in which the examinee must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations.

The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. Examinees are expected to investigate the simulated patient’s chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.

Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. The patient note is slightly different from a standard SOAP note. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The examinees will then state up to 3 differential diagnoses relating to the simulated patient’s symptoms, and tests or procedures to investigate the simulated patient’s complaints. The examinees should also list pertinent positive and negative findings to support each potential diagnosis. The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters. Examinees are required to type patient notes on a computer.