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. 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. The USMLE Step 2 is generally taken during the 4th year of medical school by medical students. From January 2010, to take the exam in North America the registration fee is $580 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.
Format
The exam is a nine-hour single-day computer-based test composed of eight question sets with no more than 45 questions per set (340 to 355 multiple-choice questions in total). Each section is one hour long. The test taker is permitted 45 minutes, in total for the whole day, for the purpose of breaks that can only be taken between sections. There is a 15-minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the allotted 1 hour time limit, the remainder of the time is added to break time. The test is administered at the Prometric testing sites around the world.
Topics
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: diagnosis, a prognosis, an indication of underlying mechanisms of disease, the next step in medical care, including preventive measures.
Step 2 CK is a broadly based, integrated examination. It frequently requires interpretation of tables and laboratory data, imaging studies, photographs of gross and microscopic pathologic specimens, and results of other diagnostic studies. Step 2 CK classifies test items along two dimensions: disease category and physician task.
Scoring
Scoring is reported in 3 digit scores. Most scores fall between 140 and 260, with the mean score for first-time examinees from accredited medical schools in the United States in the range of 220 to 230, and the standard deviation approximately 25. The mean score for Step 2CK as of 4/2/2014 for first-time test takers in US and Canadian medical schools is a 238 with a standard deviation of 19. 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. 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.
Effect on Residency Matching
The USMLE Step 2 CK score is one of many factors considered by residency programs in selecting applicants. 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 can be found in "Charting Outcomes in the Match" available at http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf
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