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. The test items are divided into blocks, and 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 45 items. The total number of items on the overall examination form will not exceed 355 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 Clinical Knowledge (Step 2 CK) consists of multiple-choice questions prepared by examination committees composed of faculty members, teachers, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada. Test questions focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training. The examination is constructed from an integrated content outline that organizes clinical science material along two dimensions.
Normal Conditions and Disease categories (Dimension 1) form the main axis for organizing the outline. The first section deals with normal growth and development, basic concepts, and general principles. The remaining sections deal with individual disorders.
Sections focusing on individual disorders are subdivided according to Physician Task (Dimension 2). The first set of physician tasks, Promoting Preventive Medicine and Health Maintenance, encompasses the assessment of risk factors, appreciation of epidemiologic data, and the application of primary and secondary preventive measures.
The second set of tasks, Understanding Mechanisms of Disease, encompasses etiology, pathophysiology, and effects of treatment modalities in the broadest sense.
The third set of tasks, Establishing a Diagnosis, pertains to interpretation of history and physical findings and the results of laboratory, imaging, and other studies to determine the most likely diagnosis or the most appropriate next step in diagnosis.
The fourth set of tasks, Applying Principles of Management, concerns the approach to care of patients with chronic and acute conditions in ambulatory and inpatient settings. Questions in this category will focus on the same topics covered in the diagnosis sections.
The diseases noted in the outline do not represent an all-inclusive registry of disorders about which questions may be asked. They reflect the development of a "High-Impact Disease List" that includes common problems, less common problems where early detection or treatability are important considerations, and noteworthy exemplars of pathophysiology. Questions are generally, but not exclusively, focused on the listed disorders. In addition, not all listed topics are included on each examination.
The Step 2 CK content outline is not intended as a curriculum development or study guide. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphases. The categorizations and content coverage are subject to change. Broadly based learning that establishes a strong general foundation of understanding of concepts and principles in the clinical sciences is the best preparation for the examination.
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Test Question Formats
Step 2 CK consists of multiple choice questions with only one best answer. Each question will be structured with a statement or question followed by three to twenty-six response options, each labeled with a letter (e.g: A, B, C, D, E) and arranged logically or alphabetically. Some response options will be partially correct, but only one option will be the best and correct answer.
Strategies for Answering the Test Questions
- Read each question carefully. It is important to understand what is being asked.
- Try to generate an answer and then look for it in the option list.
- Alternatively, read each option carefully, eliminating those that are clearly incorrect.
- Of the remaining options, select the one that is most correct.
- If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She is not yet on dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?
- Acute blood loss
- Chronic lymphocytic leukemia
- Erythrocyte enzyme deficiency
- Erythropoietin deficiency
- Microangiopathic hemolysis
- Polycythemia vera
- Sickle cell disease
- Sideroblastic anemia
- ß-Thalassemia trait
Sequential Item Sets
A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is linked to the initial patient vignette but is testing a different point. Questions are designed to be answered in sequential order. You are required to select the one best answer to each question. Other options may be partially correct, but there is only ONE BEST answer. You must click “Proceed to Next Item” to view the next item in the set; once you click on this button, you will not be able to add or change an answer to the displayed (previous) item.
This format consists of a series of questions related to a common topic. All matching sets contain set-specific instructions, a list of lettered response options, and at least two questions. There will be between four and twenty-six response options. Each set is preceded by a box that indicates the number of questions in the set associated with the response options that follow. Examinees are directed to select one answer for each question in the set. Questions will be presented one at a time, with instructions and response options repeated for each subsequent question.
Strategies for Answering Matching Sets
- Begin each set by reading through the option list to become familiar with the available responses.
- Read each question carefully.
- Within a set, some options may be used several times, while other options may not be used at all. Respond to each question independently.
- For matching sets with large numbers of options, try to generate an answer to the question and then locate the answer in the option list. This is more efficient than considering each option individually.
Example Questions (Matching Set)
(The response options for items 2-3 are the same. You will be required to select one answer for each item in the set. )
- Chronic lymphocytic leukemia
- Drug reaction
- Hodgkin disease
- Infectious mononucleosis
- Metastatic carcinoma
- Systemic lupus erythematosus
For each patient with lymphadenopathy, select the most likely diagnosis.
2. A previously healthy 30-year-old man has had fever, night sweats, pruritus, and an enlarging lump above his left clavicle for 3 weeks. Examination shows a 3-cm, nontender, rubbery, supraclavicular lymph node. An x-ray of the chest shows mediastinal lymphadenopathy.
3. A 41-year-old woman comes to the physician for a follow-up examination. She has taken aspirin for chronic headaches and phenytoin for a seizure disorder for 2 years. Examination shows mild epigastric tenderness and bilateral, 3-cm, nontender axillary lymph nodes. A lymph node biopsy shows hyperplasia.
Pharmaceutical Advertisement (Drug Ad) Format
The drug ad item format includes a rich stimulus presented in a manner commonly encountered by a physician, eg, as a printed advertisement in a medical journal. Examinees must interpret the presented material in order to answer questions on various topics, including
- Decisions about care of an individual patient
- Development and approval of drugs and dietary supplements
- Medical ethics
The abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, eg, as an abstract that accompanies a research report in a medical journal. Examinees must interpret the abstract in order to answer questions on various topics, including
- Decisions about care of an individual patient
- Use of diagnostic studies