Step 2 CK Content Outline & Specifications

Download the Step 2 Content Outline

Use the USMLE content outline and physician task/competencies documents to study for Step 2.
Download USMLE Content Outline
Download USMLE Tasks/Competencies

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These resources are intended to help examinees prepare for Step 2, the final exam of the USMLE.

Step 2 Clinical Knowledge (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. Step 2 CK 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 under supervision.

Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.

The examination also includes a minimum allotment 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.

Content Outline

All USMLE examinations are constructed from an integrated content outline, which organizes content according to general principles and individual organ systems. Test questions are classified into one of 18 major categories, depending on whether they focus on concepts and principles that are applicable across organ systems or within individual organ systems.

Step 2 CK content weighting for these topics is provided in Table 1 below. Sections focusing on individual organ systems are subdivided into normal and abnormal processes, including principles of therapy. In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology.

While not all topics listed in the content outline are included in each USMLE Step examination, overall content coverage is comparable among the various examination forms that will be taken by different examinees for each Step.

Step 2 CK Content Specifications

System Range, %*
Human Development** 2–4
Immune System 3–5
Blood & Lymphoreticular System 3–6
Behavioral Health 5–10
Nervous System & Special Senses 5–10
Musculoskeletal System/Skin & Subcutaneous Tissue 6–12
Cardiovascular System 6–12
Respiratory System 5–10
Gastrointestinal System 5–10
Renal & Urinary System & Reproductive Systems 7–13
Pregnancy, Childbirth & the Puerperium 3–7
Endocrine System 3–7
Multisystem Processes & Disorders 4–8
Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature 3–5
Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety 10-15

* Percentages are subject to change at any time.
** The Human Development topic includes Normal Age-Related Findings and Care of the Well Patient.

Step 2 CK Physician Tasks/Competencies Specifications

An additional organizing construct for Step 2 CK design is physician tasks and competencies. Each test question is constructed to assess one of the competencies listed in Table 2. More information about the physician task and competencies outline is available.

Competency Range, %*
Medical Knowledge: Applying Foundational Science Concepts 0**
Patient Care: History and Physical Exam 0***
Patient Care: Laboratory/Diagnostic Studies 13–17
Patient Care: Diagnosis 16–20
Patient Care: Prognosis/Outcome 5–9
Patient Care: Health Maintenance/Disease Prevention 5–10
Patient Care: Pharmacotherapy 8–12
Patient Care: Clinical Interventions 6–10
Patient Care: Mixed Management 12–16
Practice-based Learning & Improvement 3–5
Professionalism 5–7
Systems-based Practice & Patient Safety 5–7

* Percentages are subject to change at any time.
** Test items that assess patient care competencies may also assess knowledge of underlying foundational science concepts.
*** Test items that assess history and physical exam competencies are covered in Step 1 and Step 3 examinations.

Step 2 CK Discipline Specifications

Each Step 2 CK examination covers content related to the traditionally defined disciplines as listed in Table 3.

Discipline Range, %*
Medicine 55–65
Surgery 20–30
Pediatrics 17–27
Obstetrics & Gynecology 10–20
Psychiatry 10–15

* Percentages are subject to change at any time.

Download Content Outline & Physician Tasks/Competencies

The USMLE Content Outline and Physician Tasks/Competencies documents are available in a downloadable PDF format.

Download Content Outline

Download Tasks & Competencies