Step 2 CK Exam Content

Download Step 2 CK Resources

Use the USMLE content outline and physician task/competencies documents to study for Step 2 CK.
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.

If you are taking Step 2 CK before May 7, 2026, 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.

If you are taking Step 2 CK on or after May 7, 2026, Step 2 CK is a one-day examination.  It is divided into sixteen 30-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination form may vary, but will not exceed 20. The examination also includes a minimum allotment of 55 minutes of break time and a 5-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.  

Table 1 also includes the Nutrition discipline.  Test items that are coded to Nutrition are also coded to one of the system content categories that appear in the USMLE Content Outline. For example, a test item about routine preventive healthcare where the physician discusses lifestyle modifications (including dietary counseling) with the patient would be coded to both Human Development and Nutrition.  Test items coded to the Nutrition Discipline align with evidence-based competencies including but not limited to those outlined in the 2024 consensus statement Proposed Nutrition Competencies for Medical Students and Physician Trainees published in JAMA Netw Open.

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/Discipline Range, %*
Nutrition 15–20
Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety 10-15
Renal & Urinary System & Reproductive Systems 7–13
Cardiovascular System 6–12
Musculoskeletal System/Skin & Subcutaneous Tissue 6–12
Behavioral Health 5–10
Blood & Lymphoreticular/Immune Systems 5-10
Gastrointestinal System 5–10
Nervous System & Special Senses 5–10
Respiratory System 5–10
Multisystem Processes & Disorders 4–8
Endocrine System 3–7
Pregnancy, Childbirth & the Puerperium 3–7
Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature 3–5
Human Development** 2–4

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

* 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 Clinical Science Specifications

Each Step 2 CK examination covers content related to the traditionally defined Clinical Sciences as listed in Table 3.  Step 2 CK test items are deliberately designed to be integrative; many items are classified to more than one clinical science.  Totals add up to greater than 100%.  

 

Clinical Science Range, %*
Medicine 55–65
Pediatrics 17–27
Obstetrics & Gynecology 10–20
Psychiatry 10–15
Surgery 5–15

* 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