Step 2 CK and CS (Clinical Knowledge and Clinical Skills)

Step 2 assesses whether students 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

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

Examination Content:

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
  • Prognosis
  • Indications of underlying mechanisms of disease
  • Next steps 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.

Please note that much of the content that addresses normal growth and development and general principles of care is also related to the individual organ systems categories, so that the number of questions that deal solely with normal growth and development and general principles of care is relatively small.

Sample Step 2 CK test materials and further information on Step 2 CK test content are available at the USMLE website.

Costs associated with this exam can be found here.


Step 2 CS

Step 2 of the USMLE assesses the ability of examinees 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 ensures that due attention is devoted to the principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and effective practice of medicine.

Step 2 CS uses standardized patients to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues.

Examination Content:

Step 2 CS assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. There are three subcomponents of Step 2 CS: Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP).

Step 2 CS uses standardized patients, i.e., people trained to portray real patients. Students' role during the examination should be that of at least a first-year postgraduate resident physician with primary responsibility for the care of each patient. Students should treat each patient they see as they would a real patient. Do not defer decision-making to others.

The elements of the history and physical examination necessary for each case will be determined by the nature of the patient's problems. The cases students will see will not require them to do a complete history and a complete physical examination. In fact, if students attempt to do so, they may run out of time and will not be able to fully address the emotional and communication needs of the patient.

Students will be expected to communicate with the standardized patients in a professional and empathetic manner, being responsive to the patient’s needs. As students would when encountering real patients, they should answer any questions the patients may have, tell them what diagnoses are being considered, and advise them on what tests and studies will be ordered to clarify their diagnoses.

After each interaction with a patient, students will complete a patient note. Students will record pertinent history and physical examination findings, list diagnostic impressions, and outline plans for further evaluation, if necessary.

The cases cover common and important situations that a physician is likely to encounter in common medical practice in clinics, doctors’ offices, emergency departments, and hospital settings in the United States. The cases that make up each administration of the Step 2 CS examination are based upon an examination blueprint that defines the requirements for each examination, regardless of where and when it is administered. The sample of cases selected for each examination reflect a balance of cases that is fair and equitable across all examinees. While the set of cases administered on a given day will differ from the set of cases administered on another day, each set of cases is comparable.

The intent is to ensure that examinees encounter a broad spectrum of cases reflecting common and important symptoms and diagnoses. The criteria that are used to define the blueprint and create individual examinations focus primarily on presenting complaints and conditions. Presentation categories include, but are not limited to, cardiovascular, constitutional, gastrointestinal, genitourinary, musculoskeletal, neurological, psychiatric, respiratory, and women's health. Examinees will see cases from some, but not all, of these categories. The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.

Sample Step 2 CS test materials and further information on Step 2 CS test content are available at the USMLE website.

Costs associated with this exam can be found here.