Everything You Need To Know About the Structure of Step 2 CK – 2025 Update

  • Reviewed by: Amy Rontal, MD
  • After conquering Step 1, it’s time to strategize for Step 2 CK. This second exam in the USMLE series evaluates your clinical science knowledge and patient care skills, making it a critical step in your medical education journey.

    Now that Step 1 is pass/fail, Step 2 CK strongly affects your residency application and overall competitiveness as an applicant more than ever. If you’re feeling a bit overwhelmed by this, you’re not alone! We’re going to fill you in on some important details like Step 2 score benchmarks by specialty, the exam’s structure, content, and some frequently asked questions. Let’s dive in!

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    Why Step 2 CK Matters in 2025

    1. It showcases your clinical acumen to residency programs. 

    Take Step CK seriously, as programs consider your score an indication of your clinical reasoning skill and readiness for direct patient care.

    2. It demonstrates your broad clinical competency. 

    Step 2 evaluates knowledge across various medical specialties, emphasizing diagnosis, management, and patient outcomes, which are essential for residency training regardless of which specialty you apply to.

    3. It can give you a shot at redemption.

    For those with blemishes on their residency application, a strong Step 2 CK score can demonstrate growth and preparedness, which will strengthen your application. 


     4 FAQs About Step 2 CK 

    1. How long do most students study for Step 2 CK? 

    According to our statistics, Blueprint learners study an average of 103.5 days for Step 2 CK. 

    2. What are the most popular months to take Step 2 CK? 

    The top three months for Blueprint Med School Study Planner users to take Step 2 CK are July, June, and August. For a complete list of when our customers most often take Step 2 CK, visit our page with the most popular months.

    3. What do I need to score on Step 2? 

    The minimum passing score for the USMLE Step 2 CK is a 214. In the United States and Canada, 98% of MD students passed Step 2 on the first attempt in the 2022-2023 academic year. The pass rate for DO students was 96% for the same year.

    The mean score for the 2023-2024 academic year was 249, with a standard deviation of 15.

    4. What is considered a good score on Step 2? 

    According to the USMLE, scoring above 250 is above average, though it will highly depend on the specialiy you apply for. Scoring above 260 puts you in the top quartile. 

    💡 For even more information, be sure to check out my other post on Step 2 FAQs!


    Score Benchmarks by Specialty

    Your Step 2 score is a major factor in how you match. The most competitive specialties, including dermatology, plastic surgery, orthopedics, and interventional radiology, often have applicants with scores well over 250.

    (Source: NRMP 2024 Charting Outcomes)

    Use your target specialty’s average as a benchmark and aim to exceed it if possible. As program directors increasingly focus on Step 2 CK scores, the exam has become a differentiator. Competitive applicants often use Step 2 CK scores to highlight their ability to excel in residency training.

    Note: Step 2 CS, the clinical skills portion, was discontinued in 2021.


    Step 2 CK Exam Structure (2025 Update)

    Here’s a breakdown of the key details:

    Step 2 CK is a one-day exam divided into eight blocks of multiple-choice questions, each lasting one hour. Each block has up to 40 questions, but the number varies. The total number of questions for the entire exam will not exceed 318. You’ll see how many questions are in a given block before you start the exam.

    You’ll have the option to take a 15-minute tutorial prior to taking the exam. If you finish early on one or more blocks, your cumulative break time between blocks may exceed 45 minutes and you can use your break time at your discretion.

    So, to summarize:

    Total Testing Time:
    9 hours (including instructions and exam breaks)

    Time per Block:
    60 minutes

    Break Time:
    45 minutes (which can be extended by finishing blocks early or skipping the tutorial)

    Total Questions:
    No more than 318

    🧱 Questions per Block:
    No more than 40


    Questions Typically Seen on Step 2 CK 

    1. Single-Item Questions

    A single patient-centered vignette is associated with one question followed by four or more response options. The response options are lettered (i.e., A, B, C, D, E). A portion of the questions involves interpretation of graphic or pictorial materials.

    You’re required to select the best answer to the question. Other options may be partially correct, but there’s only ONE BEST answer. This is the traditional, most frequently used multiple-choice question format on the examination.

    2. Sequential-Item Sets

    These consist of two or three consecutive questions about the same patient scenario. You can’t return to previous questions after answering the first question in the set, as it may give away the answer to following questions. 

    A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is associated with the initial patient vignette but is testing a different point.

    You’re required to select the ONE BEST answer to each question. Questions are designed to be answered in sequential order. You must click “Proceed to Next Item” to view the next item in the set. Once you click on this button, the next question will be displayed, and you won’t be able to change the answer to the previous question.

    3. Abstract-Set Questions

    The abstract-item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, e.g., 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 the care of an individual patient
    • Biostatistics/Epidemiology
    • Pharmacology/Therapeutics
    • The use of diagnostic studies

    Step 2 CK Content Distribution

    Below is a content outline of Step 2 as provided by the USMLE.* Test questions are grouped into 18 categories, focusing either on concepts and principles relevant across organ systems or those specific to individual organ systems.

    Each topic is weighted, meaning you can expect a certain percentage of exam questions to be based on it. Be aware that not every topic from the content outline appears on every USMLE Step exam, but the overall content coverage is consistent across the different exam forms taken by examinees. 

    * Note that these percentages are subject to change at any time.

    Systems

    SystemRange, %
    Human Development**2–4
    Immune System3–5
    Blood & Lymphoreticular System4–6
    Behavioral Health6–8
    Nervous System & Special Senses6–8
    Musculoskeletal System/Skin & Subcutaneous Tissue6–10
    Cardiovascular System8–10
    Respiratory System7–9
    Gastrointestinal System7–9
    Renal & Urinary System & Male Reproductive4–6
    Pregnancy, Childbirth & the Puerperium4–6
    Female Reproductive System & Breast4–6
    Endocrine System4–6
    Multisystem Processes & Disorders4–6
    Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature3–5
    Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety10–15

    ** The Human Development topic includes Normal Age-Related Findings and Care of the Well Patient.

    Source: USMLE

    Physician Tasks/Competencies

    CompetencyRange, %
    Medical Knowledge: Applying Foundational Science Concepts0**
    Patient Care: History and Physical Exam0***
    Patient Care: Laboratory/Diagnostic Studies13–17
    Patient Care: Diagnosis16–20
    Patient Care: Prognosis/Outcome5–9
    Patient Care: Health Maintenance/Disease Prevention8–12
    Patient Care: Pharmacotherapy8–12
    Patient Care: Clinical Interventions6–10
    Patient Care: Mixed Management12–16
    Practice-based Learning & Improvement3–5
    Professionalism5–7
    Systems-based Practice & Patient Safety5–7


    ** 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.

    Source: USMLE

    Disciplines

    CompetencyRange, %
    Medicine50–60
    Surgery25–30
    Pediatrics20–25
    Obstetrics & Gynecology10–20
    Psychiatry10–15

    Source: USMLE


    Preparation Tips for USMLE Step 2 CK

    1. Use the data above to your advantage. 

    Identify Weak Areas 

    Review your performance data to determine which topics or systems you performed poorly on (e.g., pediatrics, neurology, internal medicine).

    Prioritize High-Yield Areas 

    Cross-reference weak areas with the percentage weight each subject contributes to the exam. Focus first on weak areas with higher weight.

    2. Tailor resources and practice. 

    Use targeted question banks, review books, or videos for the topics you struggle with. Practice questions specifically in these areas to solidify knowledge and improve application skills.

    Be sure to monitor your progress. Reassess performance in weak areas by tracking question bank scores or taking practice exams. Adjust focus if certain areas improve while others remain weak.

    Take advantage of NBME practice exams or the official USMLE self-assessment to gauge your readiness. Make sure you set the same timing parameters as the exam to truly test yourself. 

    3. Create a study plan.

    Although most schools allow dedicated study time, it’s up to you to figure out the schedule that works best!

    I recommend allocating 6-8 hours per day, including:

    • 4-5 hours of question bank practice
    • 2-3 hours of reviewing explanations and weak areas
    • 1 hour for passive review, such as flashcards or revisiting incorrect questions

    🗓️ Check out Blueprint’s “smart” Med School Study Planner if you need help getting started. It’s completely free! 


    Final Thoughts

    Knowing the latest when it comes to Step 2 CK structure and content means you’ll be ahead of the curve. Be sure to take note of the Step 2 content distribution update and create a good study plan so you’re ready on exam day. And remember, while some things change, others stay the same. There’s no substitution for hard work.

    Start early, create a study schedule, and you’ll reap the rewards of a good Step 2 CK score. Including—just maybe—your dream residency program!

    About the Author

    Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores, and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life – as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident.   For years, Dr. Ren has worked closely with the office of student affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills and as an advisor he will hone your interview skills with insider knowledge to commonly asked admissions questions.