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Everything You Need to Know about the Structure of Step 2

Find out all of the relevant content categories for Step 2 studying, Step 2 pass rates, popular exam dates, and more.

Now that you have conquered Step 1, it’s time to start thinking about how you’ll tackle Step2. The second exam in the USMLE series tests medical students on their knowledge of the clinical sciences and their patient care skills. That’s what it’s called the USMLE Step 2 CK (Clinical Knowledge). Step 2 emphasizes prevention and health promotion. Medical students typically take Step 2 at the end of their third year. Below we explain the structure of the exam and list some helpful information for you as you begin to prepare a study plan.

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Step 2 CK is divided into 8 blocks of multiple choice questions. The number of questions may vary between blocks. You will always be told how many questions are in a given block before you begin. You have the option to take a 15-minute tutorial prior to taking the exam. Break time may exceed 45 minutes if you finish early on one or more blocks. Below is a breakdown of the time and number of questions allotted on Step 2 CK.

Total Testing Time: 8 hours and 45 minutes
Time per Block: 60 minutes
Break Time Allotted: 45 minutes
Total Multiple Choice Questions: No more than 355 Questions per Block: No more than 44

There are 3 types of questions on Step 2:
Single-Item Questions, Sequential-Item Sets, and Matching Sets.

  1. Single-Item Questions will have 3 to 26 answer choices. You are told to choose the best answer. Only one answer is best, while others may be only partially correct.
  2. Sequential-Item Sets contain 2 or 3 consecutive questions that each address the same patient vignette. When you answer one of these questions, you will be brought to the next, and you will be unable to return to an earlier question to change your answer choice.
  3. Matching Sets contain at least 2 questions. The answers to these questions come from a bank of between 4 and 26 answer choices.

For examples of the above question types, see the USMLE Step 2 CK’s Sample Questions.


Below you will find a range next to each topic that tells you the distribution range for the amount questions you can expect. In addition to testing content knowledge of systems, Step 2 also tests physician tasks and competencies. The distribution of physician questions that test physician tasks and competencies are also listed below.


General Principles: 1%–3%
Organ Systems: 85%–95%

  • Immune System Blood and Lymphoreticular Systems
  • Behavioral Health
  • Nervous System & Special Senses
  • Skin & Subcutaneous Tissue
  • Musculoskeletal System
  • Cardiovascular System
  • Respiratory System
  • Gastrointestinal System Renal and Urinary Systems Pregnancy, Childbirth, and the Puerperium Female
  • Reproductive System and Breast
  • Male Reproductive System
  • Endocrine System
  • Multisystem Processes and Disorders

Biostatistics, Epidemiology and Interpretation of Medical Literature: 1% to 5%

Physician Tasks and Competencies

Medical Knowledge and Scientific Concepts: 10%–15% Patient Care – Diagnosis: 40%–50%

  • History/Physical Exam
  • Laboratory/Diagnostic Studies
  • Diagnosis
  • Prognosis

Patient Care – Management Health Maintenance/Disease Prevention: 30%–35%
Communication, Professionalism, Systems-based Practice, Patient Safety, Practice-based Learning: 3%–7%

Preparing for Step 2 CK

To see the most popular Step 2 CK textbooks, lecture series, question banks, and flashcards, visit Below we answer frequently asked question regarding Step 2 CK test preparation.

How long do most students study for Step 2 CK? According to Cram Fighter’s statistics, most students study for Step 2 CK for 63 days.

When are the most popular months to take Step 2 CK? The top three months among Cram Fighter users for taking Step 2 CK are (in order of popularity) July, August, and June. For a complete list, visit our page on the most popular months for taking Step 2.

What do I need to score on Step 2?
The minimum passing score for the USMLE Step 2 is a 209. 94% of medical students in the United States and Canada passed Step 2 in the 2014-2015 academic year. The mean score for the 2014-2015 academic year was 240, and one standard deviation was 18.

About the Author

Erica Forrette is the former Director of Marketing at Cram Fighter.