Step 2 CK Exam Updates: Time for a Change

  • /Reviewed by: Amy Rontal, MD
  • If Step 2 CK is looming on your horizon, you’ve likely heard a little about the changes to the examination material.

    Changes to USMLE Step 2 CK Exam Content Distribution

    As of November 11, 2020, the USMLE has implemented changes to the Step 2 CK exam to include more of the following:

    • Systems-based practice
    • Patient safety
    • Ethics
    • Legal issues
    • Professionalism


    The USMLE has stated that “no new content” will be included on the exam. This is important to recognize!

    Instead, there will only be an increase in the number of items that assess each of these content areas (which have technically been on the exam already for years).

    The new breakdown for each of these categories by system is available on the USMLE website.

    Because Step 2 CK now places more weight on the ethical/legal/patient safety aspects of medicine, many of the other systems have slightly fewer questions (by 1 or 2%).

    Whereas the “Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety” section used to be 3-7% of the questions, it is now 10-15%. A substantial chunk!

    The USMLE website provides a couple of examples of what these flushed-out sections cover. Here is the USMLE’s “Patient Safety” practice question, which is available online:

    A 45-year-old woman is hospitalized for management of Staphylococcus aureus endocarditis with persistent bacteremia. The patient is discussed during interdisciplinary rounds, which includes physicians, nurses, pharmacists, and social workers. During rounds, a pharmacy student notices that the patient missed two doses of her scheduled antibiotic last week but is unsure why. The physician and nurse are unaware of these missed doses, and the student does not mention her observation. Which of the following measures is most likely to improve communication within this interdisciplinary health care team? 


    (A) Conduct interdisciplinary rounds in a quieter location 

    (B) Encourage questions from all team members 

    (C) Implement a checklist for standardizing patient rounds 

    (D) Use computers during rounds to review medications 

    Answer: B


    [My read: Effective communication and team-based care is crucial to maximizing patient safety.]


    Here is the USMLE’s “Professionalism” practice question, which is also available online:

    Three days after hospitalization for diabetic ketoacidosis, an 87-year-old woman refuses insulin injections. She says that her medical condition has declined so much that she no longer wishes to go on living; she is nearly blind and will likely require bilateral leg amputations. She reports that she has always been an active person and does not see how her life will be of value anymore. She has no family and most of her friends are sick or deceased. On mental status examination, she is alert and cooperative. She accurately describes her medical history and understands the consequences of refusing insulin. There is no evidence of depression. She dismisses any attempts by the physician to change her mind, saying that the physician is too young to understand her situation. She says, “I know I will die, and this is what I want.” Which of the following is the most appropriate next step in management? 


    (A) Discharge the patient after she has signed an “against medical advice” form 

    (B) Seek a court order to appoint a legal guardian 

    (C) Offer insulin but allow the patient to refuse it

    (D) Admit to the psychiatric unit 

    (E) Administer insulin against the patient’s wishes 

    Answer: C


    [My read: Patients who are competent can refuse medical treatments. The patient is informed (understanding risks, benefits, alternatives including no treatment) and has made and communicated a choice clearly.]

    Should I Change How I Study for Step 2 CK?

    No, we do not recommend changing your study strategy for Step 2 CK. If you are concerned about the content distribution changes to the latest iteration of the exam, be sure to review the ethics questions available in UWorld.


    Take-home point: You’ve already been exposed to this information on practice exams and question banks. Now you’re just going to see more of it on the actual examination. No need to worry!

    In addition, the normal laboratory values table has been updated as of November 11, 2020. This is nothing you should stress about, but on the off-chance you memorized parts of the previous one, the new table will be just a little different!

    To make sure you’re being exposed to the most up-to-date exam content, check out the most updated free 120 questions (as of August 2020). You can access it as a PDF or in a simulated exam environment online.


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