Congratulations, med students! You’ve completed and passed Step 1 and now get to prepare for the arguably more important (and graded) exam: USMLE Step 2. In this blog post, I detail a seven-point guide that will provide you with essential information about USMLE Step 2, including its purpose, eligibility requirements, and a guide on how to register for one of the biggest tests of your career. Let’s dive in!

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Answering Your Top Questions About USMLE Step 2 CK: A Tutor’s Guide

What is the format of USMLE Step 2 CK? 

The CK exam is a multiple-choice test that evaluates a student’s understanding of clinical sciences and their ability to apply medical knowledge in various scenarios. Step 2 CK is a one-day examination, divided into eight 1-hour blocks, and administered in one 9-hour testing session (with 1 hour of breaks).

The number of questions per block on a given exam may vary but it won’t exceed 40, and the total number of items on the exam overall will not exceed 318. USMLE Step 2 covers various disciplines of clinical medicine such as internal medicine, surgery, OBGYN, pediatrics, psychiatry, emergency medicine, critical care, and more. The exam also includes at least 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.

How do I know which content will be on the exam?

Practice materials, which include an interactive testing experience and tutorial, sample test items in a PDF document, as well as other informational materials including the specific topics covered on the exam, are available on the USMLE website. Examinees should also read the USMLE Bulletin of Information to get additional details on exam content updates.

Who is eligible to take Step 2?

To be eligible for the USMLE Step 2 exam, you must be a medical student enrolled in, or a graduate of, a U.S. or Canadian medical school program leading to an MD or DO degree that is accredited by the Liaison Committee on Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA.) Or, for IMGs, a medical student enrolled in, or a graduate of, a medical school that is outside the U.S. and Canada, listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements. According to the USMLE website, if you meet the eligibility requirements, you may take the Step 1 and Step 2 CK exams in any sequence.

What is the time period for scheduling the exam?

Keep in mind there is a time limit for completing all USMLE Steps. For Step 2, you cannot make more than four attempts to pass the exam within a seven-year period after passing Step 1. Attempts at the formerly administered Step 2 CS count toward the limit. Additionally, you may not take the same Step exam more than three times within a 12-month period. Your fourth attempt must be at least 12 months after your first attempt, and at least six months after your most recent attempt. This includes incomplete attempts. Lastly, if you pass a Step exam, you are not allowed to retake it for a higher score.

How do I register for the exam?

For students and graduates of US medical schools, apply by logging into the NBME website. If you are a first-time user, click the first-time user link and enter your info. The name you register with must be exactly how it appears on the ID you will present when you go to the testing center (e.g., driver’s license or passport.) Your USMLE ID and a temporary password will typically be emailed to you within 48 hours. Use them to sign into the NBME website. After logging in, click “Apply for the USMLE” and follow the instructions. You’ll select a 3-month period during which you expect to take the test. Don’t worry, you can change the testing window at a later time, although there is a fee to do so.

Once the NBME receives your online application for Step 2, you will be verified by the Office of Student Records of your medical school prior to setting up your testing dates. Verifications are done after your registration information is received by the Office of Student Records from the NBME. The site is checked every Monday, Wednesday, and Friday.

After the NBME receives and processes your application form, they will email you your scheduling permit. The email will also provide the three-month window you’ve chosen for your exam date as well as instructions on making an appointment with a Prometric testing center.

How do I schedule my exam date and location?

Using the scheduling permit, visit the Prometric website to select your preferred exam date and location. Ensure availability by booking well in advance, as popular test centers may fill up quickly. I have had friends, classmates, and students who have had to travel across states just to take the test. Imagine that! So book early and avoid the hassles and costs associated with travel.

How do I register for the exam as an international student?

If you’re an international student, things are a bit different. Here are the steps you should take if you are registering for the USMLE Step 2 CK: 

Step 1: Obtain an ECFMG® Applicant Portal account.

If you are an international medical student, you need to create an account on the ECFMG website. This portal will be your primary resource for exam registration and accessing your exam results.

Step 2: Determine your eligibility period.

Visit the ECFMG website above to view the eligibility periods for the exam. Select the period that best suits your schedule and availability.

Step 3: Submit the exam application.

Fill out the online application form on the ECFMG Applicant Portal. The application requires personal information, educational history, and payment of the exam fee. Be sure to double-check all information before submitting.

Step 4: Receive the exam scheduling permit and register for your exam.

Once your application is approved, you will receive a scheduling permit from ECFMG. This permit contains your eligibility period and a scheduling number, which is essential for reserving your exam date.

When should I take the USMLE Step 2 CK?

Much of the Step 2 exam is focused on testing for clinical knowledge. Thus, you should aim to take Step 2 shortly after completing your core clinical rotations. All the shelf exams you’ve taken thus far will be hugely beneficial and contribute to a higher exam score. The strategy, in this case, is simple: it is much easier to review Step 2 exam topics when you just covered similar material studying for your rotations. Think of each core clinical shelf exam as a mini Step 2. 

My advice is to take it within 3-6 months of completing your core rotations, depending on what your med school allows. Sooner (aka within 3 months) if you feel up for it and later (between 3-6 months) if you are tired of studying and need a bit of a break. If you are going into a competitive field or desire to match to a particularly competitive program (top academic programs in big cities), make sure you score well and complete the exam in time for your score report to be available for your ERAS submission. It typically takes between 2-4 weeks for your score report to be released. I’d play it safe and take the exam 4-6 weeks prior to needing the report.

Should I use a tutor to prepare for the USMLE Step 2 CK?  

Here’s my take: most people do not need a tutor for exam prep, but most students could also benefit from having one. Tutors can help with resource management, create a personalized study schedule and make sure you stick to it, explain topics in a unique and easy-to-understand manner, and offer reassurance if test anxiety or other issues come up.

Those who would especially benefit are students who have a history of lower-than-average exam scores, those who had to repeat exams, and students scoring less than 25 points on practice NBME tests than the score they need for residency. If you are looking for a tutor, feel free to contact me or anyone at Blueprint for a free consultation!

Further Reading

Step 2 is a big step! There is a lot to think about, including the exam format, preparing, and getting registered. It can all feel a bit overwhelming. But we have you covered. This seven-point guide can help stay organized and succeed at this pivotal moment in your career. If you’re looking for more (free!) content, check out these other posts from Blueprint:

• How to Prepare for Step 2: A Few Questions to Ask Yourself So You Don’t Become Overwhelmed
• How to Study For Shelf Exams: A Tutor’s Guide
• Now That Step 1 is Pass/Fail, Does Step 2 Matter More?