The USMLE-Step 2-CK ("Clinical Knowledge") is the multiple-choice portion of the second part of the United States Medical Licensure Examination.[1] It assesses clinical knowledge through a traditional, multiple-choice examination. In contrast to the USMLE Step 1, the focus is much more on clinical application of medical knowledge. The USMLE Step 2 is generally taken during the 4th year of medical school by medical students. From January 2010, the registration fee for the test is $780 for students who take it in North America, with additional charges for applicants who choose a testing region outside the United States or Canada.[2]
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The exam is a nine-hour single-day computer-based test composed of eight 44-question sets (352 multiple-choice questions in total). Each section is one hour long. The test taker is permitted 45 minutes, in total for the whole day, for the purpose of breaks that can only be taken between sections. There is a 15 minute tutorial at the beginning of the exam, which the test-taker can choose to skip, and have the time added to the break time. If the taker finishes any section before the alloted 1 hour time limit, the remainder of the time is added to break time. The test is administered at the Prometric testing sites around the world.
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, a prognosis, an indication of underlying mechanisms of disease, the next step 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. Step 2 CK classifies test items along two dimensions: disease category and physician task.
Scoring is reported in 2 digit and 3 digit scores. On the 3-digit scale, most scores fall between 140 and 260, with the mean score for first-time examinees from accredited medical schools in the United States in the range of 220 to 230, and the standard deviation approximately 25. The 2-digit score is derived from the 3-digit score, so that 75 always corresponds to the minimum passing score.[3] Students are required to get 75 in the two digit score and 189 in the three digit score to pass.[4]
The USMLE Step 2 CK score is one of many factors considered by residency programs in selecting applicants. Along with the USMLE Step 1, this test is a standardized measure of all applicants. The median USMLE Step 2 scores for graduates of U.S. Medical Schools for various residencies are charted in Chart 7 on page 10 of "Charting Outcomes in the Match" available at http://www.nrmp.org/data/chartingoutcomes2009v3.pdf