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Guide to USMLE Step 2: Clinical Knowledge

The USMLE Step II CK exam is a test of the clinical knowledge gained during the third year medical school core clerkships. It is similar in format to Step I, but is more clinically oriented, i.e. you are given a patient scenario and asked about the diagnosis or next step. The exam consists of eight blocks, which is one section longer than the seven blocks of Step I.

Subjects tested include Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, Neurology, Emergency Medicine, Dermatology, selected surgical sub-specialties and Radiology. There are a few questions that feature audio and/or video clips. More detail on all aspects of the exam is available on the USMLE website.

The Jefferson AOA Guide to the USMLE Step II CK will answer your Common Questions about the test, will assist you in Planning a Schedule, and will suggest the Right Resources to help you prepare appropriately. Also, please check out the official USMLE Step II website for more information:

Common Questions

How important is the USMLE Step II CK score anyway?

A passing score on the USMLE Step II CK is required for all medical students prior to beginning residency. Although less important than the Step I, a strong Step II CK score can only help your residency application, as programs will see your score regardless of when you take the exam.  Due to the more clinical nature of the exam, most students improve on their prior Step I score.

What is the best time of year for Jefferson students to take the USMLE Step II CK?

Some students prefer to take the test right after third year because they feel well prepared coming off of their final shelf exam.  Additionally, they feel that taking the exam early and scoring well is a great way to strengthen their residency application, especially if they may have been disappointed with their Step I score. There are usually 2 weeks between 3rd and 4th year that students can use to study. If you have internal medicine or family medicine as your last rotation of third year you’ll be in great shape to take Step II soon after the shelf exam but others have still taken it and done well coming off Psychiatry or even the more demanding OB-GYN.

Other students choose to take the exam during the first few months of 4th year or after they submit their residency application. If you decide to take it later, programs can invite you for an interview without a Step II score.  However, you will need to take the exam before they can rank you. Some people recommend taking it later if you are happy with your Step I score, but in the end the decision should come down to the amount of time you need to study.

For those of you who were happy with your Step 1 score and who want to take Step 2 later due to concern about “ruining” a Step 1 score with a potentially poor Step 2 score, keep the following in mind. First, most people do the same or better on Step 2 as they did on Step 1 – trust us, it’s true. Second, your shelf exam scores will give you a good idea of how you might expect to do on Step 2. Third, taking Step 2 in December is not always the best option. You don’t always know what interview season will hold and Step 2 can become a lot more stressful than it needs to be if it’s intertwined with trying to coordinate interviews and traveling.

Resources

Crush Step IIFirst Aid for the USMLE Step II CKand Step-up to USMLE Step 2 provide a broad overview of topics. Most would agree that First Aid for Step II CK is much less useful than its younger sibling was for Step I, particularly with regards to surgery topics. Most don’t go back to the First Aid series for Step II. Crush Step II, however, is a frequently used resource for Step II CK preparation, and is favored by those that prefer a text-based approach to test preparation. Step-up to USMLE Step 2 is organized well (ie. H/P, labs, Radiology, Treatment, complications subtitles for each disease entity) and it has a section on ER, critical care and surgery which was weak in other texts.

DO NOT read lengthy subject-specific books. Reading individual subject-specific Blueprints or Recall books is not needed.

Practice Questions

We recommend starting questions about one month before the exam if you’re on an elective, maybe earlier if you plan to get through all of them. Some students only do UWorld questions and fit all of them into a two-week period. Not everyone completes the UWorld either before taking Step II CK. If you are strapped for time it’s not necessary to complete the bank as long as you feel you are improving, but the more practice the better. Check out some online resources below.

USMLEWorld: There are approximately 2000+ questions in the UWorld qbank. Some people will do blocks throughout 3rd year to study for shelf exams and then repeat the questions before taking Step II. Others wait to purchase the Q-bank when they begin studying for Step II. Either way, getting through all of the questions at least once is definitely enough.

Kaplan Q-bank: Very few students use this resource. It is another good yet more expensive option and consists of 2,200 on-line questions; similar to Q-Bank for Step I.

The Bottom Line: The majority of people use USMLE world Q-bank and a supplementary review book (e.g. First Aid or Step-Up to CK).  You shouldn’t need much more than this.

Planning a Schedule

The schedule for Step II CK preparation varies significantly depending on how much time has passed since completion of the clerkships, and whether you are studying during vacation or during a 4th year rotation.  Overall, study time usually ranges from 1-4 weeks with most students taking 2-3 weeks.  Students who take the exam during a vacation will often need less time since they have more time each day to study.  Students who take the exam while on rotation might need to start studying earlier given that they have less free time during the day. 

The daily study schedule is constructed similarly to a Step I schedule.  Intersperse question blocks and sections from the review book, making sure you review most/all topics at least once.  

Overall, studying for Step II is much less intense than Step I, but be sure to give yourself enough time to get through most/all of your resources.  If you do this, you should be in great shape. If you want more practice you can purchase a practice test along with the qbank. This isn’t entirely necessary since you now know what it’s like to take a day-long test, but if you want it it’s there.

Good Luck!!