Examination Day and Testing
Testing Regulations and Rules of Conduct
USMLE Step 2 Questions and Exam Pattern: USMLE Step 2 CK is a one-day examination just like USMLE step 1 exam. The test duration is 9 hours, divided into 8 blocks of one hour each. Each of the blocks will have not more than 40 questions, and the total number of questions will be 350. The questions will be MCQ type. USMLE Step 2 CK Books And Study Strategy. The proctor then calls you into the anteroom, check your ID, takes a photograph, and gives you a laminated sheet and dry erase marker for notes. After entering the testing room, you are assigned a computer and the exam begins. You have a total of 9 hours from this point.
Adminstration of the USMLE Steps are monitored by test center staff, in person and through audio and visual recording. Test center staff are required to report any violations of the USMLE or test center rules. You must follow instructions from test center staff throughout the examinations; failure to do so may result in a finding that you have engaged in irregular behavior and a permanent annotation of your transcript. Test center staff are not authorized to answer questions regarding registration, examination content or format, or testing software, scoring, or retesting.
Rules of Conduct
- If you violate these Rules of Conduct, you may be directed to leave the test center before completing your examination. Also, evidence of violation of any test administration rule, including these Rules of Conduct, will result in actions being taken under the United States Medical Licensing Examination USMLE Policies and Procedures Regarding Irregular Behavior. If you are found to have engaged in irregular behavior, your score report and transcripts will include this finding, you may be barred from taking the USMLE in the future, and your score may be canceled.
When you submit your application to take the USMLE, you agree to the following:
- You are the person named on the scheduling permit for the examination.
- You will not seek, provide, or obtain any form of unauthorized assistance at any time , including during the examination or during breaks.
- You will not have prohibited materials, including formulas, study materials, notes, papers, or electronic devices of any kind in your possession while you are in the secure areas of the center.
- You will place in a locker or cubicle all personal belongings, including cell phones, watches, pagers, tablet PCs, iPods/media players, fitness and tracking monitors, any device with transmitting or receiving capabilities (e.g., Bluetooth), formulas, study materials, notes, papers, pens/pencils, and your purse and/or wallet, before you enter the testing room (or 'orientation room' for Step 2 CS).
- During computer-based testing (Steps 1, 2 CK, and 3), you will leave your testing station for breaks only when the break screen is visible on your monitor. It is a violation of the Rules of Conduct if you indicate on the center log that your break screen is visible when it is not.
- During computer-based testing (Steps 1, 2 CK, and 3), you may use a telephone or other communication device only when outside the secure testing area and during an authorized break. During Step 2 CS, you will not use a personal telephone at any time while you are in the testing center.
- You will not remove examination content from the test center by any means.
- You will maintain the confidentiality of the materials, including, but not limited to, the multiple-choice items and the case content for Step 2 CS and Primum CCS. You will not reproduce or attempt to reproduce examination materials through recording, memorization, or by any other means. Also, you will not provide information relating to examination content to anyone, including those who may be taking or preparing others to take the examination. This includes postings regarding examination content and/or answers on the Internet.
- You will not write on anything other than the laminated note boards (computer-based examinations) or scrap paper (Step 2 CS) provided.
Personal Belongings - What You Can Bring Into The Testing Room
Personal items are prohibited in the secure areas of the testing center. For computer-based examinations (Step 1, Step 2 CK, and Step 3), the only items you are allowed to bring into the testing room are soft-foam earplugs without strings. Earplugs must be removed from the packaging and be ready for inspection by test center staff during check-in and must remain at your workstation during all breaks. Earplugs are prohibited for Step 2 CS. Visit the USMLE website for more information.
For Step 2 CS, the entire test center, including the orientation room and the restrooms, is considered a secure testing area. The only items you are allowed to bring into the secure testing area are your white lab coat (pockets must be empty) and your your stethoscope (should you forget to bring one, there are a limited number available at the test center). All other equipment, including pens, gloves, writing paper, and other medical equipment is provided by the test center. Visit the USMLE website for more information regarding the Step 2 CS examination experience and test center regulations.
For all Steps, if you bring personal items to the test center, you must store them in a small designated locker outside the secure testing area or in the designated storage area for Step 2 CS; electronic devices must be turned off. Turning down the volume is not sufficient. All personal items are subject to inspection.
Admission to the Test
Check-In Procedures
Step 1, Step 2 CK, Step 3
You should arrive at the test center approximately 30 minutes prior to your scheduled testing appointment. If you arrive after your appointment time, you may not be admitted. If you arrive more than 30 minutes after your scheduled testing appointment, you will not be admitted and must pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.
![Guide To Breaktime In Step 2 Ck Guide To Breaktime In Step 2 Ck](/uploads/1/2/5/5/125591576/254975860.jpg)
Step 2 CS
You should arrive at the test center at the time listed on the confirmation notice you will have printed after scheduling your appointment. There will be an on-site orientation to demonstrate the equipment available for you to use in the examination rooms and to review examination rules and procedures. If you arrive during the on-site orientation, you may be allowed to test after signing a Late Admission Form. If you arrive after the on-site orientation, you will not be allowed to test and must pay a fee to reschedule your test. Your rescheduled test date must fall within your eligibility period.
All Steps
When you arrive at the test center, you must present a paper or electronic copy of your scheduling permit and a government-issued unexpired photo identification. Please review your scheduling permit for additional identification requirements. Acceptable forms of unexpired identification include:
- Passport
- Driver's license with photograph
- National Identity Card
- Other form of unexpired, government-issued identification
Your name, as it appears on your scheduling permit, must exactly match the name on your form(s) of identification. Your identification must contain both your signature and a recent photograph. Please review your scheduling permit for details and limited exceptions. If the name listed on your scheduling permit is not correct, contact the organization that registered you for your examination immediately.
If you do not bring your scheduling permit on paper or electronically (e.g., via smartphone) and acceptable identification on each day of your exam, you will not be admitted to the test and will be required to pay a fee to reschedule your test. Your rescheduled test date(s) must fall within your eligibility period.
Security Procedures
For Step 1, Step 2 CK, and Step 3 ONLY
During check-in, test center staff will scan you with a metal detector (handheld or walk-through) and ask you to empty your pockets and turn them inside out before entering the testing room to confirm that you have no prohibited items. You will be asked to repeat this process each time you return to the testing room after a break. Additionally, your photo ID and fingerprint may be scanned electronically, and you must sign the test center log each time you enter or exit the test room.
Before you enter the test room, test center staff will give you laminated writing surfaces and markers to use for making notes and/or calculations during the testing session. You will be instructed to write your name and CIN, as shown on your scheduling permit, on one of the laminated writing surfaces provided. Writing surfaces and markers should be used only at your assigned testing station and only after you have entered your CIN in the computer to start your test session. If you have filled the laminated writing surfaces and need additional space for making notes, raise your hand to ask test center staff for a replacement. You must return laminated writing surfaces to test center staff at the end of the testing session. Do NOT write on anything (e.g., skin, clothing, tissue) other than the laminated writing surface. Failure to comply may result in a finding that you engaged in irregular behavior.
Test center staff will escort you to your assigned testing station and provide brief instructions on use of the computer equipment. You must enter your CIN to start the examination. A brief tutorial is available before each examination. You must run the sound check for the audio headphones either before the examination begins or during the tutorial, so that problems can be resolved before you start the examination.
For Step 2 CS ONLY
During check-in, in addition to having your photo ID scanned electronically, you will be asked to place your personal belongings (e.g., pens, study materials, cell phones) in small bins, which are inaccessible for the duration of the examination day. Any personal belongings that you may need during breaks or during the examination, including your lab coat and stethoscope, can be placed at your seat in the orientation room. Please note that every area of the testing center is under video surveillance at all times; examinees are escorted by proctors at all times, with the exception of restroom breaks.
All Steps
There are no facilities available for family and friends to wait at the center while you test; plan to meet them elsewhere after the examination ends. All examinees will be required to remove eyeglasses for close visual inspection by the test center administrator. These inspections will take a few seconds and will be done at checkin and upon your return from breaks. Jewelry, except for wedding and engagement rings, is prohibited. Hair accessories such as hats, ornate clips, combs, barrettes, or headbands are subject to inspection.
Break Time
Step 1, Step 2 CK, and Step 3
Your test session is scheduled for a fixed amount of time, and the computer keeps track of the time allocated for each block and for breaks. At the start of the testing session, you have a total of 45 minutes of break time for authorized breaks and for computer transitions between blocks. Authorized breaks include any time you spend between test blocks, whether you remain at your seat or leave the testing room. If you complete the tutorial or other testing blocks early, the remaining time will be added to your total break time.
Once you begin a testing block, you may not leave the room (except in the event of an emergency). If you leave the room for a personal emergency and you are not on an authorized break, the block and daytime clocks will continue to run, and the test center will report the incident to the USMLE program. Additionally, the unauthorized break screen, described in the examination tutorial, will appear on the monitor after a defined period of inactivity. After the unauthorized break screen appears, you will need to enter your CIN to continue with the examination. Each time you leave the testing room, you are required to sign out and sign in when you return. You must present your identification each time you sign in.
If you exceed your allocated or accumulated break time, the excess will be deducted from your total testing time. Use the time summary feature (explained in the tutorial on your test day) to keep track of your time.
Step 2 CS
Your Step 2 CS administration will include 12 patient encounters. The examination session lasts approximately eight hours. Examinees get a minimum of 45 minutes in break time, which includes a 30-minute lunch period. During lunch, a light meal will be served. The test center is unable to accommodate special meal requests. However, you may bring your own food, provided that no refrigeration is required. The frequency and length of breaks, other than the lunch break, will vary slightly by testing center. Smoking and/or the use of any tobacco products is prohibited throughout the centers.
Starting and Completing the Test
Step 1, Step 2 CK, and Step 3
After you start taking an examination, you cannot cancel or reschedule that examination. If you experience a computer issue during the test, notify test center staff immediately. The testing software is designed to restart the test at the point that it was interrupted, without loss of time.
The test session ends when you have started and exited all blocks or the total test time expires. You will receive a notice during checkout that you have appeared for the test. If your test is scheduled for multiple days, be sure to bring a copy of your scheduling permit with you each day or you may not be permitted to test.
In the rare event that a technical problem occurs that does not permit you to complete your examination, please send a written description of the incident to Test Administration Services at the NBME. Test Administration Services must receive your notice within 10 days of your testing date or it may not be possible to fully investigate your concerns. Your correspondence should include your name, your USMLE ID number, the examination name (Step 1, 2 CK, 2 CS, or 3), the date of administration, and a message with a detailed description of the difficulty experienced. Please allow at least 15 business days for your report to be investigated and evaluated. You will receive written notification of the investigation results.
If you start the examination but do not complete it for reasons other than a technical problem or expiration of time, you should promptly write to Test Administration Services explaining, in detail, the reasons you did not finish the examination. The attempt may appear as an incomplete on your USMLE transcript.
For more information on how to report a test administration problem, visit the website
Step 2 CS
Once you enter the secure areas of the test center, which includes the orientation area, you may not leave the area until the examination has been completed. All examinees taking the Step 2 CS examination are required to type the patient note portion of the exam. You are permitted to handwrite your patient note only if you were approved to receive an accommodation for a disability or if technical difficulties occur that make the patient note-typing program unavailable.
You may not solicit information about cases or discuss the cases with anyone, including other examinees, at any time (before, during, or after your examination). This includes any activity on the Internet, including on social media. All conversation at the testing center among examinees must be in English.
- The USMLE program may prohibit an examinee from completing the exam and/or may impose conditions on retesting if the examinee appears to represent a health or safety risk to the standardized patients or test center staff. Such circumstances include, but are not limited to, an examinee performing careless or hazardous acts during the physical examination, exhibiting signs of illness (e.g., persistent coughing or sneezing) during the examination, or showing visibly open skin lesions or active bleeding.
- If you do not feel well on the day of your test, we strongly encourage you to consider rescheduling your examination. If you become ill during your exam, inform a proctor promptly.
- The USMLE makes every effort to ensure that your registration information is properly processed and that the Step examinations are properly prepared, administered, and scored. In the unlikely event that an error occurs in the preparation, processing, administration, or scoring of your USMLE examination or in the reporting of your USMLE scores, the USMLE program will make reasonable efforts to correct the error, if possible, or permit you either to retest at no additional fee or to receive a refund of the examination fee. These are the exclusive remedies available to examinees for errors in the registration process; in preparing, processing, or administering exams; or in determining or reporting scores.
Step 2 CK assesses an examinee’s ability to apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills that provide the foundation for the safe and competent practice of medicine under supervision.
Step 2 CK is a one-day examination. It is divided into eight 60-minute blocks and administered in one 9-hour testing session. The number of questions per block on a given examination will vary but will not exceed 40. The total number of items on the overall examination will not exceed 318.
The examination also includes a minimum allotment of 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.
Practice materials, which include Sample Test Items (PDF) and simulated web-based Tutorial and Practice Test Items, tutorials, as well as other informational materials are available at the USMLE website. Examinees must also read the USMLE Bulletin of Information.
IMPORTANT:
- The term item is used to describe a test question in any format.
- You must run the web-based Tutorial and Practice Test Items to become familiar with the test software prior to your test date.
- The tutorial provided at the beginning of the Step 2 CK Examination has fewer screens and less detailed information than the Step 2 CK web-based Tutorial and Practice Test Items on the USMLE website.
- The web-based Tutorial and Practice Test Items on USMLE website include single multiple-choice questions, a sequential set of multiple-choice questions, a scientific abstract (a summary of an experiment or clinical investigation, accompanied by two or more questions), and items with audio or video findings.
Please visit the USMLE website often to view announcements, regarding changes in test delivery software, and to access updated practice materials. You must obtain the most recent information before taking any USMLE examination.
All USMLE examinations are constructed from an integrated content outline. Content is organized according to general principles and individual organ systems. Test questions are classified into one of 18 major categories, depending on whether they focus on concepts and principles that are applicable across organ systems or within individual organ systems. Most organ systems are subdivided into normal and abnormal processes. They include subcategories of specific disease processes. In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology. Sections focusing on individual organ systems are subdivided according to normal and abnormal processes, including principles of therapy.
Not all topics listed in the content outline are included in every USMLE examination. Overall content coverage is comparable in the various examinations that will be administered to different examinees for each Step. The Step 2 CK examination covers content of specific disease processes or pathology. The Step 2 CK systems specifications are listed in Table 1.
Table 1: Step 2 CK Test Specifications*
Range, %
1-3
4-6
4-7
6-10
6-10
6-10
8-12
7-11
7-11
4-8
4-8
4-8
4-8
5-9
Biostatistics & Epidemiology/Population Health / Interpretation of Medical Literature
* Percentages are subject to change at any time.
Physician Tasks/Competencies
An additional organizing construct for Step 2 CK design is physician tasks and competencies. Each test item is constructed to focus on assessing one of the competencies listed in Table 2. Click here for detailed information about the physician tasks and competencies outline
Table 2: Step 2 CK Physician Task/Competency Specifications
Range, %
Medical Knowledge: Applying Foundational Science Concepts
Patient Care: Diagnosis - History/Physical Examination
- Laboratory/Diagnostic Studies
- Diagnosis
- Prognosis/Outcome
- Pharmacotherapy
- Clinical Interventions
- Mixed Management
Communication/Professionalism
Systems-based Practice & Patient Safety
Practice-based Learning & Improvement
Systems-based Practice & Patient Safety
Practice-based Learning & Improvement
* Percentages are subject to change at any time.
Each Step 2 CK examination covers content related to the traditionally defined disciplines listed in Table 3.
Table 3: Step 2 CK Discipline Specifications*
Range, %
50-60
25-30
20-25
10-20
10-15
* Percentages are subject to change at any time.
Step 2 CK consists of multiple-choice questions (MCQs) prepared by examination committees composed of prominent faculty members, teachers, investigators, and clinicians who make up the USMLE Test Material Development Committees. All committee members have recognized expertise in their respective fields. They are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.
Test questions focus on the principles of clinical science that are deemed important for the practice of medicine under supervision in postgraduate training.
The content description is not intended as a curriculum development or study guide, but rather models the range of challenges that will be met in the actual practice of medicine. It provides a flexible structure for test construction that can readily accommodate new topics, emerging content domains, and shifts in emphasis. The categorizations and content coverage are subject to change.
The best preparation for the examination is broad-based learning that establishes a strong general understanding of concepts and principles in the basic and clinical sciences.
Strategies
- Read each question carefully. It is important to understand what is being asked.
- Try to generate an answer and then look for it in the response option list.
- Alternatively, read each option carefully, eliminating those that are clearly incorrect.
- Of the remaining options, select the one that is most correct.
- If unsure about an answer, it is better to guess since unanswered questions are automatically counted as wrong answers.
Single-Item Questions
This is the traditional, most frequently used multiple-choice format. It consists of a vignette and question followed by three to twenty-six options that are in alphabetical or logical order. The response options in this format are lettered (eg, A, B, C, D, E). You are required to select the one best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.
Example Item
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She is not yet on dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 m3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?
- Acute blood loss
- Chronic lymphocytic leukemia
- Erythrocyte enzyme deficiency
- Erythropoietin deficiency
- Immunohemolysis
- Microangiopathic hemolysis
- Polycythemia vera
- Sickle cell disease
- Sideroblastic anemia
- β-Thalassemia trait
(Answer: D)
Sequential Item Sets
A single patient-centered vignette may be associated with two or three consecutive questions about the information presented. Each question is associated with the initial patient vignette but is testing a different point. You are required to select the ONE BEST answer to each question. Questions are designed to be answered in sequential order. You must click “Proceed to Next Item” to view the next item in the set; once you click on this button, the next question will be displayed, and you will not be able to change the answer to the previous question.
Abstract Format
The abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, eg, as an abstract that accompanies a research report in a medical journal. Examinees must interpret the abstract in order to answer questions on various topics, including
The abstract item format includes a summary of an experiment or clinical investigation presented in a manner commonly encountered by a physician, eg, as an abstract that accompanies a research report in a medical journal. Examinees must interpret the abstract in order to answer questions on various topics, including
- Decisions about care of an individual patient
- Biostatistics/epidemiology
- Pharmacology/therapeutics
- Use of diagnostic studies