USMLE Step 2 CK
NBME/FSMB
Complete guide to passing the USMLE Step 2 CK exam on your first attempt.
$665
~96%
7 years
USA
NBME/FSMB
Residency applications
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Complete Overview
USMLE Step 2 CK is the clinical knowledge component of the United States Medical Licensing Examination, taken by medical students and graduates of LCME-accredited MD schools, COCA-accredited DO schools, and international schools listed in the World Directory of Medical Schools as meeting ECFMG requirements. The 2026 and 2027 application fee is $695 whether you register through NBME or FSMB, with a $235 region fee added for testing outside the United States and Canada. Candidates who select the India testing region also pay an 18 percent Indian goods and services tax that the USMLE program collects and remits in full.
The exam format changed on 7 May 2026. Sittings on or after that date are divided into sixteen 30-minute blocks inside a single nine-hour testing session, with no more than 20 items per block. The day includes a minimum of 55 minutes of break time and a 5-minute optional tutorial, and any time you save by finishing a block early is added to your break allowance. Sittings before 7 May 2026 used eight 60-minute blocks of up to 40 items with a 318 item ceiling and 45 minutes of break time.
Step 2 CK measures your ability to apply medical knowledge and clinical science to patient care under supervision, with explicit emphasis on health promotion and disease prevention. Every item is classified into one of 18 major content categories and into one physician task or competency. Patient Care: Diagnosis carries the largest competency range at 16 to 20 percent, followed by Laboratory and Diagnostic Studies at 13 to 17 percent. Two competencies are deliberately set at zero for Step 2 CK: applying foundational science concepts, and history and physical exam.
The minimum passing score is 218 on the three-digit scale for all exams administered on or after 1 July 2025. USMLE states that the percentage of items you must answer correctly varies by form, but that examinees typically need roughly 60 percent correct to pass. Results are reported weekly and are typically available within four weeks of your test date, though USMLE advises allowing eight weeks before making plans that depend on the result.
Pass rates are high but split sharply by group. In the 2024 to 2025 reporting year, first-time takers from US MD-granting schools passed at 98 percent and first-time takers from DO-granting schools at 96 percent, while repeaters from those same schools passed at 70 percent and 69 percent. First-time takers from non-US schools passed at 90 percent and repeaters at 64 percent.
Since Step 1 moved to pass or fail reporting in January 2022, the Step 2 CK three-digit score is the only numeric USMLE result most residency programs see when they review an application. That is why the exam now dominates fourth-year planning at US schools and why international graduates treat it as the centre of their application strategy. Most medical licensing authorities require all three Steps to be completed within a seven-year period that begins when you pass your first Step.
Why Get USMLE Step 2 CK Certified?
Step 2 CK is required for licensure in the United States, and passing Step 1 and Step 2 CK is a prerequisite for Step 3.
Since Step 1 became pass or fail for exams taken on or after 26 January 2022, the Step 2 CK three-digit score is the only numeric USMLE result on most residency applications.
The score scale gives you a concrete target: 218 is the minimum passing score for exams administered on or after 1 July 2025, and USMLE says roughly 60 percent of items correct is typically enough to pass.
First-time takers from US MD-granting schools passed at 98 percent in the 2024 to 2025 reporting year, so a well-prepared first attempt has strong odds.
The competency blueprint tells you exactly where to aim. Diagnosis at 16 to 20 percent plus laboratory and diagnostic studies at 13 to 17 percent means roughly a third of the exam turns on working up an undifferentiated patient.
Prometric delivers Step 2 CK at approximately 335 US and Canadian test centres and around 100 international centres, so scheduling flexibility is real even in peak application season.
NBME runs a fee assistance programme for USMLE candidates with demonstrated financial need, which can offset part of the $695 application fee.
Exam Format & Structure
Duration
One nine-hour testing session in a single day, including a minimum of 55 minutes of break time and a 5-minute optional tutorial for exams on or after 7 May 2026
Questions
Sixteen 30-minute blocks with no more than 20 items per block for exams on or after 7 May 2026. USMLE does not publish a total item ceiling for this format. Exams taken before 7 May 2026 used eight 60-minute blocks of up to 40 items with a stated maximum of 318 items overall.
Passing Score
218 on the three-digit scale for all exams administered on or after 1 July 2025. USMLE states that the percentage of items answered correctly required to pass varies by form, but examinees typically must answer approximately 60 percent correctly.
Question Types
- Single best answer multiple choice items
- Sequential sets of multiple choice items
- Scientific abstract items, where a summary of an experiment or clinical investigation is followed by two or more questions
- Items containing audio or video findings, which require the headphone sound check
Delivery Method
Computer based at Prometric test centres, using a biometric enabled check-in system. Approximately 335 US and Canadian centres and approximately 100 international centres deliver Step 2 CK, plus centres at four US medical schools.
Exam Domains & Topics
USMLE publishes content weighting as ranges rather than fixed percentages, and Nutrition is a discipline overlay rather than a separate slice. Items coded to Nutrition are also coded to one of the organ system categories, so a preventive care item involving dietary counselling counts under both Nutrition and Human Development.
Key Topics to Master:
- Dietary counselling within routine preventive healthcare visits
- Nutritional deficiency states and their clinical presentations
- Malnutrition assessment in hospitalised and elderly patients
- Enteral and parenteral nutrition indications and complications
- Obesity management including lifestyle and pharmacologic options
- Vitamin and mineral supplementation in pregnancy and infancy
- Nutrition competencies drawn from the 2024 consensus statement on nutrition competencies for medical students and physician trainees
The second largest published range on the content outline. These items ask what a physician should do rather than what a disease is, covering consent, capacity, confidentiality, error disclosure and the systems that surround patient care. They map onto the professionalism and systems-based practice competencies, each published at 5 to 7 percent.
Key Topics to Master:
- Informed consent, decision-making capacity and surrogate decision makers
- Confidentiality limits, mandatory reporting and duty to warn
- Advance directives, end of life care and withdrawal of treatment
- Disclosure of medical error and apology
- Quality improvement methods and root cause analysis
- Patient safety concepts including handoffs, checklists and never events
- Health care delivery systems, insurance types and cost of care conversations
- Impaired or unprofessional colleague scenarios
The highest weighted organ system grouping on the Step 2 CK outline. It combines renal and urinary disease with male and female reproductive medicine. Items are subdivided into normal and abnormal processes, with normal physiology tested in the context of a disease process rather than in isolation.
Key Topics to Master:
- Acute kidney injury workup and distinguishing prerenal, intrinsic and postrenal causes
- Chronic kidney disease staging, complications and dialysis indications
- Electrolyte and acid base disorders presented as clinical vignettes
- Glomerular disease patterns and their serologic markers
- Urinary tract infection, nephrolithiasis and obstructive uropathy
- Abnormal uterine bleeding, contraception and infertility
- Cervical, ovarian, endometrial, prostate and testicular cancer screening and management
- Sexually transmitted infection diagnosis and partner management
Cardiovascular items carry a published range of 6 to 12 percent and lean heavily on the diagnosis and laboratory or diagnostic studies competencies. Expect ECG tracings, echo findings and decision points about which test to order next in a patient with chest pain or dyspnoea rather than recall of pathophysiology.
Key Topics to Master:
- Acute coronary syndrome recognition, risk stratification and reperfusion decisions
- Heart failure with reduced and preserved ejection fraction management
- Atrial fibrillation rate versus rhythm control and anticoagulation scoring
- Valvular heart disease murmurs and surgical timing
- Hypertension diagnosis, secondary causes and treatment targets
- Syncope evaluation and distinguishing cardiac from non-cardiac causes
- Peripheral arterial disease, aortic aneurysm and dissection
- Lipid management and primary prevention decisions
A combined category published at 6 to 12 percent covering rheumatology, orthopaedics and dermatology. Dermatology items frequently include clinical photographs, and musculoskeletal items often hinge on which imaging study to order and when conservative management is correct.
Key Topics to Master:
- Inflammatory versus non-inflammatory arthritis differentiation
- Rheumatoid arthritis, lupus, vasculitis and their serologic workup
- Crystal arthropathies and septic joint evaluation
- Fracture and sports injury management including imaging choice
- Low back pain red flags and when imaging is indicated
- Common inflammatory dermatoses and drug eruptions
- Skin cancer recognition and biopsy technique selection
- Cellulitis, abscess and necrotising soft tissue infection
Psychiatry items are published at 5 to 10 percent and are among the most reliably scored on the exam because the diagnostic criteria are explicit. Many items combine a psychiatric diagnosis with a pharmacotherapy decision, which sits in the 8 to 12 percent pharmacotherapy competency band.
Key Topics to Master:
- Major depressive disorder, bipolar disorder and their first line treatments
- Anxiety disorders, obsessive compulsive disorder and post traumatic stress disorder
- Psychotic disorders and antipsychotic side effect profiles
- Substance use disorder screening, withdrawal management and relapse prevention
- Suicide risk assessment and involuntary hold criteria
- Somatic symptom and factitious disorders
- Eating disorders including refeeding syndrome
- Child and adolescent presentations including ADHD and autism spectrum disorder
USMLE publishes four separate system categories each at 5 to 10 percent: blood and lymphoreticular and immune systems, the gastrointestinal system, the nervous system and special senses, and the respiratory system. Taken together they represent the largest block of organ system content on the exam.
Key Topics to Master:
- Anaemia workup by mean corpuscular volume and iron studies
- Leukaemia, lymphoma and plasma cell disorder presentations
- Coagulopathy, thrombophilia and transfusion reactions
- Upper and lower gastrointestinal bleeding management pathways
- Inflammatory bowel disease, cirrhosis and pancreatitis
- Stroke recognition, thrombolysis windows and secondary prevention
- Seizure classification, headache red flags and neuropathy workup
- Asthma and COPD staging and step therapy
- Pneumonia severity scoring, pulmonary embolism workup and interstitial lung disease
The smaller published categories: multisystem processes and disorders at 4 to 8 percent, endocrine system at 3 to 7 percent, pregnancy, childbirth and the puerperium at 3 to 7 percent, biostatistics and epidemiology, population health and interpretation of medical literature at 3 to 5 percent, and human development at 2 to 4 percent. Human development covers normal age-related findings and care of the well patient.
Key Topics to Master:
- Sepsis recognition and early management bundles
- Diabetes diagnosis, complications and inpatient glycaemic control
- Thyroid and adrenal disorders including incidentaloma workup
- Routine prenatal care, gestational diabetes and hypertensive disorders of pregnancy
- Labour abnormalities, postpartum haemorrhage and puerperal complications
- Sensitivity, specificity, predictive values and likelihood ratios
- Study design identification, bias, confounding and number needed to treat
- Age-specific screening schedules and vaccination timing across the lifespan
Recommended Study Plan
- 1Sit an NBME Step 2 CK Comprehensive Clinical Science Self-Assessment cold to get a starting score against the 218 pass mark
- 2Download the USMLE Content Outline and the Physician Tasks and Competencies document from the Step 2 CK Materials page
- 3Map your clerkship grades against the published ranges to find which systems you have never studied properly
- 4Run the new Step 2 CK interactive testing experience so you know the post-7 May 2026 software before you rely on it
- 5Set your daily UWorld question target based on the number of weeks until your test date
- 1Complete UWorld cardiology and pulmonology blocks in timed, random mode rather than tutor mode
- 2Drill ECG interpretation to the level of naming the rhythm and the next step within 30 seconds
- 3Build an algorithm sheet for chest pain, dyspnoea and syncope with the diagnostic test at each branch
- 4Review acute coronary syndrome, heart failure, atrial fibrillation, pulmonary embolism and COPD exacerbation management end to end
- 1Complete UWorld gastrointestinal, hepatology, renal and electrolyte blocks
- 2Build an acid base worksheet and work 20 mixed disorder cases until the stepwise approach is automatic
- 3Review gastrointestinal bleeding, cirrhosis complications, pancreatitis and inflammatory bowel disease management
- 4Practise acute kidney injury differentiation using urine studies and fractional excretion of sodium
- 1Complete UWorld endocrinology and haematology or oncology blocks
- 2Drill the anaemia algorithm from mean corpuscular volume through iron studies to diagnosis
- 3Review thyroid nodule, adrenal incidentaloma and pituitary lesion workup pathways
- 4Work inpatient and outpatient diabetes management including insulin adjustment cases
- 1Complete UWorld neurology and psychiatry blocks
- 2Memorise stroke thrombolysis and thrombectomy time windows and contraindications
- 3Review antidepressant, antipsychotic and mood stabiliser side effect profiles, since pharmacotherapy is a 8 to 12 percent competency
- 4Practise suicide risk assessment and capacity assessment vignettes, which cross into the social sciences category
- 1Complete UWorld obstetrics and gynaecology and paediatrics blocks
- 2Build a prenatal visit timeline showing which screening test happens at which gestational age
- 3Review labour abnormalities, fetal heart tracing categories and postpartum haemorrhage management
- 4Drill the paediatric vaccination schedule and developmental milestones, which sit under human development at 2 to 4 percent
- 1Complete UWorld surgery, orthopaedics, rheumatology and dermatology blocks
- 2Work trauma and acute abdomen vignettes, focusing on the next best step rather than the final diagnosis
- 3Drill dermatology image recognition, since photographs appear frequently in this category
- 4Review perioperative risk assessment and postoperative fever timelines
- 1Work every biostatistics question in your question bank, covering sensitivity, specificity, predictive values and likelihood ratios
- 2Practise study design identification and bias recognition against published abstracts
- 3Drill ethics and professionalism vignettes on consent, capacity, confidentiality and error disclosure
- 4Review quality improvement and patient safety frameworks, which carry a published 5 to 7 percent competency range
- 5Sit an NBME self-assessment form to check progress against 218
- 1Sit the Free 120 sample items from the USMLE Step 2 CK interactive testing experience under timed conditions
- 2Complete two full days of 16 blocks at 20 items each to rehearse the post-7 May 2026 structure
- 3Plan your break strategy around the 55 minute minimum and decide which blocks you will finish early to bank time
- 4Review every incorrect answer by competency, not just by organ system
- 1Rebuild the two lowest scoring systems from your latest NBME self-assessment with fresh question blocks
- 2Redo previously incorrect UWorld questions in a custom block
- 3Rewrite your algorithm sheets from memory, then check them against the source
- 4Sit another NBME self-assessment to confirm the repair worked
- 1Sit a final NBME Comprehensive Clinical Science Self-Assessment as a nine-hour simulation
- 2Register for a Prometric practice session if you have never tested at your assigned centre
- 3Check that the name on your scheduling permit matches your government-issued photo ID exactly, and contact your registration entity immediately if it does not
- 4Confirm your ID is unexpired and carries both a signature and a recent photograph
- 1Do light mixed question blocks rather than new material, keeping volume low in the final three days
- 2Reread your own algorithm sheets and biostatistics formulas rather than starting new resources
- 3Pack a paper or electronic copy of your scheduling permit and your ID, and plan to arrive 30 minutes early
- 4Prepare only permitted items: cordless soft-foam earplugs without strings and water in a clear container with all labels removed
- 5Rehearse the sound check step, since audio and video items require working headphones
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Best Study Resources
USMLE Content Outline and Physician Tasks and Competencies
Official blueprint documentsBoth documents are downloadable from the Step 2 CK Materials page and contain the published system and competency ranges that every item is coded against. Read them before choosing a question bank.
Free
New Step 2 CK interactive testing experience
Official practice software and sample itemsUSMLE states that examinees testing on or after 7 May 2026 must run the new interactive testing experience. It includes single multiple choice items, sequential sets, a scientific abstract with two or more questions, and items with audio or video findings.
Free
NBME Comprehensive Clinical Science Self-Assessments
Official practice assessmentsNBME's own retired-item self-assessments, scored on a scale that predicts Step 2 CK performance. These are the closest available proxy for the real exam because they are written by the same organisation.
Paid, priced per form by NBME
UWorld Step 2 CK question bank
Commercial question bankThe most widely used Step 2 CK question bank. Its explanations are long enough to function as a review text, which is why many candidates use it as their primary content resource rather than a supplement.
Subscription pricing by duration
AMBOSS Step 2 CK question bank and library
Commercial question bank and reference libraryA question bank paired with a searchable clinical library. The integrated library is useful when a question exposes a gap you need to fill immediately rather than logging for later.
Subscription pricing by duration
First Aid for the USMLE Step 2 CK
Review bookA condensed review text organised by clerkship discipline. Most useful as a rapid revision pass in the final two weeks rather than as a primary learning source.
Standard textbook pricing
Divine Intervention podcast
Free podcastA long-running free podcast series with episodes dedicated to Step 2 CK topics, including several on ethics, biostatistics and patient safety. Useful for the social sciences category, which carries the second largest published range at 10 to 15 percent.
Free
OnlineMedEd
Video curriculumStructured video lessons organised by clerkship. Suits candidates who need to build clinical reasoning frameworks before question banks become productive.
Free and paid tiers
Prometric practice session
Official test centre familiarisationA booked session at a Prometric centre that lets you experience the real test environment and check-in process, including the biometric enabled check-in system used for USMLE.
Paid, priced by Prometric
NBME Fee Assistance for USMLE
Financial assistance programmeNBME runs a fee assistance programme for medical students and residents with demonstrated financial need to help cover Step exam fees. Application windows are announced on the NBME examinee resources pages.
Free to apply
Common Mistakes to Avoid
Preparing for the eight block, 60-minute structure when your test date falls on or after 7 May 2026.
From 7 May 2026 the exam is sixteen 30-minute blocks of no more than 20 items, with 55 minutes of break time and a 5-minute tutorial. Practise in 20 item chunks and rehearse twice as many block transitions as the old format required.
Treating ethics, patient safety and health systems questions as unstudyable common sense.
The social sciences category carries a published range of 10 to 15 percent, second only to Nutrition. Professionalism and systems-based practice each carry a 5 to 7 percent competency range. Work these vignettes deliberately rather than guessing on exam day.
Skipping biostatistics because it feels low yield next to the organ systems.
Biostatistics, epidemiology, population health and interpretation of medical literature carry a published 3 to 5 percent range, and the exam includes scientific abstract items with two or more questions attached. A single abstract can put several marks in play at once.
Leaving a block unopened because you are running out of energy late in a nine-hour day.
USMLE states that if you do not open every block, your examination may not be scored and the attempt may be reported as an incomplete on your transcript. Incomplete attempts still count towards the attempt limit.
Assuming break time is fixed and taking long breaks early in the day.
The 55 minutes is a minimum allotment that grows only if you finish blocks or the tutorial early. If you exceed your allocated or accumulated break time, the excess is deducted from your total testing time.
Leaving the testing room mid-block because a break feels overdue.
Once a block starts you may not leave except in an emergency. If you do, the block and daytime clocks keep running and the test centre reports the incident to the USMLE program.
Booking a retake too soon after a failure without checking the timing rules.
You may not take the same Step more than three times within a 12-month period. A fourth attempt must be at least 12 months after your first attempt at that Step and at least six months after your most recent attempt, and incomplete attempts count.
Arriving at the test centre without a copy of the scheduling permit because the appointment is confirmed by email.
You must present a paper or electronic copy of the scheduling permit alongside your ID. Without both you will not be admitted and you will pay a fee to reschedule within your eligibility period.
Testing internationally without budgeting for the region fee.
Step 2 CK carries a $235 region fee for exams taken outside the US and Canada on top of the $695 application fee. Candidates who select the India testing region also pay an 18 percent Indian goods and services tax.
Exam Day Tips
- 1
Arrive about 30 minutes before your appointment. Arriving after your appointment time may cost you admission, and arriving more than 30 minutes late means you will not be admitted and must pay a reschedule fee.
- 2
Bring your scheduling permit on paper or on a phone plus an unexpired government-issued photo ID that carries both your signature and a recent photograph. Passports, photo driving licences and national identity cards are named as acceptable.
- 3
Check that the name on your ID matches the scheduling permit exactly. If a name change has been processed, bring the revised permit, since the old one will not admit you.
- 4
Expect to be scanned with a handheld or walk-through detector and to turn your pockets inside out before entering the room, and to repeat this every time you come back from a break.
- 5
Leave jewellery at home. Only wedding and engagement rings are permitted, and hair accessories such as clips, combs, barrettes and headbands are subject to inspection.
- 6
You will be asked to remove your eyeglasses for close visual inspection at check-in and after every break, so plan for it rather than being surprised by it.
- 7
You write only on the laminated writing surfaces provided, using the markers the centre gives you. Writing on skin, clothing or tissue can be treated as irregular behavior. Raise your hand for a replacement board when you fill one.
- 8
Run the headphone sound check before the exam begins or during the tutorial. Step 2 CK includes items with audio or video findings, and a sound problem discovered mid-block costs you time.
- 9
Permitted items in the secure area include cordless soft-foam earplugs without strings and water in a clear container with the lid on and all labels removed. Everything else goes in the small locker outside the secure area, with electronic devices switched off rather than silenced.
Career Paths & Salary Ranges
Residency applicant in a competitive specialty
Dermatology, orthopaedic surgery, neurosurgery, plastic surgery, ENT and radiation oncology programs screen large applicant pools. With Step 1 reported as pass or fail since January 2022, the Step 2 CK three-digit score is the numeric filter many of these programs apply first.
Residency applications
Residency applicant in primary care
Internal medicine, family medicine, paediatrics and psychiatry programs weigh Step 2 CK alongside clerkship performance and letters. A passing score at or above 218 keeps the application viable, and the clinical reasoning tested overlaps directly with intern work.
Residency applications
International medical graduate seeking ECFMG certification
Graduates of schools listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements take Step 1 and Step 2 CK on the path to certification. In the 2024 to 2025 reporting year, first-time takers from non-US schools passed Step 2 CK at 90 percent.
Residency applications
DO student pursuing ACGME residency alongside COMLEX
Students at COCA-accredited DO schools are eligible for the USMLE and many sit Step 2 CK in addition to COMLEX-USA Level 2-CE. First-time takers from DO-granting schools passed Step 2 CK at 96 percent in the 2024 to 2025 reporting year.
Residency applications
Physician progressing to Step 3 and full licensure
Passing Step 1 and Step 2 CK is a stated eligibility requirement for Step 3, which carries a $955 application fee for 2026 and 2027 and is administered only in the United States. Most licensing authorities require all three Steps within a seven-year window beginning when you pass your first Step.
Residency applications
MD/PhD candidate on an extended timeline
Combined degree candidates often sit Step 2 CK years after Step 1. The USMLE program recommends that licensing jurisdictions consider exceptions to the seven-year limit for MD/PhD candidates who hold both degrees from LCME-accredited and regionally accredited institutions and can explain the delay.
Residency applications
Prerequisites & Requirements
- You must be officially enrolled in, or a graduate of, a US medical school leading to the MD degree accredited by the LCME, or a US school leading to the DO degree accredited by COCA, or a medical school outside the US listed in the World Directory of Medical Schools as meeting ECFMG eligibility requirements and satisfying ECFMG's other criteria.
- You must hold that eligibility both at the time you apply and on the day of your examination.
- You must apply through the correct registration entity: NBME for students and graduates of LCME or COCA-accredited US programs, FSMB for students and graduates of medical schools outside the US.
- You must read the USMLE Bulletin of Information and certify that you agree to comply with its policies at the time you apply.
- There is no requirement to have passed Step 1 before Step 2 CK. USMLE notes that at LCME-accredited schools the two can be taken in either order, though most students take Step 1 at the end of year two and Step 2 in year four.
- If you have attempted any Step four or more times, including incomplete attempts, and have not passed, you are ineligible to apply for any Step in the USMLE sequence.
Frequently Asked Questions
How much does USMLE Step 2 CK cost?
The 2026 and 2027 application fee is $695, the same whether you apply through NBME as a student or graduate of an LCME or COCA-accredited US program or through FSMB as a student or graduate of a school outside the US. A region fee of $235 is added for exams taken outside the United States and Canada, and USMLE notes this is not a USMLE fee. Candidates selecting the India testing region also pay an 18 percent Indian goods and services tax, which the USMLE program collects and remits in full without retaining any part of it.
What is the passing score for Step 2 CK?
The minimum passing score is 218 on the three-digit scale for all exams administered on or after 1 July 2025. USMLE states that the percentage of items you must answer correctly to pass varies by Step and from form to form, but that examinees typically must answer approximately 60 percent of items correctly. The USMLE Management Committee sets the standard and reviews each component roughly once every four years.
How many questions are on Step 2 CK and how long is the exam?
For exams on or after 7 May 2026, Step 2 CK is one nine-hour day divided into sixteen 30-minute blocks, with the number of items per block varying but not exceeding 20. USMLE does not publish a total item ceiling for this format. Exams taken before 7 May 2026 used eight 60-minute blocks of up to 40 items with a stated maximum of 318 items in total.
How much break time do I get?
Exams on or after 7 May 2026 include a minimum allotment of 55 minutes of break time plus a 5-minute optional tutorial. Any time you save by completing a block or the tutorial before the allotted time expires is added to your break total. If you exceed your allocated or accumulated break time, the excess is deducted from your total testing time.
Can I leave the room during a block?
No, except in an emergency. Once you begin a testing block you may not leave the room. If you leave for a personal emergency while not on an authorized break, the block clock and the day clock keep running and the test centre reports the incident to the USMLE program. Every time you leave and return you must sign the test centre log and present your identification again.
What happens if I fail Step 2 CK?
You may retake it, subject to the attempt rules. You cannot take the same Step more than three times within a 12-month period. A fourth attempt must be at least 12 months after your first attempt at that Step and at least six months after your most recent attempt. Incomplete attempts count towards these limits, and attempts at the formerly administered Step 2 Clinical Skills count towards the overall limit. If you have attempted a Step four or more times without passing, you become ineligible to apply for any Step in the sequence.
What are the Step 2 CK pass rates?
In the 2024 to 2025 reporting year, examinees from US MD-granting schools passed at 98 percent overall, with 98 percent for first-time takers and 70 percent for repeaters. DO-granting school examinees passed at 96 percent overall, with 96 percent for first-time takers and 69 percent for repeaters. Non-US school examinees passed at 87 percent overall, with 90 percent for first-time takers and 64 percent for repeaters.
How long do Step 2 CK results take?
Results are typically available within four weeks of your test date, and scores are processed continuously and reported weekly. USMLE advises allowing at least eight weeks before you rely on the result, because various factors can delay reporting. You receive an email notification from the organisation that registered you, and the score report stays available on that organisation's secure website for approximately 365 days.
Can I stop my medical school from seeing my score?
Yes, with advance notice. NBME reports USMLE results to LCME and COCA-accredited medical school programs for their students and graduates. To prevent Step 1 or Step 2 CK results being reported to your school, you must send a request from your email account of record to [email protected] at least 10 business days before your scheduled test date, and a separate request is required for each administration.
Can I take a calculator or reference materials into the exam?
No outside reference materials or calculators are permitted. You are given laminated writing surfaces and markers for notes and calculations, and you must return them at the end of the session. Permitted personal items in the secure area are limited to things like cordless soft-foam earplugs without strings, water in a clear container with labels removed, and certain medicines or medical devices, all subject to inspection by test centre staff.
Is Step 2 CK offered outside the United States?
Yes. Step 1 and Step 2 CK are administered worldwide, at approximately 335 US and Canadian Prometric centres and approximately 100 international Prometric centres, plus centres at four US medical schools. Step 3 is administered only in the United States.
Are test accommodations available?
Yes. The USMLE program provides test accommodations for examinees with documented disabilities under the Americans with Disabilities Act. Requests are submitted through the accommodations process described on the USMLE website, and the additional break or testing time is built into your scheduled session rather than granted at the test centre on the day.
How long are my USMLE scores valid?
USMLE itself does not expire a passing Step result, but most medical licensing authorities require completion of Steps 1, 2 and 3 within a seven-year period that begins when you pass your first Step. The exact rule is set by each state board, so check the FSMB website for the jurisdiction where you intend to apply for licensure.
Can I retake Step 2 CK to improve a passing score?
No. If you pass a Step you are not permitted to retake it, apart from the limited exceptions set out in the Bulletin of Information. This is why the timing of your first attempt matters so much: with Step 1 reported as pass or fail, the Step 2 CK score you earn on your one permitted passing attempt is the numeric result residency programs see.
How does Step 2 CK compare with COMLEX-USA Level 2-CE?
COMLEX-USA is the NBOME licensing sequence for osteopathic physicians and includes osteopathic principles and practice content that does not appear on the USMLE. Students at COCA-accredited DO schools are eligible for both, and many take Step 2 CK in addition to Level 2-CE to compete for ACGME residency positions that are more familiar with USMLE scores. Step 2 CK carries a $695 application fee for 2026 and 2027.
What question formats should I expect?
The interactive testing experience shows single multiple choice items, sequential sets of multiple choice items, scientific abstracts summarising an experiment or clinical investigation followed by two or more questions, and items containing audio or video findings. USMLE uses the word item to describe a test question in any of these formats.
Do I need to run the practice software before test day?
Yes. USMLE states that examinees testing before 7 May 2026 must run the Step 2 CK interactive testing experience, and those testing on or after that date must run the new Step 2 CK interactive testing experience. The tutorial offered at the start of the real exam has fewer screens and less detail than the practice version, so arriving without having run it costs you orientation time you cannot get back.
What if I do not open every block?
Your examination may not be scored and the attempt may be reported as an incomplete on your USMLE transcript. Incomplete attempts also count towards the limit of three attempts in any 12-month period and towards the four attempt ceiling that ends your eligibility for the whole sequence.
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