USMLE Step 2 CK: The Complete Guide
USMLE Step 2 CK is the exam that now carries your number. Since Step 1 stopped reporting a score in January 2022, this is the only USMLE result a residency program sees!
Everything below is current for exams sat from May 2026, when the format changed. A guide written before then is describing a different day, so trust this one 🙂
- What USMLE Step 2 CK tests
- The USMLE Step 2 CK format, changed May 2026
- What is on USMLE Step 2 CK
- USMLE Step 2 CK scoring, and the 218 line
- USMLE Step 2 CK pass rates
- Cost, eligibility and when to sit it
- How to prepare for USMLE Step 2 CK
- Step 2 CS no longer exists
- USMLE Step 2 CK, common questions
- Related reading
What USMLE Step 2 CK tests
Clinical knowledge, applied. The exam asks whether you can look after a patient under supervision, with an emphasis on health promotion and disease prevention.
Where Step 1 asks whether you understand the science, Step 2 CK asks what you would do with a patient in front of you. Almost every item is a clinical vignette.
Most people sit it late in the clinical years, after rotations have done the teaching. Our USMLE overview covers how the three Steps fit together.
Step 1 is pass/fail. Step 2 CK reports a three-digit score, and that score is what programs read.
The USMLE Step 2 CK format, changed May 2026
Same nine hours, a completely different rhythm, and on balance a kinder one!
Sixteen blocks is two more than Step 1's fourteen, in an hour longer. It is the longest single-day exam in the sequence!
Practice in sets of 20 at 30 minutes. A 40-question block now trains you for a format that no longer exists, and most published advice still describes it.
What is on USMLE Step 2 CK
Three published tables, and the clinical science split is what people mean by high yield 🙂
Medicine at 55 to 65% dominates. Everything else together is roughly what medicine is on its own, which should shape how you spend a dedicated period!
The competency table says what the exam asks you to do with that content.
Diagnosis, investigation and management are more than half the exam between them. Foundational science concepts, which carried 60 to 70% of Step 1, are weighted at zero here!
Both tables are published at usmle.org and are revised periodically.
USMLE Step 2 CK scoring, and the 218 line
A three-digit score, with a minimum passing score of 218 since 1 July 2025. Before that date the threshold was lower, so an older guide quotes a different number.
- Passing is the floor, not the goal. Competitive specialties read the number well above 218.
- The scale is not a percentage. A 240 does not mean 240 out of anything.
- Roughly 60% correct is the USMLE program's own wording for what passing takes, varying by form.
- Results usually arrive inside four weeks, and the program advises planning for eight!
Our USMLE scoring guide covers all three Steps, and our Step 1 pass/fail page covers why the weight landed here.
USMLE Step 2 CK pass rates
The highest of the three Steps for every group, which is the best news on this page 🙂
Step 2 CK reporting runs July to June rather than by calendar year, so the label covers a period rather than a year.
The gap between a first attempt and a repeat is 26 to 28 points, wider than on Step 1. Getting it right once matters more here than anywhere else in the sequence!
98% of US MD first-takers pass. Almost nobody applying to residency is worried about clearing 218, and almost everybody is worried about the number above it.
Which makes Step 2 CK the exam in the sequence where preparing beyond the line earns you something 🙂
Cost, eligibility and when to sit it
The practical facts, in one place, so you can plan from them!
Since Step 1 went pass/fail, a growing number of students sit Step 2 CK first, so a score is on the transcript earlier in the application cycle. Both orders are allowed.
Full fee detail is on our USMLE cost page, and the rules on who qualifies are on our eligibility page!
How to prepare for USMLE Step 2 CK
The shape is the same as Step 1, so nothing you learned there is wasted. What changes is the weighting and the target 🙂
- Sit an NBME self-assessment early. Clinical Science forms exist for Step 2 CK and they are the only practice written by the people who write the exam.
- Weight medicine heavily. At 55 to 65% it is more than everything else combined.
- Practice in sets of 20 at 30 minutes, matching the post-May 2026 format.
- Review for the reason you missed, not the fact. Management questions punish pattern-matching.
- Aim above the line. Unlike Step 1, the margin here is what programs read!
Our Step 1 study schedule lays out phases that transfer directly, and our difficulty page compares the Steps by pass rate.
Step 2 CS no longer exists
Step 2 Clinical Skills was suspended in 2020 and permanently discontinued in January 2021. There is no CS component and no replacement exam in the USMLE sequence.
International graduates now meet the clinical and communication skills requirements for ECFMG certification through the Pathways route instead!
Plenty of guides still describe CS as paused or returning. If one does, its other advice deserves the same suspicion 🙂
USMLE Step 2 CK, common questions
How long is USMLE Step 2 CK?
Nine hours in one day, in sixteen 30-minute blocks of up to 20 questions, with a minimum of 55 minutes of break time.
What is a passing USMLE Step 2 score?
218, since 1 July 2025, on the three-digit scale.
Is Step 2 CK harder than Step 1?
Not by pass rate. 98% of first-time takers from US MD schools passed Step 2 CK against 93% on Step 1. It is longer and more clinical rather than harder to clear.
Can I take Step 2 CK before Step 1?
Yes, and a growing number do since Step 1 stopped reporting a score.
What is the most important subject?
Medicine, at 55 to 65% of the exam, ahead of pediatrics at 17 to 27%.
Does Step 2 CS still exist?
No. It was discontinued permanently in January 2021, and our pass rate page covers the three Steps that remain 🙂
Related reading
- What is the USMLE, the three Steps and how they fit together
- USMLE scoring, how each Step is reported
- USMLE pass rates, all three Steps by examinee group
- USMLE cost, every fee for all three Steps
- USMLE eligibility, who can sit each Step
- The complete USMLE Step 1 guide, what Step 1 tests
- The USMLE exam guide, all three Steps