What is Step 2 CS and Step 3 CK?

STEP 2 CLINICAL KNOWLEDGE (CK)

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:

• a 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, as shown in Table 2.

USMLE Step 2 CK Specifications*

Normal Conditions and Disease Categories

• Normal growth and development and general principles of care
• Individual organ systems or types of disorders
  • immunologic disorders
  • diseases of the blood and blood-forming organs
  • mental disorders
  • diseases of the nervous system and special senses
  • cardiovascular disorders
  • diseases of the respiratory system
  • nutritional and digestive disorders
  • gynecologic disorders
  • renal, urinary, and male reproductive systems
  • disorders of pregnancy, childbirth, and the puerperium
  • disorders of the skin and subcutaneous tissue
  • diseases of the musculoskeletal system and connective tissue
  • endocrine and metabolic disorders

Physician Task

15%-20% Promoting preventive medicine and health maintenance
20%-35% Understanding mechanisms of disease
25%-40% Establishing a diagnosis
15%-25% Applying principles of management

* Percentages are subject to change at any time. See the USMLE website for the most up-to-date information.

STEP 2 CLINICAL SKILLS (CS)

Step 2 CS assesses whether you can demonstrate the fundamental clinical skills essential for safe and effective patient care under supervision. There are three subcomponents of Step 2 CS (see Table 3): Integrated Clinical Encounter (ICE), Communication and Interpersonal Skills (CIS), and Spoken English Proficiency (SEP).

The Subcomponents of Step 2 CS

Integrated Clinical Encounter (ICE)

• Data gathering - patient information collected by history taking and physical examination
• Documentation - completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up

Communication and Interpersonal Skills (CIS)

• Questioning skills
• Information-sharing skills
• Professional manner and rapport

Spoken English Proficiency (SEP)

• Clarity of spoken English communication within the context of the doctor-patient encounter

Step 2 CS uses standardized patients, i.e., people trained to portray real patients. You are expected to establish rapport with the patients, elicit pertinent historical information from them, perform focused physical examinations, answer questions, and provide counseling when appropriate. After each interaction with a patient, you will record pertinent history and physical examination findings, list diagnostic impressions, and outline plans for further evaluation, if necessary. The cases cover common and important situations that a physician is likely to encounter in common medical practice in clinics, doctors' offices, emergency departments, and hospital settings in the United States.

The cases that make up each administration of the Step 2 CS examination are based upon an examination blueprint. An examination blueprint defines the requirements for each examination, regardless of where and when it is administered. The sample of cases selected for each examination reflects a balance of cases that is fair and equitable across all examinees. While the set of cases administered on a given day will differ from the set of cases administered on another day, each set of cases is comparable.

The intent is to ensure that examinees encounter a broad spectrum of cases reflecting common and important symptoms and diagnoses. The criteria that are used to define the blueprint and create individual examinations focus primarily on presenting complaints and conditions. Presentation categories include, but are not limited to, cardiovascular, constitutional, gastrointestinal, genitourinary, musculoskeletal, neurological, psychiatric, respiratory, and women's health. Examinees will see cases from some, but not all, of these categories. The selection of cases is also guided by specifications relating to acuity, age, gender, and type of physical findings presented in each case.