Step 2 Clinical Knowledge

An example of a study plan from european med student

What is the diagnosis? What is the most appropriate next step in management? What additional sign is most likely present in this patient? Welcome to the clinical years, when med student finally begins to feel like a physician.

Compared to Step 1, the amount of knowledge tested by Step 2 CK is probably larger (yes, sounds terrible I know), but the organization of knowledge is more about (subconscious) pattern recognition rather than strictly about sequence of logical reasoning (cause and effects). Therefore, by studying and practicing cases (either with a book or in a clinic), you become better shaped for the test. I personally found this way of studying more enjoyable and requiring less focused attention (than the facts in Step 1).

Content of Step 2 CK

Distribution of questions in USMLE Step 2 CK by subject

The imge shows distribution of questions in common Q banks, which fairly reflect the unknown frequency in the real exam. Following subjects are included (ordered by decreasing importance):

  • Internal medicine
  • Pediatrics
  • Gynecology/Obstetrics
  • Surgery
  • Psychiatry
  • Preventive medicine
  • ENT, ophtalmology, ortopedics, ethics

The questions are typically clinical vignettes. To quickly understand the scenario, and know the basic diagnosis, treatment and follow up is more useful at the test than detailed "textbook knowledge" of treatment protocols (which is usually slower). Few questions might ask you to interpret a leaflet or a study, but there is no need to learn from clinical/scientific papers at this level.

When to take it

In my opinion the best time to take it is after the internal medicine state exam in the 6th year. At this level, you have clinical experience which helps you experience or imagine the cases. Another important point is that passing CK early will allow you time to finish all the Steps and apply for a residency early in your medical career.

Study plan for Step 2 CK

A written plan is a great start. But even more important is to follow your plan :) . Everyone is different and not everyone has the 9 months during school to study for a CK. But if you have the luxury, the plan I describe is safe, I believe.

1 textbook for each subject

9-3 months before exam, ideally during your home school rotations, you can focus on each subject separately (IM, Peds, ObGyn, Surgery, Psychiatry). I would study from a proper textbook, like series of Blueprints, NMS, Kaplan Step 2 CK lecture notes, Case Files, PreTest, Step-Up. Especially Blueprints or NMS are enough for the exam at your school (we have mostly oral tests at Czech Masaryk University).

If you hate reading long paragraphs like me, then I (apologize for these long memoirs and) strongly reccommend Essential Med Notes (Toronto Notes). Although US students complain they are Canadian, they are the knowledge you need compressed into a bullet point format, which you can easily carry on the rotations. I particularily enjoyed references to recent trials/publications which explained why one treatment is preffered over another. And finally, I appreciated the dual metrics, saving me from conversion of stones to grams and kilograms, and of inches to centimeters.

The key is to apply the knowledge from textbooks to the cases. Practicing with Case Files or PreTest is good, starting one Qbank early even better. I fell in love with educational serie at NEJM called Clinical problem solving - a bit advanced, but good for IM and just brilliant.

What is good for ech subject? Pick one:

  • Internal medicine (poll): Step-Up to Medicine, Essential Med Notes, Clinical problem solving
  • Pediatrics (poll): Case Files, or NMS (National Medical series) or Blueprints if you get through, Kaplan LN
  • Gynecology/Obstetrics (poll): Case Files, Blueprints, Toronto Notes for wards
  • Surgery (poll): one of Kaplan LN, Pestana's surgery review, Case Files
  • Psychiatry (poll): Kaplan LN or Blueprints
  • Preventive medicine: Kaplan LN
  • ENT, ophtalmology, ortopedics, ethics

Alternatively, if you are in clinic and have a lot of cases, practice + UpToDate reviews are great choice. If you don't have time to study a textbook from one subject, do PreTest questions, or you may skip it (an leave for review with Qbank later).

Comprehensive review

0-3 months before exam, it is time to combine the subjects. Frequently recommended books are Master the Boards (MTB), Step-up to Step 2, and I used anotated Toronto Notes from my rounds, too. There are two MTB: for Step 2 and for Step 3. Many people study Inernal medicine from MTB for the CK, and use MTB3 for all other subjects.


A couple of months before the exam, a Qbank is the best friend of a CK-taker. USMLEWorld is better than Kaplan's, but both are the best ;) Do all the Qs and read the answers for as long as you keep your attention. It takes at least 1 month to get through the 2200 Q&A.

In the final month before the test, you should be studying only questions. Ideally 100-150 per day. When doing random Qs for the first time, 70-80% of correct answers is the goal. Then, the test day will be just another day full of questions you are used to solve.

Also, you may consider one NBME test to rate yourself.

What can be skipped?

Not everyone have 9 months for Step 2 CK and not everyone need a top quartile score.

The safiest is to shorten the first part: review textbooks for separate subjects. Especially if you have already done those rotations (or graduated), going through them would just cost you too much time. Case files or pretest can be read quickly, and have the "high-yield" info you need.

If you are really short of time, with only about 3 months, just doing MTB2/3 and Qbanks will make you pass the exam with a regular score, expecially if you have good background from med school. In fact, this is what many students/graduates do.

It all depends on the score you want. If you want to beat the meanor be even higher, I would suggest to pick some subject-spedific casebooks, but I would suggest not to abandom them altogether.

Last edited: 10/2014