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Complete description of Step -2 Examination in 2021 details and direct link to apply available her

Overview :

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 accessed from 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.

Content description :

Step 2 CK consists of multiple-choice questions (MCQs), also known as items, created by USMLE committees composed of faculty members, investigators, and clinicians with recognized prominence in their respective fields. Committee members are selected to provide broad representation from the academic, practice, and licensing communities across the United States and Canada.

Step 2 CK focuses 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.

QUESTION:
What new content appeared on Step 2 CK exams administered after the exam was updated in October 2020?

ANSWER:
No new content was assessed in Step 2 CK exams administered after the exam was updated in November 2020. Examinees who tested after the November 2020 update saw a small increase in the number of items that assess knowledge of Professionalism, Legal/Ethical, and Patient Safety; this content has been included on the Step 2 CK exam for many years.

You can see representative items in these categories: Step 2 CK Patient Safety and Step 2 CK Professionalism.

Content Outline

All USMLE examinations are constructed from an integrated content outline, which organizes content 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.

Step 2 CK content weighting for these topics is provided in Table 1 below. Sections focusing on individual organ systems are subdivided into normal and abnormal processes, including principles of therapy. In most instances, knowledge of normal processes is evaluated in the context of a disease process or specific pathology.

While not all topics listed in the content outline are included in each USMLE Step examination, overall content coverage is comparable among the various examination forms that will be taken by different examinees for each Step.

Table 1: Step 2 CK System Specifications*

System Range, %

General Principles of Foundational Science** 2–4
Immune System 3–5
Blood & Lymphoreticular System 4–6
Behavioral Health 6–8
Nervous System & Special Senses 6–8
Musculoskeletal System/Skin & Subcutaneous Tissue 6–10
Cardiovascular System 8–10
Respiratory System 7–9
Gastrointestinal System 7–9
Renal & Urinary System & Male Reproductive 4–6
Pregnancy, Childbirth & the Puerperium 4–6
Female Reproductive System & Breast 4–6
Endocrine System 4–6
Multisystem Processes & Disorders 4–6
Biostatistics & Epidemiology/Population Health/Interpretation of Medical Literature 3–5
Social Sciences: Legal/Ethical Issues & Professionalism/Systems-based Practice & Patient Safety 10–15

* Percentages are subject to change at any time.
** The Step 2 CK General Principles category includes normal and abnormal processes that are not limited to specific organ systems.

Physician Tasks/Competencies

An additional organizing construct for Step 2 CK design is physician tasks and competencies. Each test question is constructed to assess 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/Competencies Specifications*

Competency Range, %

Medical Knowledge: Applying Foundational Science Concepts 0**
Patient Care: History and Physical Exam 0***
Patient Care: Laboratory/Diagnostic Studies 13–17
Patient Care: Diagnosis 16–20
Patient Care: Prognosis/Outcome 5–9
Patient Care: Health Maintenance/Disease Prev 8–12
Patient Care: Pharmacotherapy 8–12
Patient Care: Clinical Interventions 6–10
Patient Care: Mixed Management 12–16
Practice-based Learning & Improvement 3–5
Professionalism 5–7
Systems-based Practice & Patient Safety 5–7

* Percentages are subject to change at any time.
** Test items that assess patient care competencies may also assess knowledge of underlying foundational science concepts.
*** Test items that assess history and physical exam competencies are covered in Step 1 and Step 3 examinations.

Discipline

Each Step 2 CK examination covers content related to the traditionally defined disciplines as listed in Table 3.

Table 3: Step 2 CK Discipline Specifications*Competency

Range, %

Medicine 50-60
Surgery 25-30
Pediatrics 20-25
Obstetrics & Gynecology 10-20
Psychiatry 10-15

* Percentages are subject to change at any time.

Test Questions

More than 100 sample Step 2 CK test questions are available in both PDF format and as an interactive testing experience.

Below are examples of different types of competencies tested on the Step 2 CK examination.

Example Question: Patient Care: Diagnosis -Laboratory / Diagnostic Studies

A 17-year-old girl comes to the office for an examination prior to entering college. She reports that she feels well but is nervous about leaving home for the first time. She states that she has tried to diet to improve her appearance but that food restriction often "backfires" because she becomes hungry and then engages in episodes of binge eating. She reports a loss of control during these episodes, saying, "It's like I stop thinking at all and before I know it, I have eaten two pizzas." She induces vomiting several times during each binge and has developed a pattern of binging and purging every evening. She has no history of serious illness and takes no medications. She is 165 cm (5 ft 5 in) tall and weighs 57 kg (125 lb); BMI is 21 kg/m2. Vital signs are within normal limits. Physical examination shows dry mucous membranes, erosion of enamel on the lingual surface of the front teeth, and hypertrophy of the parotid gland. Serum studies are most likely to show which of the following sets of findings in this patient?

Potassium Bicarbonate

(A)Decreased decreased

(B)Decreased increased

(C)Increased decreased

(D)Increased increased

(E) Normal decreased

(F) Normal increased

(Answer: B)

Example Question:

Patient Care: Health Maintenance/Disease Prevention & Surveillance

A 21-year-old woman comes to the office for counseling prior to conception. She is recently married and would like to conceive within the next year. She does not eat meat, fish, or dairy products and wishes to decrease the risks of her diet on her baby. Menses occur at regular 28-day intervals and last 5 days. She does not smoke or drink alcohol. She takes no medications. She is 157 cm (5 ft 2 in) tall and weighs 50 kg (110 lb); BMI is 20 kg/m2. Physical examination shows no abnormalities. Pelvic examination shows a normal appearing vagina, cervix, uterus, and adnexa. Which of the following is most likely to decrease the risk of fetal anomalies in this patient?

Adjusting diet to include more sources of protein during the first trimester
Beginning folic acid supplementation prior to conception
Calcium supplementation during the first trimester
Iron supplementation during the first trimester
Soy protein shakes throughout pregnancy and lactation
Randomized clinical trial

(Answer: 2)

Example Question: Professionalism

Three days after hospitalization for diabetic ketoacidosis, an 87-year-old woman refuses insulin injections. She says that her medical condition has declined so much that she no longer wishes to go on living; she is nearly blind and will likely require bilateral leg amputations. She reports that she has always been an active person and does not see how her life will be of value anymore. She has no family and most of her friends are sick or deceased. On mental status examination, she is alert and cooperative. She accurately describes her medical history and understands the consequences of refusing insulin. There is no evidence of depression. She dismisses any attempts by the physician to change her mind, saying that the physician is too young to understand her situation. She says, "I know I will die, and this is what I want." Which of the following is the most appropriate next step in management?

Discharge the patient after she has signed an "against medical advice" form
Seek a court order to appoint a legal guardian
Offer insulin but allow the patient to refuse it
Admit to the psychiatric unit
Administer insulin against the patient's wishes

(Answer: 3)

Example Question: Patient Safety

A 45-year-old woman is hospitalized for management of Staphylococcus aureus endocarditis with persistent bacteremia. The patient is discussed during interdisciplinary rounds, which includes physicians, nurses, pharmacists, and social workers. During rounds, a pharmacy student notices that the patient missed two doses of her scheduled antibiotic last week but is unsure why. The physician and nurse are unaware of these missed doses, and the student does not mention her observation. Which of the following measures is most likely to improve communication within this interdisciplinary health care team?

Conduct interdisciplinary rounds in a quieter location
Encourage questions from all team members
Implement a checklist for standardizing patient rounds
Use computers during rounds to review medications

(Answer: 2)