USMLE Step 2 CK: compare resources and practise clinical reasoning.

Choose a topic for focused revision and check your plan against the official specification.

• Diagnosis (Patient Care)
• Pharmacotherapy, interventions & management (Patient Care)
• Health maintenance, prevention & surveillance (Patient Care)
• Systems-based practice and patient safety
• Communication, professionalism, ethics, PBLI

System weightings from the NBME score report blueprint.

• Renal/urinary and reproductive systems (7–13% combined) — AKI, CKD, GU oncology, pregnancy complications, contraception
• Cardiovascular system (6–12%) — ACS, heart failure, arrhythmia, valve disease, hypertension management
• Gastrointestinal (6–12%) — IBD, GI bleeding, hepatology, pancreatitis, oncology
• Respiratory (6–12%) — asthma, COPD, pneumonia, PE, lung cancer screening
• Behavioral health (6–10%) — depression and anxiety pharmacotherapy, substance use, suicide risk
• Multisystem (6–12%) — sepsis, anaphylaxis, electrolyte emergencies, oncologic emergencies

Themes from US and IMG candidate feedback in 2025–26.

Candidate-reported observations — not official guidance.

1. Treating Step 2 CK like the old Step 1 — Step 2 CK now carries far more weight in residency applications since Step 1 became pass/fail.
2. Targeting 218 — that's the pass mark but sits at the 3rd percentile for US/Canadian first-time takers. Competitive residency applications need 240+; competitive specialties need 250+.
3. Non-US/Canadian first-time pass was 89% in the 2023-24 USMLE performance data, but retaker performance is lower. IMGs should prepare for the current Step 2 CK standard rather than relying on older score assumptions.
4. Underestimating systems-based practice and patient safety (8% of items) — these require US-specific knowledge of QI, safety frameworks and team-based care.
5. Ethics and professionalism questions — US frameworks differ from UK GMC standards; expect questions on autonomy, informed consent specifics.
6. Time pressure across 9-hour day — most failing candidates run out of time on the final blocks rather than missing the threshold on knowledge.

Designed for full-time dedicated study after clerkships.

1. Weeks 1–4

   Foundation across all systems. 80 questions/day. Identify bottom three systems using iatroX dashboard.

2. Weeks 5–10

   Targeted weak-area drilling. Read First Aid or US-aligned textbook chapters for weak areas. Spaced repetition surfaces incorrect items.

3. Weeks 11–13

   Six to eight NBME practice exams under timed conditions. Track score trajectory weekly.

4. Weeks 14–16

   Mixed adaptive sessions, mock-exam simulations, final week light review only. Confirm Prometric appointment.

Dedicated USMLE Step 2 CK question practice with answer explanations, guided Tutor review and study planning.

• Focused question practice — Choose the relevant bank and use your answers to identify what to study next.
• Guided reasoning — Explore a difficult answer with Tutor, then apply the distinction independently.
• Review and timed practice — Return to important mistakes and choose a timed practice set where available.

Choose the relevant bank and use the official exam guidance to plan your preparation.

Since 1 July 2025 the passing standard is 218 on the three-digit scale (raised from 214). The mean score for US/Canadian first-time takers is approximately 250, so 218 sits well below the mean for adequately prepared candidates.

From 7 May 2026 Step 2 CK is delivered as 16 × 30-minute blocks of up to 20 questions each, over a 9-hour testing session. The total number of questions is similar to before; the block structure changed for shorter sustained focus periods.

USMLE performance data for 2023-24 lists Step 2 CK first-taker pass rates of 98% for US/Canadian MD candidates, 96% for DO candidates and 89% for non-US/Canadian candidates. Retaker pass rates are lower, so treat these as cohort-level data, not a personal prediction.

For most US/Canadian graduates a score above the national mean of 250 is good. Above 260 (75th percentile) is competitive for most specialties. IMGs typically need 240s+ to be competitive for residency applications.

Full USMLE Step 2 CK bank access is included in all-access. Up to 10 new sample questions per day are shared across exams, with no account required. A verified free account includes one guided Tutor session; continued Tutor use is included in all-access.