What You Need to Know about USMLE Step 1 and Step 2 CK (Clinical Knowledge) Content Distribution Changes

Last fall, the USMLE announced that they would be making changes to the content distribution of the USMLE Step 1 and Step 2 CK exams. The goal was to increase the number of questions assessing communication skills, system-based practice, patient safety, legal and ethical skills, and professionalism.

However, due in part to the disruption caused by the COVID-19 pandemic, the USMLE was compelled to delay the planned rollout of these new questions. Last month, they confirmed an updated timetable for these content distribution changes:

  • Starting in mid-October 2020, Step 1 will increase the number of items assessing communication skills. An example of one of these questions can be found here.
  • Starting in mid-November 2020, Step 2 CK will increase the number of items assessing systems-based practice, patient safety, legal/ethical issues, and professionalism. The USMLE has released example questions for patient safety and professionalism.

The updated Step 1 exams are expected to show up at test centers on or shortly after October 20th, 2020, while the updated Step 2 CK exams will begin appearing on or after November 11th, 2020. Students who are planning to take Step 1 between mid-October and mid-November should prepare for both versions, while students taking Step 2 CK between November 11th and mid-December should also prepare accordingly.

Pharmacology Changes to Step 1 and Step 2 CK

According to the USMLE, Step 1 pharmacology items will continue to focus on the test-taker’s understanding of drug mechanisms rather than on pharmacotherapy. Step 1 examinees will generally not be required to identify specific medications indicated for a specific condition. Instead, they will be given information about a drug (e.g. name, mechanism, or side effects) and asked for other information about that drug. Step 2 CK examinees will be asked to identify the specific medication indicated for a given disease, as before.

Here is an example of a drug mechanism question from the USMLE Step 1:


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