(Clinical Knowledge)

Download Step 2 CK content description and sample test materials


Step 2 assesses whether you can 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 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.


Step 2 Clinical Knowledge (Step 2 CK) consists of multiple-choice questions prepared by examination committees.

Normal Conditions and Disease categories (Dimension 1) form the main axis for organizing the outline. The first section deals with normal growth and development, basic concepts, and general principles. The remaining sections deal with individual disorders.

Sections focusing on individual disorders are subdivided according to Physician Task (Dimension 2). The first set of physician tasks, Promoting Preventive Medicine and Health Maintenance, encompasses the assessment of risk factors, appreciation of epidemiologic data, and the application of primary and secondary preventive measures.

The second set of tasks, Understanding Mechanisms of Disease, encompasses etiology, pathophysiology, and effects of treatment modalities in the broadest sense.

The third set of tasks, Establishing a Diagnosis, pertains to interpretation of history and physical findings and the results of laboratory, imaging, and other studies to determine the most likely diagnosis or the most appropriate next step in diagnosis.

The fourth set of tasks, Applying Principles of Management, concerns the approach to care of patients with chronic and acute conditions in ambulatory and inpatient settings. Questions in this category will focus on the same topics covered in the diagnosis sections.

The diseases noted in the outline do not represent an all-inclusive registry of disorders about which questions may be asked. They reflect the development of a “High-Impact Disease List” that includes common problems, less common problems where early detection or treatability are important considerations, and noteworthy exemplars of pathophysiology. Questions are generally, but not exclusively, focused on the listed disorders. In addition, not all listed topics are included on each examination.


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 classifies test items along two dimensions: disease category and physician task.

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.

Pakistani Foreign Medical Students and Graduates