Exam Prep
The Step 2 CK Checklist
by Mike
Apr 9, 2026 · 4 min read
What changed in 2026
Starting May 7, 2026, Step 2 CK uses 16 blocks of up to 20 questions, 30 minutes each, instead of 8 blocks of 40 at an hour each. The total questions (316), total time (9 hours), and content didn't change. The new software also has better keyboard navigation and a contrast tool for clinical images.
The passing score went from 214 to 218 on July 1, 2025.
For your prep, that means setting UWorld and practice blocks to 20 questions, 30 minutes, timed. The content and difficulty are the same. Plan breaks around 16 transitions instead of 8, and practice settling in fast at the start of each shorter block.
The latest details are on the USMLE site: USMLE Test Delivery Software Updates.
During clerkships
While you study for each shelf, finish that section of UWorld and, if you can, the matching Dorian Anki cards. The same topics and question styles keep coming up on the wards, the NBMEs, and Step 2.
On every rotation, read up on how your own patients are managed (I mostly used UpToDate and PubMed), especially the bread and butter of that specialty. On medicine that's CHF, COPD, cirrhosis, pancreatitis, and sepsis. On pediatrics it includes DKA. On surgery it's gallbladder disease, post-op complications, appendicitis, hernias, and hemorrhoids.
Dedicated
Take 2 to 4 weeks if you can. Before that, a 3 to 4 week lead-in of 2 to 4 blocks of 20 UWorld questions a day will show you where you're weak. Make Anki cards from your misses, or unsuspend the matching cards in the AnKing deck.
The official content outline is here: Step 2 CK Content Outline Specifications.
The sample questions (the new Free 120) are at the bottom of this page, as a PDF or in the testing interface: Step 2 CK Overview.
Checklist
Get through this before test day:
- Finish UWorld
- Review your UWorld incorrects
- Take 2 to 3 NBME forms (9 to 12)
- Take the new Free 120
- Do the Amboss articles and questions on "Statistical analysis of data," "Epidemiology," "Quality and Safety," and "Ethical Principles." You usually get 5 free articles a day, so you can do these without a subscription.
- Practice timed 20-question, 30-minute blocks
- Go through the new USMLE interface tutorial before exam day
- Figure out travel, caffeine, and snacks for the day (these matter!)
Working through your misses
For any disease you keep missing, go back to the pathophysiology until you could write the vignette yourself. Then ask what the next step would be in the acute setting, what long-term management looks like (medications, lifestyle changes, rehab, and preventive care like vaccines), and what the risk factors are.
Reading the questions
Think about what the question writer is testing. I read and highlight the first sentence of the vignette and the last one, which is the actual question. Then I read the whole thing with that question in mind. I start a differential from the chief complaint and history and narrow it with what the stem gives me, the same way you would with a real patient.
Anki is good for building a first differential off buzzwords and exam findings. "Tearing" chest pain should make you think of the aorta. But context matters more on Step 2 and the NBMEs. The stem will often give you only a few symptoms and ask which diagnosis they fit best.
Questions come in three kinds: diagnosis, next step or management, and prevention, risk factors, or health maintenance. The NBME forms and UWorld self-assessments reflect the real mix of topics and formats. The question approach guide goes through the method step by step.
Going in
Confidence matters on this exam. Walk in knowing you're prepared. You could always study more, but the NBMEs and UWorld predict what shows up on Step 2 very well. If you've done the checklist, you're ready.
If you want a score prediction, predictmystepscore.com is a good resource.
Best of luck!
Mike
Disclaimer: StrudelMed / Strudel Academy LLC is an independent medical education resource. The content above is not medical or clinical advice and is intended for educational purposes and general guidance only.