You Can't Retake a Passed Step 2 CK: What Your Score Means, When It Arrives and How to Plan (2026)

Published 29 October 2026 · Luke, co-founder of OET BANK and USMLE BANK · 12 min read

If you pass Step 2 CK, you cannot sit it again to raise your score. The number you pass with goes on every USMLE transcript a residency program receives, together with any attempt you failed. Since Step 1 became pass/fail in January 2022, Step 2 CK is the first USMLE exam that gives you a three-digit score. This article sets out what the exam looks like since May 2026, what it tests, what a score means against the official percentile table, how precise that score is, when results arrive and how they reach programs, how to plan your test date, and what it all costs.

1. What Step 2 CK is, and what happened to Step 2 CS

Step 2 Clinical Knowledge (CK) tests whether you can apply medical knowledge and clinical science to patient care under supervision. The USMLE describes it as placing emphasis on health promotion and disease prevention. Put simply, Step 1 asks why something happens; Step 2 CK asks what you do about it.

For a graduate of a medical school outside the US and Canada, Step 2 CK is one of the two exams that ECFMG Certification requires, alongside Step 1. You can take the two in either order, and Step 3 needs passes in both.

Step 2 Clinical Skills (CS), the in-person exam with standardised patients, no longer exists. It was suspended in 2020 and discontinued on 26 January 2021. For international graduates, clinical and communication skills are now checked through ECFMG's Pathways, which include OET Medicine. Anything you read about sitting "Step 2 CK and CS" was written before 2021.

2. The exam day since 7 May 2026

Step 2 CK moved to new test-delivery software on 7 May 2026. The USMLE says the content, the total number of questions and the length of the day did not change; the blocks became shorter and more numerous.

Either way it is one day of about nine hours. Time you do not use in a block or in the tutorial is added to your break time. The new software also has a settings menu and lets you adjust the contrast of each image.

Most questions are a single clinical vignette with one best answer from four or more options. Some come as a sequential set of two or three questions about the same patient: once you move to the next question in the set, you cannot change your previous answer. Others ask you to interpret a scientific abstract, present the case as a chart in list form rather than a paragraph, or include audio or video findings.

3. What it tests

The USMLE publishes three breakdowns, and every question is classified in all three. Many questions belong to more than one clinical science, and nutrition is coded on top of an organ system, so the percentages add up to more than 100%.

By physician task, diagnosis (16–20%) leads, followed by laboratory and diagnostic studies (13–17%), mixed management (12–16%), pharmacotherapy (8–12%), clinical interventions (6–10%), health maintenance and disease prevention (5–10%), prognosis (5–9%), systems-based practice and patient safety (5–7%), professionalism (5–7%) and practice-based learning (3–5%). Taking a history and examining a patient are tested on Step 1 and Step 3, not here.

By system, two lines stand out for a doctor trained elsewhere. Nutrition is coded on 15–20% of items, alongside the organ system each question belongs to. And legal and ethical issues, professionalism, systems-based practice and patient safety together take 10–15%, more than any single organ system. Renal, urinary and reproductive (7–13%), cardiovascular (6–12%) and musculoskeletal and skin (6–12%) come next, with biostatistics and epidemiology at 3–5%.

4. Answer the way a doctor in the US would

Because Step 2 CK emphasises prevention, some questions ask what to offer a patient now: a screening test, a vaccine, a follow-up interval. The answer is the US standard, not the one where you trained. For adult screening, that standard is usually the US Preventive Services Task Force (USPSTF).

Two places where training outside the US can point the wrong way:

• Gastric cancer. Japan and South Korea both screen for it in their national programmes. The USPSTF does not, so routine screening endoscopy is not the US answer for an average-risk adult.
• BCG and tuberculosis. Many countries give BCG to infants. The CDC says BCG is not generally used in the US, and that a TB blood test (IGRA) is the preferred test for anyone who has had it, because BCG does not make an IGRA positive. A positive skin test in a BCG-vaccinated patient is evaluated as if they had never been vaccinated.

The same applies to names and units. The official sample questions use US drug names, such as acetaminophen, albuterol, epinephrine and glyburide; none of them says paracetamol, salbutamol, adrenaline or glibenclamide. Laboratory results in the questions are in US conventional units (mg/dL, mEq/L), with SI units alongside them in the USMLE's laboratory reference table. Temperatures and weights are given in both systems.

5. The passing score and the percentiles

Step 2 CK is reported on a three-digit scale from 1 to 300. The passing score is 218 for exams taken on or after 1 July 2025; before that it was 214. The USMLE reviews each passing standard about every three to four years and announces changes on its website.

Your score report compares you with US medical students: first-time takers from LCME-accredited schools (Canadian schools were included until 2024–25). Their mean was 251, with a standard deviation of 15, in the 2025–26 academic year (249 in 2023–24 and 250 in 2024–25). The Score Interpretation Guidelines turn a score into a percentile rank against 67,824 of these first-takers who tested between 1 July 2023 and 30 June 2026:

A percentile rank is the share of that group who scored lower. At 250, 44% of US first-takers scored below you, so you sit just under the middle. The passing score of 218 falls between the 2nd and 3rd percentile. Remember who the comparison group is: students from US schools taking the exam for the first time, not everyone who sits it. The USMLE updates the table every year and asks you to use the latest one.

6. How precise a score is

The guidelines give three measures of error:

• Standard error of the estimate (SEE), about 8 points. If you tested again on different questions, without learning or forgetting anything, your score would land within 8 points of this one two times out of three. Your score report prints this range: the sample report's 221 is shown as 213–229.
• Standard error of measurement (SEM), about 6 points. How far a single sitting can stray from your true level: two times out of three, within 6 points.
• Standard error of difference (SED), about 8 points. Two scores need to differ by two SEDs, about 16 points, before the difference probably reflects a real difference in knowledge.

The USMLE's own advice to programs is to read scores alongside other criteria, not to base selection decisions on small differences alone, and not to compare scores taken more than three or four years apart. For you this cuts both ways. A 245 and a 250 are within each other's margin of error, so a few extra points late in your preparation buy less than they seem. But the number is still what a program reads, and you get only one passing number.

7. One pass, no second try

If you pass a Step, you may not retake it to raise your score. The only exception is a time limit for completing all the Steps, set by a US licensing authority or by another authority the USMLE recognises, such as ECFMG. Even then, failing the retake costs you your eligibility for Step 3.

If you fail:

• You may take the same Step at most three times in 12 months.
• A fourth attempt must come at least 12 months after your first and at least six months after your most recent.
• Four or more attempts at a Step without passing make you ineligible for every Step. Incomplete attempts count, and so do attempts at the old Step 2 CS.

Your USMLE transcript lists your complete examination history: every attempt at every Step, including fails and attempts with no result. If you do not open every block, the attempt may be reported as incomplete.

Most people pass. In the 2024–25 academic year, 90% of first-time takers from schools outside the US passed (16,186 examinees), against 98% from US MD schools. Repeat takers from schools outside the US passed at 64% (1,762 examinees). Since 2025 these figures count Canadian schools among the non-US schools.

8. When results come, and how programs see them

• Timing. Results are typically available two to four weeks after your test date. Scores are released on Wednesdays, generally for people who tested in the four weeks before. The USMLE asks you to allow up to eight weeks.
• Where. The organisation that registered you emails you, which for schools outside the US is FSMB. The report stays on its website for about 365 days; after that you get your scores only as an official transcript, for a fee.
• Your report is for you. It shows your score, the 8-point range and whether each content area was higher, the same or lower than your overall performance. Programs are told to rely only on your official transcript, which carries the scores and your exam history but not that performance profile.
• Sending scores to ERAS. Since 4 June 2026, every examinee requests the USMLE transcript for ERAS through FSMB's USMLE portal, for $70 once per application season, then clicks "Initiate Score Retrieval" in MyERAS. It usually arrives the same day. A wrong USMLE ID, or a name or date of birth that does not match, delays it. FSMB also sends transcripts to ResidencyCAS, which obstetrics and gynaecology and emergency medicine programs use.
• Rechecks. You can ask for a score recheck for a fee within 90 days. The USMLE says that, to date, no recheck has changed a score.

9. Planning your test date

1. The Match you are entering

   For an international graduate to take part in the Match, you must have met every exam requirement for ECFMG Certification, Step 2 CK included, by the rank order list deadline. For the 2027 Match that is 3 March 2027, 9 p.m. US Eastern. Counting back the eight weeks the USMLE asks you to allow for results lands on 6 January 2027.

2. When programs start reading applications

   In the 2027 season, applicants could submit from 2 September 2026 and programs could start reviewing on 23 September 2026. Programs see what your application contains when they open it. The 2028 dates are not published yet. If they follow the same pattern, a score you want on your application from the first day would need a test date around late July 2027, eight weeks before. That is our own calculation, not an official date.

3. January 2029: Designated Testing Dates

   From January 2029 the USMLE will cut the number of exam administrations each year and reserve Prometric centres for the Steps on set dates. Step 2 CK will not be offered in some months. The dates will be published more than a year before each calendar year; eligibility rules do not change, and score reporting times are expected to stay the same. Until then, appointments remain available all year. If you plan to test in 2029 or later, the calendar will help set your date, and a retake may not be available when you want it.

10. Applying, fees and official practice material

Graduates of schools outside the US and Canada apply through FSMB once their application for ECFMG Certification is accepted. You choose a three-month eligibility period, receive a scheduling permit by email and book at Prometric, up to six months ahead. Seats at some centres fill quickly. The details are in our article on USMLE Step 1; the process is the same for both Steps.

If you test in India, an 18% goods and services tax has been collected on Steps 1 and 2 since 4 December 2024. If you cannot test within your eligibility period, you can ask for one extension for a fee; otherwise you apply and pay again.

The material published by the exam's own sponsors:

• Free sample questions. The PDF booklet, last updated in July 2023, has 120 questions in three blocks of 40. The interactive version runs in the new software as six blocks. The USMLE asks you to run the new interactive testing experience before your test day.
• NBME Comprehensive Clinical Science Self-Assessment. Seven forms, from $62 each, of four sections of 50 questions (1 hour 15 minutes per section). The score report estimates your probability of passing Step 2 CK, and you can review the questions and explanations for two years.
• Practice session at Prometric. Once you have your scheduling permit, you can sit sample material at a test centre for a fee.

Frequently asked questions

What is the passing score for USMLE Step 2 CK?

218, for exams taken on or after 1 July 2025; it was 214 before that. Scores run from 1 to 300. First-time takers from US medical schools averaged 251, with a standard deviation of 15, in the 2025–26 academic year.

What percentile is a Step 2 CK score of 250?

The 44th, according to the USMLE Score Interpretation Guidelines updated on 17 August 2026: 44% of first-time takers from US medical schools who tested between July 2023 and June 2026 scored lower. A 240 is the 23rd percentile, a 260 the 71st and a 270 the 93rd.

Can I retake Step 2 CK to improve my score?

No. Once you pass a Step, you may not retake it to raise your score. The only exception is a time limit for completing all the Steps set by a US licensing authority or another recognised authority, and failing that retake makes you ineligible for Step 3. Every attempt, including fails, appears on your USMLE transcript.

When do Step 2 CK results come out?

Typically two to four weeks after your test date. Scores are released on Wednesdays, and the USMLE asks you to allow up to eight weeks. Graduates of schools outside the US receive an email from FSMB and see the report on FSMB's website for about a year.

Is Step 2 CS still required?

No. Step 2 CS was discontinued on 26 January 2021. For graduates of schools outside the US and Canada, clinical and communication skills are now checked through an ECFMG Pathway, which includes OET Medicine.