What You Need to Know About the November 2020 Update to the Step 2 CK Exam

As of November 11, 2020, the United States Medical Licensing Examination (USMLE) Step 2 clinical knowledge (CK) exam will increase the percentage of questions assessing the social sciences of examinees.

What questions are included in the social sciences?

The social sciences, or “soft skills,” will test an applicant’s knowledge of legal and ethical issues, professionalism, systems-based practices, and patient safety. These questions will consist of a particular concept, such as professionalism, rooted in a clinical situation. Such questioning aims to ensure graduating medical students have the skills to become competent, safe practitioners.

Is this something new?

No. This material has been tested for many years and is not a new topic for the Step 2 CK exam. However, the percentage of questions on such topics will increase to approximately 10 to 15% for upcoming exams.

Overall, no new material will be added to the exam. The same questions used on previous exams will continue to be used on exams after November 11, 2020. It is just the percentage of questions dealing with the social sciences that are changing. As such, the percentage of questions on other topics will slightly decrease.

For a breakdown of the topics tested and the percentage of questions expected for each topic, visit this USLME webpage.

What do you need to study for the Step 2 CK exam?

In general, the study material should not change; rather, a little more emphasis should be placed on topics related to the social sciences. For a complete outline of topics covered on the Step 2 CK exam, browse the .

One of the tested topics deals with legal and ethical issues regarding interactions with patients and families. This includes subjects such as competence, which is determined by the courts; decision-making capacity, as determined by a physician; and an understanding that the level of decision-making capacity needed differs with the complexity of the situation, such as deciding on surgery vs. deciding on pain medication.

Other topics include the knowledge that explaining the nature of the procedure and its indications, risks, benefits, and alternatives treatments are the components of informed consent. Similarly, understanding the treatment of minors and the need for parental consent are frequently tested on the Step 2 CK exam.

Legal and ethical issues regarding end-of-life care are frequently encountered and require a general understanding of certain terms and concepts, such as the definitions of a living will, durable power of attorney for health care, and the order of decision-making if neither exists (spouse, adult children, parents, adult siblings, and friends). Understanding the patient has the right to forego/refuse treatment or withdraw treatment will help in evaluating challenging clinical situations. Finally, it is important to understand the concepts of euthanasia, physician-assisted suicide, and futile treatment.

The social science questioning will also include issues regarding medical errors and the duty physicians have in disclosing these errors to the patients, and knowing the elements of malpractice that must be satisfied with a preponderance of evidence to succeed.

Confidentiality is an important concept in medicine, and understanding HIPAA is essential. However, knowing when confidentiality between physician and patient must be broken is essential to doing well on the Step 2 CK exam. This requires the physician to seek additional help when dealing with suicidal or homicidal patients. Reasons to break the confidential bond between doctors and patients include reporting concerns of child and elder abuse, infectious diseases that risk the safety of the public, impaired drivers, and gunshot/knife wounds to appropriate authorities.

Although this is not an exhaustive list of topics, it provides some of the most tested topics and is a great starting point.

Studying these topics is time well spent.

Do not overly stress about this change in the exam. Many of the social sciences topics regarding interactions with others are instinctual and even common sense. Therefore, if you find yourself at a crossroads in answering a question, think as to which option is in the best interests of the patient.

Additionally, unlike the many hours devoted to memorizing the Krebs cycle, the hours spent studying these topics will translate into you becoming a better physician. Systems-based practices can help improve your leadership skills and further your career development.

Sample question:

A 49-year-old unconscious male arrives in the trauma bay and requires emergent surgery. No family members can be reached. What is the most appropriate next step?

1. Continue calling family members until someone can provide informed consent.
2. Continue supportive measures.
3. Proceed with surgery.
4. Contact the local courts to appoint a power of attorney for healthcare.

Answer: C. In emergent, life-threatening situations a physician can proceed with the emergent treatment without requiring informed consent.

USMLE Step 2 CK Exam Prep

It is important to understand that there will not be any additional information added to the exam. Instead, the percentage of questions with an emphasis on the social sciences or “soft skills” will change. With these questions accounting for 10-15% of the exam, additional time should be devoted to these topics to better prepare you for the style of the exam. For USMLE tutoring and study resources, visit ThePassMachine.